Zhonghua yi xue za zhi = Chinese medical journal; Free China ed最新文献

A 34-year-old woman suffered from palpitation, easy sweating, heat intolerance, increased appetite, irregular menstrual cycle and hand tremor for 1 year. Thyroid function tests showed elevated serum thyroxine (T4), tri-iodothyronine (T3) and thyrotropin (TSH). Computerized tomography (CT) revealed pituitary tumor with supraseller extension. Thyrotropin releasing hormone (TRH) test showed blunted TSH response with elevated baseline level and paradoxical growth hormone (GH) response with elevated baseline level. T3 suppression test (T3 60 microg per day x 10 days) showed no inhibition of TSH (11.1 microU/mL, normal range < 6.2 microU/mL). She received transphenoidal approach and removal of tumor which measured 0.5 x 0.3 x 0.2 cm. Histopathologically, it was a pituitary adenoma which was immunoreactive for TSH, GH, follicular stimulating hormone (FSH) and luteinizing hormone (LH). To our knowledge, this case is the first case of TSH-secreting pituitary adenoma in Taiwan.

Background: The aim of this retrospective study was to review our practice of the management of open tibial fractures in children.

Methods: Twenty-seven children aged 3-15 years (mean 9.5) with open fractures of the tibia were treated with early aggressive wound debridement and lavage. Gustilo grading was used. The wounds were graded as follows: I (13 patients), II (6 patients), IIIa (3 patients), IIIb (5 patients). Open wounds were treated as appropriate, 30% of patients required a plastic surgical procedure.

Results: Five patients were treated by initial external fixation of the tibia; the remainder was treated by cast immobilisation. The mean period for fracture healing was 6 months (1.5-48 months). There were no cases of non-union or deep infection. The incidence of complications where external fixation was applied was significant: one malunion required osteotomy, there were 2 cases of delayed union and four cases of pin track infection. In the group treated in casts, the most significant complication was loss of reduction of the fracture (five cases), requiring conversion to external fixation in 2 and screw and wire fixation in another; the remaining cases of displaced fractures responded to re-manipulation and plaster application.

Conclusions: We conclude from our results hat majority of isolated open tibial fracture in children can be treated by wound debridement and plaster cast immobilisation. There is still a role for the use of external fixation especially where there is a grossly unstable fracture or extensive soft tissue injury requiring a flap procedure.

Background: Color kinesis (CK) is a recently developed echocardiographic technique. This report describes our initial effort in the validation of the use of CK for the diagnosis of coronary artery disease (CAD).

Methods: Two-dimensional (2-D) echocardiography and CK were studied in 30 normal subjects and 24 CAD patients. Coronary angiography was performed in the 24 patients. Significant (> 70% luminal diameter stenosis) CAD was present in 18 patients (79%), all of whom had history of myocardial infarction. Regional fractional area change in each segment was displayed as a stacked color histogram. The histograms derived from these 30 normal subjects were averaged to obtain the normal pattern of left ventricular contraction; the mean value +/- 1 SD was considered the reference histogram. When the regional fractional area change deviated from this normal reference, this segment was considered as having regional wall motion abnormality. The detection of wall motion abnormalities by visual interpretation of 2-D echocardiography, reviewing the CK loop recording, and CK stacked histograms were compared. To assess the relationship of measurement of endocardial excursion of CK images, the width of the color band was measured at the midpoint of each segment along a line perpendicular to the cardiac border. The endocardial excursion measured by 2 independent observers was compared using linear regression analysis and calculation of intraclass correlation coefficient.

Results: The sensitivity and specificity for detection of CAD were 77.8% and 66.6%, respectively, for CK loop reviewing, 83.3% and 66.7% for CK stacked histogram analysis, and 77.8% and 83.3% for 2-D echocardiography. The overall accuracies for CAD detection were 75% for CK loop reviewing, 79.2% for CK stacked histogram analysis, and 79.2% for the 2-D echocardiography (not significant in all comparisons). The correlation of measurement of endocardial excursion from the CK images by 2-observers was good (r = 0.85, p < 0.01), and intraclass correlation coefficient was 0.99 (p < 0.0001).

Conclusions: Our data demonstrate that both the CK loop reviewing and stacked histogram analysis were comparable to 2-D echocardiography for detecting CAD.

Background: The role of frequency doubling technology perimetry (FDT) in glaucoma has been promising in terms of speed and simplicity as well as in its high sensitivity and specificity compared to conventional automatic perimetry. In this study, we investigated the possible role of FDT in exudative type age-related macular degeneration (ARMD).

Methods: FDT using full-threshold C-20 mode was performed in patients with ARMD. The macula was classified into 3 zones by the distance from the fovea center (zone I: central 1 degrees, zone II: central 3 degrees except zone I, zone III: central 5 degrees except zones I & II). The lesion was scored into 3 ranks by the area ratio of involvement in each zone. The retinal scores, visual acuity and disease duration were compared with the FDT scores of the central target, which was graded into 5 ranks according to the probability level of abnormal points on total deviation plots using Spearsman's rank correlation method.

