Effective Decision-Making and Decisional Regret in Living Kidney Donors of Taiwan

BACKGROUND

While most living kidney donors are satisfied with their decision and do not regret donating, few studies have been conducted on the determinants related to the effectiveness and regret of the decision. This study aims to explore the relationship between basic attributes, quality of life, positive affect, negative affect, effectiveness of decision-making, and regret in living kidney donors.

METHODS

In this cross-sectional study, living kidney donors were recruited from urology and kidney transplant outpatient services. The structured questionnaire used to collect the data included the Positive and Negative Affect Schedule, Medical Outcomes Study 12-Item Short-Form Health Survey, Decision Conflict Scale, and Decision Regret Scale.

RESULTS

The findings indicate that living donors with better health status, 24-hour creatinine clearance, physical health-related quality of life (HRQOL), and positive affect experienced greater feelings of effective decision-making. Moreover, women and donors with better physical HRQOL, positive affect, and decision effectiveness were less regretful about the decision of kidney donation.

CONCLUSION

Health status, physical HRQOL, and positive affect are related to decision validity and regret of living donors. Therefore, clinical care providers should regularly assess the mood and health of living kidney donors. Furthermore, activities promoting their health should be encouraged, especially for men.

[The clinical analysis of corneal interface fluid syndrome after Laser lamellar corneal refractive surgery]

Objective: To analysis, the clinical characteristics, refractive changes, and clinical treatment of interface fluid syndrome after laser lamellar corneal refractive surgery. Methods: During Dec. 2010 to Apr. 2016. In total 6 cases(9 eyes), 3 cases were bilateral, 3 cases were unilateral. Five patients were male and 1 was female. The age of the patients ranged from 20 to 29 years was (24.83±4.02) years. Six cases(9 eyes)of IFS were diagnosed at our hospital. The history and complete ophthalmic examination that include Slit-lamp examination, Slit-lamp photography, refraction, corneal thickness measurement, corneal endothelial cell counting, IOP, anterior segment OCT(AS-OCT), exams were recorded. Results: Post-lasik Primary open angle glaucoma was 2 eyes in 1 patient. 1 patient(1 eye)was Posner-Schlossmann Syndrome and 1 patient(1 eye)was iritis after femtosecond laser. Post-small incision lenticule extraction by steroid drops induced elevated IOP were 5 eyes in 3 patients. Slit-lamp exam indicated edematous corneal flap or cap, lamellar haze, interface fluids accumulation. AS-OCT showed obvious interface dark area. The corneal flap or cap thickening and wrinkles, IOP change, diopter myopic shift, Corneal thickening. Conclusions: IFS is a rare but serious complication after Laser lamellar corneal refractive surgery. The main causes are high intraocular pressure and/or dysfunction of corneal endothelium. For patients with high IOP after laser lamellar corneal refractive surgery, follow up should be observed closely. accurate diagnosis by OCT and corneal endothelial cell counting. Early diagnosis, accurate treatment, its prognosis is good. (Chin J Ophthalmol, 2017, 53: 847-854).

¹⁸F-FP-(+)-DTBZ positron emission tomography detection of monoaminergic deficient network in patients with carbon monoxide related parkinsonism

BACKGROUND AND PURPOSE

Although parkinsonism after carbon monoxide (CO) intoxication is well known, neurotransmitter deficient networks that are responsible for the severity of parkinsonism have rarely been systemically evaluated.

METHODS

Eighteen patients with CO-related parkinsonism and nine age- and sex-matched controls were enrolled for detailed neurological examinations, three-dimensional T1-weighted images, diffusion tensor imaging and (18)F-9-fluoropropyl-(+)-dihydrotetrabenzazine ((18)F-FP-(+)-DTBZ) positron emission tomography (PET). The structural analysis included voxel-based morphometry to assess grey matter atrophy and tract-based spatial statistics related to white matter involvement. For presynaptic monoaminergic assessment, volume of interest analysis in six subcortical regions and non-parametric voxel-wise comparison were performed on PET images with estimation of registration parameters from magnetic resonance images. All the imaging modalities were compared between the patients and controls. For the patients, a regression model for correlation with cognitive behaviour and Unified Parkinson's Disease Rating Scale (UPDRS) score was used.

RESULTS

In the patients, monoaminergic deficit networks were found in the caudate, anterior putamen, anterior insular, thalamus and anterior cingulate cortex. The UPDRS revealed significant correlations with the prefrontal white matter fractional anisotropy values and with the (18)F-FP-(+)-DTBZ uptake values in the caudate nucleus, insular, medial prefrontal and dorsomedial thalamus. The neuropsychiatric inventory score correlated with the (18)F-FP-(+)-DTBZ uptake values in the anterior cingulate cortex and dorsolateral prefrontal cortex.

