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

This study examined the effects of the predisposing, enabling, and need characteristics on the use of health services by the elderly which includes hospital care, physician services, herb doctor services, self-medication with western drugs, and self-medication with herb drugs. The data for the analysis came from a household interview survey of 1,519 non-institutionalized elderly individuals residing in Taipei city and Taipei county. The results indicated that (1) the elderly tended to use health services frequently; (2) most of the explained variance of health services utilization could be attributed to the need variables as well as the enabling variables; and (3) the type of health services used was related to the regular medical care system selected and the type of health needs. The research and policy implications for delivering health care to the elderly were discussed.

Clinical experience shows that young children with gastrointestinal bleeding have frequently had some preceding febrile illness for which aspirin was administered. Febrile young children often have poor food or liquid intake, or have been in a fasting state because of diarrhea, vomiting or anorexia. The objective of this study was to determine the acute effects of fever, fasting and oral aspirin administration on the gastrointestinal mucosa. One hundred and sixty-eight infant rats, from 21 to 28 days of age and weighting from 70 to 120 g were studied. Random assignment was made to eight groups (Grs): Control (Gr I); aspirin administration only (Gr II); fasting only (Gr III); fever only (Gr IV); aspirin and fever (Gr V); fasting and fever (Gr VI); aspirin and fasting (Gr VII); and aspirin, fever and fasting (Gr VIII). Aspirin was given orally in a single daily dose of 200 mg/kg for two days. Fever was induced by an intraperitoneal injection of 0.6 ml salmonella vaccine. Fasting time lasted from 40 to 48 hours (8 hours prior to the beginning of the experiment to the end of study). The severity of the gastric bleeding was estimated by scoring the number of petechiae and the percentage of the hemorrhagic erosion area from grade 0 to 3. Results showed that rats in Grs VII and VIII had significantly more severe grades of petechiae and hemorrhage than the other groups. These were the groups where the risk factors of fasting and aspirin administration coexisted. In addition to fasting, Gr VIII had fever, but this group did not show more gastric mucosal damage than Gr VII showed.(ABSTRACT TRUNCATED AT 250 WORDS)

Clear cell sarcoma of tendons and aponeuroses (CCSTA, malignant melanoma of soft parts), first described by Enzinger in 1965, is a rare and slow-growing soft tissue tumor mainly affecting the extremities of young adults. The tumor is believed to be a tumor of melanocyte, although its histogenesis is not definitely established. Here we report 2 cases of CCSTA with typical clinical and pathological features. A tumor grew from the right ankle of a 32-year-old man (case 1) and from the left foot of an 18-year-old woman (case 2). The tumors were deep seated and intimately bound to tendons or aponeuroses without involvement of the overlying skin. Grossly, they were greyish white, variegated with brown or black patches. Histologically, the tumor cells were arranged in nests or fascicles and composed of fusiform or polygonal cells with clear cytoplasm. Ultrastructurally, they consisted of closely apposed cells with intracytoplasmic melanosomes. Case 1 was found to have distant metastases within 6 months and died 1 year later. Case 2 received postoperative radiotherapy and was free of recurrence or metastasis 14 months after operation. The treatment of CCSTA should include radical excision, radiotherapy, and chemotherapy. The prognosis is poor.

A 64-year-old carpenter had an unsteady gait, severe dizziness, nocturia, and a loss of erection for more than 4 years. The neurological manifestations consisted of a wide-based ataxic gait, bilateral dysmetria with intentional tremor, staccato speech, rigidity, bradykinesia, and an iris-thinning. There was reproducible orthostatic hypotension. A sweat test revealed severe anhidrosis. Nicotine and methylbenzene sensitivity was absent, whereas norepinephrine infusion test showed a significant elevation of blood pressure. The resting plasma norepinephrine level on recumbency was low and a subnormal surge was noted on standing or exercise. We conclude that the clinical features caused by a degenerative process involving both the central and peripheral autonomic systems, together with atrophy of other systems in this patient, constitute the Shy-Drager syndrome.

From January 1962 through April 1988, 188 patients with Cushing's syndrome were hospitalized at the Veterans General Hospital. Iatrogenic Cushing's syndrome was found in 123 (65.4%) of the patients. The other 43 patients (22.9%) had excess secretion of adrenocorticotropin (ACTH) and 22 patients (11.7%) had benign or malignant adrenocortical tumors. The clinical features and the functional reserve of the adrenal glands in those patients with iatrogenic Cushing's syndrome were evaluated. A retrospective analysis of the diagnostic rate of the various endocrine evaluations and the radiological examinations was also carried out. Four approaches were used in the management of Cushing's syndrome: (1) pituitary surgery, (2) pituitary irradiation, (3) adrenal surgery, and (4) drug therapy. Both the clinical and hormonal responses to these four management types were evaluated. The endocrinological, radiological, surgical and pathological experiences of 25 patients with Cushing's disease treated with pituitary surgery are presented. Five patients (20%) had an atypical endocrine pattern (20% false-negative). Twenty-four patients received a pituitary CT scan and 16 patients (66.7%) had positive CT findings. Of these 25 patients, 19 had pathology-proven microadenomas (less than 1cm), one had macroadenoma (greater than 1cm) and 5 had no evidence of adenomatous tissue. Among the 22 patients with adrenal Cushing's syndrome, 4 (18%) were suffering from adrenocortical carcinoma and 18 (82%) with benign adrenal tumors. The incidence of left adrenal adenoma was approximately twice that of right adrenal adenoma. The cure rate of adrenocortical adenoma by surgical treatment with unilateral adrenalectomy was excellent, but for adrenocortical carcinoma was poor.

