Development of a robotic navigation system for neurosurgery

This paper presents a robotic navigation system for image-guided neurosurgery, which can be applied to the treatment of Parkinson's disease and biopsy of brain tumor. The system integrates a computer for real-time display of brain anatomy, a magnetic tracking device for measuring the positions and orientations of surgical instruments, and a robot manipulator for guiding surgical instruments to the preplanned positions and orientations. The computer display of brain anatomy offers a convenient tool for surgeons to diagnose brain disease and to plan safe surgical paths; while the tracking device assists the robot manipulator to automatically guide surgical instruments to the preplanned direction. The registrations among the tracking device, the image system, and the robot are completed on the base of coordination mappings of external markers. An experiment of using a skull model for simulating a robotic biopsy of brain tumor has been done to verify the performance of the navigation system. The result shows that the system can accomplish a positioning accuracy around 2 mm.

Serum uric acid levels in patients with cirrhosis: a reevaluation

It has been reported that the serum uric acid levels in patients with cirrhosis were decreased compared with healthy subjects. These studies suggested that the lower serum uric acid levels in cirrhotic patients were attributed mainly to an increased effective vascular volume, and consequently to an excessive renal clearance of uric acid. However, the previous observations are challenged by a recent hypothesis for the pathogenesis of hyperdynamic circulation and formation of ascites in cirrhosis. The current study was undertaken to reevaluate serum uric acid levels in patients with cirrhosis. Ninety-eight cirrhotic patients with normal renal functions were included in this study. All biochemical and hemodynamic data were utilized for analysis. The mean serum uric acid level (mean, 6.1+/-1.2 mg/dL; range, 2.7-9.1 mg/dL) was higher than that of the age- and sex-matched healthy control subjects (mean, 5.5+/-1.3 mg/dL; range, 2.9-8.1 mg/dL; p = 0.018). Using multiple regression analysis it was determined that the serum uric acid level was not related to the severity of liver disease, cardiac index, systemic vascular resistance, and hepatic venous pressure gradient but was related closely to age (r = 0.210, p = 0.026) and effective renal plasma flow (r = -0.677, p < 0.0001). Compared with cirrhotic patients without ascites, those with ascites had a significantly higher serum uric acid level (6.7+/-1.6 mg/dL vs. 5.6+/-1.7 mg/dL, p < 0.05) and lower effective renal plasma flow (396+/-125 mL/min vs. 445+/-149 mL/min, p < 0.05). In conclusion, for cirrhotic patients with normal serum creatinine levels, the current study shows that the mean serum uric acid level is higher than that of healthy control subjects. It is not related to the severity of liver failure and systemic and portal hemodynamics, but is related closely to renal functions, especially the renal plasma flow.

Heart transplantation with marginal recipients and donors

With improvements in surgical techniques and management of postoperative complications, heart transplantation can now be performed with donors and recipients who were previously considered unsuitable. In this study, we report the results of heart transplantation with marginal donors and recipients in our hospital. From June 1993 through June 1998, we performed 79 heart transplantations. Marginal recipients were defined as those with high pulmonary vascular resistance (> 6 Wood units), severe renal impairment (serum creatinine > 2 mg/dL and creatinine clearance < 50 mL/min), or severe hepatic dysfunction (ALT and AST > 100 IU/L or serum bilirubin > 2.5 mg/dL). Marginal donors were those with any of the following conditions: old age (> 40 years), size mismatch (donor/recipient body weight ratio < 0.8), history of chronic alcohol use, previous cardiopulmonary resuscitation and hypotension, hepatitis B or C virus positivity, coronary artery disease, high-dose dopamine (> 10 micrograms.kg-1.min-1), or prolonged allograft ischemic time (> 4 hours). Of the 79 transplantations performed, 45 (58%) involved marginal recipients or donors. The 30-day mortality rate was 5%, and the 1-year and 5-year survival rates were 87% and 83%, respectively. The survival rates did not differ significantly between cases involving marginal donors or recipients and those involving nonmarginal donors and recipients. There were 27 marginal recipients (34%), only one of whom died during surgery. Five of six recipients with severe renal impairment needed short-term hemodialysis after transplantation. Recipients with high pulmonary vascular resistance had a higher incidence of early acute rejection (5/10 vs 22/69). Thirty-three (42%) of the patients received transplants from marginal donors, four of whom died during surgery; two died of acute vascular rejection, one of allograft failure caused by prolonged ischemic time, and one of bleeding secondary to preoperative sepsis and coagulopathy. These results show that heart transplantation may be performed in marginal recipients and donors, with acceptable operative mortality.

