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

Actinomycotic infection involving the head and neck is not commonly diagnosed and is often a diagnostic enigma to the otolaryngologist. The reasons for this are due to the infrequency of this disease itself, the current general lack of familiarity with this disease and the pronounced sensitivity of actinomyces organisms to most of the common antibiotics in current use. The case reported here is fairly typical of cervicofacial actinomycosis. A 26-year-old man suffering from trismus and a noncharacteristic mass over the right parotidomasseteric region for one month after a lower molar tooth was extracted presented at our hospital. There were many yellowish gritty "sulfur granules" found within the pus when surgical drainage was made. Immediate Gram stain examination of these granules showed numerous filamentous Gram-positive bacilli, some of which showed true branching. Bacterial culture grew only an anaerobic organism which was identified as Actinomyces israelii by biochemical tests. This patient improved after further treatment with intensive intravenous penicillin injections for ten days and prolonged oral tetracycline treatment for two months. We suggest that increased alertness of clinicians and microbiologists to the presence of anaerobic organisms as the cause of cervicofacial infections could result in an earlier and more frequent diagnosis of actinomycosis.

Of the 31 cases of allogeneic bone marrow transplantation performed in the past 4 years at the National Taiwan University Hospital, 25 evaluable cases were retrospectively studied for incidence, severity, and risk factors of acute graft-versus-host disease (GVHD). The incidence was 60% (15/25) with the proportion of severe form (greater than or equal to grade II) being 53% (8/15). Skin involvement was the most common (13/15), gut the second (5/15), and liver the third (4/15). Most of the diagnosis of skin disease were confirmed by biopsy. Acute GVHD accounted for 3 deaths directly and was the next most common cause of death in post-transplant patients. The long-term survival rate for cases with grade 0-I disease was 65%, and that for those with grade II-III disease was 38%. Multivariate linear regression analysis of risk factors associated with severe form GVHD showed that the diagnosis of aplastic anemia was the most significant factor. Total lymphoid irradiation with or without plasmapheresis in aplastic anemia might contribute to the occurrence of severe acute GVHD.

To discern the relative prognostic role of complete atrioventricular block (CAVB) in patients with acute myocardial infarction (AMI), 908 consecutive patients with AMI were studied over a 7-year period. Of the 559 patients with anterior wall AMI, 13 (2.3%) demonstrated CAVB, of whom 10 (76.9%) died in the hospital (vs 10.4% in those without CAVB) (p less than 0.001). In 349 patients with inferior wall AMI, 30 (8.6%) developed CAVB, of whom 6 (20%) died (vs 6.3% in those without CAVB) (p less than 0.01). In anterior wall AMI, all 5 patients with narrow QRS complexes (vs 8/11 with wide QRS complexes) (p = NS) died; in inferior wall AMI, 4/25 with narrow QRS complexes (vs 2/5 with wide QRS complexes) (p = NS) died. The mortality rate of patients with an escape frequency of less than or equal to 50/min did not differ significantly from that of patients with greater than 50/min regardless of the site of infarction or whether a pacemaker was used. In anterior wall AMI, the mortality rate of paced patients was 70% (7/10) compared to 100% (3/3) of non-paced patients (p = NS). In inferior wall AMI, the mortality rate of paced (5/25) and non-paced (1/5) patients was both 20%. Thus, none of the clinical parameters such as escape rhythm, the width of escape QRS complexes and pacemaker therapy discriminated the survivors from the deaths. In anterior wall AMI, episodes of cardiac standstill or bradycardia were of short duration, and pacemaker therapy was only one of the therapies applied.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute intermittent porphyria is a genetic hepatic porphyria characterized by acute gastrointestinal and neurological symptoms, and accompanied by excess excretion of delta-aminolevulinic acid and porphobilinogen. Here, we report a case of acute intermittent porphyria with attacks of abdominal pain, an elevated serum thyroxine level, and hypercholesterolemia with an increased level of high-density lipoprotein-cholesterol concentration. The diagnosis of acute intermittent porphyria was confirmed by a high urinary excretion of porphobilinogen and a low level of erythrocyte hydroxymethylbilane synthase activity. After being treated with a high carbohydrate intake and propranolol, the patient improved gradually during the following 3 weeks. The patient remained asymptomatic during the 6-month follow-up period. The serum thyroxin and cholesterol levels returned to normal 6 months later. In conclusion, we suggest that for any patient who presents with unexplained abdominal pain, abnormal thyroid function and hypercholesterolemia, a simple Watson-Schwartz urine test should be performed for the screening of acute intermittent porphyria. If the Watson-Schwartz test is positive, the erythrocyte hydroxymethylbilane synthase activity should be determined to confirm the diagnosis of acute intermittent porphyria.

Plasma levels of homovanillic acid (pHVA), a major metabolite of dopamine (DA), were measured in a group of 51 schizophrenic inpatients before and during 6 weeks of neuroleptic treatment. Steady-state plasma drug concentrations were monitored in parallel with pHVA. Good responders (n = 22) had higher pretreatment pHVA levels as compared to poor responders (n = 22). Differential pHVA changes during neuroleptic treatment were also found between each group. The two groups did not differ significantly in terms of age, duration of illness, severity of presenting symptoms, neuroleptic, dose, or plasma drug concentration. Two hypothetical subtypes in the group of schizophrenics were proposed.

Malignant fibrous histiocytoma is a rare tumor in the head and neck region. This paper describes 5 cases, one was primary, and the remaining 4 cases were supposed to be secondary to previous radiotherapy for malignant diseases in the head and neck region. Three cases were in the maxillary sinus and two at the tongue base. All patients received surgical treatment with or without postoperative irradiation. Two patients survived more than 3 years after surgical intervention.

