Changgeng yi xue za zhi最新文献

This case report illustrates a rare case of motor weakness caused by a free fat graft herniation. A 40-year-old woman who had undergone surgery for a herniated lumbar intervertebral disc experienced right lower leg weakness. On magnetic resonance image (MRI) a herniated free fat graft was noted. An emergent operation was performed and the herniated fat graft was removed. Postoperatively, the patient recovered well with improvement of the motor weakness. MRI is a good method for diagnosis of fat graft herniation. The mechanisms of this complication have been documented, and the size of the fat graft plays an important role. The methods for prevention of this herniation are also discussed. Although the transplantation of adipose tissue has many advantages, including the prevention of postoperative epidural fibrosis, great care is needed when applying a fat graft intra-operatively. When a postoperative neurologic deficit develops, herniation of the fat graft must be considered. An emergent operation is the treatment of choice for this particular complication.

Background: The excellent resolution of brain imaging modalities has important contributions in the diagnosis of brain diseases. However, involuntary movement by the patient may cause poor image quality. In this study, we developed a device to help keep a patient's head immobilized during brain image acquisition, for comparison between each follow-up study, and for functional-anatomical image correlation.

Methods: This device includes an acrylic material head supporter and a thermoplastic material facemask. The head supporter and the facemask can be firmly attached as a whole to support the head in a fixed position. Two capillary tubes filled with technetium-99m solution were placed perpendicularly on one side of the facemask as fiducial for imaging correlation between different studies. Ten patients, who each had two technetium-99m hexamethyl propyleneamine oxime (99mTc-HMPAO) brain single photon emission computer tomography (SPECT), were tested with this device for imaging.

Results: Three-dimensional cine motion and sectional imaging were displayed and confirmed head immobilization in all of these studies. In addition, the 99mTc fiducial were useful in the comparison of head positions among the different studies. In five subjects, the device also proved to be useful in functional-anatomical correlation among SPECT, magnetic resonance imaging (MRI), and computed tomography (CT) images.

Conclusion: In conclusion, this device has been developed and found to be useful in (1) keeping patient's head immobilization, (2) keeping consistent head position for follow-up studies, and (3) SPECT, MRI and CT functional-anatomical imaging correlation.

Background: Familial hypercholesterolemia is associated with a very high risk of premature coronary heart disease. In order to identify cases of familial hypercholesterolemia in Taiwan, we screened the hyperlipidemic patients in our metabolic clinics.

Methods: Hyperlipidemic patients were screened in the metabolic outpatient department and the cases which fulfilled the clinical criteria of definitive or possible familial hypercholesterolemia were further analyzed. Their clinical characteristics, including age, gender, physical findings, past history of coronary heart disease or cerebrovascular accident (CVA), family history, and lipid profiles before and after medical treatment, were reviewed.

Results: Eight women and 3 men fulfilled the diagnostic criteria. The mean age at diagnosis was 51.1 +/- 11.9 years old. Tendon xanthomas were found in 5 patients with definitive familial hypercholesterolemia. Coronary heart disease was confirmed in one patient and old CVA was noted in another 2 patients. The mean total cholesterol level was 390.3 +/- 88.9 mg/dl and the mean low density lipoprotein-cholesterol (LDL-cholesterol) level was 309.6 +/- 89.9 mg/dl before treatment. After a mean treatment duration of 45.2 months, the mean total cholesterol level and LDL-cholesterol level were 326.8 +/- 87.8 mg/dl and 249.1 +/- 91.1 mg/dl, respectively.

Conclusion: Clinically diagnosed familial hypercholesterolemia indeed exists in Taiwan. As compared to other reports, the mean age at diagnosis in our series was older and the majority of patients were women. Most patients were not vigorously treated and the family members were not thoroughly screened. Adequate treatment of patients with familial hypercholesterolemia in clinical practice and screening their family members are crucial in preventing new or recurrent coronary heart disease.

Background: This study was designed to determine whether screening for high-risk human papillomaviruses testing could improve the detection of cervical dysplasia and cancer in assistance with conventional Papanicoloau (Pap) smears.

Methods: The study was based on 114 patients with abnormal Pap smears referred for colposcopy from Feb. 1997 to Dec. 1997. The presence of high-risk human papillomavirus (HPV) DNA was determined with the Hybrid Capture method (including HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). Cytologic examination by Papanicolaou smear was based on the Bethesda system and cervical biopsy was done via colposcopy.