Results: Measurements from 32 eyes (30 patients) with exudative ARMD were collected. The FDT scores of the central target correlated significantly with the lesion scores in zone III (p = 0.033), but not with the lesion scores in central 3 degrees (zone I: p = 0.383, zone II: p = 0.077). Visual acuity was weakly correlated with the FDT scores of the central target (p = 0.022), and the lesion scores in zone III (p = 0.038), but strongly correlated with the lesion scores in zone I and zone II (p < 0.001). The FDT scores of the central target were within normal limit in 20 eyes.

Conclusions: Our results suggest that FDT using full-threshold C-20 mode is not sensitive enough for the detection of small macular lesions in ARMD. Therefore, it might not be a useful functional evaluation in ARMD. Further modification of the central target of FDT is necessary to detect small macular lesions in ARMD.

Background: Paragonimus has emerged as an important parasitic zoonosis in recent years in Manipur, India. However, no scientific data on the systematic and phylogenetic classification of lung fluke in India is available. Therefore, a study was conducted to determine the species of lung fluke prevalent in Manipur by infecting an experimental animal with Paragonimus metacercariae obtained from fresh water crabs.

Methods: Thirteen Paragonimus metacercariae isolated from the fresh water crabs, Potamiscus manipurensis, at Churachandpur, Manipur, India were used to infect a puppy orally using a Pasteur pipette. After the infection, fecal specimens were checked for Paragonimus eggs by microscopic examination. Autopsy was performed on day 121 post-infection. The worms recovered from the worm cysts were alcohol fixed, flattened and stained with carmine for morphological study.

Results: Four adult worms were recovered. The worms presented with singly spaced cuticular spines, and the ventral suckers were slightly larger than the oral suckers. The ovaries consisted of 4 to 5 lobed masses branched like a ginger stem, and the testes were irregularly lobed and elongated. One ofthe worms showed a different shape and size ofthe right testis. The morphological features of the worms are similar to the Chinese species, Paragonimus hueit'ungensis.

Conclusion: The results of this study indicate the possibility of occurrence of P hueit'ungensis as 1 of the important Paragonimus species prevalent in Manipur, India after its initial discovery in China.

Background: Buried penis is a result of penile skin deficiency and inadequate attachment of the skin to the Buck's fascia. A modified prepuce unfurling technique and the results are reported.

Methods: Thirty-two boys with buried penis, aged 14 months to 12 years, underwent the surgical procedure. A circumferential incision is made at the junction of the outer and inner prepuce. The subcutaneous tissue is dissected from the inner prepuce and degloved from the Buck's fascia, so that a thin inner prepuce can be sutured directly to Buck's fascia. Reapproximation of the outer and the inner prepuce completes the procedure.

Results: Prolonged preputial edema was seen in two patients. No patient had skin necrosis. Most patients achieved satisfactory results.

Conclusions: This procedure unfurls the inner prepuce to cover the penile shaft. Ideal cosmetic results could be achieved in selected patients if some details of the procedure are emphasized.

We describe a 46-year-old man with a mass in the lower lobe of the right lung. The tumor was initially suspected to be a poorly differentiated adenocarcinoma after endobronchial biopsy. Subsequently, a right lower lobectomy was performed, and a paraganglioma was diagnosed histologically. Using whole-body CT scan and metaiodobenzylguanidine (MIBG) scintigraphy, we excluded the involvement of other organs. No evidence of recurrence or metastasis was found during the follow-up period of 3 years. Primary pulmonary paragangliomas are very uncommon tumors. Literature relevant to this disease entity is discussed.

Background: Paraoxonase (PON), a high density lipoprotein (HDL)-associated enzyme, is capable of inhibiting low density lipoprotein (LDL) oxidation by destroying the biologically active phospholipids in oxidatively modified LDL. An increased risk of coronary artery disease (CAD) has shown to associate with polymorphisms of PON gene (PON1) in different population. The risk of CAD associated with the other PON1-like gene, designated PON2, which has a similar function and is structurally related to PON1, is least discussed. A population-based case-control study was conducted to investigate the association between CAD and the polymorphisms at two common codons 148 and 311 of PON2 in the population of Taiwan.

Methods: Totally 364 unrelated, angiographically proved CAD-positive patients (338 male and 26 female) and 337 unrelated, CAD-free control subjects (249 male and 88 female) enrolled in this study. Lipids and lipoproteins profile and the association of PON2 genotypes and allele frequencies were analyzed in all study cohorts.

Results: The plasma levels of HDL-cholesterol and apoA-I were significantly lower in patients with CAD than in control subjects (both p = 0.0001). There was no difference in the genotype frequency distribution at codon 148 of PON2 between CAD patients and the controls. However, age-, sex- and diabetes-adjusted odds ratios for individuals with the SS genotype of the codon 311 polymorphism (Cys --> Ser, PON2*C allele --> PON2*S allele) showed a 4.6-fold higher risk of CAD (95% CI = 1.6-15.3, p = 0.006) they ran. Also, in the control subjects, PON2*C allele carriers (CC and CS genotypes) had higher plasma levels of HDL than cases with the SS genotypes (p = 0.035 and p = 0.012, respectively).

Conclusions: Our data implicate that the genotypic variation at codon 311 of PON2 contributes to the susceptibility of CAD in the population of Taiwan.