In order to find the most comfortable and effective posture to reduce lower leg edema, 31 young women working in Chang Gung Memorial Hospital, ages ranging from 20 to 40, were studied by the volumetric displacement method with leg placed in a specially designed container. The effects of five different angles of leg elevation on reduction of leg edema were separately evaluated in 5 days. For each evaluation, two measurements of volumetric displacement of lower leg edema were performed after prolong sitting or standing of more than 4 hours, and at the end of 15 minutes of supine lying (angle of leg elevation = 0 degrees), or after the leg was elevated in an angle of 30 degrees, 45 degrees, 60 degrees, or 90 degrees respectively. A good correlation was found between the displaced volume and increasing angle of leg elevation (regression line Y = 99.109-0.016X, r = -0.96). There was a significant difference between leg elevation of 90 degrees and supine lying (t = 3.01, p less than 0.01). The degree of comfort in leg elevation was in the order of 30 degrees, 45 degrees, 60 degrees, 0 degrees, 90 degrees. Many subjects complained of numbness and throbbing pain over the lower legs or pain at the buttocks in the upright leg elevation to 90 degrees posture, but felt rather comfortable in the 30 degrees posture. Seventeen of these subjects were further studied for the degree of comfort in leg elevation at 30 degrees for 30 minutes as compared with those of 30 degrees, 15 minutes and 90 degrees, 15 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Human sperm chromosomes can be analyzed using the zona-free hamster egg system. In order to familiarize ourselves with this new technique and to investigate the chromosome aberration frequency in fertile and possibly infertile men, we performed sperm chromosome analysis in 39 successful experiments. The subjects were divided into two groups. Group 1 was healthy men with proven fertility. Group 2 was husbands of couples with unexplained infertility. Semen samples were prepared freshly or preserved in TEST-yolk buffer for 12 to 72 hours. In group 1 using fresh samples, the mean penetration rate was 67.40 +/- 14.08% (mean +/- 2SD), the maturation index was 1.33 +/- 0.31. For samples treated with yolk buffer, the mean penetration rate was 91.34 +/- 7.42%, and the maturation index was 1.58 +/- 0.42. There was a statistically significant increase in penetration after yolk buffer treatment (p less than 0.001). In group 1 there were 89 haploid chromosomes, four were aneuploidy (4.5%), and three with structural aberrations (3.4%). In group 2, for fresh samples, the mean penetration rate was 71.34 +/- 27.96%, and the maturation index was 1.37 +/- 0.25. For samples treated with yolk buffer, the penetration rate was 86.33 +/- 25.18%, and maturation index 1.40 +/- 0.23. In group 2, there were 135 haploid chromosomes, 6 were aneuploidy (4.4%), and 4 with structural aberrations (3.0%). There was no statistically significant difference between group 1 and group 2 in the penetration rate, maturation index and frequency of chromosome abnormalities.

The prevalence of caries associated prevalence with Streptococcus mutans in saliva and pooled plaque was investigated among 13-year-old Chinese children. In conjunction with saliva sampling simplified greatly by adopting the oral rinse method, an initial threshold value of 10(4) colony forming units (cfu) per ml of rinse was established on the basis of the S. mutans counts from 27 caries-free individuals. The results of the present study showed that, of the total 58 children, 67.3% had S. mutans counts above the threshold value in their saliva, and they developed significantly more decayed surfaces (D) and decayed, missing, filled surfaces (DMFS) than did the children below this value. The association between caries activity and S. mutans counts either in saliva or in pooled plaque samples was even stronger when only decayed surfaces were taken into account. In addition, the detection frequency of S. mutans (81.8%) was higher in saliva than in the pooled plaque samples (43.2%). This may demonstrate that saliva is more sensitive than dental plaque in predicting caries activity. The most prevalent biotypes of the S. mutans strains observed in this study were c and d. The results of this study indicate a significant association of S. mutans levels with caries prevalence. In the estimation of salivary S. mutans levels, the rinse method offered an easy and rapid identification for children with high caries risk and proved to be very practicable for epidemiological study on a larger scale.

A 21-year-old woman had suffered from repeated vasculitis and panniculitis with fever and chills after following mosquito bites since age 7. These manifestations were confirmed with a direct mosquito bite test during her admission to another hospital at age 17. The patient presented to our hospital with progressive dyspnea, productive cough and intermittent fever for one week. In addition to the bilateral infiltrative lesions on chest roentgenography, hepatosplenomegaly with an abnormal liver function test, pancytopenia, and elevated IgE were also detected. Blood and sputum cultures grew no microorganisms. Epstein-Barr virus-IgM, Cytomegalovirus-IgM and Mycoplasma pneumonia antibodies were all negative. Bone marrow aspiration and biopsy revealed histiocytosis with hemophagocytosis. No atypical histiocyte was found. The patient was put on dexamethasone treatment with improvement. Unfortunately, symptoms relapsed two weeks later. A repeated bone marrow aspiration and biopsy revealed a picture similar to the previous one. Despite antibiotic administration and ventilator support, a rapidly deteriorated course terminated in the patient's death by respiratory failure. Mosquito bite allergies were reported to be associated with malignant histiocytosis in Japan. However, atypical histiocytes were not found in our case upon repeated bone marrow aspirations, biopsies and skin biopsies. Mature histiocytes with hemophagocytosis were prominent instead. Reactive histiocytosis was thus favored rather than malignant histiocytosis. Although opportunistic infection cannot be excluded, we propose that a mosquito bite allergy with consequent histiocytic activation by antigen, immune complex or IgE is the possible pathogenetic mechanism for hemophagocytic histiocytosis in this patient.