CONCLUSIONS

Our study demonstrated monoaminergic deficits and white matter damage networks in CO-related parkinsonism that determined the severity of parkinsonism or behaviour changes. As the substantia nigra was spared, the monoaminergic topography of involvement suggests a different pathophysiology in CO-related parkinsonism.

Development of a selective and differential medium for capsulated Lactococcus garvieae

A selective and differential medium termed 'LG agar' was developed for the isolation and presumptive identification of Lactococcus garvieae that results in black colonies with red halos. In this study, all 14 strains of L. garvieae and only 9 of the 148 strains representing 38 other species were able to grow on the LG agar. The nine viable strains on LG agar plates (including Enterococcus faecalis, Enterococcus faecium, Lactococcus lactis, Vibrio fluvialis, Vibrio furnissii, Vibrio mimicus and Vibrio salmonicida) were further differentiated from L. garvieae by various colours or colony features. Colonies isolated from the mixing culture and the infected giant sea perch using LG agar plates were all positively identified as L. garvieae by conventional tests and 16S rDNA sequencing. Furthermore, LG agar discriminated capsulated strains of L. garvieae, which were believed to be correlated with pathogens of fish and shellfish, from non-capsulated ones by colony appearances. The specificity and differentiating ability of LG agar suggest that this medium displays considerable potential for primary isolation and presumptive identification of L. garvieae from pathological and environmental samples.

(G2019S) LRRK2 activates MKK4-JNK pathway and causes degeneration of SN dopaminergic neurons in a transgenic mouse model of PD

(G2019S) mutation of leucine-rich repeat kinase 2 (LRRK2) is the most common genetic cause of both familial and sporadic Parkinson's disease (PD) cases. Twelve- to sixteen-month-old (G2019S) LRRK2 transgenic mice prepared by us displayed progressive degeneration of substantia nigra pars compacta (SNpc) dopaminergic neurons and parkinsonism phenotypes of motor dysfunction. LRRK2 is a member of mixed lineage kinase subfamily of mitogen-activated protein kinase kinase kinases (MAPKKKs). We hypothesized that (G2019S) mutation augmented LRRK2 kinase activity, leading to overphosphorylation of downstream MAPK kinase (MKK) and resulting in activation of neuronal death signal pathway. Consistent with our hypothesis, (G2019S) LRRK2 expressed in HEK 293 cells exhibited an augmented kinase activity of phosphorylating MAPK kinase 4 (MKK4) at Ser(257), and protein expression of active phospho-MKK4(Ser257) was upregulated in the SN of (G2019S) LRRK2 transgenic mice. Protein level of active phospho-JNK(Thr183/Tyr185) and phospho-c-Jun(Ser63), downstream targets of phospho-MKK4(Ser257), was increased in the SN of (G2019S) LRRK2 mice. Upregulated mRNA expression of pro-apoptotic Bim and FasL, target genes of phospho-c-Jun(Ser63), and formation of active caspase-9, caspase-8 and caspase-3 were also observed in the SN of (G2019S) LRRK2 transgenic mice. Our results suggest that mutant (G2019S) LRRK2 activates MKK4-JNK-c-Jun pathway in the SN and causes the resulting degeneration of SNpc dopaminergic neurons in PD transgenic mice.

Clinical presentations of thyroid cancer patients with multiple primary cancers

BACKGROUND

In thyroid cancer patients with multiple primary cancers, primary cancers tend to be more aggressive.

AIMS

We analyzed multiple primary cancers in thyroid cancer patients and determined the differences between the incidence and the characteristics of primary cancers.

MATERIALS AND METHODS

A total of 3070 patients with thyroid cancer underwent a thyroidectomy and follow-up examination at a single medical center. The times of diagnosis of the primary cancers were categorized as antecedent, synchronous, or subsequent to the diagnosis of thyroid cancer.

RESULTS

After a mean follow-up period of 8.8 ± 0.5 yr, the presence of multiple primary cancers was histopathologically confirmed in 163 patients (5.3%). Patients with multiple primary cancers had a lower female-to-male ratio, an older mean age, advanced tumor-node-metastasis (TNM) stage, higher total mortality, and higher therapeutic radioactive iodide (131I) doses than patients without multiple primary cancers. Hematological malignancy and renal cell carcinoma, neither of which are among the 10 most common cancers observed in the general population of Taiwan, were the most common multiple cancers among women and men with thyroid cancer. Patient age, thyroid cancer tumor size, and thyroid cancer mortality in the antecedent, synchronous, and subsequent groups were not significantly different.

CONCLUSIONS

Patients with multiple primary cancers in advanced stages had shorter disease-free survival period after treatment. Thyroid cancer patients with multiple primary cancers should be closely followed up for the occurrence of other secondary cancers in order to improve total mortality.