Percutaneous abdominal and pelvic interventional procedures using CT fluoroscopy guidance

OBJECTIVE

The purpose of our study was to assess the use of low-milliamperage CT fluoroscopy guidance for percutaneous abdominopelvic biopsy and therapeutic procedures.

MATERIALS AND METHODS

We reviewed the clinical records and relevant imaging studies of 97 patients who underwent 119 percutaneous CT fluoroscopy-guided abdominal or pelvic procedures: fluid collection aspiration or drainage catheter insertion (n = 59), biopsy (n = 49), hepatocellular carcinoma ethanol ablation (n = 6), chemoneurolysis (n = 4), and brachytherapy catheter insertion (n = 1). These procedures were guided using a helical CT scanner providing real-time fluoroscopy reconstruction at six frames per second. A control panel and video monitor beside the gantry allowed direct operator control during all interventional procedures.

RESULTS

One hundred twelve (94.1%) procedures were successfully performed using either a stand-off needle holder and continuous real-time CT fluoroscopy guidance or incremental manual insertion and intermittent CT fluoroscopy to confirm position. Image quality using low milliamperage was adequate for needle or drainage tube placement in all but two low-contrast liver lesions. Two hematomas were accessed but yielded no fluid on aspiration; one drainage procedure was abandoned after the patient developed endotoxic shock. Imaging of ethanol distribution during injection facilitated tumor ablation and neurolytic procedures. CT fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement, especially in nonaxial planes. Average CT fluoroscopy time for biopsy and therapeutic procedures was 133 sec (range, 35-336 sec) and 186 sec (range, 20-660 sec), respectively.

CONCLUSION

CT fluoroscopy is a practical clinical tool that facilitates effective performance of percutaneous abdominal and pelvic interventional procedures.

Effects of vasopressin on portal-systemic collaterals in portal hypertensive rats: role of nitric oxide and prostaglandin

This study investigated the effect of vasopressin on portal-systemic collaterals in portal hypertensive rats and the influence of nitric oxide (NO) and prostaglandin on the responsiveness of collateral vessels to vasopressin. The vascular responsiveness to graded concentrations of vasopressin was tested with or without the incubation of n(omega)-nitro-L-arginine (NNA) (100 micromol/L) and/or indomethacin (10 micromol/L) in perfused collateral vascular beds of rats with portal hypertension induced by partial portal vein ligation. In addition, concentration-response curves to vasopressin with incubation of a vasopressin V(1) receptor antagonist d(CH(2))(5)Tyr(Me) arginine vasopressin and concentration-response curves to a V(2) receptor agonist 1-desamino-8-D-arginine vasopressin were performed. Vasopressin significantly increased the perfusion pressure of collaterals, and this effect was suppressed by the addition of the V(1) receptor antagonist. Perfusion with the V(2) receptor agonist had no effect on the collaterals. Incubation with NNA, indomethacin, or both significantly potentiated the response of collaterals to vasopressin. In addition, the pressor response to vasopressin in the combination group was significantly higher than that in the NNA-alone group. The results show that vasopressin produces a direct vasoconstrictive effect on the portal-systemic collaterals of portal hypertensive rats. This effect is mediated by the vasopressin V(1,) but not V(2), receptors. The attenuation of the response to vasopressin by NO and prostaglandin suggest a function role of both mediators in the regulation of the portal-systemic collateral circulation in portal hypertensive rats.

