Clinical analysis on thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, with plasma level of cytokine

We studied 10 patients with thrombotic thrombocytopenic purpura (TTP) and 5 patients with hemolytic uremic syndrome (HUS). Common cold symptoms were observed in 2 with TTP and 3 with HUS, and SLE was noted or suspected in 3 with TTP, and the onset was after operation in on with TTP and one with HUS. All TTP patients had coma and high fever. Renal failure was noted in 3 with TTP and their prognosis was poor. Seven patients with TTP and 4 patients with HUS survived. Autoantibody was highly positive in TTP but slightly positive in HUS. High molecular weight multimer of von Willebrand factor was decreased in 3 of 6 with TTP, platelet aggregating factor was positive in 4 of 6 with TTP, and microthrombus was observed in 7 of 8 with TTP. Tumor necrosis factor was increased in 5 of 9 with TTP and HUS, Interleukin-1 beta was increased in all TTP and HUS patients, and soluble interleukin 2 receptor and interferon alpha were also increased. Although plasma exchange was generally effective, some patients required combination therapy with steroids. We speculated that an autoimmune mechanism was involved in the on onset of TTP.     

弓形虫感染精神分裂症患者心理行为障碍比较研究

目的探讨弓形虫感染精神分裂症患者心理行为特征,了解弓形虫感染对精神分裂症症状的影响。方法采用症状白评量表（SCL一90）和住院患者观察量表（NOSIE）对100例弓形虫感染精神分裂症患者和100例未感染弓形虫精神分裂症患者的心理行为障碍进行比较,所有数据均用SPSSl6．0统计学软件进行处理。结果I）感染弓形虫精神分裂症患者在躯体化、抑郁、人际关系、敌对、恐怖等因子评分分别为1．68±0．44、1．61±0．43、1．64±0．45、1．80±0．72和i．57±0．36,未感染弓形虫精神分裂症患者分别为1．47_4-0．41、i．80±0．59、I．85±0．51、I．48±0．56和1．4I±0．4I差异均有统计学意义（P均〈0．01）;2）感染和未感染弓形虫精神分裂症患者在社会兴趣、激惹和退缩等因子评分分别为16．05±3．63、5．69±2．57和7．60±2．98,未感染弓形虫精神分裂症患者分别为18．69±4．12、4．06±2．08和9．28±3．51,差异均有统计学意义（P均〈O．01）。结论弓形虫感染精神分裂症患者的心理、行为障碍程度与未感染弓形虫精神分裂症患者比较存在差异,表明弓形虫感染可能影响精神分裂症患者的心理和行为症状。     

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound （US） guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient＇s condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent （gemfibrozil） was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.     

Histocompatibility antigens in psoriatic arthritis.

Histocompatibility (HL-A) antigen typing was performed on 82 patients with psoriatic arthritis. The prevalance of HL-AB27 was increased (28%) compared with that in a control group (7-5%), and this was most marked in those with spinal changes. The prevalence in patients with sacroiliitis and syndesmophytes was 75%, with sacroiliitis alone 78%, but with syndesmophytes and normal sacroiliac joints only 36%. The overall prevalence in psoriatic spondylitis was 60%, with a prevalence of 71% in those fulfilling the New York criteria for anklosing spondylitis. The prevalence was not increased in those with only peripheral arthritis (11%). The prevalence of HLA-B13 was decreased in those with psoriatic spondylitis, though this was not statistically significant. The overall prevalence of HLA-BW17 was increased, this being particularly so in those with syndesmophytes, but values were not significant.     