A selective and differential medium for Vibrio alginolyticus

In this paper, we present a selective and differential medium, termed Vibrio alginolyticus (VAL) agar, developed for the isolation and identification of V. alginolyticus. The presence of bile salts, high salinity and high incubation temperature allows the selective growth of moderately halophilic Vibrio species. Differentiation of bacteria is achieved by identifying species capable of sucrose fermentation, made visible by the pH indicator bromocresol purple. In this study, all of the 26 strains of V. alginolyticus and only three of the 99 strains representing 30 species (including 19 Vibrio species) other than V. alginolyticus were able to grow in the VAL medium. The remaining three strains could be further differentiated from V. alginolyticus according to colour or the diameter of colonies produced on VAL agar plates. Colonies isolated from shellfish rearing water and infected shrimp through the use of VAL agar plates were all positively identified as V. alginolyticus by conventional tests and 16S rDNA sequencing. The testing of specificity and differentiation capability of VAL shows the potential of the agar as a medium for the primary isolation of V. alginolyticus from pathological and environmental samples.

Biodistribution study of [99mTc] TRODAT-1 alone or combined with other dopaminergic drugs in mice with macroautoradiography

A 99mTc labeled tropane derivative, [99mTc] TRODAT-1 (2beta-((N,N'-bis(2-mercaptoethyl) ethylene diamino)methyl), 3beta-(4-chlorophenyl) tropane), is a potential dopamine transporter (DAT) imaging agent for the central nervous system. To better understand the binding localization of [99mTc] TRODAT-1 both in the brain and the body, whole-body macroautoradiography (WBAR) was used in this study. The effect of DAT competing drugs, such as levadopa (L-DOPA), N-methyl-2beta-carbomethoxy-3beta-(4fluorophenyl)tropane (CFT, WIN 35,428) and methylphenidate, on the biodistribution of [99mTc] TRODAT-1 were also included in this study. Doses of 150 MBq [99mTc] TRODAT-1 were injected into normal male ICR mice through the caudal veins. For comparison, mice treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), L-DOPA, methylphenidate and CFT, respectively, were also investigated under the similar protocols. One and a half hours after [99mTc] TRODAT-1 injection, the mice were sacrificed. Whole-body autoradiography was performed immediately after sacrifice. Both frontal and sagittal sections showed that the liver and mucosa of stomach had the highest uptake of [99mTc] TRODAT-1. Other binding sites included the periphery of the spinal cord and the epithelium of the intestine. In the brain, autoradiographic imaging obtained from frontal sections showed symmetrical uptakes of [99mTc] TRODAT-1 in bilateral striata. Remaining binding sites include olfactory bulbs, thyroid gland, and salivary gland. The autoradiographic imaging obtained from sagittal sections showed a similar biodistribution. Mice treated with MPTP or L-DOPA showed no significant difference in the uptake of [99mTc] TRODAT-1 in bilateral striata, as compared to those of the control. In CFT or methylphenidate-treated mice, DAT binding sites were almost completely inhibited. These data showed that [99mTc] TRODAT-1 has potential clinical use for neurological investigation, such as Parkinson's and similar diseases.

Prophylactic effect of four prescriptions of traditional Chinese medicine on alpha-naphthylisothiocyanate and carbon tetrachloride induced toxicity in rats

AIM

To study the prophylactic effects of four Chinese traditional prescriptions against experimental liver injury.

METHODS

Liver toxins, alpha-naphthylisothiocyanate (ANIT), and carbon tetrachloride (CCl4) were used to induce acute liver injury. Simo Yin(SMY), Guizhi Fuling Wan (GFW), Xieqing Wan (XQW), and Sini San (SNS) were fed (500 mg/kg, in saline, po) to the rats before toxin administration. All the animals were killed 48 h after toxin insulted. Serum index of liver function and hepatic lipid peroxidation (LPO) were estimated. Histopathological observation was conducted simultaneously.

RESULTS

The rats treated with ANIT exhibited elevations of serum total bilirubin (TBI), alkaline phosphatase (ALP), glutamate-oxalate- transaminase (GOT), glutamate-pyruvate-transaminase (GPT), as well as cholestasis and parenchyma necrosis. In rats, challenged with ANIT, receiving the pre-treatment of prescriptions of SMY, XQW, and SNS, the biochemical and morphological parameters of liver injury were significantly reduced. The increased LPO level in liver tissue, associated with the provoked serum GOT and GPT levels were the salient features observed in CCl4-insulting rats. Pre-treatment of four prescriptions showed a remarkable protective effect, and also was effective in counteracting the free radical toxicity by bringing about a significant decrease in peroxidative level.

