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

Cytomegalovirus retinitis is an opportunistic and vision-threatening disease in immunosuppressed patients. Currently available antiviral agents have been unsuccessful in halting its progression. We report a case of cytomegalovirus retinitis which occurred 6 months after renal transplantation and was successfully treated with an investigational drug, ganciclovir (DHPG [Dihydroxy propoxymethyl guanine], Cytovene, BW-B759U), via intravenous administration, with resolution of active retinal lesions and the cessation of cytomegalovirus shedding in the urine. There was neither a recurrence of cytomegalovirus retinitis nor an occurrence of retinal detachment during the 9-month follow-up after intravenous ganciclovir therapy.

Transrectal ultrasonography was used to examine and to preoperatively evaluate rectal carcinoma invasion in 30 patients. Satisfactory sonography pictures were obtained in 23 patients. Four stages of tumor invasion were identified in our study. The sensitivity of preoperative evaluation in this study was 91%. In order to verify the correspondence between the ultrasonographic findings and the actual histo-anatomic condition of rectum, 10 resected rectal specimens were studied by in vitro ultrasonography. We conclude that the appearance of the muscularis propria layer of rectum as a homogeneous hypoechogenic band can be stably defined with transrectal ultrasonography and is crucial for accurate evaluation of cancer invasion. Although lymph node enlargement was shown as hypoechogenic nodules on the sonographic pictures, the existence of cancer metastasis could not be differentiated in this study.

Seventeen cases of untreated Hashimoto's thyroiditis were selected from the files of the Taipei Municipal Jen-Ai Hospital during the period from Jan. 1985 to Jan. 1986. All the cases were confirmed by a physical examination, determination of thyroid antibodies and fine needle aspiration cytology. Thyroid function was also determined. According to the echogenicity of the thyroid, they were divided into 2 groups, group A (8 cases) and group B (9 cases). In group A, homogeneous hypoechogenicity of the thyroid was noted and was lower than that of the adjacent muscles. In group B, heterogeneous echogenicity of the thyroid with equal or higher echogenicity than that of the adjacent muscles was noted. Group A showed a significantly lower serum T4, T3 and a higher serum TSH in comparison with group B. Five cases in group A presented hypothyroidism clinically while only 1 in group B presented. In conclusion, in the cases of Hashimoto's thyroiditis, the homogeneous hypoechogenicity of the thyroid echogram suggested the possibility of hypothyroidism. Statistically, the sensitivity was 83.3%, specificity 72.8%, positive prediction value 62.5% and the negative prediction value was 88.9%.

Ninety patients with a strict diagnosis of aplastic anemia were observed during a 4-year period. The incidence of aplastic anemia is estimated to be much higher here than in western countries. A disproportionately large number of young males were noted among our patients. Two cases were congenital. One case presented a past history of paroxysmal nocturnal hemoglobinuria. The etiology of 8 cases (8.9%) could be attributed to drugs and/or chemicals. In the remaining 79 cases (87.8%), the causes of the disease were unknown. The carrier rate of the hepatitis B surface antigen in the patients with aplastic anemia was similar to that of the general population, and chronic hepatitis B infection was not considered a major etiological factor. Coexistence of abnormal liver functions at the initial presentation was noted in 21.9% of the patients. Exposure to unknown drugs by self-medication was possibly one of the major causes of the high incidence of aplastic anemia and the associated abnormal liver functions in our patients.

Bone mineral density (BMD) was measured in 17 patients with gonadal dysgenesis, 21 patients with premature ovarian failure, 14 patients with hyperprolactinemia, 23 patients postoophorectomy and 41 normal healthy women. Each group was divided into two subgroups, on the basis of whether or not they were receiving estrogen replacement therapy. Linear regression analysis showed a significant loss of BMD at a rate of 0.006 g/cm2 per year in the lumbar spine of normal healthy women. The distribution of individual values in each study group was near or within normal confidence limits, except for the group with gonadal dysgenesis. The mean BMD of each group without estrogen replacement therapy was significantly less than that of the control group. There was a significant correlation between the duration of amenorrhea and BMD values in the groups with premature ovarian failure and postoophorectomy. These results indicate that BMD, measured by dual photon absorptiometry, was reduced in amenorrheic patients, especially in patients with gonadal dysgenesis. Estrogen replacement therapy was able to decrease the severity of bone loss, but failed to increase the bone mass. Dual photon absorptiometry (DPA) is a simple, effective, and accurate tool for assessing the severity of osteoporosis and monitoring the effect of therapy.

To investigate the surface morphology of peripheral blood cells, venous blood specimens drawn from 16 normal healthy subjects were studied with scanning electron microscopy. Blood cells were fixed with 2% glutaraldehyde and stained with Riu's A and B solutions. Red blood cells, platelets and specific types of leucocytes were identified and photographed through a light microscope. The cells were then fixed with OSO4, dehydrated, dried and metal-coated. Observation with a scanning electron microscope revealed that the erythrocytes were biconcave in shape with smooth surfaces. Adhesion to one another was in rouleaux formation. The surface morphology of the neutrophils was characterized by irregular and branching ridges. Prominent pits on the cell membranes were also noted. A few microvilli, similar to those seen in lymphocytes, were distributed sporadically on the surface. Lymphocytes were much smaller in size than neutrophils. Variable amounts of short upright microvilli, which probably represented the different functional status of the cells, were observed. The monocytes possessed folding cellular processes, while the eosinophils had a villous and granular appearance. Circulating platelets existed in two forms: the native form with discoid shape and the activated form with pseudopodia. The surface was smooth. It is concluded that most peripheral blood cells can be identified by their specific topographic characters. The information thus obtained by scanning electron microscopy can facilitate the cytodiagnosis of abnormal specimens such as sputum, pleural effusion and ascites.