Postoperative short-term sedation with propofol in cardiac surgery

We conducted a randomized double-blind study to assess the safety and effectiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery. Sixty hemodynamically stable adult patients who underwent cardiac surgery were randomly assigned to receive propofol postoperatively or no postoperative sedation. The propofol group (n = 30) received propofol infusion (1 mg.kg-1.hr-1) immediately after they awoke postoperatively. The infusion rates were adjusted to maintain a sedation level (Ramsay score) of 3. Nurses assessed the effectiveness of the sedation according to Ramsay scores; the patients also subjectively evaluated sedation. Postoperative pulmonary oxygenation dysfunction (PaO2/FiO2 < 300 mm Hg) was noted in 10 patients receiving propofol and in eight patients in the control group. The dysfunction was greatly improved after overnight ventilator support, and this improvement was not affected by propofol sedation. The propofol group received an average of 13.6 +/- 5.3 hours of propofol infusion, at an average infusion rate of 0.96 +/- 0.16 mg.kg-1.hr-1. Patients receiving propofol remained well sedated (Ramsay score > or = 2) during 99.3% of the study period, while the control patients remained anxious or agitated (Ramsay score, 1) during 12% of the study period. Patients receiving propofol were successfully extubated 9 +/- 4 minutes after cessation of propofol infusion, without complications. The turnover of intensive care unit beds was not delayed by propofol sedation. Subjective evaluations (scored on an analog scale: 0 = nil, 10 = extreme) revealed that patients receiving propofol felt less pain than those in the control group (2.3 +/- 2.7 vs 4.7 +/- 3.1, p < 0.05), had better sleep quality (7.8 +/- 2.9 vs 5.1 +/- 2.9, p < 0.05), and were more satisfied with the care they received (8.3 +/- 2.2 vs 5.8 +/- 3.9, p < 0.05). These findings suggest that propofol infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay score of 3 may be ideal. Postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or agitation.

Normative data of quantitative thermal and vibratory thresholds in normal subjects in Taiwan: gender and age effect

BACKGROUND

Quantitative sensory testing has gained popularity as a tool in the diagnosis of peripheral neuropathies. This study aims to establish normative data of quantitative thermal and vibratory thresholds in normal subjects in Taiwan. In addition, we also examined the effect of age and gender differences on these thresholds.

METHODS

The study included 100 healthy subjects (50 males and 50 females) who were admitted for regular physical examination. The quantitative testing of thermal, cold and vibratory sensations were performed having recourse to a Thermotest instrument applied on the right hand and foot of these subjects. Measurements included perception thresholds of warm (WT), cold (CT), heat pain, cold pain and vibration as well as a visual analog pain scale.

RESULTS

Age was comparable between the sexes, but the male subjects were taller than the female subjects. A higher WT and CT in the hand, but not in the foot, were found in the male subjects in comparison with the female subjects. Heat pain threshold and cold pain threshold of both sites did not significantly differ between genders. Moreover, the groups did not differ in vibration threshold and visual analog pain scale. Young subjects (age < 30 years) showed a higher CT in the foot than the older subjects (age > 50 years). None of the above parameters were different between these two age groups. Overall, the age or height bore no significant relation to the difference between WT and CT (DDWT-CT).

CONCLUSIONS

The female subjects were found to be more sensitive to warm and cold stimulation in the hand than their counterparts. These results have provided valuable normative data on sensory perceptive thresholds in Taiwanese, which are useful as a tool in the diagnosis of peripheral neuropathy.

Long-term efficacy of plasma-derived hepatitis B vaccine: a 15-year follow-up study among Chinese children

To determine necessity and timing of booster of hepatitis B vaccine, we need to observe the duration of its protection. We report the results of a 15-year follow-up of a cohort of 649 children who participated a randomized, double blind, placebo-controlled trial on a plasma-derived hepatitis B vaccine in 1982. During the 15 years after vaccination, more vaccinated children had anti-HBs of 10 S/N ratios or over, compared with the controls, at all nine observations. At 15 years 50.0% (26/52) of the participants studied in the vaccinated group and 33.3% of the tested controls (18/54) retained anti-HBs levels of S/N ratios> or =10 (P < 0.09). However, since 5 years after vaccination, median S/N ratios of anti-HBs among the vaccinated children with detectable anti-HBs were lower than those of the controls except that detected at 15 years. 16.7% (9/54) of the tested children in the control group were HBsAg positive at 15 years after vaccination, in comparison with 1.9% (1/52) of the tested children in the vaccinated (P < 0.02). 28 chronic HBsAg carriers were identified in the control cohort over the 15 years, whereas only 1 case was noted in the vaccinated group (8.2% vs. 0.3%, P < 0.00001), corresponding to an efficacy of 96%.

