Homozygosity mapping of the gene for alkaptonuria to chromosome 3q2

Alkaptonuria, the first human disorder recognized by Garrod as an inborn error of metabolism, is a rare recessive condition that darkens urine and causes a debilitating arthritis termed ochronosis. We have studied two families with consanguineous parents and four affected children in order to map the gene responsible for alkaptonuria. Coinheritance of either neonatal severe hyperparathyroidism or sucrase-isomaltase deficiency and alkaptonuria provided a candidate location for the mutated genes on chromosome 3. Homozygosity mapping with polymorphic loci identified a 16 centiMorgan region on chromosome 3q2 that contains the alkaptonuria gene. Analysis of two additional nonconsanguineous families supports linkage of alkaptonuria to this single locus (combined lod score = 4.3, theta = 0).

[Foreign body in the urinary bladder]

Foreign bodies in the urinary bladder are not uncommon, however, only a few cases have been reported in recent literature. This is not a fatal disease, however, it may lead to serious complications such as chronic cystitis, urolithiasis, or rectal abscess formation. These foreign bodies were inserted for autoerotic or unknown reasons by patients. In this paper we report 4 cases of foreign bodies in the urinary bladder. They include a cucumber, glass tube, chewing gum, and filliform catheter. We found that most of the foreign bodies in the urinary bladder can be removed endoscopically, but if the patients also had a lower urinary tract obstructive disease, removal necessitated surgical procedures. All of the four cases had no urological complications for at least one year after treatment.

Persistent pulmonary hypertension of the newborn associated with excessive pulmonary arterial muscularization: report of an autopsy case

A 3700-g male infant born at 37 weeks' gestation presented with cyanosis at birth. He was diagnosed as having persistent pulmonary hypertension of the newborn (PPHN) on the basis of persistent hypoxemia, despite continuous mechanical ventilatory support with 100% O2, and right-to-left shunting through the foramen ovale shown by Doppler echocardiography. Treatment with hyperventilation, and administration of tolazoline, prostaglandin E1 and MgSO4 failed to reverse his hypoxemia. High ventilator settings were required, and pneumothoraces ensued. Airway resistance increased gradually with development of hypercapnia and deterioration of hypoxemia. Bradycardia unresponsive to resuscitation occurred, and he died at eight days of age. Postmortem examination of the lungs revealed increased peripheral connective tissue and diffuse extension of medial smooth muscle to the precapillary pulmonary arteries. Excessive antenatal muscularization of the peripheral pulmonary arteries and resultant increased vasoconstriction capacity may have played an important role in the pathogenesis of PPHN in this case.

Staging of bladder cancer by transabdominal real-time ultrasound

In the past six years, there were 726 cases of proved bladder cancer in our hospital. Among these, 376 cases received transabdominal ultrasonographic examination of the urinary bladder for evaluation of the bladder tumor. Two hundred and fourteen cases of them were newly diagnosed as bladder cancer and had adequate pathological specimens for staging of the tumor. The retrospective comparison between preoperative local staging of the bladder tumor by ultrasound and final pathological report showed 78.5% of total accuracy, 9.8% of overstaging, and 11.7% of understaging. The accuracy is 87% for stage A tumor; 60.5% for stage B; 41.2% for stage C; 83.3% for stage D. Strong echogenic foci on the surface or in the tumor were detected in 39.3% (84/214) of cases, which may indicate encrusted stones on the surface of the tumor or intratumoral dystrophic calcification. There was no strong correlation between tumor grading and staging, except that most of the grade I lesions were at stage A (30/31, 97%). The preoperative local staging of urinary bladder cancer by real-time ultrasound might be of great value to determine the management planning and prognosis of the patients.

Total parenteral nutrition-associated cholestasis in infants: clinical and liver histologic studies

To evaluate total parenteral nutrition-associated cholestasis (TPN-C) in infants, a retrospective clinicopathologic study was conducted of 15 infants who had received TPN. The mean gestational age and birth weight were 32.1 weeks (26-40 weeks) and 1807 g (840-5840 g) respectively. Two-thirds of the patients were kept on TPN for more than 60 days. The onset of rising direct bilirubin ranged 2-9 weeks (mean 4.5 +/- 2.4) after TPN therapy. Preterm babies less than 32 weeks of age had an earlier rise of direct bilirubin and AST. Bile sludge of the gallbladder was observed in only one case, and none had gallstone. The main histologic findings of liver biopsy or autopsy were cholestasis (intracellular and canalicular), periportal inflammation, fibrosis and bile ductular proliferation. Sixty percent of these survived, the remaining 40% died of complications unrelated to TPN-C. The liver function profile became normalized within a mean of 14.0 +/- 9.4 (8-34) weeks after discontinuation of TPN in the survival cases. It was concluded that infant TPN-associated cholestasis was mostly reversible, but that the younger preterm babies were susceptible to a prolonged TPN course with more marked clinical and pathological changes.