Symptoms, gastric function, and psychosocial factors in functional dyspepsia

INTRODUCTION: The classification of functional dyspepsia into meaningful subgroups remains an important goal. The aim of this investigation was to determine correlations between dyspeptic symptoms with gastric physiology and psychologic distress. METHODS: Consecutive patients with functional dyspepsia were evaluated with electrogastrography (EGG), drink test, and solid phase gastric emptying. Subjects also completed the Nepean Dyspepsia Index, Psychologic General Well-Being Index, SCL-90R, and SF-36. RESULTS: Eighty-one patients were evaluated. Gastric emptying was performed in 29 of 81 patients and was abnormal in 21%, but no correlation existed between symptoms and T1/2 or TLAG. EGG was abnormal in 42% and drink test was abnormal in 40% of patients. Both were significantly associated with nausea but not with other symptoms. Significant correlations existed with 10 of 15 assessed symptoms and various subscales of the SCL-90R. Somatization was associated with abdominal burning, chest pain, abdominal pressure, abdominal discomfort, bad breath, chest burning, excessive fullness, bloating, abdominal pain, and regurgitation. Anxiety was associated with abdominal burning, chest pain, abdominal pressure, and abdominal discomfort. Anger-hostility was associated with abdominal burning and abdominal pressure. Increased interpersonal sensitivity was associated with abdominal burning and chest burning. SCL-90R Global Symptom Score was associated with abdominal burning, chest pain, abdominal discomfort, and bad breath. CONCLUSIONS: Abnormal gastric physiology as measured in this study was not associated with symptoms other than nausea. Significant associations existed between measures of psychiatric distress and digestive symptoms. Symptoms in functional dyspepsia had greater associations with psychologic distress than with commonly employed tests of gastric physiology.     

门脉高压性胃病患者幽门螺杆菌感染率调查

目的探讨幽门螺杆菌（Hp）与肝硬化并发胃和十二指肠病变的关系。方法采用快速尿素酶试验和改良的Giemsa染色法检测Hp感染。结果在264例肝硬化患者,Hp阳性183例（69．4％）,在262例慢性胃炎（EG）患者,Hp阳性172例（66．4％,19〉0．05）;在79例肝硬化伴有PHG患者,Hp阳性60例（75．9％）,在114例肝硬化不伴PHG患者,Hp阳性75例（65．8％）,在37例肝硬化伴轻型PHG患者,Hp阳性26例（70．2％）,在42例肝硬化伴重型PHG患者,Hp阳性34例（80．9％,P〉0．05）;在56例肝硬化伴十二指肠溃疡（DU）患者,Hp阳性48例（85．7％）,在109例肝硬化不伴消化性溃疡（Pu）患者,Hp阳性67例（61．4％,P〈0．05）;在125例DU患者,Hp阳性112例（89．6％）;在28例肝硬化伴胃溃疡（GU）患者,Hp阳性20例（71．4％）,在47例GU患者,Hp阳性43例（91．5％）。结论肝硬化伴DU患者Hp感染率较高。     

Antrafenine, naproxen and placebo in osteoarthritis: a comparative study

Antrafenine is a new non-narcotic analgesic. In a double-blind, cross-over study the efficacy of antrafenine at doses of 450 mg/day and 900 mg/day was compared to naproxen 750 mg/day and placebo in patients with osteoarthritis. Each drug treatment was given for two weeks, the total duration of the study being eight consecutive weeks. Antrafenine, at either dose, was effective in relieving pain associated with osteoarthritis; the efficacy was comparable to naproxen. There was no definite indication that 900 mg/day was more effective than 450 mg/day. Antrafenine, at both dosage levels, was well tolerated. Any noted side-effects were mild. There was a total of 12 side-effects in nine patients with the high dose, five side-effects in five patients with the low dose, compared with 11 side-effects in nine patients with naproxen and 10 side-effects in seven patients with placebo.     

Esophageal dysfunction in patients with progressive systemic sclerosis and mixed connective tissue diseases

Esophageal motility was studied in 37 patients with progressive systemic sclerosis (PSS), 12 patients with mixed connective tissue disease (MCTD) and 40 controls by the manometry method, using an open tube and continuous perfusion, and by radiological examination. Radiology was normal in 17 patients with PSS and five patients with MCTD, and abnormal in 15 patients with PSS and three with MCTD. The most frequent abnormality was slow transit time of barium. Manometry of the esophageal body was normal in 20 patients with PSS and six patients with MCTD, and abnormal in 17 patients with PSS and six with MCTD. Lack of contraction in the middle lower segments of the esophagus was the abnormality most frequently observed. Lower esophageal sphincter pressure was significantly lower among patients with PSS and MCTD than among the controls. Dysphagia was reported by ten patients with PSS and by six patients with MCTD. Radiology and manometry showed similar changes in PSS and MCTD, but dysphagia was more frequent among patients with MCTD.     

