Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association最新文献

We assess Chinese fetal orbital growth by biparietal diameter (BPD) in normal pregnancies. One hundred and ninety-six normal fetuses, whose gestational periods ranged from 14 weeks to term, were measured by prenatal ultrasonography. Orbital parameters measured included orbital diameter (OD), biorbital distance (BOD), and interorbital distance (IOD). At the same time, fetal BPD was measured. The results show that orbital growth correlates well with BPD; OD versus BPD (r = 0.94, p less than 0.001), BOD versus BPD (r = 0.96, p less than 0.001), and IOD versus BPD (r = 0.83, p less than 0.001). Polynomial regression analysis demonstrates that the best-fit model for orbital parameters versus BPD was the first-order linear regression. From the above analysis, the 5th, 50th and 95th confidence limits of OD, BOD, and IOD were computed for specific growth values of BPD, and these can serve as a reference for prenatal diagnosis of fetal orbital malformations when menstrual age is not defined.

In recent years apolipoproteins A-I and B examinations have been performed on patients with coronary artery disease as a better predictor of the severity of atherosclerosis. In the present study, 21 treated male and 22 treated female patients with non-insulin-dependent diabetes mellitus (NIDDM) were examined and compared with controls of the same sex, age and body mass (23 males, 21 females). Cholesterol, triglyceride, LDL-cholesterol in male and female patients with NIDDM were significantly higher than in male and female controls. HDL-cholesterol in male and female patients with NIDDM was not different from those of male and female controls. Apolipoproteins A-I and B in male and female patients with NIDDM were higher than in male and female controls. [Apolipoproteins A-I (g/L) male 1.40 +/- 0.21 vs 1.25 +/- 0.15, p less than 0.005; female 1.56 +/- 0.23 vs 1.42 +/- 0.24, p less than 0.025. Apolipoproteins B (g/L) male 1.29 +/- 0.30 vs 0.97 +/- 0.22, p less than 0.001; female 1.34 +/- 0.34 vs 0.98 +/- 0.35, p less than 0.001.] Discrepancy between the higher apolipoprotein A-I and the normal HDL-cholesterol in in NIDDM supports the theory of altered composition of HDL particles in diabetic patients. The controversy between the higher apolipoprotein A-I and the higher incidence of atherosclerosis in patients with NIDDM makes the clinical usefulness of this laboratory measurement doubtful in these patients.

We report a case of cutaneous Nocardia brasiliensis infection. The patient had received radiotherapy and anti-neoplastic chemotherapy for epidermoid carcinoma of the left sphenoid sinus with bone destruction. He developed fever and an ulcer on the dorsal medial surface of the left hand after an intravenous infusion of chemotherapeutic agents in the same site 3 days earlier. Needle aspiration of the abscess disclosed polymorphonuclear leukocytes, and a partially acid-fast, gram-positive filamentous branching organism. Cultures of the aspirate grew N. brasiliensis 1 week later. The patient was treated successfully with a regimen of parenteral ceftazidime and amikacin with definite improvement 1 week later. Therapy was continued for 1 more week, and then the patient was switched to oral trimethoprim-sulfamethoxazole for 3 months with no recurrence. The diagnosis, clinical manifestations, treatment and prognosis of cutaneous abscesses cause by N. brasiliensis are discussed.

Diabetic care in the community has become a public health issue. To assess the effect of a community diabetes care program (CDCP) on knowledge acquisition and its impact on metabolic control, a 2-year study including 260 non-insulin-dependent diabetics from two different districts in Taipei city was conducted. The experimental group consisted of 140 cases. The remaining 120 cases served as controls. Preintervention knowledge scores were significantly correlated with the formal education level and the duration of diabetes [Diabetic knowledge score = 50.06 + 0.82 (duration of education in years) + 0.23 (duration of diabetes in years), p less than 0.001]. A large increase in the knowledge scores for experimental patients was noted 1 year after intervention. A significant difference in diabetic knowledge still existed between the control and experimental groups 2 years after intervention. HbAlc levels (mean +/- SD) for the experimental patients decreased from a baseline of 7.47 +/- 1.87% to 7.23 +/- 1.68% and 6.88 +/- 1.30% 1 year and 2 years after intervention, respectively. However, no significant decrease was found in the control group (7.20 +/- 2.00% at baseline and 6.98 +/- 1.96%, and 7.14 +/- 2.25% at 1 year and 2 years after intervention, respectively). Reduction in body weight was found in the experimental group. In order of baseline, 1 year and 2 years after intervention, the results were 63.6 +/- 9.6, 62.6 +/- 9.3 and 62.5 +/- 9.2 kg, respectively. There was no remarkable change in body weight in the control group during the 2-year observation period. In conclusion, an integrated approach to CDCP provides a cost-effective method for management of diabetes in the community.

Subconjunctival 5-FU injections were used as an adjunctive therapy in trabeculectomy for high risk glaucoma patients. We injected 5 mg once a day for five to seven days as a routine treatment. For the first 10 eyes, the injections were started immediately after the operation. However, for the remaining 9 eyes, the injections began 24 to 48 hours postoperative. If the appearance of the bleb was not prominent or enriched in vascularity, the duration of the injections should be extended to 10 to 14 days. At least 8 months of follow-up were available for 19 eyes, including aphakic glaucoma, 8 eyes; neovascular glaucoma, 2 eyes; previous failed filter, 6 eyes; total collapse of the anterior chamber with leucoma adherence, 1 eye; glaucoma due to mesodermal dysgenesis, 1 eye; and juvenile glaucoma, 1 eye (whose fellow eye had received twice failed filtering procedures). The results revealed a success rate of 79% (intraocular pressure below 22mmHg with or without topical medication). The success rate for aphakic glaucoma was 63% (5/8), for neovascular glaucoma 100% (2/2) and for the failed filters 83% (5/6). We also presume that 5-FU injections would be effective in the treatment of to abnormally marked fibrous proliferations caused by age factors. The complications related to the use of 5-FU include corneal epithelial defect 4/9 (21%), conjunctival leak 3/9 (16%), subconjunctival hematoma 1/19 (5%), and conjunctival sterile ulcer 1/19 (5%).

