Effects of anterolateral spinal lesions on escape responses of rats to hindpaw stimulation

In order to determine the effects of spinal cord lesions on nociceptive sensitivity of rodents, methods were developed to assess the speed of operant escape responses to electrocutaneous stimulation (ES). ES was delivered across the dorsal and ventral surfaces of either hindpaw, producing a current path through deep tissues. In order to guide establishment of a range of stimulus intensities for this manner of stimulation, a preliminary human psychophysical experiment was conducted with stimulation between the dorsal and ventral surfaces of a finger. For the human subjects, detection thresholds averaged 0.13 mA, and thresholds for a sharp (but nonpainful) sensation were 0.42 mA. Levels of stimulation between these thresholds for detection and a sharp quality elicited sensations of tingle or itch. Thresholds for reports of pain averaged 0.67 mA. On the basis of these results, intensities of ES ranging from 0.05 to 1.0 mA were presented to the feet of rats that were trained to perform an escape response with one forelimb. Thresholds for escape averaged slightly less than 0.1 mA; responding was consistent at 0.4 mA; and response probability and speed were maximal at approximately 0.8 mA. Thus, the rats responded aversively at intensities below those rated as sharp or painful by the human subjects, but the speed of escape reached a plateau at intensities that were above pain threshold for the human subjects. Unilateral thoracic lesions of the lateral spinal column of rats produced a contralateral hypalgesia. Escape thresholds were elevated, and the speed of escape responses to all intensities was reduced. This effect depended upon interruption of axons in the middle and anterior portions of one lateral column, corresponding to the location of long ascending pathways for nociception, including the spinothalamic tract. The speed of escape responding increased over 20 weeks of postoperative testing of animals with the largest lesions. This confirms results obtained previously from monkeys (by means of a similar paradigm), and corresponds to clinical reports of humans who have received spinal lesions for control of intractable pain. Thus, the location and organization of nociceptive pathways in the spinal cord of rodents appear to be similar to those of primates, and similar adaptations occur following interruption of these pathways.

Portal blood flow in acute hepatitis with and without ascites: a non-invasive measurement using an ultrasonic Doppler

To evaluate the role of portal blood flow in severe acute hepatitis leading to the formation of ascites, we studied the portal blood flow of 30 patients with severe acute hepatitis (20 without ascites and 10 with ascites), 20 patients with mild acute hepatitis and 20 healthy normal volunteers using duplex sonography. The portal blood flow of patients with severe acute hepatitis and ascites (421 +/- 94 mL/min) was lower than that of the volunteers (725 +/- 131 mL/min), the mild acute hepatitis (658 +/- 148 mL/min), and the severe acute hepatitis (633 +/- 108mL/min) without ascites (P < 0.001). The congestion index of severe acute hepatitis and ascites (0.16 +/- 0.04 cm.s) was higher than that of the volunteers (0.09 +/- 0.03 cm.s, P < 0.001), the mild acute hepatitis (0.09 +/- 0.02 cm.s, P < 0.001), and the severe acute hepatitis (0.12 +/- 0.04 cm.s, P < 0.02) without ascites. Portal blood flow was negatively correlated with prolonged prothrombin time (P < 0.001) and serum total bilirubin level (P = 0.002) and congestion index was positively correlated with heart rate (P = 0.006), prolonged prothrombin time (P < 0.001) and serum total bilirubin level (P = 0.001). Our study shows that in severe acute hepatitis, portal blood flow was reduced in patients with ascites. The non-invasive ultrasonic Doppler is a safe and helpful method in the clinical evaluation of portal hypertension in severe acute hepatitis.

A preliminary report on Borrelia burgdorferi infection in the Taiwan area

A total of 273 serum specimens from different areas and sources were tested against Borrelia burgdorferi antigens by enzyme-linked immunosorbent assay method. Positive rates of serological reactions were 3% and 58% for healthy persons and syphilis patients, respectively. Obviously, there was a lot of cross-reaction in the venereal disease group. Meanwhile, positive rates were 3% and 13% in the sera collected from Taiwan and Orchid Island, respectively. This difference may reflect a less developed environment in the latter. Since reported cases of Lyme disease in Taiwan are rare, serologic tests are usually adapted for rapid diagnosis in common laboratories. As for disease confirmation, clinical observations, epidemiological data and exposure in an endemic area must also be considered.

