Genetic variation at nine STR loci in populations from the Philippines and Thailand living in Taiwan

In order to apply a set of nine STR loci and the amelogenin locus in forensic testing, we have performed a population study on individuals from the Philippines and Thailand living in Taiwan (273 Philippine and 146 Thai individuals were typed by commercially available kits and an automated sequencer). A total of 73 alleles for all systems for both populations could be observed in these two populations. No new intermediate fragments were found. Allele frequencies showed no deviation from Hardy-Weinberg equilibrium. The mean exclusion power (MEP) ranged from 0.327 (TPOX) to 0.706 (FGA), the discriminating power (DP) ranged from 0.790 (TPOX) to 0.963 (FGA) for Philippinos, MEP ranged from 0.247 (TPOX) to 0.723 (FGA), DP ranged from 0.761 (TPOX) to 0.968 (FGA) for Thais, the combined MEP is > 0.9988 and the combined DP is > 0.9999999993 for both Philippinos and Thais.

Radiographic anatomy: multimedia interactive instructional software on CD-ROM

OBJECTIVE

We wanted to create a filmless radiographic anatomy curriculum, a didactic software with a digital image database on CD-ROM for first-year medical students.

CONCLUSION

We created a CD-ROM that includes an introduction, radiographic anatomy tutorial, and interactive questions. Additional features include Boolean text searching, links to related images, and Internet accessibility. The software can be updated.

Sonohysterography: the next step in the evaluation of the abnormal endometrium

Sonohysterography is a simple ultrasound (US) procedure that may be used to evaluate the endometrium. The technique involves placement of a 5-F catheter into the endometrial canal with subsequent instillation of sterile saline solution under US guidance. Fifty patients successfully underwent sonohysterography because of apparent abnormal endometrial thickening at transvaginal US, a nonspecific finding. Patients tolerated this procedure well, and no complications were encountered. In the 39 patients who proved to have endometrial pathologic conditions, sonohysterography demonstrated focal processes (polyps, carcinoma, hamartoma) in 15, diffuse processes (hyperplasia, secretory endometrium) in 21, and both focal and diffuse pathologic conditions in three. If a focal process can be delineated, a visually directed biopsy may be necessary. However, if the process is diffuse, a blind aspiration biopsy may be performed on an outpatient basis. In the majority of patients, the diffuse or focal nature of the disease could not be predicted on the basis of initial transvaginal US. Because sonohysterography allows distinction between diffuse and focal abnormalities, it provides physicians with a cost-effective way to plan the next step in case management.

The CT appearance of pleural and extrapleural disease in lymphoma

OBJECTIVE

Pleural effusions in patients with lymphoma that are assumed to be related to malignancy are attributed to either lymphatic obstruction by tumour with resultant decreased clearance of pleural fluid, or direct tumour involvement of the pleura. The purpose of our study was to determine how often pleural or extrapleural disease was detected by computed tomography (CT) of patients with pleural effusions and primary or recurrent lymphoma.

METHODS AND MATERIALS

We reviewed CT examinations showing evidence of pleural effusion in 61 patients with a diagnosis of primary or recurrent lymphoma and no history of other systemic disorders, including infection. The study population consisted of patients with non-Hodgkin's lymphoma (n = 44) or Hodgkin's disease (n = 17); both primary disease (n = 11) and recurrent disease (n = 50) were represented. Each CT examination was evaluated for the presence of disease involving the visceral and parietal pleura and extrapleural space, mediastinal adenopathy, and pulmonary parenchymal disease.

RESULTS

Fourteen patients (23%) (nine with non-Hodgkin's lymphoma and five with Hodgkin's disease) had parietal pleural disease (thickening or nodules). Eighteen patients (30%) (14 with non-Hodgkin's lymphoma, four with Hodgkin's disease) had tumour or enlarged lymph nodes in the extrapleural space. Forty-three patients (70%) had mediastinal lymphadenopathy. Patients who received intravenous contrast did not have evidence of visceral pleural abnormalities or underlying pulmonary parenchymal disease.