[Complications of transurethral resection of prostate]

A total of 342 benign prostatic hypertrophy patients were treated at the Department of Urology, Kaohsiung Medical College Hospital from January 1972 to December 1988. Median duration of operating time was 74.4 minutes, 67 patients (20%) required a blood transfusion and the mean volume of blood per patient transfused was 1019.4 ml. Median post-operative catheter management was 7 days and the median post-operative ward time was 8.6 days. Two patients (0.5%) had a bladder lesion with peritoneal perforation and required a secondary operation for bladder suture. Secondary hemorrhaging return for treatment of clotting was seen in 11 cases (3.2%). Stress incontinence was noted in 11 cases (3.2%). Anterior urethral stricture was noted in 9 cases (2.6%), impotence occurred in only one case (0.3%) and TUR syndrome in 2 (0.6%). There were two post-operative deaths, for a mortality rate of 0.6 percent. The causes of death were sepsis in one patient and acute renal failure in the other.

Delayed-onset intraventricular hemorrhage in a full-term neonate: report of one case

Intraventricular hemorrhage (IVH) in the full-term neonates is not as common as in the premature neonates. We describes a full-term neonate who presented with delayed onset of intraventricular hemorrhage and fever. Her perinatal and delivery course were uncomplicated. Clinically, omphalitis was found on admission. However, no definite etiology of IVH was discovered. Follow-up brain sonography at the age of seven months revealed complete resolution of IVH. The prognosis of the patient was good on follow-up, which was comparable with other reports.

Liver resection for hepatic metastasis from colorectal carcinoma

One hundred and eighteen patients who suffered from metastatic liver tumors from colorectal carcinoma during the period from January 1980 to June 1991 at the National Taiwan University Hospital were retrospectively reviewed. The modes of treatment included hepatic resection (n = 18), transarterial embolization (TAE, n = 17), chemotherapy only (C/T, n = 36), and no treatment (n = 47). In the 18 patients who underwent hepatic resection during the last 10 years, the types of surgery included: wedge resection (n = 8), segmentectomy (n = 2), right hepatic lobectomy (n = 5), left hepatic lobectomy (n = 2) and extended right hepatic lobectomy (n = 1). There were no operative mortalities in this series. The overall three-year actuarial survival rate of the resection group was 57.5%. It was better than that of the TAG group (17%, p < 0.05). For a solitary tumor, the three-year actuarial survival rate rose to 64% in the resection group. There were no three-year survivors in the nonsurgical solitary tumor group. This experience defends aggressive surgical treatment of resectable hepatic metastatic liver cancer from colorectal carcinoma as a safe procedure which is able to prolong a patient's life.

Retinopathy of prematurity: an analysis of risk factors

In order to investigate the possible clinical factors related to the occurrence of retinopathy of prematurity (ROP), 37 very-low-birth-weight infants documented to have ROP were compared to a group of 50 controls during the period from July 1988 to December 1991. The results revealed that: 1) the overall occurrence rate of ROP was 42.5% (37/87), with a higher occurrence rate in the less mature weight-stratified subgroup; 2) patients in the lower stages of ROP generally regressed during the follow-up, while nearly all of those in the higher stages eventually progressed and received surgical intervention; and 3) after multiple logistic regression analysis, the consistently significant factors were birth weight, duration of PaO2 > or = 80 mmHg, ventilation time > or = five days and a blood exchange transfusion. It is suggested that regular examination for ROP in high-risk premature infants is important in combination with other monitoring modalities in neonatal intensive care units to reduce the possible complications and sequelae of ROP.

A disease locus for familial hypertrophic cardiomyopathy maps to chromosome 1q3

Familial hypertrophic cardiomyopathy (FHC) is caused by missense mutations in the beta cardiac myosin heavy chain (MHC) gene in less than half of affected individuals. To identify the location of another gene involved in this disorder, a large family with FHC not linked to the beta MHC gene was studied. Linkage was detected between the disease in this family and a locus on chromosome 1q3 (maximum multipoint lod score = 8.47). Analyses in other families with FHC not linked to the beta MHC gene, revealed linkage to the chromosome 1 locus in two and excluded linkage in six. Thus mutations in at least three genetic loci can cause FHC. Three sarcomeric contractile proteins--troponin I, tropomyosin and actin--are strong candidate FHC genes at the chromosome 1 locus.

A case of acute renal artery thrombosis caused by blunt trauma: computed tomographic and Doppler ultrasonic findings

A 16-year-old girl who was involved in a traffic accident subsequently received emergency surgery for facial lacerations and an exploratory laparotomy. She had gross hematuria which was ignored initially. A left renal infarction, detected by computed tomography on the 12th post-operative day, showed no enhancement of the left renal artery with the cortical rim sign. Further study by color and pulsed Doppler ultrasound revealed the absence of normal renal arterial flow with only venous flow detected, confirming the diagnosis of acute renal artery thrombosis.