Radioimmunotherapy of human B-cell chronic lymphocytic leukemia in nude mice

After i.v. or i.p. inoculation of 5 x 10(6) D10-1 cells, a subclone of an Epstein-Barr virus transformed human B-cell chronic lymphocytic leukemia (CLL) line, 100% of nude mice developed solid or ascites tumors and died within 17-60 days of tumor inoculation. There was significant tumor inhibition, including tumor cure, when these tumor-inoculated mice were treated with either unmodified or 131I (300 microCi)-linked Dal B02 (50 micrograms/mouse), a monoclonal antibody directed against surface-associated antigens on human CLL B-cells and several histological types of B-lymphoma cells. There was no significant difference between the antitumor activity of unmodified Dal B02 and 131I-linked Dal B02 when the treatment was given 3 days after i.p. or i.v. inoculation of 5 x 10(6) D10-1 cells. However, when the mice were treated 3 days after i.p. inoculation of 15 x 10(6) D10-1 cells, or 7 days after the i.v. inoculation of 5 x 10(6) D10-1 cells, 131I-linked Dal B02 was a more potent tumor inhibitor than was unmodified Dal B02 (P < 0.05 and P < 0.01, respectively). Two injections of 131I (500 microCi) linked to 100 micrograms of a Dal B02 F(ab')2 fragment preparation also prolonged the survival of i.p. or i.v. tumor-inoculated mice (P < 0.05 and P = 0.05, respectively). In nude mice with established s.c. xenografts of D10-1 cells, two injections of 131I (300 microCi) linked to 50 micrograms of Dal B02 led to complete tumor cure in 3 of 4, mice, but two injections of 50 micrograms of unmodified Dal B02 had no effect on the s.c. xenografts. Two injections of 131I (500 microCI) linked to 100 micrograms of Dal B02 F(ab')2 fragment caused significant tumor inhibition but no tumor cure. 131I (300 microCi) linked to 50 micrograms of a nonspecific IgG1 only led to minor tumor inhibition. A mixture of unmodified Dal B02 and 131I-linked nonspecific IgG1 was not a more potent tumor inhibitor than the 131I-linked nonspecific IgG1 preparation by itself. These results suggest that Dal B02 may be an effective carrier for the radioimmunotherapy of human B-cell CLL and other appropriate B-cell lymphomas, especially in the progressive phase of B-cell CLL, which is usually not amenable to currently available therapeutic modalities.

Isolation of Bacillus cereus in the feces of healthy adults in Taipei City

Fecal specimens from 100 healthy adults were collected and examined for the presence of Bacillus cereus which has been associated with 28% of the outbreaks of food poisoning on Taiwan within the last 3 years. Total isolate rate from these specimens was 8%. Variations in isolation rates were found not only in sexes, but also in different age-groups. Therefore, presence of B. cereus in the feces of healthy adults may be unpredictable and relate to foods consumed or to other factors. Obviously, an isolation rate of B. cereus as high as 30% during the outbreak investigation is still not a strong evidence to implicate this organism as an etiological agent.

Use of Palmer's Point for Insertion of the Operative Laparoscope in Patients with Severe Pelvic Adhesions: Experience of Seventeen Cases

