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

An improved "liquid drop retainer" was made by gluing a circular cover glass within a selected ceramic ring of a serological ring slide. One to three small sections of tissue mounted within corresponding circles on an ordinary microscopic slide could be immunostained with primary antisera when placed upside-down on the liquid drop retainer. After rinsing in the buffer, the sections were placed upside-down over the liquid drop retainer containing fluorescein isothiocyanate-conjugated immunoglobulin and photomicrographs were taken by placing the inverted sections over the liquid drop retainer. After taking the photomicrographs, the sections were incubated in peroxidase-antiperoxidase complex and placed upside-down over the liquid drop retainer. These liquid drop retainers provided the following advantages in immunocytochemical staining: (1) greatly reduced volumes of antibody solutions to micro-amounts (0.08-0.12 ml); (2) allowed simultaneous localization of different antibodies in adjacent serial sections on the same slide; and (3) allowed immunofluorescence and peroxidase-antiperoxidase techniques to be done on the same section without any damage by immunofluorescence photography before using the peroxidase-antiperoxidase technique.

An intracavernous injection with papaverine or prostaglandin E1 (PGE1) combined with duplex ultrasonography is an objective technique to conduct a penile blood flow study (PBFS). Three hundred patients with impotence underwent papaverine (9-60 mg) induced PBFS at the University of California School of Medicine, San Francisco (UCSF), U.S.A. and another 80 patients with impotence received PGE1-induced (20 micrograms) PBFS at Veterans General Hospital-Taichung (VGH-TC), R.O.C. Preliminary evaluation of age, duration of disease and pre-injection diameter of cavernous arteries disclosed no significant difference in these 2 series. It was interesting to find that almost all parameters of vascular response to pavaverine vs PGE1 differed significantly, such as onset of response (6.5 +/- 6.5 vs 11.7 +/- 6.4 min, slower in the PGE1 group, p less than 0.001); post-injection diameter of cavernous arteries (right: 0.73 +/- 0.20 vs 0.79 +/- 0.18 mm, p = 0.03; left: 0.74 +/- 0.20 vs 0.82 +/- 0.21 mm, p = 0.005); diametral increment of cavernous arteries (right: 0.23 +/- 0.17 vs 0.33 +/- 0.17 mm, p less than 0.001; left: 0.24 +/- 0.17 vs 0.36 +/- 0.19 mm, p less than 0.001) and peak velocity (right: 27.5 +/- 16.1 vs 42.0 +/- 20.1 cm/sec, p less than 0.001; left: 28.9 +/- 15.9 vs 39.7 +/- 17.9 cm/sec, p less than 0.001). The side effects, primarily injection pain (23.8%, 19/80) in the PGE1 group and dizziness (3.0%, 9/300) in the papaverine group, were minor in these 2 series. Prolonged erection was not encountered in either series; however, immediate treatment was performed if a papaverine-induced erection lasted over 60 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Over a period of 6 years, 8 patients underwent surgical treatment at our hospital for congenital coronary artery fistula (CAF). The ages of the patients ranged from 4 months to 50 years (mean 22.7 years). Continuous heart murmurs could be heard in all patients, except one. The diagnosis was made by retrograde aortography and/or selective coronary arteriography. Only one patients had associated cardiac disease. All the drainage sites of the CAF were on the right side of the heart (right atrium, right ventricle, pulmonary artery). Two patients had both right and left CAFs. Symptoms due to "coronary steal" by a coronary artery fistula were demonstrated by a nuclear medicine study in one of our patients. Four patients were operated on with the aid of cardiopulmonary bypass. The other 4 patients were treated with suture ligation directly. There was no surgical mortality or morbidity, and the longterm results have been good. Since surgical correction is safe and effective, it would appear desirable for all patients with CAF be operated on. However, surgical intervention is controversial in asymptomatic patients.

Fifty-six dogs were used for the comparison of the allogenous and autogenous bone graft in anterior interbody and posterior spinal fusion. Excluding 7 cases with wound infections, the end results of the allograft and autograft in anterior interbody and posterior spinal fusion were nearly the same, provided that the rules of technique for the spinal fusion were strictly followed, especially in the allograft group. Grossly, there was a reduction tendency in the fusion mass of the allograft group that was proven by roentgenographic examination of the harvested spinal block. Histologically, there was no evidence of regeneration of the allograft that can be readily detected in the autograft. In the allograft group, osteogenesis can only be seen in the recipient sites, the allograft transplants become sequestrated and resorbed.

A case of acute primidone intoxication, due to overdose, was evaluated at National Taiwan University Hospital. Serial assessment of the clinical manifestations, electroencephalograms and serum levels of primidone and phenobarbital were made. From these data, we conclude that the toxic effects, such as depression of the central nervous system and dysequilibrium, are due mostly to primidone itself, rather than its metabolite, phenobarbital.