Refined mapping of two regions of loss of heterozygosity on chromosome band 11q23 in lung cancer

11q23-24 chromosome is a region containing frequent allelic loss (loss of heterozygosity; LOH) in human cancers. To examine cancer-related allelic loss in the region between D11S940 and APOC3, we used 17 polymorphic markers and allotyped 28 lung cancer-derived cell lines and their corresponding matched lymphoblastoid cell lines. LOH was found in 71.4% (20/28) of the lung cancer cell lines and was localized to two distinct minimal regions of loss. One region is bracketed by markers D11S1647 and NCAM2 and contains the gene encoding the beta isoform of the A subunit of the human protein phosphatase 2A (PPP2R1B). Recently, mutations in this gene were described in lung and colon cancers, suggesting that PPP2R1B functions as a tumor-suppressor gene. A second minimal region of loss was defined between markers D11S1792 and D11S1885, a region estimated to be less than I Mb. Thus, chromosome 11 likely harbors two sites of suppressor oncogene activity in lung cancer, one defined by the PPP2R1B gene and the second located telomeric to PPP2R1B. This study facilitates the identification and cloning of a second critical tumor-suppressor gene involved in lung cancer, and possibly a variety of other cancers, on human chromosome band 11q23.

Evidence against a role for endotoxin in the hyperdynamic circulation of rats with prehepatic portal hypertension

BACKGROUND/AIMS

Excessive formation of nitric oxide may mediate the generalized vasorelaxation and hyporesponsiveness to vasoconstrictors observed in portal hypertensive states. Endotoxin, released from the bowel and detoxified by the liver, could stimulate inducible nitric oxide synthase directly or indirectly via the cytokine cascade. This study investigated the effect of chronic intraperitoneal injection of polymyxin B, a neutralizing antagonist of endotoxin, on the hemodynamics of partially portal vein-ligated (PVL) rats.

METHODS

Concomitantly with endotoxin (600 EU) and dactinomycin (80 microg), polymyxin B (0.1 mg) or normal saline (N/S) was administered via an intraperitoneal route to male Sprague-Dawley rats. Twenty-four hours later, mean arterial pressure was determined. In PVL rats polymyxin B (0.1 mg in 5 cc N/S) or N/S was given intraperitoneally twice daily from 2 days prior to operation until 5 days (short-term) or 14 days (long-term) after the operation. Long-term polymyxin B- or N/S-treated sham-operated rats were included as controls. Hemodynamic studies with a thermodilution technique were performed at the end of treatment. Blood samples were collected from another series of PVL rats with long-term treatment to determine plasma levels of endotoxin and tumor necrosis factor-alpha. Plasma levels of endotoxin and tumor necrosis factor-alpha were measured by Limulus assay and the ELISA method, respectively.

RESULTS

With the dosage of 0.1 mg polymyxin B, hypotension in rats subjected to endotoxin and dactinomycin administration could be corrected (polymyxin B vs. placebo: 130.0+/-7.7 vs. 108.8+/-6.7 mm Hg, p<0.05). However, long-term or short-term treatment with the same dosage of polymyxin B failed to ameliorate the hyperdynamic circulation of PVL rats. In addition, long-term treatment with polymyxin B did not change systemic and portal hemodynamics in sham-operated rats. Plasma levels of endotoxin and tumor necrosis factor-alpha were comparable in PVL rats treated with long-term polymyxin B or N/S (p>0.05).

CONCLUSIONS

Our findings do not support the role of endotoxin in the hyperdynamic circulation of PVL rats.

Low incidence of transplant coronary artery disease in Chinese heart recipients

OBJECTIVES

This study sought to assess the incidence of transplant coronary artery disease (CAD) in Chinese heart recipients.

BACKGROUND

The prevalence of transplant CAD detected by angiography at 1, 2 and 4 years after heart transplantation was 11%, 22% and 45%, respectively. The incidence of transplant CAD in Chinese heart recipients has not been reported.

METHODS

For those recipients surviving for more than 1 year after transplantation, coronary angiography was performed annually for surveillance of transplant CAD. The recipient characteristics, donor characteristics, rejection episodes, medication and human leukocyte antigen (HLA) mismatches were recorded.