Seventeen patients who had known or suspected intra-abdominal adhesions underwent laparoscopic surgery with the use of Palmer's Point for insertion of the operative laparoscope. Five of them were found to have extensive periumbilical adhesions. Intestinal or omental injury can occur if the trocar is inserted directly through the umbilical fossa. Though the incidence of direct trauma is reportedly low, there were still mild to moderate omental adhesions to the anterior abdominal wall, as we expected, in the remaining 12 patients. Possible inadequate aspiration and irrigation during laparoscopic removal of a dermoid cyst in one woman had resulted in severe postsurgical intraabdominal adhesions. More than two 10 mm incisions were used in our patients for insertion of the laparoscope interchangeablely to facilitate the procedure of laparoscopic adhesiolysis. The operative field can be expanded greatly. Fourteen patients completed the laparoscopic surgery, and the other 3 had alternative procedures eventually. No complications occurred during the laparoscopic procedure. The postoperative courses were uneventful in all 17 patients. Our experience suggests that Palmer's Point is a good alternative for insertion of the Veress needle and laparoscope in patients with previous laparotomies and suspected severe pelvic adhesions.

Trauma case review: survival following impalement

Prehospital care of patients with penetrating wounds must begin within minutes of the injury; definitive treatments should be initiated within an hour. Due to the advanced skills of the paramedics, nurses, doctors, and ancillary personnel, this patient arrived in the operating room within an hour of his accident. Fortunately, the impaled reinforcement rods missed the vital structures within the patient's thoracic and pleural cavities and spared his lower abdominal organs, vascular structures, and skeletal structures in his groin. This case study illustrates the importance of coordinated efforts in caring for this patient from the prehospital setting through the emergency department and operating room.

Trauma case review: survival following impalement

Prehospital care of patients with penetrating wounds must begin within minutes of the injury; definitive treatments should be initiated within an hour. Due to the advanced skills of the paramedics, nurses, doctors, and ancillary personnel, this patient arrived in the operating room within an hour of his accident. Fortunately, the impaled reinforcement rods missed the vital structures within the patient's thoracic and pleural cavities and spared his lower abdominal organs, vascular structures, and skeletal structures in his groin. This case study illustrates the importance of coordinated efforts in caring for this patient from the prehospital setting through the emergency department and operating room.

Omental-mesenteric inflammatory pseudotumor. Cytogenetic demonstration of genetic changes and monoclonality in one tumor

BACKGROUND

Extrapulmonary inflammatory pseudotumor (plasma cell granuloma) is an uncommon lesion in adults and children, and little is known either of its etiology or clinical characteristics. However, it remains a significant source of morbidity to patients and confusion to clinicians.

METHODS

Case reports are presented of three patients with intraabdominal inflammatory pseudotumor who recently underwent surgery. A review of the recent world literature is also presented. Clinical and laboratory characteristics of omental-mesenteric inflammatory pseudotumor are reviewed along with a discussion of its etiology.

RESULTS

Cytogenetic data from cells of one patient show a derivative chromosome evolved from a translocation between the long arm of chromosome 2 and the short arm of chromosome 9 [(2;9)(q1,3;p2,2)].

CONCLUSIONS

The lesion is monoclonal, and genetic changes may play a crucial role in the development of this neoplasm. Omental-mesenteric inflammatory pseudotumor appears to represent a distinct clinicopathologic entity as a benign neoplasm in children.

Inhibition of human B-cell chronic lymphocytic leukemia by a monoclonal antibody in xenograft models