CONCLUSION

These recipes ameliorate liver damage induced by both ANIT and CCl4 despite the differences in their mechanisms of injury. Therefore they may be able to exert hepatoprotective effects through more than one mechanism of action because they contained a mixture of anti-hepatotoxic ingredients with mutual reinforcement and assistance.

Pathogenicity and drug susceptibility of the Pasteurella anatis isolated in chickens in Taiwan

A strain of Pasteurella anatis (PA) was isolated from the sinus of an adult leghorn laying chicken with sinusitis, nasal discharge, drop in egg production, and low mortality, symptoms initially thought to indicate infectious coryza. The tiny, smooth, whitish colonies were identified as PA. To compare its pathogenicity with that of commercial broilers, nine groups, 10 birds per group, of 10-day-old broilers were individually inoculated with the strain of PA, Pasteurella multocida (PM), or Escherichia coli (EC) by intravenous, intraperitoneal, intramuscular, or subcutaneous inoculation. The PA was determined to cause the signs, lesions, and septicemic death, which are similar to the symptoms of PM or EC infection. At 1 wk postinfection (PI), the mortality rate was between that of PM and EC infection at 1 wk PI. Twenty antimicrobial-containing discs were evaluated, and the isolate was highly sensitive to cetiofer, amoxicillin, lincopectin, and furazolidone. Furthermore, it was moderately sensitive to tetracycline and enrofloxacin and only slightly sensitive to cephalothin, chloramphenicol, flumequine, nalidixic acid, neomycin, oxolinic acid, streptomycin, and trimethoprim. The PA infection was treated successfully with amoxicillin.

Breast uptake of iodine-131 mimicking lung metastases in a thyroid cancer patient with a pituitary tumour

We report a case of a 44-year-old female thyroid cancer patient with a pituitary tumour. 131I whole body scanning showed a change of chest uptake from a unilateral crescent uptake to a bilateral full breast uptake pattern. Hyperprolactinaemia and a pituitary tumour were diagnosed as a result of observing the 131I breast uptake.

Sonographic features of breast abscesses with emphasis on "hypoechoic rim" sign

BACKGROUND

There are only limited reports on the ultrasound (US) features of breast abscess. The purpose of this paper is to review the US features of breast abscess with emphasis on "hypoechoic rim" sign which is more commonly seen in chronic abscess.

METHODS

In a period of 10 years, 20,998 patients were referred for breast US examinations. Medical records identified 204 patients in whom breast abscess was diagnosed. All patients were examined using high-resolution real-time US scanners. The initial ultrasound reports and hard copy images were all carefully reviewed. The grading of the echogenicity of the abscess was classified from grade 0 to grade 5. The contours of the lesions were described as smooth, macrolobulated, microlobulated, irregular, zigzag, spiculate or indistinct. The wall thickness was measured to document the presence of "hypoechoic rim" which denoted a wall thickness greater than 2 mm. The associated findings and other acoustic phenomena related to the lesion were recorded.

RESULTS

One hundred and thirty-six patients (136/204) having specific aspiration and/or biopsy/histopathological results were included in the study. All of the 136 patients showed abnormal US findings (100%). Most lesions showed grade 1 or grade 2 echogenicity (117, 86%). The contour of the abscess was usually smooth (42, 31%), macrolobulated (42, 31%), or irregular (22, 16%). A hypoechoic rim was noticed in 18 lesions (13%). Focal skin thickening was chiefly noticed in 91% of superficial abscesses (39/43) and 17% of intramammary abscesses (14/84). Diffuse skin thickening was exclusively evident in the breasts coexisting with mastitis. Hypoechoic interstitial streaks were not a common finding (7%), occurring in acute abscesses. The other findings included surrounding hypoechoic amorphous tissue (26%), posterior wall enhancement (71%), distal enhancement (60%) and lateral shadows (57%).

CONCLUSIONS

US plays an important role in confirmation of the clinical diagnosis of breast abscess and aids significantly in the management of inflammatory breast diseases. Presence of the hypoechoic rim surrounding a fluid space or a central area of low-level echoes (i.e., grade 1 to grade 3) is indicative of a chronic abscess.

Diagnostic value of 99mTc-labeled red blood cell SPET for a solitary solid liver mass in HBV carrier patients with different echogenicities

BACKGROUND/AIMS

The purpose of this study is to evaluate the efficacy of technetium-99m labeled red blood cell liver single photon emission computed tomography (RBC liver SPET) in evaluating the diagnostic ability for differentiating the nature of a solitary liver tumor detected with ultrasonography in hepatitis B carrier patients.

METHODOLOGY

One hundred and one hepatitis B carrier patients (56 males, 45 females, aged 13-70 years) with a solitary solid liver mass found on ultrasonography were included in this study. The final diagnosis was made after liver biopsy, aspiration with cytology and/or autopsy in 27 patients and after follow-up with both clinical and ultrasonography findings in 74 patients.