Results: Cytologic examination demonstrated high-grade squamous intraepithelial lesions (HSIL) in 24 patients with HPV positive (75%), low-grade squamous intraepithelial lesions (LSIL) in 38 with 61% HPV positive, and atypical squamous cells of undetermined significance (ASCUS) in 52 with 37% HPV positive. Among patients with a cytologic diagnosis of borderline abnormalities (ASCUS or LSIL), those with who were HPV positive were significantly more likely to have cervical dysplasia (both p < 0.05). The sensitivity of combined HPV assay and/or cytology for detection of noninvasive precursor (91%) was significantly greater than those of cytology (68%) or HPV assay (81%) alone.

Conclusion: The addition of the hybrid capture high-risk HPV DNA assay to cytologic examination of cervical smears appears to increase the sensitivity of cervical screening. Our findings suggest that HPV DNA may be a useful adjunct marker for early detection of cervical dysplasia in women with minimally abnormal Pap smears (ASCUS/low-grade SIL).

Background: Interleukin-5 (IL-5) is a potent eosinophilopoietic factor implicated in the chronic inflammatory cell accumulation accompanying bronchial asthma. We studied the expression of the IL-5 receptor alpha-subunit (IL-5R alpha) on bone marrow-derived cluster of differentiation molecule 34 positive (CD34+) progenitor cells in asthmatics to prove the ability of progenitor cells to respond to IL-5 more readily.

Methods: Non-adherent non-T cells (NANT) were separated from heparinized bone marrow blood from 6 asthmatics and 3 normal subjects, loaded with CD34+ and IL-5R alpha monoclonal antibodies conjugated with immunofluorescence and then analyzed by flow cytometry. Colonies grown from progenitor cells cultured in methylcellulose were determined for 14 days in the presence or absence of growth factors, including granulocyte-monocyte colony stimulating factor, stem cell factor, and interleukin-3.

Results: The proportion of IL-5R alpha expression on the CD34+ cell surface was significantly increased in asthmatics (12.9 +/- 3.3%, n = 6, p = 0.0163) compared to normal subjects (1.8 +/- 0.6%, n = 3). A significantly greater number of colonies committed to eosinophilic differentiation were found in the asthmatic subjects.

Conclusion: We demonstrated an increased expression of IL-5R alpha on bone marrow-derived progenitor cells in asthmatics. This supports the concept that bone marrow-derived progenitor cells are ready for eosinophilopoiesis.

Vibrio parahemolyticus (V. parahemolyticus) is a halophilic gram-negative bacillus that lives in the ocean. It is the leading cause of infectious diarrhea in Taiwan and sometimes produces soft tissue infections, but it is rarely a cause of bacteremia. There have been only 11 cases reported in the literature. Most of the cases involved a history of ingestion of seafood or exposure to seawater. In addition, those patients were all immunosuppressed, especially with leukemia and cirrhosis. We report a 60-year-old male patient with chronic hepatitis C and adrenal insufficiency. He developed V. parahemolyticus bacteremia following ingestion of seafood one week prior to admission. His condition was complicated with neck and right lower leg soft tissue infection, as well as multiple organ failure. The patient survived after intravenous ceftazidime, oral doxycycline, and surgical debridement. To our knowledge, this is the 12th reported cases on Medline, and the second bacteremic case in Taiwan. After reviewing the literature, we suggest that all patients with immunosuppressed conditions or adrenal insufficiency should eat foods that are well cooked and avoid raw seafood. Moreover, when patients who are at risk to develop fever, diarrhea, and soft tissue infection after ingestion of seafood, V. parahemolyticus infection should be suspected. All culture specimens should be inoculated on Vibrios selective media.

Cardiac catheterization and percutaneous transvenous mitral commissurotomy using the Inoue technique were attempted in a 44-year-old woman with mitral stenosis. The pulmonary arterial wedge pressure was 25 mmHg, mean transmitral diastolic pressure gradient 20.3 mmHg, cardiac index 1.80 L/min/m2, and mitral valve area 0.70 cm2. After the diagnostic catheterization, the guide wire for the transseptal procedure was checked in the middle of the inferior vena cava (IVC). A 7-French end-holed Bermann catheter was then used to detect the course of the IVC. It was found that the IVC coursed along the left border of the 4th and 5th lumbar vertebrae, to the left of the abdominal aorta. At the upper border of the third lumbar vertebra, the IVC returned to the right side of the vertebra. In consideration of the inability to pass the Brockenbrough needle through the detoured infrarenal IVC and the risk of rupturing the vessel, the transseptal procedure and attempted percutaneous transvenous mitral commissurotomy were aborted. Therefore, the patient underwent open mitral commissurotomy instead.