To establish xenograft models of human B-cell chronic lymphocytic leukemia (CLL), we inoculated 5 x 10(6) D10-1 cells, a subline of Epstein-Barr virus (EBV)-transformed human B-cell CLL with a marker chromosomal anomaly, into SCID or irradiated nude mice by the intravenous (i.v.) or intraperitoneal (i.p.) route. All i.p. tumor-inoculated mice developed rapidly progressive, lethal ascites tumor, and 100% of i.v. tumor-inoculated mice developed disseminated CLL. All mice died of tumor within 8 weeks of tumor inoculation. Tumor-inoculated SCID mice died earlier with wider tumor dissemination than the tumor-inoculated nude mice. All the tumor-inoculated mice had histologically confirmed metastases in lymph nodes, and most of them also had metastases in one or more internal organs. Cytogenetic analysis confirmed the origin of these tumors from the xenografted D10-1 cells. The D10-1 cells harvested from the xenografts did not differ from the parent D10-1 cells as regards (i) reactivity with 2 monoclonal antibodies (MAbs) directed against CLL-associated cell-surface antigens; (ii) rate of proliferation in vitro; and (iii) sensitivity to the 2 chemotherapeutic agents, methotrexate and adriamycin. Administration of 50 micrograms/mouse of Dal B02, an IgG1 (kappa) MAb directed against surface-associated antigens of human B-cell CLL, significantly prolonged the survival of D10-1-inoculated nude and SCID mice. The MAb was more effective in D10-1-inoculated nude mice than in SCID mice. In all the D10-1 xenograft models, the effectiveness of Dal B02 decreased with higher tumor load but increased with the amount of MAb injected. Dal B02 F(ab)'2 fragment failed to demonstrate any anti-tumor activity in D10-1-inoculated nude mice. In vitro assays revealed that Dal B02 had no direct inhibitory effect on D10-1 cells, but could be cytotoxic towards D10-1 cells in the presence of splenic cells or peritoneal macrophages from nude and SCID mice, or together with rabbit complement.

Pharmacokinetics, biodistribution and tumor localization of two anti-human B-cell chronic lymphocytic leukemia monoclonal antibodies and their F(ab)'2 fragments in a xenograft model

We investigated the pharmacokinetics, biodistribution and tumor localization of intravenously injected Dal B01 and Dal B02, two monoclonal antibodies (MoAbs) directed against tumor associated antigens on human chronic lymphocytic leukemia (CLL) B cells, and their F(ab)'2 fragments in nude mice bearing xenografts of the human B cell CLL line D10-1. More of the percentages of the injected dose (% ID) of these two MoAbs and their F(ab)'2 fragments specifically localized in the tumor xenografts than in normal tissues. Compared to intact MoAbs, their F(ab)'2 fragments had lower % ID in tumors and were cleared from circulation faster. Well-defined tumor images were obtained at 24 and 48 h after administration of [131I]Dal B02 F(ab)'2 fragment and at 96-192 h after administration of [131I]Dal B02. A comparison between intravenous and intraperitoneal routes of administration of [131I]Dal B02 did not reveal any difference in the localization of % ID in tumor or normal tissues.

Characterization of vincristine-resistant HOB1 lymphoma cell line showing the classical MDR phenotype and altered expression of membrane glycoproteins

A multidrug-resistant (MDR) cell line isolated from HOB1 lymphoma cells was characterized. The MDR phenotype in this cell line was typified by resistance to vincristine with varying degrees of cross-resistance to Adriamycin, colcemid and actinomycin D. Decreased intracellular [3H]vincristine with concurrent increase in the expression of a 170-kDa membrane glycoprotein (P-glycoprotein) suggested a plausible underlying mechanism for the development of resistance. Amplification of the mdr1 gene as well as a homogeneous staining region on the long arm of the 7th chromosome was observed. Moreover, metabolic studies with [14C]glucosamine or [14C]mannose indicated differential expressions of membrane glycoproteins between the drug-sensitive parental and drug-resistant descendant cells. It is concluded that the development of drug resistance in HOB1 lymphoma cells was strongly correlated with the overexpression of P-glycoprotein.

The management of ovarian cysts by sono-guided transvaginal cyst aspiration

Nineteen transvaginal, sono-guided ovarian cyst punctures were performed in 18 patients. These patients, who were high surgical risks, were diagnosed to possess benign ovarian tumors as revealed with sonography. Aspiration curettage of the inner surface of the cyst present during aspiration was also performed to facilitate cytologic diagnosis. The recurrence rate was 11.1%. Sono-guided transvaginal cyst aspiration has been demonstrated here to be the treatment of choice for dealing with an ovarian cyst in patients at high surgical risk.