Congenital factor VII deficiency complicated with hemoperitoneum and intracranial hemorrhage: report of a case

Hypoproconvertinemia, or factor VII deficiency, is a rare congenital coagulopathy. We report on a female infant with congenital factor VII deficiency complicated by hemoperitoneum and intracranial hemorrhage. Most reports indicate that the bleeding of victims tends to be mild and confined to the superficial mucosa area. However, other reports and our experience with this patient suggest that it can result in fatal cerebral hemorrhage and necessitate early diagnosis, effective treatment and careful genetic counseling.

Congenital bronchoesophageal fistula in childhood. Case report and review of the literature

A case of congenital bronchoesophageal fistula in a 9-month-old infant is presented. He had had repeated pulmonary infections since he was 2 months old. A barium swallow examination showed a communicating fistula between the mid-esophagus and the posterior segmental bronchus of the right upper lobe. MRI clearly demonstrated the course of the fistula.

Obstructive intestinal herniation due to improper use of a seat belt: a case report

The term "seat belt syndrome" has been used to describe injuries to the abdominal viscera caused by seat belts during car accidents. These injuries are usually sustained as a result of the rapid deceleration that occurs in front-end collisions, with the consequent compression of the abdominal viscera. The spectrum of injuries includes intestinal perforation or stenosis, mesenteric disruption, and lumbar fracture-dislocation. We present an uncommon case of obstructive herniation in a 2-year-old girl which we believe was due to improper use of a seat belt.

Cell cycle-dependent changes in the organization of an intermediate filament-associated protein: correlation with phosphorylation by p34cdc2

During mitosis in BHK-21 baby hamster kidney cells the hyperphosphorylation of the type III intermediate filament (IF) protein vimentin is accompanied by the disruption of the IF network into punctate, protofilamentous structures. In this study, the morphological and biochemical changes of IFAP 300, a 300-kDa IF-crossbridging protein, are examined during mitosis. Double-label immunofluorescence shows that the distribution of IFAP 300 coincides with the typical filamentous pattern displayed by vimentin in interphase cells, whereas in mitotic cells it is reorganized into a punctate, nonfilamentous pattern. Accompanying these latter morphological changes, IFAP 300 is phosphorylated at a unique, mitosis-specific site. Comparison of the sites phosphorylated in cultured cells with those phosphorylated in vitro by various kinases suggests that IFAP 300 is phosphorylated by the same two kinases that phosphorylate vimentin during mitosis. One of these is p34cdc2 protein kinase, which appears to be responsible for the phosphorylation of the mitosis-specific site. The other kinase phosphorylates IFAP 300 in vitro at a site that is also found in the protein immunoprecipitated from either mitotic or interphase cells. In contrast to vimentin, the phosphorylation levels of IFAP 300 are not obviously altered between interphase and mitosis. Our results show that IFAP 300 is a physiological substrate for p34cdc2 and that this kinase may be involved in the mitotic reorganization of IFAP 300 by phosphorylating a mitosis-specific site. Taken together with our previous results, this study suggests that the activation of p34cdc2 coordinates the mitotic reorganization of the vimentin IF network both by severing IF-IF connections mediated by IFAP 300 and by disassembling individual IFs into protofilaments.

Splenic abscess: sonographic diagnosis and percutaneous drainage or aspiration

During a recent 5-year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound (US) examination. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. The latter four patients had developed splenic microabscesses with a diameter of less than 1.5 cm. The larger abscesses showed an irregular wall, weak or no internal echoes, ovoid or round in shape, and accompanied by mild to moderate distal acoustic enhancement. Wedge-shaped abscesses were typically noted in patients with infectious endocarditis and septic embolism. US-guided percutaneous drainage was done in five patients (abscesses greater than 4 cm). Simple aspiration in conjunction with antibiotic administration was done for seven smaller abscesses (diameter less than 3.5 cm) in five patients. A second drainage, either for a dislodged catheter or a recurrent abscess, was performed in two cases. All patients had uneventful clinical course following this therapeutic approach.

Intermediate filaments: not so tough after all

The dynamic properties of cellular protein polymers such as microtubules and microfilaments depend to a large extent on the cell's capacity to modify rapidly the exchange rate between polymerized and unpolymerized pools of subunits. Until quite recently the dynamic nature of intermediate filaments was underestimated because of their biochemical stability in vitro and a paucity of studies on their characteristics in vivo. However, the recent studies described in this review show that the karyoskeletal and cytoskeletal structures that assemble from many intermediate filament proteins possess the properties expected of dynamic protein polymer networks.