RESULTS

Fifty patients were included in this study. Thirteen (26%) recipients had ischemic heart disease. Two patients (4%) had active cytomegalovirus (CMV) infection after transplantation. The mean number of rejection episodes in the 1st year after transplantation was 1.15. Among 47 patients with complete data of donor and recipient histocompatibility antigens, there were seven patients (14.9%) with two or fewer HLA mismatches. Among 74 angiograms of 50 patients reviewed, only one patient had discrete stenosis less than 50% in the middle portion of the left anterior descending artery at 1 year after transplantation. The cumulative incidence of transplant CAD was 2% at 1 year and 2% at 2 and 4 years after transplantation.

CONCLUSIONS

The incidence of transplant CAD was low in Chinese heart transplant recipients. Low percentage of ischemic heart disease in recipients, low occurrence of active CMV infection and rejection episodes after transplantation, less racial disparity, and lower HLA mismatches may be the important factors.

The risk factors for gallstone disease among senior citizens: an Oriental study

BACKGROUND/AIMS

Few Occidental studies have addressed the risk factors for gallstone disease (GSD), among aged people. It is unknown whether these factors also present in the Orientals. Therefore, we studied the prevalence and risk factors for GSD among aged people in Taiwan.

METHODOLOGY

1441 aged subjects (> or = 60 years) who received a paid physical checkup at this hospital were investigated. Their demographic characteristics and biochemical parameters were recorded and compared. Ultrasonographic diagnosis revealed a normal gallbladder in 1092 subjects, gallbladder stones in 171, cholecystectomy for gallstones in 65, gallbladder polyps in 83, mixed gallbladder stones/polyps in 10, and miscellaneous results in 20. We enrolled 236 subjects showing either gallbladder stones or cholecystectomy for gallstones as the GSD group.

RESULTS

Excluding those subjects with mixed gallbladder stones/polyps, the overall prevalence of GSD in our series was 16.6%. Using multivariate analysis, the encountered factors manifesting risk for the development of GSD were old age (p<0.001), lower serum high-density lipoprotein level (p<0.01), diabetes mellitus (adjusted odds ratio: 2.127; p<0.001) and glucose intolerance (adjusted odds ratio: 1.954; p<0.001), whereas past history of alcohol consumption (adjusted odds ratio: 0.335; p<0.01) exhibited a protective effect against the development of GSD. Other demographic characteristics and biochemical parameters, such as body mass index, ABO blood type, cigarette smoking, blood pressure, serum cholesterol level, hepatitis B virus carrier, liver function, and parity, did not have any correlation to GSD.

CONCLUSIONS

Among the aged senior citizens in Taiwan, individuals with old age, lower serum high-density lipoprotein level, diabetes and glucose intolerance are at high risk for developing GSD.

Plasma concentrations of interferon-alpha in patients with liver cirrhosis: relationship to systemic and portal hemodynamics

BACKGROUND

Nitric oxide (NO) plays an important role in the pathogenesis of the hyperdynamic circulation observed in portal hypertensive states. Interferon (IFN)-alpha can stimulate NO formation directly or indirectly via cytokines. However, IFN-alpha concentrations seem to increase or decrease in cirrhotic patients. This study investigated the plasma concentration of IFN-alpha in patients with cirrhosis and its relationship to systemic and portal hemodynamics.

METHODS

Thirty-six patients with cirrhosis and 47 healthy controls had blood samples taken for the determination of plasma concentrations of IFN-alpha by enzyme-linked immunosorbent assay. Systemic and portal hemodynamics were measured in patients with cirrhosis on the same day of blood sampling using Swan-Ganz catheterization and the thermodilution technique.

RESULTS

As compared with healthy subjects, patients with cirrhosis demonstrated a significantly higher IFN-alpha detectable rate (> 3 pg/ml, 14.9% vs 36.1%, p < 0.05). In cirrhotic patients, the IFN-alpha detectable rates were similar between those with and without decompensation, a hepatic venous pressure gradient greater than 12 mmHg, or the presence of large esophageal varices (p > 0.05). There was no significant difference in the systemic vascular resistance or hepatic venous pressure gradient between cirrhotic patients with and without a detectable plasma IFN-alpha concentration.