CONCLUSION

Forty-one percent of the patients with lymphoma and pleural effusions had CT evidence of pleural and/or extrapleural disease. The majority of the patients with extrapleural disease had adjacent posterior mediastinal disease.

Focal delivery during direct infusion to brain: role of flow rate, catheter diameter, and tissue mechanics

Direct interstitial infusion is a technique capable of delivering agents over both small and large dimensions of brain tissue. However, at a sufficiently high volumetric inflow rate, backflow along the catheter shaft may occur and compromise delivery. A scaling relationship for the finite backflow distance along this catheter in pure gray matter (x(m)) has been determined from a mathematical model based on Stokes flow, Darcy flow in porous media, and elastic deformation of the brain tissue: x(m) = constant Q(o)(3)R(4)r(c)(4)G(-3)mu(-1) 1/5 [corrected] = volumetric inflow rate, R = tissue hydraulic resistance, r(c) = catheter radius, G = shear modulus, and mu = viscosity). This implies that backflow is minimized by the use of small diameter catheters and that a fixed (minimal) backflow distance may be maintained by offsetting an increase in flow rate with a similar decrease in catheter radius. Generally, backflow is avoided in rat gray matter with a 32-gauge catheter operating below 0.5 microliter/min. An extension of the scaling relationship to include brain size in the resistance term leads to the finding that absolute backflow distance obtained with a given catheter and inflow rate is weakly affected by the depth of catheter tip placement and, thus, brain size. Finally, an extension of the model to describe catheter passage through a white matter layer before terminating in the gray has been shown to account for observed percentages of albumin in the corpus callosum after a 4-microliter infusion of the compound to rat striatum over a range of volumetric inflow rates.

Pattern of defervescence in response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis and advanced human immunodeficiency virus infection

The pattern of fever response to empiric anti-tuberculosis therapy in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) infection, and the relationship between fever response patterns and anti-TB drug susceptibility profiles of Mycobacterium tuberculosis isolates are rarely described. In this study, we evaluated the fever responses to a four-drug anti-TB regimen in 26 HIV-infected patients with culture-proven extrapulmonary TB, and compared the results with those in 12 patients with disseminated Mycobacterium avium complex (DMAC) infection treated with a clarithromycin-containing regimen. The CD4 lymphocyte counts did not differ significantly between TB and DMAC patients (26 x 10(6)/L in TB patients vs 5 x 10(6)/L in DMAC patients). Drug susceptibility data were available for 22 patients with TB. Most TB patients had rapid defervescence after initiation of anti-TB therapy. Fever resolved within 1 week in 85% (22/26) of patients, including three of six (50%) with multidrug-resistant (MDR) TB. The median duration of fever in patients with drug-susceptible TB was similar to that in patients with drug-resistant TB (3 vs 4 days, p = 0.33). However, patients with MDR-TB were more likely than those with non-MDR TB to have fevers lasting longer than 1 week after initiating anti-TB therapy (3/6 vs 1/16, p = 0.046). Only 17% (2/12) of the patients with DMAC infection became afebrile within 1 week of beginning anti-MAC therapy (p < 0.001 vs those with TB). Our observations suggest that in HIV-infected patients with advanced immunosuppression, anti-TB regimens achieve significantly faster defervescence in TB patients than do anti-MAC regimens in DMAC patients. Rapid defervescence in patients with TB does not necessarily indicate that TB isolates are not MDR strains.

Radiographic measurement of prevertebral soft tissue thickness on lateral radiographs of the neck

PURPOSE

The prevertebral soft tissue measurement is commonly used for assessing prevertebral pathology such as abscesses or hematomas after injury. Very few references concerning the ratio of retrotracheal thickness to C5 diameter are available in the literature. The purpose of this study was to measure the normal soft tissue thickness at the C5 level of the neck and to establish the normal ratio of retrotracheal soft tissue thickness to the diameter of C5 for daily use.