Neonatal lupus erythematosus with negative anti-Ro and anti-La antibodies: report of one case

Since 1981 when anti-Ro (SS-A) and/or anti-La (SS-B) antibodies were described to be present in infants with neonatal lupus erythematosus (NLE) and their mothers, subsequent studies have demonstrated the almost universal association of NLE with either or both of these autoantibodies. To our best knowledge, three cases of NLE were reported to be negative in anti-Ro (SS-A) and anti-La (SS-B) antibodies. We report one infant born to a mother with systemic lupus erythematosus (SLE). He had neonatal pancytopenia (thrombocytopenia, anemia, and leukopenia) which got resolved after intravenous immunoglobulin (IVIG) administration. Both anti-Ro (SS-A) and anti-La (SS-B) antibodies were not detectable in his serum by immunodiffusion method while other such as RNP (nonspecific, including U1,U2,U3,...,U6), Sm and Scl-70 antibodies were all positive. This mother had all the above antibodies detectable in her serum. After excluding other possibilities, his pancytopenia was most likely to be attributed to neonatal lupus. We suggest that autoantibodies such as RNP and Sm antibodies may play an important role in the pathogenesis of thrombocytopenia of NLE.

Epithelioid hemangioendothelioma of spleen with intrasplenic metastasis: ultrasound and computed-tomography appearance

The US and CT appearances of epithelioid hemangioendothelioma of the spleen with intrasplenic metastasis have not been previously reported. We described a 29-yr-old female with such a disease. Abdominal US study revealed a large mass in the upper pole and multiple small nodules in the rest of the spleen. CT scan also showed similar lesions of hypodensity which were not apparently enhanced by contrast medium.

The gene responsible for familial hypocalciuric hypercalcemia maps to chromosome 3q in four unrelated families

Familial hypocalciuric hypercalcemia (FHH) is an autosomal dominant syndrome of unknown aetiology characterized by lifelong elevation in serum calcium concentration and low urinary calcium excretion. These features suggest that the causal gene is important for maintenance of extracellular calcium homeostasis by the parathyroid gland and kidney. To identify the chromosomal location of FHH gene(s), we clinically evaluated 114 individuals in four unrelated affected families and performed linkage analyses. The disease gene mapped to the long arm of chromosome 3 in each family (combined maximum multipoint lod score = 20.67). We suggest that this is the predominant FHH locus and anticipate that identification of the FHH gene will improve our understanding of the molecular basis for physiologic and pathologic regulation of calcium.

Essential myoclonus: report of four cases

Four cases of essential myoclonus in childhood are reported. These include three males and one female, whose age-at-onset ranged from 2 months to 16 years. All manifested as involuntary movement of face, neck, or extremities without any known etiology. Only one case has a family history of myoclonus. They showed no other neurological abnormalities. The image or electrophysiological studies of nervous systems were within normal limits except that electromyogram (EMG) showed myoclonic discharge. All were treated by clonazepam with or without valproic acid. No significant effects were noted.

[Factors in recurrence after curative resection of rectal cancer]

Data on 409 Patients who had a curative resection for rectal cancer at the National Taiwan University Hospital between 1977 and 1989 were analysed to determine the independent effect on recurrence. In our series, the total operative mortality rate was 1.7% and the resectability rate was 88.1%. For these cases who received curative resection, the overall 5-year survival rate was 62.6%. The 5-year survival rate varied according to the Dukes' stage: stage A, 96.4%; stage B, 73.3% and stage C, 39.6%. The total recurrence rate after curative resection was 35.9%, including local recurrence 18.3%, systemic recurrence 12.0%, and combined recurrence 5.6%. According to Dukes' staging system, the recurrence rate for stage A, B and C were 0%, 22.4% and 63.8%, respectively. We used Cox's regression model to analyse the patients characteristics and pathological variables on recurrence and to assess the independent influence of each when all other factors were held constant. The pathological stage of the cancer had the strongest association. Other variables found to have an independent yet significant importance, were CEA level and tumor size. The identification of the patient group, at a high risk of recurrence, might promote a more judicious selection for surgical procedure and trials of adjuvant therapy.

Marinesco-Sjögren syndrome: report of one case

A three-year-old Taiwanese boy with Marinesco-Sjögren syndrome is reported. Psychomotor retardation had been noticed since early infancy with hypotonia, muscle weakness, delayed motor milestones and imbalance in sitting and standing. Bilateral visual impairment proved to be congenital cataract. Speech was limited to a few words. The parents were consanguineous, and there are two similarly affected siblings. The brain computed tomography revealed cerebellar atrophy. The evoked potential studies indicated a central origin or brainstem lesion. The histopathologic study of the muscle showed variation in fiber size and regenerating fibers. The patient received intraocular lens implantation and was discharged under a home rehabilitation program.