CONCLUSIONS

Plasma IFN-alpha concentrations tended to increase in patients with cirrhosis. However, IFN-alpha concentrations do not play a role in the hyperdynamic circulation observed in patients with cirrhosis.

Developmental effects of phenytoin may differ depending on sex of offspring

Phenytoin (sodium salt), a developmental neurotoxicant, was administered orally by gavage (50-150 mg/kg) to pregnant rats on days 7-18 of gestation. Various developmental and behavioral indices were evaluated. Results indicated that phenytoin produced decreases in maternal and pup body weight gains, pup hindbrain, and F1 adult forebrain, whole brain, and cerebellar weights. Behavioral/developmental effects included performance deficits in a modified Morris water maze assay, in air righting and auditory startle responses, and increases in locomotor activity, accelerated eye opening, incisor eruption, negative geotaxis, and olfactory orientation. Female offspring appeared to be more severely affected when measuring incisor eruption, negative geotaxis, air righting, reactivity, and locomotor and maze activity. Males appeared to be more affected when measuring eye opening, olfactory orientation, and decreases in startle response. This study suggests that prenatal phenytoin exposure may result in developmental changes and behavioral deficits that may differ depending on the sex of the offspring.

Brominated 7-hydroxycoumarin-4-ylmethyls: photolabile protecting groups with biologically useful cross-sections for two photon photolysis

Photochemical release (uncaging) of bioactive messengers with three-dimensional spatial resolution in light-scattering media would be greatly facilitated if the photolysis could be powered by pairs of IR photons rather than the customary single UV photons. The quadratic dependence on light intensity would confine the photolysis to the focus point of the laser, and the longer wavelengths would be much less affected by scattering. However, previous caged messengers have had very small cross sections for two-photon excitation in the IR region. We now show that brominated 7-hydroxycoumarin-4-ylmethyl esters and carbamates efficiently release carboxylates and amines on photolysis, with one- and two-photon cross sections up to one or two orders of magnitude better than previously available. These advantages are demonstrated on neurons in brain slices from rat cortex and hippocampus excited by glutamate uncaged from N-(6-bromo-7-hydroxycoumarin-4-ylmethoxycarbonyl)-L-glutamate (Bhc-glu). Conventional UV photolysis of Bhc-glu requires less than one-fifth the intensities needed by one of the best previous caged glutamates, gamma-(alpha-carboxy-2-nitrobenzyl)-L-glutamate (CNB-glu). Two-photon photolysis with raster-scanned femtosecond IR pulses gives the first three-dimensionally resolved maps of the glutamate sensitivity of neurons in intact slices. Bhc-glu and analogs should allow more efficient and three-dimensionally localized uncaging and photocleavage, not only in cell biology and neurobiology but also in many technological applications.

Editing of cytochrome b mRNA in physarum mitochondria

The reading frame in the mRNA for the cytochrome b apoprotein in mitochondria of Physarum polycephalum is created by the insertion of 43 nucleotides in the mRNA relative to the mtDNA sequence encoding it (RNA editing). Most of these insertions (31) are single cytidines; however, single uridines are inserted at six sites, and the dinucleotides, CU and GC, are inserted at two sites and one site, respectively. These insertions create a 392-codon reading frame in the mature mRNA. The amino acid sequence inferred from this reading frame has similarity to cytochrome b apoproteins encoded by other mtDNAs. The insertions are quite evenly distributed throughout the length of the reading frame with an average spacing of 27 nucleotides. This mRNA has the highest percentage (23%) of noncytidine insertions of any Physarum RNA characterized to date. cDNAs corresponding to partially edited RNAs can be enriched by selective amplification. Some cDNAs that lack the GC dinucleotide insertion are fully edited at sites flanking the GC dinucleotide insertion site. Similarly some cDNAs lack the CT dinucleotide insertion or have a CC or TT insertion flanked by a fully edited sequence. These results imply that dinucleotide editing occurs by a process separate from the global insertion of cytidines.