RESULTS

Hemangioma was found in 79 patients, hepatocellular carcinoma in 14, focal nodular hyperplasia in 5, fatty liver in 2, and metastasis in 1. The diagnostic sensitivity of RBC liver SPET for hemangioma, with a hyperechoic, hypoechoic, or isoechoic ultrasonography pattern, was between 75-80%, while the specificity for all patterns was 100%. For mixed-echoic lesions, the sensitivity was 100%, but the specificity was only 50%. Two false-positives were noted; both were mixed-echoic lesions.

CONCLUSIONS

RBC liver SPET is useful for differentiating hemangioma from other liver tumors in hepatitis B carrier patients with a various sonographic patterns, especially for those who had a mixed-echoic sonographic liver mass.

Interleukin-8 as a predictor of the severity of bacteremia and infectious disease

The relationship between cytokines and sepsis has been studied frequently in the intensive care unit (ICU). However, the determination of cytokines in patients as they enter the emergency department (ED) would be more meaningful in predicting the outcome of infection. This study investigated plasma interleukin-8 in the ED as the predictor of bacteremia and sepsis. One hundred patients admitted through the ED with signs of systemic inflammatory response syndrome were studied. Plasma IL-8, IL-6, and tumor necrosis factor (TNF) were assayed by enzyme-linked immunosorbent assay. Patient's data were evaluated using the APACHE II scoring system as predictive factors of morbidity and mortality. Plasma IL-8 (149 pg/mL) detected bacteremia with a positive predictive value of 90.9% and a specificity of 98.7%. Results indicated that the odds ratios (ORs) of bacteremia were 24.78 (P < 0.01, CI = 2.27-270.8), 5.42 (P < 0.05, CI = 1.37-21.4), and 6.05 (P < 0.05, CI = 1.36-26.8) for IL-8, IL-6, and APACHE II, respectively. Occurrence of bacteremia was highly correlated with increases in plasma IL-8 (P < 0.01). IL-8 (OR = 8.25, CI = 1.03-65.9) and APACHE II scores (OR = 12.6, CI = 2.24-70.4) were found to be significantly better predictive factors of mortality (P < 0.01) than IL-6 (OR = 3.60, CI = 0.57-22.7), TNF (OR = 0.24, CI = 0.01-11.0) and age (OR = 1.02, CI = 0.98-1.06). During bacteremia, IL-8 also correlated well with patient use of a ventilator (P < 0.01, OR = 2.43, CI = 2.41-311.19), use of vasopressors (P < 0.05, OR = 2.67, CI = 1.79-370.78), length of stay in the hospital (P < 0.01, OR = 3.14, CI = 1.87-988.31), and stay in the ICU (P < 0.01, OR = 2.51, CI = 2.98-449.80). Measuring IL-8 on patients in the ED with apparent bacterial infections appears to be a reliable predictor of bacteremia and the severity of disease.

The role of 67Ga in the early detection of spinal epidural abscesses

In this study, we evaluated the role of 67Ga whole-body and single photon emission tomographic (SPET) imaging in the early diagnosis and lesion localization of spinal epidural abscess before confirmation by gadolinium-enhanced magnetic resonance imaging (MRI). Six patients with fever of unknown origin had a 67Ga whole-body scan, four of whom also underwent SPET imaging. For further confirmation of a spinal epidural abscess, gadolinium-enhanced MRI was performed in all patients. All patients had increased 67Ga uptake in a spinal or paraspinal area on the whole-body scan. They were later confirmed to have a spinal epidural abscess after gadolinium-enhanced MRI. Of these six patients, five underwent surgical drainage plus parenterally administered antibiotics, and had complete or partial recovery. One died before operation due to sepsis. In conclusion, we suggest performing a 67Ga whole-body survey as early as possible in patients with fever of unknown origin, fever and back pain and/or the spinal syndrome, before MRI is performed. If a spinal epidural abscess is strongly suspected, SPET is needed for further confirmation of spinal versus non-spinal and contiguous versus non-contiguous lesion(s). If MRI is unavailable, then 67Ga scintigraphy is a satisfactory method for investigating spinal epidural abscesses.

Value of Ga-67 SPECT in monitoring the effects of therapy in invasive aspergillosis of the sphenoid sinus

PURPOSE

We report a case of invasive sphenoid sinus aspergillosis clinically presenting as a pituitary mass.

METHODS

After exploration via the trans-sphenoidal approach and subsequent treatment with amphotericin-B, Ga-67 brain SPECT was performed twice to monitor the therapeutic effect.