DESIGN AND PATIENTS

We measured soft tissue thickness in the neck of 54 normal subjects and calculated the mean and standard deviation.

RESULTS AND CONCLUSION

Using mean plus one standard deviation the maximum retrocricoid soft tissue thickness was 0.7xC5 diameter and maximum retrotracheal thickness was 1.0xC5 diameter. Soft tissue thickness that exceeds this limit must be studied further for signs of potential disease.

[Analysis of 50 cases of sexual dysfunction]

Fifty cases of male sexual dysfunction were analyzed in order to investigate the incidence and causes of the erectile dysfunction in the different injuries. The results showed that the incidence of erectile dysfunction of the patients with brevic fracture and urethra injury is 62.50%, main caused by the damage of pudendal nervous and arterial system. The incidence in the patients with the spinal fracture and light spinal cord injury is 50%, caused by the damage of nervous system. The erection in the 17 cases of the patients with only one testis injury is normal. Two cases with bilateral testis injury have suffered from erectile dysfunction.

Abnormal calcification on plain radiographs of the abdomen

The purpose of this pictorial review is to facilitate recognition and understanding of calcifications seen on conventional radiographs of the abdomen. Calcifications can be categorized by organ system and location in the abdomen. Both common and rare calcifications in the urinary tract, liver, gallbladder, spleen, pancreas, adrenal glands, digestive tract, genital tract, peritoneal cavity, and retroperitoneum are illustrated. Abnormal calcifications in the urinary tract are subcategorized by kidneys, ureters, bladder, and urethra. The density, shape, size, margins, pattern, position, and mobility of calcifications are emphasized for differential diagnoses.

[The study of family structure, illness symptom, and stress adaptation of psychotic patients]

The major purposes of this paper are to explore the phenomena of family structure, illness symptoms, family coping and adaptation for patients with schizophrenia or manic-depression psychosis. This paper tries to provide a good reference instrument for application by nurses in home care, in order to understand and evaluate family needs. Subjects are schizophrenic or manic-depression outpatients from 3 hospitals located in northern Taiwan. Data were collected through home interview with primary caregivers and observations. There were fifty subjects from each of the 3 hospitals, and 151 subjects in total. Descriptive statistics, t-test, one way ANOVA, Pearson correlation and multiple stepwise correlation were used to analyze data. Research indicates that most patients are aged between 31 to 40, with over 10 years elapsed since onset, and are not married. Most primary caregivers are parents over 60 years old. Most family development was at the stage with young adult offspring. The manic-depressive patients have more working opportunities than schizophrenic patients. For schizophrenic patients, paranoia was the most serious in active symptoms; lack of interpersonal interaction was the most serious in negative symptoms; the other major problem was sleep disturbance in emotion-behavior assessment. Patient's disposition was the most concerning issue for families and the worst coping efficiency occurred with lazy behavior and sleep disturbance. For manic-depressive patients, aggressive behavior was the most serious active symptom, lack of energy was the most serious in negative symptom, and sleep disturbance was the most concerning problem in emotion-behavior assessment. The patient's symptom was the most concerning issue for families and the worst coping efficiency was found in drug side effect. The result also indicates that active and negative symptoms are both related to coping efficiency.

The role of tissue studies in facilitating early initiation of antimycobacterial treatment in AIDS patients with disseminated mycobacterial disease

SETTING

The question of whether aggressive investigations are useful in diagnosis and initiation of treatment in AIDS patients with disseminated mycobacterial disease (DMD) is still under debate.

OBJECTIVE

To define the role of tissue studies in facilitating early initiation of antimycobacterial treatment and in establishing diagnosis in AIDS patients with DMD.

DESIGN

From July 1994 through June 1997, 167 AIDS cases with fever were evaluated by stepwise investigation using a standardized protocol. Data of DMD cases were analyzed to define the role of tissue studies.