Laparoscopic hysterectomy with the Endo GIA 30 stapler

Eighty-two patients underwent laparoscopic hysterectomies from March 1991 to September 1992. The indications were adenomyosis, myomata uteri, intractable menorrhagia and endometriosis with severe pelvic adhesions. The operations were performed through usage of the techniques of videolaparoscopy, including a combination of Kleppinger bipolar forceps for hemostasis and scissors and/or CO2 laser for lysis of adhesions. Fourteen used the Endo GIA 30 stapler in transecting the infundibulopelvic and/or cardinouterosacral ligament. The mean blood loss was 175 mL, and two patients had intraoperative bladder injuries requiring laparotomy repair, but none of them was related to the utilization of the Endo GIA 30 stapler. Most of the patients were discharged on the second postoperative day. The advantages of laparoscopic hysterectomy are short hospitalization, small blood loss and less postoperative discomfort. Implementation of the Endo GIA 30 stapler could facilitate the procedure.

Hepatitis C markers in hemodialysis patients

The prevalence of hepatitis C virus (HCV) infection among the patients of a hemodialysis unit in Taiwan was determined by an immunoblot and reverse transcriptase-polymerase chain reaction algorithm to be 58.8% (67 of 114 patients) after serological surveys with two advanced-generation enzyme-linked immunosorbent assays (ELISAs) for anti-HCV and a C 100-3 single-antigen test. The results of the second-generation ELISAs, the supplementary immunoblot test, and the test for HCV RNA were in good agreement with each other, from 86.0 to 98.2%. The first-generation C 100-3 test lacked the sensitivity of the four other systems. The two advanced-generation screening ELISAs for anti-HCV, a multiple-recombinant-antigen test, the Abbott second-generation ELISA, and a synthetic peptide multiple-antigen test, the UBI HCV EIA, provided reliable and virtually equivalent detection of potentially infected blood. Antibodies to capsid 1 and capsid 2 determinants of the Liatek immunoblot system were the most frequently detected reactivities to HCV in the HCV-infected hemodialysis patients. The percentage of HCV-infected patients with abnormal liver function (alanine aminotransferase level, greater than 100 IU/liter) was higher than that of the uninfected patients. The prevalence of HCV infection was correlated to the duration of hemodialysis treatment and the amount of blood transfused, and the most common transmission mode was thought to be patient-to-patient transmission through the dialysis equipment. Several means of reducing the frequency of transmission between hemodialysis patients are suggested.

Urinary chorionic gonadotropin subunits and beta-core in nonpregnant women. A study of benign and malignant gynecologic disorders

BACKGROUND

The presence of urinary excretion products of human chorionic gonadotropin (hCG) has been proposed as a tumor marker. To ascertain the clinical value in gynecologic cancers, the authors studied 612 nonpregnant women.

METHODS

Three different assays in four clinical groups were compared: no disease, benign disease, malignant disease, and complete remission of previously treated malignant disease. The assays were for the urinary beta-core, "total" beta-hCG, and free alpha-subunit.

RESULTS

Measurement of the alpha-subunit was of no obvious clinical value. In some patients with benign disease, hCG metabolites were elevated. In the 141 patients with active gynecologic malignancy the sensitivity of the total beta-hCG assay was 47% and that of the beta-core assay was 36%. The specificities were 80.3% and 90.4%, respectively. Advanced cancers generally had higher levels of total beta-hCG and beta-core. Squamous cell and poorly differentiated cervical tumors had higher levels of total beta-hCG than did adenocarcinomas and well-differentiated cervical tumors. Invasive, serous, endometrioid, and germ cell ovarian tumors had higher total beta-hCG, beta-core, and alpha-subunit levels than did borderline, mucinous, and clear cell ovarian tumors. Six of 16 patients with disease in complete remission had elevated levels.

CONCLUSION

The excretion of hCG and its metabolic fragments is a common event in gynecologic cancer, but sensitivity and specificity are low, and there is little consistent relationship between tumor stage and histologic type.

A successful pregnancy after subzonal insertion with epididymal sperm and coculture on Vero cell monolayer

A 26-year-old nulliparous woman conceived after transfer of three embryos cocultured on a Vero cell monolayer. The ET followed SUZI of epididymal sperm from her husband with congenital absence of vas deferens.