Forty-five patients with hydronephrosis due to pelviureteric junction stricture were operated on at Kaohsiung Medical College Hospital between 1971 and 1986. In unilateral cases, the left kidney was affected more frequently than the right (24 to 13), while 8 (18%) had bilateral ureteropelvic stricture. Of the 45 cases, 24 cases (53%) underwent Anderson-Hynes pyeloplasty, 5 cases underwent Y-V plasty, 5 cases underwent ureterolysis and 11 cases underwent simple nephrectomy due to severe hydronephrosis. Except for the 11 nephrectomy cases, 11 of the remaining 34 cases had ureteral catheter placement and 9 cases had double-J ureteral catheter placement, postoperatively; another 14 cases received no ureteral stent for draining urine. The results were very encouraging with clinical improvement in 64% of the patients, and improvement in the pelviocaliceal system and early appearance of contrast medium in the ureter in 47% of the patients. The results of pyeloplasty with and without a nephrostomy or ureteral stent were compared. Patients with a nephrostomy or ureteral stent tended to have an increased incidence of urinary tract infections and longer hospital stays. In general, the results of treatment were poorer for patients with a nephrostomy or ureteral stent, than for patients without.

This experiment was carried out to explore the effect of estrogen on platelet aggregation, using Hartly strain guinea pigs. For the in vivo experiments, estradiol benzoate 1 mg/kg or 4 mg/kg was injected into male guinea pigs to observe the effects of this drug on platelet aggregation. In vitro studies were performed by incubating platelet-rich plasma with estradiol benzoate for 30 minutes at 37 degrees C. Aggregation was induced by the addition of aggregating agents: adenosine diphosphate (ADP, lobster or rabbit muscle, Merck), and collagen (calf skin, Bio-Data). The change in transmittance at 660 nm was recorded using NKK HEMA TRACER 1, model PAT-4A (Nippon Denshi Kagaku Co., Japan). Our results revealed that a 1 mg/kg injection of estrogen had a statistically significant suppressive effect on both ADP and collagen-induced platelet aggregation. While in the group with the 4 mg/kg injection of estrogen, this suppressing effect was not significant. In vitro studies by incubating platelet-rich plasma with estradiol had no inhibitory effect on aggregation induced by both ADP and collagen.

Ten short-limbed fetuses caused by skeletal dysplasia were diagnosed prenatally from September 1984 through July 1988. The final diagnosis was thanatophoric dwarfism in 7 cases and osteogenesis imperfecta congenita in 3 cases. The diagnosis was based on sonographic findings in all cases and postnatal radiography was performed in 3 cases for further confirmation. Sonographic examinations revealed markedly shortened limbs and other associated abnormalities, including abnormal skull appearance, pear-shaped chest with protuberant abdomen, polyhydramnios and hydrops in fetuses with thanatophoric dwarfism. Fetuses with osteogenesis imperfecta congenita were characterized by fractures of the long bones. These findings were helpful in making the specific diagnosis of short-limbed dwarfism. According to our experience, sonographic examination is effective in the prenatal diagnosis of short-limbed dwarfism.

The effectiveness and safety of diltiazem monotherapy was evaluated in 29 patients with mild to moderate essential hypertension (diastolic pressure between 95 and 115 mmHg). There were 16 men and 13 women, ages ranged from 29 to 58 years (mean 43). After a 2-week placebo period, each patient was given a 60 mg diltiazem tablet three times a day for 8 weeks. Blood pressure and heart rate were determined at weekly clinic visits. Three patients were withdrawn from the study because of a skin rash, palpitation and a frequent loose stool, respectively. In the remaining 26 patients, the mean systolic and diastolic blood pressures were reduced significantly in 2 weeks of therapy and thereafter. At the end of the 8-week treatment the mean supine blood pressure decreased from 158/103 at baseline to 139/94 mmHg, the mean sitting blood pressure from 156/104 to 136/93 mmHg, and the mean standing blood pressure from 151/104 to 134/96 mmHg. The heart rate did not change significantly before or during diltiazem treatment. In 16 (61.5%) of the 26 patients, diltiazem consistently reduced the diastolic blood pressure more than 5 mmHg throughout 2 to 8 weeks of treatment. The left ventricular mass and ejection fraction assessed with M-mode echocardiograms were normal before diltiazem treatment, and remained unchanged 8 weeks after the treatment. By using treadmill exercise tests, there was a significant increase in exercise duration and a significant reduction in the peak heart rate at 8 weeks after the treatment. The peak systolic blood pressure did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

We report a case of a 32-year-old man who showed paradoxical enlargement of pathologically verified intracranial tuberculomas during a course of adequate antituberculous chemotherapy. Serial computed tomographic scans of the brain disclosed this uncommon phenomenon. Total excision of the lesions with concomitant four-combined antituberculous therapy proved successful. Although the mechanism of this paradoxical phenomenon is not well understood, a defective local tissue immune response with gradually increasing maturity of the lesions during antituberculous therapy, which results in poor penetration of these drugs into the lesions, might be a possible explanation.