RESULTS

A total of 40 cases of culture-proven DMD were identified. Antimycobacterial treatment was initiated due to positive acid-fast bacilli smears of sputum in only five cases. In the remaining cases, positive pathologic findings from tissue biopsies (lymph node, bone marrow or liver) facilitated early initiation of treatment in 60% (21/35). In 50% of all cases (20/40), the diagnosis could not have been established if cultures of tissue biopsies had not been performed. Both the pathologic examinations and mycobacterial cultures from liver biopsies had positivity rates of more than 50% (53.8% and 69.2%, respectively).

CONCLUSIONS

Tissue studies were useful in facilitating early initiation of treatment and establishing diagnosis at least in half of the AIDS cases with DMD. Liver biopsy is worthwhile if the cause of fever is not discovered using less invasive investigations.

Expression of bone morphogenetic protein 7 in murine epididymis is developmentally regulated

Bone morphogenetic proteins (BMPs) have been shown to play a role in the functional maintenance of the adult epididymis. To begin to investigate the role of BMP signal transduction during postnatal epididymal development, we examined the expression profile of Bmp7 in murine epididymis by in situ hybridization. Our data show that during early postnatal development (younger than 3 wk of age), Bmp7 transcripts are detected uniformly in epithelial cells throughout the epididymis. As the mice aged (from 3 to 4 wk), Bmp7 expression was gradually restricted to the initial segment, with increased levels. Bmp7 expression in the rest of the caput and corpus regions became undetectable after 4 wk of age. However, after 4 wk of age, an ascending gradient of Bmp7 expression was observed in the epididymal epithelial cells in the transition from the cauda epididymal tubule to the vas deferens. Such a unique expression profile of Bmp7 strongly suggests that epididymis-produced BMP7 may play a role in the development and functional maintenance of the epididymis, and that Bmp7 expression in the epididymis is developmentally regulated.

Dynamics of plasma cytokine levels in patients with advanced HIV infection and active tuberculosis: implications for early recognition of patients with poor response to anti-tuberculosis treatment

OBJECTIVE

To examine whether the serial measurement of plasma cytokine levels can assist in the early recognition of AIDS/tuberculosis patients with poor response to anti-tuberculosis treatment.

DESIGN

Longitudinal, prospective cohort study.

SETTING

A university hospital, the largest centre for HIV/AIDS patients in Taiwan.

METHODS

Between January 1997 and September 1998, 25 consecutive patients with advanced HIV infection and suspected tuberculosis were enrolled in the study. Plasma samples were obtained on day 1 (baseline), 3, 7 and 14 of anti-tuberculosis treatment and the levels of tumour necrosis factor-alpha (TNF-alpha) were measured. Patients were classified as either responders or non-responders according to the results of assessment of symptoms and follow-up cultures during the sixth and eighth week of anti-tuberculosis treatment. Thirty consecutive HIV-negative tuberculosis patients were also enrolled in the study.

RESULTS

The data of a total of 16 AIDS patients (median CD4 cell count 16 x 10(6)/l; 12 responders and four non-responders) and 21 HIV-negative patients (16 responders and five non-responders), whose tuberculosis was culture-proven, were included for analysis. In responders, TNF-alpha levels declined remarkably within the first week of anti-tuberculosis treatment; however, the decline of TNF-alpha levels in non-responders was significantly less [the median ratio of TNF-alpha level on day 7 to that at baseline was 0.32 versus 0.85 (P < 0.001) in AIDS patients; 0.34 versus 0.80 (P = 0.001) in HIV-negative patients). The lack of a > or = 50% reduction in pre-treatment TNF-alpha levels during the first week of treatment was strongly associated with a poor response to anti-tuberculosis treatment (P = 0.001 in AIDS patients; P < 0.001 in HIV-negative patients).

CONCLUSION

Serial measurement of plasma TNF-alpha levels may help to assess the response to anti-tuberculosis treatment in AIDS patients, in spite of very low CD4 cell counts. Failure of TNF-alpha levels to decline by > or = 50 % of pre-treatment levels in the first week of treatment may be an early surrogate marker of a poor response.