Pulmonary cryptococcosis, a less common fungal infection, frequently reveals nodular lesions (single or multiple) and patchy infiltrations (alveolar or interstitial) on chest X rays. A large mass-like pattern is less common. Here we report 2 cases of pulmonary cryptococcosis with negative bronchoscopic findings. One patient received a right lower lobectomy under the impression of malignancy; the other received a transthoracic needle aspiration, and numerous cryptococci were found by India ink preparation. Thus, pulmonary cryptococcosis should be included in the differential diagnosis of a mass lesion. A brief review of the literature is also included about diagnostic approach and management of pulmonary cryptococcosis.

Dissecting aneurysm of the aorta associated with local consumption coagulopathy is a rare clinical entity. We report one such case, a 71-year-old man with DeBakey type I aortic dissection and bleeding tendency. This patient had aortic dissection 4 years previous, and had developed a bleeding tendency in the last 2 years. Both computed tomographic scan and digital subtraction angiographic studies revealed DeBakey type I aortic dissection starting at the ascending aorta and extending all the way down to the renal artery, with an inlet at the aortic arch. The area of false lumen was larger than that of the true lumen, and thrombi were noted within the false lumen. A detailed blood coagulation study of this patient showed thrombocytopenia and coagulopathy. Blood coagulation studies in an additional 13 patients, who were seen at NTUH during the past 1 year with aortic dissection, but without the bleeding tendency, revealed no sign of coagulopathy. From analysis of these patients, we note that a large surface area in a false lumen, thrombus formation within a false lumen and blood flow into a false lumen with stasis seem to be the major determinants for causing coagulopathy in patients with aortic dissection. The treatment of aortic dissection with bleeding tendency caused by local consumption coagulopathy is graft replacement of the aneurysm. Hemostatic abnormalities may cause excessive blood loss during surgical operation, and careful and meticulous management of hemostasis are required.

Twenty-eight adult patients with primary refractory or relapsed acute leukemia were treated. The regimens consisted of mitoxantrone plus cytosine arabinoside for 17 patients with acute non-lymphocytic leukemia (ANLL) and mitoxantrone accompanied with vincristine and prednisolone for 11 patients with acute lymphoblastic leukemia (ALL). In primary refractory patients, 1 of the 4 (25%) ANLL and 1 of the 3 (33%) ALL attained complete remission (CR). Excluding 2 patients who underwent bone marrow transplantation, 8 of the 13 (62%) relapsed ANLL and 4 of the 8 (50%) relapsed ALL achieved CR with a median duration of remission of 6.2 months and 3.8 months, respectively. Myelosuppression occurred in all treatment courses and was associated with pyrexia due to infections in 84% of the cases. Nausea, vomiting and stomatitis were mild. Abnormal liver function tests were observed in 8 (28%) patients. One patient, pretreated with 550 mg/m2 of doxorubicin, developed congestive heart failure. The results suggest that mitoxantrone is of value in the treatment of Chinese patients with refractory or relapsed acute leukemia.

Seven cases with uremia (6 men, 1 woman, mean age = 55.6 +/- 2.2 years) were studied with four combined hypothalamic releasing hormones (corticotropin-releasing hormone, CRH; luteinizing hormone-releasing hormone, LHRH; thyrotropin-releasing hormone, TRH; and growth hormone-releasing hormone, GHRH) for assessment of anterior pituitary functions. The mean basal levels of corticotropin (ACTH, 22.4 +/- 5.2 pg/ml), thyrotropin (TSH, 2.4 +/- 0.6 microU/ml), and follicle stimulating hormone (FSH, 26.0 +/- 3.4 mIU/ml) in uremic patients were not significantly different from those (34.0 +/- 3.5 pg/ml, 2.0 +/- 0.4 microU/ml, and 23.2 +/- 6.4 mIU/ml) of controls (5 men, 1 woman, mean age = 54 +/- 2.5 years), but the ACTH and TSH responses to the releasing hormones were significantly lower than those of the controls. The mean basal levels of luteinizing hormone (LH, 70.7 +/- 16.3 mIU/ml), cortisol (9.8 +/- 1.2 micrograms/dl) and prolactin (109.3 +/- 23.2 ng/ml) in uremic patients were significantly higher than those of normals (27.3 +/- 6.6 mIU/ml, 6.5 +/- 0.7 micrograms/dl and 15.7 +/- 3.4 ng/ml), while suppressed LH, cortisol and prolactin responses to the releasing hormones were observed in the uremic group. The mean basal growth hormone (GH) level in uremic patients (3.1 +/- 0.4 ng/ml) was not significantly different from that (2.8 +/- 0.7 ng/ml) of normals, but the GH response to the releasing hormones was significantly higher than that of controls. These results show pituitary dysfunction, such as blunted ACTH, TSH, LH and prolactin response, exists in uremic patients.(ABSTRACT TRUNCATED AT 250 WORDS)