An outbreak of enterically transmitted non-A, non-E viral hepatitis

Patients with isolated serum transaminase elevations of unknown cause are common in China. An outbreak of such disease took place in a technicians' school during 1996. To define the epidemic and determine the etiology, a study was carried out, which included investigation of epidemiological, clinical and histological features. The symptoms of this disease were mild. The major clinical feature was transaminase elevation, and all serum markers of known hepatitis viruses were negative. Although the course of disease in most patients was self-limiting, in a few it was prolonged and relapsed. Histological findings were mild portal hepatitis or non-specific reactive hepatitis. The disease first appeared in 1994, and this outbreak occurred after October 1996. A total of 381 people were affected and the prevalence was as high as 60.7%. Casual contact and small-scale food transmission were considered to be risk factors for infection and the epidemic was under control 2 months later following the introduction of preventive measures for gastroenteric infection. Viral genomic fragments from the so-called transfusion-transmitted virus (TTV) were detected in acute-phase sera and stool samples collected 2 weeks before onset. Therefore, this disease outbreak might be another form of enterically transmitted viral hepatitis, not related to hepatitis A and E.

A Java speech implementation of the Mini Mental Status Exam

The Folstein Mini Mental Status Exam (MMSE) is a simple, widely used, verbally administered test to assess cognitive function. The Java Speech Application Programming Interface (JSAPI) is a new, cross-platform interface for both speech recognition and speech synthesis in the Java environment. To evaluate the suitability of the JSAPI for interactive, patient interview applications, a JSAPI implementation of the MMSE was developed. The MMSE contains questions that vary in structure in order to assess different cognitive functions. This question variability provided an excellent test-bed to evaluate the strengths and weaknesses of JSAPI. The application is based on Java platform 2 and a JSAPI interface to the IBM ViaVoice recognition engine. Design and implementations issues are discussed. Preliminary usability studies demonstrate that an automated MMSE maybe a useful screening tool for cognitive disorders and changes.

Prophylactic octreotide reduces the severity of histopathologic changes and hemodynamic shock in early taurodeoxycholate-induced experimental pancreatitis

The findings related to the effects of somatostain and octreotide in experimental and clinical acute pancreatitis are so far inconclusive. In this study, we examined the early effects of prophylactic octreotide in acute experimental pancreatitis. Serum levels of amylase and lipase, pancreatic histopathology and systemic hemodynamic profiles, including mean arterial pressure, cardiac index, systemic vascular resistance and heart rate, were evaluated 5 hours after glycodeoxycholic acid (GDOC) or sodium taurodeoxycholate (TDC)-induced pancreatitis with or without prophylactic octreotide (10 micrograms/Kg) in rats, GDOC and TDC induced mild and severe pancreatitis, respectively. Octreotide significantly reduced serum levels of amylase and lipase at 5 hours in GDOC and TDC-induced pancreatitis. Octreotide significantly reduced the severity of pancreatic edema, necrosis and hemorrhage in TDC-induced pancreatitis. In addition, hemodynamic shock in TDC-induced pancreatitis was improved significantly by the administration of octreotide (mean arterial pressure 70.3 +/- 7.7 vs. 95.0 +/- 3.5 mmHg, p < 0.05; cardiac index 16.7 +/- 2.5 vs. 24.0 +/- 5.1 ml.min-1. 100 g-1, p < 0.05). However, octreotide did not show significant beneficial effect in pancreatic histopathology and hemodynamics in GDOC-induced pancreatitis. Thus we conclude that prophylactic octreotide improves pancreatic histopathology and hemodynamic shock in TDC-induced pancreatitis.

Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis

OBJECTIVE

Proinflammatory cytokines are involved in the pathogenesis of acute pancreatitis. The value of serum levels of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, and interleukin-8 in predicting the outcome of acute pancreatitis was evaluated.

METHODS

In 50 patients with acute pancreatitis, the serum concentrations of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, interleukin-8, and C-reactive protein were determined on days 1, 2, 3, 4, and 7 after admission. Acute Physiology and Chronic Health Evaluation (APACHE II) scores were recorded on days 1, 2, and 3.