Free jejunal grafts of the pharynx: surgical methods, complications, and radiographic evaluation

Free jejunal grafts have been used in the surgical treatment of patients with carcinoma of the pharynx and upper esophagus. Post-operative complications, including swallowing difficulty, are frequent and radiographic assessment may be required. In this pictorial paper, we describe the surgical technique of free jejunal grafting of the pharyngoesophagus, and the radiographic appearances and clinical importance of early and delayed complications following the procedure. Dysphagia after placement of a jejunal graft is a common occurrence which is often multifactorial, and may be related to functional, anatomic, or a combination of factors.

The effectiveness of health promotion counseling to family caregivers

This study examined the effectiveness of health promotion counseling of the family caregivers from Taipei Metropolitan Area. An established Chinese version of the health-promoting scale was developed by the author of this study (which was modified and authorized by Walker, Sechrist, & Pender, 1987). A two-group quasi-experimental research design was employed. From October 1996 to July 1997, 84 family caregivers were selected and assigned to one of the two groups. Members of the treatment group received health promotion counseling from four trained professional home care nurses during home visiting. The members of the control group were given no counseling but instead received traditional care. Pre-assessment was carried out after subjects were selected and post evaluation was done 6 months later. The findings showed that the counseling enabled members of the treatment group to adopt healthier lifestyles. The research outcome supports the value of home-care nurse counseling of family caregivers.

Epstein-Barr virus-associated intravascular lymphomatosis within Kaposi's sarcoma in an AIDS patient

Intravascular lymphomatosis (IL) is an unusual neoplasm characterized by multifocal proliferation of lymphoma cells exclusively within the blood vessels. We report here a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Kaposi's sarcoma. A 233-bp amplification product of HHV-8 was detected in the DNA extracted from specimens of Kaposi's sarcoma at different sites by polymerase chain reaction (PCR). At autopsy, the vessels within the Kaposi's sarcoma were dilated and filled with atypical large mononuclear cells. No such feature was seen in the vessels of non-Kaposi's sarcomatous regions. Immunohistochemically, the spindle cells of Kaposi's sarcoma were positive for CD31 (endothelial cell marker). The intravascular tumor cells were positive for CD45 (leukocyte common antigen) but negative for others, including chloroacetate esterase, CD45-RO (UCHL-1, Pan-T), CD3, CD43, CD20 (L26, Pan-B), CD30 (Ki-1), immunoglobulin heavy chains and light chains, CD56 (natural killer cell antigen), and CD31. Monoclonal rearrangement of immunoglobulin heavy chain gene was detected in the DNA extracts from fresh tissue of Kaposi's sarcoma by PCR, which indicated that the lymphoma cells within the Kaposi's sarcoma were of monoclonal B cell origin. In situ hybridization revealed that EBER-1 transcripts were present in the lymphoma cells of IL but not in the spindle cells of Kaposi's sarcoma. To the authors' best knowledge, this is the first instance of IL in an AIDS patient with direct evidence of EBV association.

Ultrasound-guided percutaneous transthoracic needle aspiration biopsy for diagnosis of pulmonary lesions in advanced HIV infection

Pulmonary diseases remain the most common complication associated with high morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Invasive diagnostic procedures are often needed to establish a specific diagnosis of pulmonary disease. We report our experience with ultrasound (US)-guided percutaneous transthoracic needle aspiration (PTNA) biopsy in 20 consecutive patients with advanced HIV infection who presented with a variety of pulmonary lesions with or without pleural effusion. A specific diagnosis was established in 16 patients (80%), with infection being the most common etiology. Sputum culture yielded the same causative pathogen in three patients (15%) and all had more than one bacterial or fungal isolates. Mild pneumothorax, the only complication, was observed in two patients (10%) following the procedure. Neither patient required chest tube drainage. Our findings suggest that US-guided PTNA can be a useful and safe alternative to fluoroscopy-guided PTNA in selected HIV-infected patients with focal pulmonary lesions and pleural effusion.

Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?

The objective of this study was to determine whether helical computed tomography (CT) performed without oral or intravenous contrast agents is accurate in the evaluation of patients with suspected acute renal colic. One hundred consecutive patients with suspected renal colic or ureteral colic were referred by our institution's emergency department for unenhanced helical CT scans. We reviewed the original radiographic report for each patient and recorded the size and location of ureteral calculi and other concurrent urinary tract calculi, if any. We also recorded the presence or absence of hydronephrosis, hydroureter, perinephric edema, and periureteral edema. A total of 49 patients had ureteral calculi, 17 patients had only renal calculi, and 34 patients had no stones. Forty-nine patients had ureteral calculi, and 40 (82%) of these 49 patients had associated CT signs including hydroureter and periureteral edema. Calculi were present in the proximal ureter in 11 patients, the midureter in seven patients, and the distal ureter including ureterovesical junction in 31 patients. Calculi were seen elsewhere in the urinary tract and renal pelvis in 44 patients. Other diagnostic tests and stone passage were used to confirm the CT diagnosis of ureteral stones. The sensitivity and specificity of helical CT in evaluating ureteral calculi were 100% and 94%, respectively. Sixteen extraurinary lesions were detected in 34 patients who had no urinary calculi. Most extraurinary lesions (81%) were deemed the cause of acute flank pain. The room time for CT averaged 26 min, compared to 69 min for intravenous urography (IVU). The charge for CT was $600 compared to $400 for IVU in our institution. Unenhanced helical CT was fast and accurate in determining the cause of colic and proved to be highly accurate for emergency situations.

Variables affecting convection-enhanced delivery to the striatum: a systematic examination of rate of infusion, cannula size, infusate concentration, and tissue-cannula sealing time

OBJECT

Although recent studies have shown that convection can be used to distribute macromolecules within the central nervous system (CNS) in a homogeneous, targeted fashion over clinically significant volumes and that the volume of infusion and target location (gray as opposed to white matter) influence distribution, little is known about other factors that may influence optimum use of convection-enhanced distribution. To understand the variables that affect convective delivery more fully, we examined the rate of infusion, delivery cannula size, concentration of infusate, and preinfusion sealing time.

METHODS

The authors used convection to deliver 4 microl of 14C-albumin to the striatum of 40 rats. The effect of the rate of infusion (0.1, 0.5, 1, and 5 microl/minute), cannula size (32, 28, and 22 gauge), concentration of infusate (100%, 50%, and 25%), and preinfusion sealing time (0 and 70 minutes) on convective delivery was examined using quantitative autoradiography, National Institutes of Health image analysis software, scintillation analysis, and histological analysis. Higher rates of infusion (1 and 5 microl/minute) caused significantly (p < 0.05) more leakback of infusate (22.7+/-11.7% and 30.3+/-7.8% [mean+/-standard deviation], respectively) compared with lower rates (0.1 microl/minute [4+/-3.6%] and 0.5 microl/minute [5.2+/-3.6%]). Recovery of infusate was significantly (p < 0.05) higher at the infusion rate of 0.1 microl/minute (95.1+/-2.8%) compared with higher rates (85.2+/-4%). The use of large cannulae (28 and 22 gauge) produced significantly (p < 0.05) more leakback (35.7+/-8.1% and 21.1+/-7.5%, respectively) than the smaller cannula (32 gauge [5.2+/-3.6%]). Varying the concentration of the infusate and the preinfusion sealing time did not alter the volume of distribution, regional distribution, or infusate recovery.

CONCLUSIONS

Rate of infusion and cannula size can significantly affect convective distribution of molecules, whereas preinfusion sealing time and variations in infusate concentration have no effect in this small animal model. Understanding the parameters that influence convective delivery within the CNS can be used to enhance delivery of potentially therapeutic agents in an experimental setting and to indicate the variables that will need to be considered for optimum use of this approach for drug delivery in the clinical setting.