RESULTS

Three months after antifungal treatment, Ga-67 brain SPECT showed partial resolution of the lesion in the sella turcica region. The patient continued with fluconazole treatment for another 2 months and received another Ga-67 brain SPECT, which showed complete clearing of the previous lesion.

CONCLUSION

Ga-67 brain SPECT may play a potentially useful role in monitoring the therapeutic effect of treatment of invasive sphenoid sinus aspergillosis.

Complementary role of dual isotope in non-bacteriuric renal infection--a case report

To detect non-bacteriuric renal infection in a diabetic patient, though difficult but is very important because early diagnosis and early treatment can prevent later complications such as renal abscess, renal hypertension or even end stage renal disease. Herein, we presented a case of diabetic patient with septicemia whose urine culture and renal ultrasonography were negative initially. By using a combination of dual isotope images and single photon emission computed tomography technique, an infectious lesion in the upper pole of left kidney was revealed, which was identified as acute focal bacterial nephritis by computed tomography four days later. This case report showed that 67Ga plus 99mTc dimercaptosuccinic acid images are useful in patients under clinical suspicion of renal infection, especially for those with negative urine analysis and/or urine culture initially.

Multiple pyogenic granuloma demonstrated by SPECT using 99Tcm-labelled red blood cells

Pyogenic granuloma is a polypoid form of capillary haemangioma that occurs on the skin and mucosal surface. The eruption of multiple pyogenic granuloma is a rare phenomenon. We report the case of a 73-year-old male with a 2 year history of intermittent lower gastrointestinal bleeding. 99Tcm-labelled red blood cell scintigraphy was performed to rule out the possibility of capillary haemangioma on the mucosal surface of the gastrointestinal tract. The images showed disseminated haemangiomas involving the skull, abdominal wall, intestine, scrotum and right leg. The final diagnosis of multiple pyogenic granuloma was made by skin biopsy. To the best of our knowledge, this is the first case using 99Tcm-labelled red blood cell scintigraphy to demonstrate multiple pyogenic granuloma.

133Xenon ventilation scan as a functional assessment in bronchiectasis

BACKGROUND

Mucus impaction in the airways impairs ventilation and exercise tolerance in patients with bronchiectasis. Parameters for evaluating the ventilatory dynamic change have been limited by variable cofactors. We developed a tool to evaluate the changes directly on images of a ventilation scan.

MATERIALS AND METHODS

We used a 133Xenon ventilation washout scan to assess the time of half clearance (T1/2) of the regions of interest (ROIs) corrected by that of a control area (CA) as T1/2ROI/CA. We then compared the ventilation washout scan with high-resolution computer tomography (HRCT) scoring to assess the severity of bronchiectasis, as well as conducting 6-minute walking tests or spirometry for the evaluation of the clinical response to a 3-day course of chest physiotherapy. Nine patients with bronchiectasis and mucus hypersecretion were enrolled in this study.

RESULTS

The functional impairments by mucus impaction or air trapping were well documented in the ventilation washout scan, which not only provided an anatomical image but also dynamic profiles. The ratios of T1/2ROI/CA were significantly correlated to the corresponding scoring of HRCT (3.45 +/- 0.85 vs 7.50 +/- 1.51, r2 = 0.61, p = 0.023, n = 8). The improvement in T1/2ROI/CA (from 3.45 +/- 0.85 to 2.60 +/- 0.59, p = 0.022, n = 9) was paralleled by an increase in the 6-minute walking test (from 310.4 +/- 43.2 m to 352.4 +/- 45.1 m, p = 0.028, n = 7).

CONCLUSION

The 133Xenon scan may be used to evaluate the heterogeneity of ventilation abnormalities and the efficacy of clinical therapy directly in patients with bronchiectasis.

Fine needle aspiration cytodiagnosis of liver tumors. Results obtained with Riu's stain

OBJECTIVE

To present our experience with liver fine needle aspiration (FNA) diagnosis based on Riu's stain.

STUDY DESIGN

We reviewed a total of 322 liver fine needle aspirates from 286 patients seen in a seven-year period from April 1990 to April 1997 at Koo Foundation Sun Yat-Sen Cancer Center, Taipei. Surgical and/or clinical follow-up was available for confirmation in 292 aspirates.

RESULTS

The cytologic diagnosis was categorized into four groups: benign in 81 cases, suspicious in 13, malignant in 225, and inadequate specimen in 3 cases. There were 16 false negative and no false positive diagnoses. Two suspicious aspirates were negative. Our results showed a sensitivity of 93.3% and a specificity of 100% for the detection of malignancy. If suspicious cases were considered positive, the specificity decreased to 95.1%, while the sensitivity increased to 93.6%. Among 87 hepatocellular carcinomas (HCCs) in our series, correct FNA diagnosis was made in 84 cases with an accuracy of 96.6%. Out of 135 cases of non-HCCs, 1 was incorrectly diagnosed. The accuracy of identifying a liver malignancy as non-HCC was 99.3%.

