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

This study assesses the relative risks of first trimester transcervical chorionic villus sampling (CVS) versus midtrimester amniocentesis performed between April 1986 and March 1988. The most common indication for prenatal diagnosis was advanced maternal age. We discovered 5.1% chromosomal aberrations in CVS compared to 1.0% in amniocentesis. Bleeding was the most frequent early complication, and only 1 case had major hemorrhage with subsequent spontaneous abortion. The fetal loss rate (gestational age less than 28 weeks) was 4.5% in CVS versus 1.2% in amniocentesis, which was not significantly different from the background fetal loss rate reported in normal pregnancies after an 8-week gestational age. Three cases of fetal loss after CVS were probably procedure-related; 1 case had spontaneous abortion and 2 cases had chorioamnionitis. Therefore, we considered that the causal relationship between CVS and the infection was highly probable. The clinical pregnancy outcome indicated that there were no differences in overall perinatal mortality, Apgar score, body weight, body length, gestational age at delivery, intrauterine growth retardation, placenta weight and placental disorders between the CVS group and the amniocentesis group. The pregnancies did not reveal any specific effects of the prenatal diagnostic procedure, but a long-term pediatric follow-up is needed.

To assess the long-term growth status and the effects of steroid therapy on the linear growth of nephrotic children, growth patterns were analyzed in 52 patients who had been followed for 2 to 12 (5.51 +/- 2.82) years. They were divided into 2 groups: (1) Group A had less favorable clinical courses, this included 29 children with frequent relapsing, steroid-dependent, and steroid-resistant nephrotic syndromes; (2) Group B, consisting of 23 nephrotic children with occasional or no relapse. When assessed by a growth velocity index (GVI) and a change in standard deviation score of height (delta SD score), 24 patients (46%) were found to have growth impairment; of these, 21 (88%) belonged to Group A. The mean adult height of 6 Group A patients was subnormal when compared to normal adults, while the value for 6 Group B patients was normal. Based on covariance analysis, steroid usage of more than 6 months per year with a dose higher than 0.2 mg/kg/day (and/or 0.4 mg/kg/48h) was found to be the major determinant on the growth pattern of nephrotic children. In conclusion, high-dose prednisolone therapy should be administered no more than 6 months per year if normal growth and adult height are desired.

Twenty-nine female patients were diagnosed as stress urinary incontinence (SUI) and treated with different surgical procedures from March 1982 to December 1987. One patient was operated on twice. The surgical procedures included the Marshall-Marchetti-Krantz(M-M-K) operation in 2 cases, Burch's operation in 2 cases, revised Pereyra's needle suspension in 9 cases and the modified Pereyra-Stamey's operation in 17 cases. Two of the 29 cases were lost to follow-up. The mean duration of follow-up after operation was 44 months. Five patients responded poorly to treatment. The other 22 cases are in good and continent condition. The success rate of the four different procedures were, M-M-K operation 50%(1/2), Burch's operation 100%(2/2), revised Pereyra's needle suspension 66.7%(6/9), and modified Pereyra-Stamey's operation 94.1%(16/17), respectively. Since the application of the Pereyra's needle in SUI, the Marshall-Marchetti-Krantz and Burch's operations have been performed rarely because of their complexity and the entrance into the abdomen. On the contrary, the revised Pereyra's needle suspension and Stamey's procedure became gradually popular. We started with the revised Pereyra's needle suspension for SUI in 1982, and experienced a high failure rate with this procedure. Thus, we modified the procedure using dacron bolsters like Stamey to take over the helical suture in the bladder neck. We conclude that a modified Pereyra-Stamey's procedure is a simple operation with a high success rate.

Interest in sweetening agents is encouraging manufacturers and researchers to find a safe substance to maintain the life quality of diabetics. The popularity of sweetened food items has increased recently in Taiwan. The glycemic index of fructose has been reported to be 20%, much lower than most carbohydrate foods. A high-fructose corn syrup (HFCS) has come onto the market of sweetening agents and has been proposed as a low-cost substitute for fructose in dietetic management of diabetes. The aim of this study was to compare the glycemic effects of HFCS and glucose to see if there is a place for high-fructose corn syrup in diabetic management. In 8 normal and 21 non-insulin dependent diabetes mellitus (NIDDM) subjects, we performed oral tolerance tests. After an overnight fast, the subjects were given either 75g of glucose or an equivalent amount of HFCS containing 75g of carbohydrate. Blood was sampled before and at 30, 60, 90, 120 and 180 minutes after the glucose load. Blood glucose was analyzed by the glucose oxidase method using YSI 23 A (Yellow-Springs Intrument). The insulin and C-peptide were measured by RIA kits from Daiichi. The area under the curves (AUC) was calculated for plasma glucose, immunoreactive insulin (IRI) and immunoreactive C-peptide (IRCP). The results showed that the glycemic effect of HFCS was 73% of glucose. The AUC of IRI after HFCS was 56% of that of glucose. The AUC of IRCP after HFCS was 57% of that of glucose. The high glycemic index of HFCS in our study does not support the use of HFCS as a substitute for fructose.