Metastatic pulmonary nodules were found in a 70-year-old man, who also had osteoblastic bone lesions and symptoms of prostatism. Extensive searching, including a transurethral resection of the prostate, failed to establish the primary site of the malignancy. One of the pulmonary nodules was biopsied using a fine needle aspiration technique, and revealed adenocarcinoma. The tumor cells in this lesion stained positive for prostate specific antigen. The patient was treated with estrogen for prostatic carcinoma and improved.

A 58-year-old Taiwanese woman was admitted to Mackay Memorial Hospital for evaluation profuse watery diarrhea. She presented with watery diarrhea, hypokalemia, and hypochlorhydria, and had experienced these problems for 2 years prior to admission. A pancreatic tumor with liver metastasis was noted by the ultrasound, abdominal CT scanning, and angiography studies. Surgical exploration disclosed an ill-defined ovoid tumor in the body and tail of the pancreas measuring 8 x 3 x 3 cm. The immunohistochemistry study of the tumor for VIP-immunoreactivity (VIP: vasoactive intestinal polypeptide) was markedly positive, and also stained slightly positive for other peptides, including pancreatic polypeptide (PP), calcitonin, glucagon, and neuron-specific enolase (NSE). Postoperatively, the patient recovered immediately from her symptoms and there has been no evidence of recurrence during the past 8 months of follow-up.

It has been found that both adenosine deaminase (ADA) and gamma-interferon (r-IFN) are higher in tuberculous pleural effusions than in other types of pleural effusion. Both mechanisms may be related to the T-lymphocytes in effusions. We studied 39 pleural effusions: 19 tuberculous and 20 malignant [The ADA was determined according to the Giusti method and r-IFN by ELISA]. We compared the ADA and r-IFN levels in both groups of effusions and tried to determine if there was any correlation between them. The results showed: (1) The ADA enzyme level was significantly higher in tuberculous effusions than in malignant effusions as was expected (133.0 +/- 50.4 vs 32.0 +/- 17.7 U/L). (2) The r-IFN was also significantly higher in tuberculous effusions than in malignant effusions (30.4 +/- 17.4 vs 2.9 +/- 2.8 U/ml). (3) The coefficients of regression for the ADA and r-IFN levels were poor. In conclusion, both tests for measuring ADA and r-IFN levels are excellent methods for differentiating tuberculous and malignant effusions, and especially measurement of the r-IFN level could serve as a more specific test for differentiating malignant pleural effusions with high ADA levels. However, no strong correlation was found between the ADA and r-IFN levels.

To elucidate the role of HBeAg and other influential factors for the presence of serum HBV DNA and their interactions, serum HBV DNA was examined in 68 patients with chronic HBV infections and 23 HBsAg negative persons by molecular hybridization. Based on the univariate analysis, the positive rate of HBV DNA was higher in patients with HBeAg (31/43, 72.1%) than in patients with anti-HBe (5/22, 22.7%) with an odd ratio of 8.78. The positive rates of HBV DNA between men and women were not significantly different, and the positive rates of HBV DNA were not related to the SGPT levels. The mean age of patients without HBV DNA was higher than that of patients with HBV DNA (p value less than 0.025), and the positive rate and concentration of HBV DNA were decreased with increasing age (p value less than 0.005). The positive rates of serum HBV DNA among different histological changes were not statistically different. However, the discordance of HBV DNA and HBeAg/anti-HBe was increased when the liver parenchymal damage became severe (p less than 0.05). Only 5 patients were anti-D positive and 3 of them had serum HBV DNA. To exclude interactions of the influential factors, multivariate analysis was also performed. HBeAg was the only significant factor for the presence of serum HBV DNA when logistic regression was used (p less than 0.001). The age was an important factor when the concentration of serum HBV DNA was considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Since the establishment of a Hemophilic Center at the National Taiwan University Hospital in 1984, all hemophilic patients have been registered. They have received regular follow-ups by specialists in appropriate fields. Orthopedic surgeons are assigned to evaluate and handle the complications of the musculoskeletal system. From January 1984 to April 1988, 20 of these patients were referred for various reconstructive procedures. Seventeen had a moderate to severe depletion of factor VIII and 2 had a severe factor IX deficiency. The indications for surgery include pain, swelling, frequent bleeding, and flexion contracture of the involved joints. Knee joints outnumbered the others. The operative procedures included: synovectomy in 7 patients, total knee replacement in 3 patients, total hip replacement in 1 patient, tendon reconstruction and supracondylar osteotomy of the femur in 3 patients, excision of a pseudotumor or cyst in 4 patients and amputation in 2 patients. Postoperatively, joint pain was relieved greatly, recurrent bleeding became rare and walking ability was significantly improved. To prevent a decrease in the arc of motion of the operated knee joint, exercise was initiated early using a continuous passive motion machine with promising results. Postoperative complications were minimal. Indications for various surgical procedures, and the details of hematological handling are discussed.