Background: Palate surgery at an early age may cause retardation of maxillary growth. The second intention healing of the raw bone surface created on the palate is considered to be the cause of the growth retardation. The animal experiment in this study was designed to evaluate this effect.

Methods: Four-week-old Sprague-Dawley rats were divided into 3 groups. In the first group, a strip of mucoperiosteum was excised on both sides of the hard palate. A second group of rats received a sham surgery in which bilateral mucoperiosteal flaps were raised and redraped. The third group served as controls with no surgery. Flap elevation with and without excision was performed under an operative microscope to facilitate the delicate manipulation of tissue and to avoid injury to the underlying bone. The animals were killed 11 weeks later and the skulls were prepared for measurements, which included the palatal inter-molar width, maxillary height, and maxillary length.

Results: The results revealed statistically significant decreases in palatal width and maxillary length in the experimental group (excision of mucoperiosteum). No differences were observed in the vertical height of the maxilla.

Conclusion: This study confirms that surgically created bone denudation of the palate causes maxillary growth disturbances.

Background: Neutrophil recruitment to the lungs and transmigration through the pulmonary epithelium to reach the respiratory tract are characteristics of airway inflammation. Interleukin-8 (IL-8) plays a critical role in the recruitment of neutrophils to epithelial cells. We investigated the effect of neutrophil adherence to epithelial cells on cytokine secretion.

Methods: The production of IL-8 from cultured A549 epithelial cells was assayed and neutrophil adherence assay in the presence or absence of interferon-gamma (IFN-gamma) plus tumor necrosis factor-alpha (TNF-alpha) plus interleukin-1 beta (IL-1 beta) stimulation was studied on cultured A549 epithelial cells. The role of an adhesion molecule in the modulation of neutrophil adherence was examined by pretreatment with intercellular adhesion molecule-1 (ICAM-1) blocking antibody.

Results: There was an increase in IL-8 release from epithelial cells that was time-dependent and in the magnitude of neutrophil adherence to the epithelial cells. Stimulation of epithelial cells with IFN-gamma +TNF-alpha +IL-1 beta significantly increased IL-8 release and neutrophil adherence. The spontaneous or IFN-gamma +TNF-alpha +IL-1 beta-induced IL-8 release was significantly augmented after the addition of neutrophils. The inhibition of neutrophil adherence to epithelial cells by ICAM-1 blocking antibody downregulated the augmented release of IL-8 with or without IFN-gamma +TNF-alpha +IL-1 beta stimulation. Placing a membrane filter on cultured epithelial cells to prevent neutrophil adherence significantly decreased IL-8 release from epithelial cells with IFN-gamma +TNF-alpha +IL-1 beta stimulation.

Conclusion: Our results indicate that lung epithelial cells not only provide a harboring site for neutrophils to be activated, but also amplify the neutrophil sequestration in the lung by releasing IL-8. Moreover, the release of IL-8 is dependent on the adherence between neutrophils and lung epithelial cells.

Retinal detachment is an unusual complication of hypertensive disorder in pregnancy. It has been reported in 1% to 2% of patients with severe preeclampsia and in 10% of patients with eclampsia. Choroidal ischemia may be the cause of retinal detachment. We know that mild arteriolar spasm involving the bulbar conjunctival vessels has been observed in the normal pregnancy, but in pregnancy-induced hypertension the vasospasm may be severe and result in choroidal ischemia. Most patients with retinal detachment in pregnancy-induced hypertension have had full spontaneous resolution within a few weeks, and they did not have any sequelae. Medical treatment with antihypertensive drugs and steroids may be helpful. We report two rare cases of retinal detachment and persistent hypertension in association with postpartum eclampsia and post-cesarean section preeclampsia. These patients had normotension throughout pregnancy. Preeclampsia or eclampsia developed after delivery, and blurred vision, headache, and reduced vision accompanied serous retinal detachment. The serous retinal detachment disappeared within 3 weeks. Good outcomes were found in the follow-up examinations in both of these cases. For women who had been normotensive at the time of delivery and then complained in the postpartum period of blurred vision, headaches, nausea and vomiting, we should consider the possibility of retinal detachment and perform fundoscopy.