Levels of insulin-like growth factor-I and insulin-like growth factor-binding protein-1 in pregnancy with preterm delivery

OBJECTIVE

To investigate the relationship between preterm delivery and maternal serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-1 (IGFBP-1) levels.

DESIGN

A study over a 12 month period in which all samples were collected according to a pre-set protocol.

SETTING

St. Bartholomew's Hospital, London.

SUBJECTS

Thirty-eight nonpregnant adult females, 456 pregnant women at various gestational ages, 84 women with average-for-gestational-age babies at term delivery, and 49 pregnant women with preterm delivery (44 with singleton pregnancy and five with twin pregnancy).

MAIN OUTCOME MEASURES

Serum IGF-I and IGFBP-1 levels were determined by radioimmunoassay.

RESULTS

Serum IGF-I concentrations increased as pregnancy progressed. In the third trimester, serum IGF-I levels in singleton preterm deliveries were lower than those in normal pregnancies, and IGFBP-1 concentrations were higher than those in normal pregnancies. This phenomenon was not obvious in the second trimester. Maternal circulating IGFBP-1 levels were correlated inversely with birthweight in women with singleton preterm delivery.

CONCLUSIONS

Neither IGF-I nor IGFBP-1 appears to play a significant role in preterm delivery since maternal serum IGF-I and IGFBP-1 levels are similar in preterm and term deliveries.

Treatment of infertility using controlled ovarian hyperstimulation with intrauterine insemination: the experience of 343 cases

Fecundity rates were measured for 343 patients in 467 cycles of ovulation induction with intrauterine insemination (IUI) from January 1990 to April 1992. Total pregnancy rate per cycle (PR) was 15.6% with a spontaneous abortion (SA) rate of 19.2%, an ectopic pregnancy (EP) rate of 4.1%, a multiple pregnancy (MP) rate of 19.2%, and an ongoing or live-birth (LB) rate of 12.0%. Using gonadotropins as a unique or as an additional stimulatory reagent improved the pregnancy rate of anovulatory patients by more than three-fold over use of clomiphene citrate (CC) alone (33.3% vs 10.7%). In other diagnostic entities, the PRs were higher, but the difference was not statistically significant between these two stimulation protocols (13.9% vs 8.4%; t = 1.70, p > 0.05). Pretreatment sperm motility and the post-treatment total motile sperm count were significantly correlated with the PRs. The same phenomena occurred when the number of follicles > or = 12 mm and the serum estradiol concentrations were taken into account. The highest PR was detected when the endometrial thickness fell between 8 and 13 mm. The spontaneous abortion rate was higher in CC only cycles and when the serum E2 was below 1000 pg/mL on the day human chorionic gonadotropin was administered. A multiple pregnancy could be predicted when a cycle of more than 10 follicles > or = 12 mm was detected (44.4%). The complications of controlled ovarian hyperstimulation with IUI were low and mild in our study, comprising six cases of moderate to severe ovarian hyperstimulation syndrome and three cases of acute pelvic inflammatory disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy

To investigate the role of abdominal ultrasonography (US) in predicting possible difficulties during laparoscopic cholecystectomy, we performed preoperative US evaluation prospectively in 82 consecutive patients. We correlated our predictions of "easy" and "difficult" with difficulties experienced at operation in surgery. The binary outcomes were analyzed by taking both easy category of US and surgical operation as positive results and both difficult category as negative results. We obtained satisfactory sensitivity (93.8%), accuracy (81.4%), and positive predictive value (84.7%), but low specificity (35.3%) and negative predictive value (60%). The highly positive results were the result of careful US examination. The low specificity and negative predictive value were attributed to the fact that most surgically difficult cases were due to adhesions around the gallbladder, difficult indeed to detect at US. We conclude that thorough abdominal US examination before laparoscopic cholecystectomy is useful in preoperative evaluation of patients undergoing laparoscopic cholecystectomy, even if it not infrequently fails to predict the surgically difficult cases mainly due to adhesions around the gallbladder.