The ability of single-photon emission computed tomography (SPECT) with thallium-201 to detect transmural myocardial infarction was compared with that of planar imaging. Planar imaging was performed at rest after SPECT in 80 patients with the first myocardial infarction and in 20 patients without myocardial infarction. The planar and SPECT images were interpreted qualitatively. Tomography was significantly more sensitive than planar imaging in detecting inferior infarctions (43/46 or 93% vs 22/46 or 48%; p less than 0.05). In detecting anterior infarctions, the sensitivity rate was 92% (35/38) for SPECT and 79% (30/38) for planar imaging (p = NS). The overall sensitivity was 93% for tomography and 63% for planar imaging (p less than 0.05). The specificity was similar (100%) with the 2 techniques. It is concluded that SPECT significantly improves the detection of thallium-201 myocardial perfusion defects in patients with myocardial infarctions, especially those occurring on the inferior wall.

Aortic valve replacement was performed in 31 patients with symptomatic chronic aortic regurgitation. The patients ranged in age from 13 to 66 (mean = 39) years and included 29 men and 2 women. They were followed up for a mean of 47 months. Perioperatively, 2 patients (6.5%) died, and 2 (6.5%) received a permanent pacemaker for complete heart block. Thirty patients received an M-mode echocardiographic examination both before, and 6 to 11 days after, the operation. In this early postoperative period, the end-diastolic dimension (EDD) and left ventricular end-diastolic radius/posterior wall thickness ratio (R/Th) decreased in all patients. This decrease in EDD could be predicted by preoperative ejection fraction (EF), but not by end-systolic dimension (ESD) or R/Th ratio. The ESD regressed only in patients with preoperative EF greater than 50%, or ESD less than 55mm, or R/Th less than 3.8. During the long-term follow-up, one each had mild tissue valve degeneration, stroke, infective endocarditis, and severe myocardial failure, but none died. Eighteen patients had repeated M-mode echocardiographic studies. There was no further regression of EDD and R/Th, while ESD showed significant decrease. The EF and fractional shortening (FS) did not change. Clinically, the patients who survived the operation improved or remained unchanged postoperatively in a functional status. However, those who had preoperative EF greater than 50% or ESD less than 55mm had a better postoperative functional class (1.2 +/- 0.4 vs 1.9 +/- 1.0, p less than 0.05, 1.2 +/- 0.4 vs 2.0 +/- 1.1, p less than 0.05, respectively). Thus, patients with symptomatic chronic aortic regurgitation can often benefit from valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

This is a review of bacteriologic data on 175 patients with pyogenic liver abscesses seen over a period of 8 years at Veterans General Hospital, Taipei, Taiwan. Positive cultures were obtained from liver aspirates in 151 of the 163 patients in which cultures were taken. One hundred and twenty patient specimens grew one isolate and 31 specimens grew two or more isolates. A total of 149 aerobic gram-negative rods, 25 aerobic cocci and 29 anaerobes were isolated. Ninety of the 159 patients from whom blood was taken had positive cultures. In 11 patients, two or more isolates were grown concurrently from the blood. A total of 87 aerobic gram-negative rods, 7 aerobic cocci and 10 anaerobes were isolated. Klebsiella pneumoniae was the most common microorganism, accounting for 50.8% of the cases. Other major pathogens were Escherichia coli (27.4%), anaerobes (15.4%), and viridans streptococci (6.2%).

From September 1983 to October 1988, 13 undifferentiated non-Hodgkin's lymphomas (NHL) of Burkitt's or non-Burkitt's type and 3 B cell acute lymphoblastic leukemias were treated with various multiagent chemotherapy regimens containing modest to high dose methotrexate (HDMTX) infusions. All were children between the ages 2 years 8 months and 14 years 1 month. The group included 13 boys and 3 girls. The lymphomas were located primarily in the head and neck, 5; abdomen, 7; and lymph nodes, 1. The clinical stages at diagnosis were stage I, 1; stage II, 6; stage III, 3; and stage IV, 3. The MTX infusion dosage ranged from 300 to 4,285 mg/M2, and the total cumulative dose per patient ranged from 750 to 30,168 mg/M2. Citrovorum Factor Rescue was given following all MTX infusions, except for 62 of the 300 mg/M2 infusions. The serum MTX levels were monitored following all HDMTX. The chemotherapy related toxicities were graded and analysed. The clinical characteristics, which might predispose to HDMTX-related toxicities, were identified and are discussed. Our data reveals the inpatient and interpatient variations in the kinetics of MTX. There were no drug-related deaths, and the overall outcome of the patients was satisfactory. We conclude that MTX infusion continues to play an important role in the current management of childhood B cell malignancies; however, obstacles still remain, especially for those with widespread B cell disease.