CONCLUSION

Cytologic features of HCC are well demonstrated by Riu's stain, with high accuracy in identifying them. Liver FNAs using Riu's stain combined with cell block study and clinicopathologic correlation can achieve very high sensitivity and specificity in the detection of hepatic malignancies.

Rectus abdominis rhabdomyolysis after sit ups: unexpected detection by bone scan

Uptake of technetium-99m methylene diphosphonate by the rectus abdominis muscle was unexpectedly found in a 29 year old man who had started to perform 30 to 40 sit ups a day for five days before the bone scan. After a week of rest, serum creatine kinase activity was still abnormal but muscle uptake of technetium-99m methylene diphosphonate had ceased. This specific muscle injury after short term sit ups as well as the resolution of the phenomenon within a week are of interest.

Diagnostic thoracic-computed tomography in radiotherapy for loco-regional recurrent breast carcinoma

PURPOSE

This study was initiated to evaluate whether pretreatment diagnostic thoracic CT scan was useful for patients with loco-regional recurrent breast carcinoma, and to assess its impact on the design of radiotherapeutic treatment.

METHODS AND MATERIALS

Between March 1991 and January 1997, 44 patients underwent thoracic CT examination with contrast material before the consideration of radiotherapy for their isolated loco-regional recurrent breast carcinoma. The CT radiographs were prospectively reviewed for additional findings clinically undetected by prior physical examination and plain-chest radiograph. The changes made in treatment design and dosage of radiation as a result of CT findings were recorded for analysis. The correlation between prognostic indicators and the CT findings was also studied.

RESULTS

Twenty-two of 44 (50%) patients were found to have additional abnormalities detected only after thoracic CT examinations were performed. The strategy of radiation therapy was altered in 17 of 22 (77%) patients as a result. Patients with shorter disease-free interval (p = 0.08) and multiple sites of recurrence (p = 0.05) tended to have greater numbers of findings on CT scan previously unsuspected. Thus, CT scan is a valuable guide to treating loco-regional recurrent disease.

CONCLUSION

Pretreatment diagnostic thoracic CT scan offers essential information that can alter treatment planning and thus optimize treatment strategy for a large proportion of patients with clinically isolated loco-regional recurrent breast carcinoma. In this population of patients we recommend that thoracic CT examination be considered before the initiation of radiation therapy.

Comparison of acute physiology and chronic health evaluation III and II for prediction of mortality in multiple organ failure patients treated by plasma exchange

This study examined the efficacy of a different scoring system for multiple organ failure (MOF) patients treated by plasma exchange (PE). Twenty-five patients with MOF resulting from fulminant hepatitis who had been treated by PE for a total number of 91 PEs in a consecutive period of 22 months were included in our study. Data were collected from each patient to compute acute physiology and chronic health evaluation (APACHE) II and APACHE (AP) III scores. The sensitivity, specificity, and correct prediction of outcomes were measured. The correct prediction of outcomes was 86.5%in AP III and 77.5% in AP II. For the prediction of patient mortality, the AP III system seems to be more reliable than AP II.

Moebius syndrome: report of case

This is a review of diagnosis, etiology and abnormalities of Moebius syndrome. The Moebius syndrome is rare and the cause is still unclear. It presents a case of a premature newborn baby with Moebius syndrome, showing unilateral facial nerve palsy, asymmetry of facial expression, inability to tightly close the right eyelids, asymmetry of the angles of the mouth with frequent drooling, poor sucking ability, dysphagia, extremity abnormalities and other cranial nerve involvement (VIII, IX, X, XI). He also had hypoplasia of the pons, a heart defect, and bilateral cryptorchism. The baby died of apnea on the 41st day after birth.

Antimicrobial activities of iodinated polystyrene derivatives

The antimicrobial activities of insoluble halogenated acetamidomethy1-styrene polymers (prepared by covalent bonding of iodine to polystyrene) were assessed as were the factors determining antimicrobial efficacy. The most active materials were selected from chlorinated or iodinated polymers. Antimicrobial activities were assessed for Escherichia coli (ATCC 25922; American Type Culture Collection, Rockville, MD, U.S.A.), Saccharomyces cerevisiae, and Candida albicans by determining time-course changes in microbial counts in vitro. A 2-iodoacetamidomethylstyrene polymer (No.6-I:-CH2I) was found to have the greatest antimicrobial activity against both bacteria and fungi. No.6-I is the first antimicrobial material that did not make an inhibition hollow in the conventional diffusion test or for which conjugated iodine showed antibacterial activity. This material can be introduced into styrene units on the surface of devices by chemical modification. This material was most active at 37 degrees C. For coated dishes, antimicrobial activity depended on the depth or swollen character of the reactive layer. NO.6-I requires not only a minimum width of polymer layer, but also frequent contact with microbes to have an antimicrobial effect. No.6-I is valuable as a new material because it has strong antimicrobial activity by itself but does not release active iodine. This material is expected to have various applications in implantable clinical devices.