RESULTS

Serum concentrations of interleukin-1-beta, interleukin-6, interleukin-8, and C-reactive protein on days 1-7 were significantly higher in patients with severe pancreatitis than in patients with mild pancreatitis. Patients with severe attacks had significantly elevated serum tumor necrosis factor-alpha concentrations on days 1-3 compared with those with mild attacks, but not on days 4 and 7. The median peak value of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, and interleukin-8 was reached on day 1, in contrast to the median peak of C-reactive protein, which was reached on day 2. Using cutoff levels of 12 pg/ml for tumor necrosis factor-alpha, 1 pg/ml for interleukin-1-beta, 400 pg/ml for interleukin-6, 100 pg/ml for interleukin-8, 12 mg/dl for C-reactive protein, and 10 for the Acute Physiology and Chronic Health Evaluation (APACHE II) score, the accuracy rates for detecting severe pancreatitis were 72%, 82%, 88%, 74%, 80%, and 72%, respectively, on day 1 and 78%, 74%, 80%, 76%, 80%, and 78%, respectively, on day 2.

CONCLUSION

Among the proinflammatory cytokines, interleukin-6 is the most useful parameter for early prediction of the prognosis of acute pancreatitis.

Proximal femoral dimension in elderly Chinese women with hip fractures in Taiwan

To investigate the relationship between proximal femoral geometry and the occurrence of hip fracture, we compared the geometry of contralateral normal hips of 120 elderly Chinese women with hip fractures, including 63 femoral neck fractures (group A) and 57 intertrochanteric fractures (group B) due to minor trauma, with that of 72 normal elderly Chinese women (group C). The mean ages for group A, B and C subjects were 77.3, 79.7 and 72.9 years, respectively. The femoral neck length (NL), neck width (NW), diameter of femoral head, femoral shaft width just below the lesser trochanter, and neck-shaft angle (theta;) were measured on the anteroposterior plain pelvic radiographs. The mean +/- SD of NL for group A was 50.4 +/- 3.3 mm; for group B, 50.6 +/- 3.1 mm; and for group C, 48.8 +/- 3.6 mm. Statistical analysis by ANOCOVA and regression showed that only NL of women with hip fractures was significantly longer than controls after correction for age, body height and weight (p <0.01). However, the difference in NL between group A and group B was not significant. By linear regression, the probability of fracture increased only with older age (p <0.001), longer NL (p <0.005) and lighter body weight (p <0.05). By logistic regression, each standard deviation increase in NL increased the risk of hip fracture (age-adjusted odds ratio 1.84; 95% CI, 1.11-3.06). The results confirm the relationship between proximal femoral geometry and the occurrence of hip fracture in elderly Chinese women in Taiwan.

Video-assisted endoscopic saphenous vein harvesting for coronary artery bypass grafting

Saphenous vein grafts for coronary artery bypass can be harvested by means of the traditional long incision method, the skin bridge method, or a newly developed endoscopic technique. We applied the endoscopic technique to reduce the length of leg incision and to decrease the frequency of complications. Between September and December 1996, 47 patients underwent coronary artery bypass grafts, 17 of whom volunteered to undergo saphenous vein harvest with the Endopath video-assisted endoscopic saphenous vein harvest (ESVH) system; the other 30 patients underwent the traditional long incision harvest procedure. A total of 22 saphenous veins were harvested from the 17 patients who underwent ESVH. The mean length of the leg wound was 5.8 +/- 1.3 cm and the mean length of the vein harvested was 32.9 +/- 3.4 cm (wound/vein length ratio 17.6%). The wound/vein length ratio of the 30 patients who underwent the traditional open harvest method was 91.5% (30.8 +/- 2.2 cm/34.1 +/- 3.0 cm). ESVH failed and was converted to the conventional method in two cases. The mean time required to harvest the saphenous vein was 72.7 +/- 20.8 minutes in the ESVH group and 45.8 +/- 12.5 minutes in the open surgery group. No wound complications were noted in the ESVH group, except for ecchymosis in three cases. Five patients in the open surgery group had wound discharge (17%). The length of hospital stay was shorter (10.5 +/- 2.6 days vs 15.8 +/- 4.2 days) and fewer analgesics were used in the ESVH group. The rate of cardiac complications was not different between the two groups. Examination of the vein graft under light microscopy also did not reveal any differences. We conclude that the endoscopic technique can provide adequate vein grafts for use in coronary artery bypass grafting and reduce the leg wound complication rate, hospital stay, and use of analgesics.