Synthetic GHRH-(1-44)NH2 was administered as an i.v. bolus dose of 2 micrograms/kg to 14 normal short children and 20 children with growth hormone deficiency. In normal short children, mean plasma GH levels reached a peak value of 54.8 mU/L at 30 min; in children with growth hormone deficiency, mean plasma GH levels reached a peak value of 18.6 mU/L at 45 min. In the majority of normal short children, the peak GH values after GHRH administration were greater than GH values after clonidine. The 20 children with growth hormone deficiency had a lower median maximum plasma GH concentration than the 14 normal short children (median 17.1 mU/L vs 49.6 mU/L). There was no significant difference in the distribution of peak GH response time between these two groups. Among 19 children with idiopathic growth hormone deficiency, 47% had a peak GH above 20 mU/L after GHRH. In these children, GHRH administration provided information on the putative hypothalamic etiology of their growth hormone deficiency. These results confirm that GHRH testing is useful for differentiating hypothalamic from pituitary growth hormone deficiency and may be of potential therapeutic value.

A 43-year-old G12P4 mother delivered, at 35 weeks of gestation, a girl with a birth weight of 1980 g. Since her last pregnancy 20 years ago, she had had 8 subsequent abortions. Amniocentesis was done at the 18th week of gestation and revealed negative findings. Because of maternal age, the baby was delivered by cesarean section. The family history was not pertinent. After birth, the baby was noted to have a large head girth (34.5 cm) with widened anterior fontanel and mild frontal protrusion. The neurosonography showed symmetric dilatation of the frontal horns and temporal horns of the lateral ventricles, hyperechodensity in the periventricular wall, absence of corpus callosum and cavum septum pellucidum, and a large communicating pear-shaped ventricular cavity on the posterior coronal view. The brain CT scan demonstrated evidence of extreme dilatation of the occipital horns of the lateral ventricles and prominence of the subarachnoid spaces in the supra-Sylvian fissures. Based on these findings, the baby was diagnosed as a case of colpocephaly. Patients with colpocephaly usually have moderate to severe mental retardation, motor deficits, visual abnormalities and seizures. They need speech and physical therapies as early as possible. Therefore, if early diagnosis is confirmed by fetal sonography before the 5th month of gestation, this congenital brain malformation can be prevented by therapeutic abortion.

To assess the value of tumor marker determinations in diagnosing lung cancer and monitoring the response to therapy in lung cancer patients, we tested the serum concentration of TuMark-reactive protein and carcinoembryonic antigen (CEA) in 78 patients with lung cancer and 81 patients with non-malignant diseases. The sensitivity of TuMark in detecting the presence of lung cancer was 63.8%, compared to 37.2% for CEA (p less than 0.05). The specificity was 91.3% for TuMark and 97.5% for CEA. The combination of TuMark and CEA increased the sensitivity to 74.3%. The sensitivity of TuMark for non-small cell carcinoma was significantly higher than that for small cell carcinoma (67.6% vs 30.0%) (p less than 0.05). The incidence of positive TuMark reactivity did not correlate with the stages of lung cancer. Since the incidence of positive CEA reactivity was lower in the limited stage than in the extensive stage of lung cancer (20.0% vs 43.1%), the sensitivity of TuMark with regard to the detection of early stage lung cancer appeared far superior to CEA (65.0% vs 20.0%, p less than 0.05). Serial monitoring of TuMark levels in 32 patients with all types of lung cancer showed that 84% correlated with their clinical courses. Six patients with stage I or II disease received complete surgical resection of tumors. All showed a decline of the TuMark level to normal levels in 17 to 48 days (average of 32 days). These results suggested that the TuMark test may be a useful new marker for diagnosing lung cancer and monitoring response to therapy, especially for non-small cell lung cancer.

Twenty-eight subjects, 16 with old myocardial infarction (OMI) and a control group of 12, received ticlopidine 250 mg/day for 4 weeks. All subjects underwent the standard Bruce protocol exercise test before and after therapy. Blood was collected from a peripheral vein to study platelet function at pre-exercise (rest), peak exercise (end point), and 6 min post-exercise (recovery). Platelet count, platelet aggregatory response, plasma thromboxane B2 (TXB2), and 6-keto-PGF 1 alpha were measured by Coulter counter, aggregometry, and radioimmunoassay, respectively. The platelet count, aggregatory response (induced by ADP, adrenalin, and collagen) and the plasma concentration of TXB2 and 6-keto-PGF 1 alpha were not significantly affected by exercise in the OMI and control groups. Overall, there were no significant changes in exercise duration, heart rate, and blood pressure in both groups before or after ticlopidine treatment, with some minor exceptions. There were no significant changes in the peripheral blood profiles, the bleeding and coagulation times, the blood chemistry data, and the platelet counts between the groups before or after treatment. There was a significant decrease in collagen- and ADP-induced platelet aggregation in both groups after ticlopidine therapy. Prior to treatment, a higher plasma TXB2 concentration was noted in the OMI group during and after exercise; the difference was no longer statistically significant after ticlopidine therapy when both groups were compared. There was a significant reduction in the TXB2 levels in the OMI group after ticlopidine treatment despite exercise. Before therapy, plasma 6-keto-PGF 1 alpha was significantly elevated in the OMI group before or after exercise but was not statistically significant after ticlopidine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)