A specific 4977-bp deletion of mitochondrial DNA in human ageing skin

Mitochondrial DNA (mtDNA) mutations have recently been proposed as important contributors to ageing and degenerative diseases. In this study, we applied the polymerase chain reaction technique to detect 4.977 bp-deleted mtDNA, the most common and abundant deletion of mtDNA, in normal human skin. None of the skin specimens from patients less than 60 years of age were found to bear this type of mtDNA deletion. The incidence of the 4977-bp-deleted mtDNA increased with advancing age. The incidence of the deletion was 20%, 46.7% and 83.4% for patients of the age groups of 61-70, 71-80, and 81-90 years, respectively. Moreover, the incidence of 4977-bp-deleted mtDNA was significantly higher in exposed skin than that in non-exposed skin. We suggest that mtDNA mutations are molecular events associated with the human skin ageing process.

Treatment of septic shock with a protease inhibitor in a canine model: a prospective, randomized, controlled trial

OBJECTIVES

To evaluate the efficacy and mechanism of action of a protease inhibitor (ulinastatin) in septic shock.

DESIGN

Prospective, randomized, controlled trial.

SETTING

A university laboratory.

SUBJECTS

Twelve mongrel dogs.

INTERVENTIONS

One of the protease inhibitors, ulinastatin, a glycoprotein (molecular weight 67,000 daltons) detected in human urine was estimated. We used Escherichia coli to obtain a model of septic shock in dogs in vivo study. Human neutrophils were used as an activating target in vitro.

MEASUREMENTS AND MAIN RESULTS

The final concentration of E. coli was 1.9 x 10(6) colony-forming units/mL. There was no significant difference in E. coli concentration between ulinastatin-treated and control groups. Human neutrophils treated with 100 U/mL of ulinastatin showed 70.5% to 78.7% of the superoxide production or untreated neutrophils. Phagocytic activity was enhanced in a dose-dependently manner by ulinastatin. At a ulinastatin concentration of 100 U/mL, an approximate two-fold increase in activation was found. In the ulinastatin-treated group, cardiac index, blood pressure, lactic acid, blood glucose, and blood base values significantly improved 60 mins after ulinastatin administration, and the bacterial count was significantly decreased, while the endotoxin concentration in the control group showed a continuous increase of endotoxin concentration. The improvement in the monitored factors observed 60 mins after initiation of treatment persisted after the end of treatment. The survival rate after 1 wk in the ulinastatin-treated group was 84% (five of six dogs survived), while it was 16% (one of six dogs survived) in the control group (p = .04).

CONCLUSIONS

Ulinastatin does not have antimicrobial activity, and it does not sufficiently activate phagocytes. It is suggested that the efficacy of this agent in experimental septic shock is due to a mechanism that activates the reticuloendothelial system and septic reactions.

[Computed tomography for evaluation of hepatocellular carcinoma after treatment with transarterial chemoembolization]

Totally 135 series of computed tomography (CT) and angiographic examination were performed in 53 patients with proved hepatoma treated by TAE. CT examination was performed four to six weeks after TAE, and a comparative angiographic examination was performed within three weeks after CT examination. The pictures of CT scanning were read to determine 1). the grading of lipiodol retention inside the tumor, 2). the presence/absence of filling defect in the tumor margins coated by lipiodol, 3). the presence/absence of residual tumor tissue within or surrounding the main tumor, and 4). the presence/absence of developed satellite nodules. In comparison with angiographic findings, CT demonstrated 96.3% specificity and 58.2% sensitivity in the grading of lipiodol filling, and 96.3% specificity and 65.7% sensitivity in the tumor margins of lipiodol coating. However, it was difficult for CT to detect small nodules, especially those less than 1 cm in diameter. We find no statistically significant association between newly developed satellite nodules and grading of lipiodol retention inside the tumor or tumor margins of lipiodol coating. Therefore, when CT pictures reveal filling defect over the margins of the tumor coated by lipiodol or less-than-50% lipiodol filling inside the tumor, repeated angiography and further treatment with TAE are suggested.

Reflex bronchospasm-induced acute massive pulmonary collapse

Acute massive pulmonary collapse following reflex bronchospasm is described in a patient undergoing general anesthesia. The authors suggest that a chest radiograph should be taken as routine procedure after the onset of airway constriction during anesthesia.