中国肝病患者血清铜蓝蛋白水平的研究

目的　探讨我国不同肝病患者血清铜蓝蛋白 (CP)水平交叉程度 ,为肝豆状核变性(WD)的诊断和鉴别诊断提供科学的依据。方法　测定 90 5例正常人、WD及其他各种肝病患者血清CP水平 ,采用SPSS12统计软件进行统计分析。结果　WD患者血清CP平均为 (93 9± 98 1)mg/L ,与其他各组相比差异有非常显著性 ,72 7%的患者低于 10 0mg/L ,其中 4 2 9%的患者低于 5 0mg/L ,但是也有 9 1%的患者其血清CP正常 ,其中 3例高于 4 0 0mg/L ,最高达 5 0 1mg/L。 6 8%的非WD患者血清CP低于正常 ,最低为 2 8mg/L。急性肝炎患者血清CP平均为 (398 4± 15 1 3)mg/L ,显著高于其他各组。重型肝炎患者血清CP平均为 (2 96 5± 10 6 5 )mg/L ,显著低于其他各组 ,其中18 8%的患者低于正常。结论　WD患者CP水平显著低于正常人和其他肝病患者 ,但是与其他肝病有一定程度的交叉 ,单凭CP水平不足以确诊或排除WD。     

弓形虫GRA8真核表达质粒的构建与体外表达

目的构建弓形虫致密颗粒蛋白GRA8的真核重组表达质粒。方法设计GRA8的特异引物,采用多聚酶链反应(PCR)技术从弓形虫RH株基因组DNA中扩增编码GRA8的基因片段,经克隆至pMD18-T载体后,亚克隆至真核表达载体pVAC而构建真核重组表达质粒pVAC-GRA8,转化大肠杆菌DH5α;将构建的真核重组表达质粒pVAC-GRA8转染vero细胞,分析转染vero细胞中GRA8的表达状况。结果PCR扩增出GRA8基因的特异片段,所获克隆的序列正确,并被亚克隆到真核表达载体pVAC,构建了真核重组表达质粒pVAC-GRA8;在vero细胞中获得表达。结论成功构建了GRA8的真核重组表达质粒pVAC-GRA8。     

Comparison of Restenosis Rate in Various Devices for Coronary Intervention: Analysis Using Vessel Diameter and Lesion Length

The purpose of this study was to retrospectively compare the restenosis rates related to vessel diameter and lesion length among plain old balloon angioplasty (POBA), cutting balloon (CB) angioplasty, Palmaz-Schatz (PS) stems, Gianturco-Roubin (GR) stents, and directional coronary atherectomy (DCA). In 909 consecutive successfully treated cases, target lesion dimensions were divided into diameters of ± 2.5 mm and lengths of ± 20 mm to compare the restenosis rates obtained by the individual devices. Quantitative angiographic analysis was performed before the procedure, after the procedure, and at FU angiography at a mean FU time of 6 ± 3 months. Restenosis was defined as %DS > 50 at FU angiography. Patients with acute myocardial infarction, chronic total occlusions, left main lesions, ostial as well as venous graft lesions, severe calcifications, severe coronary thrombosis, and bleeding complications were excluded. The overall restenosis rate was 32%, with the CB it was 29%, with the PS stent it was 27%, and with DCA it was 39%. Each of these restenosis rates was significantly lower than that with POBA. The overall restenosis rate with short lesions at small vessels was 35%, while CB angioplasty yielded 29%, being significantly lower compared to that obtained by POBA. The overall restenosis rate with long lesions at small vessels was 53%. With those lesions there was no significant difference among the devices. The overall restenosis rate with short lesions at large vessels was 27%, with CB angioplasty it was 24%, with the PS stent it was 22%, and with DCA it was 25%. These restenosis rates were significantly lower compared to POBA. With long lesions at large vessels, the overall restenosis rate was 44%. In this subgroup, there was again no significant difference among the devices. Our study suggests that restenosis rates with short lesions are lower after CB angioplasty, stenting, and DCA, when compared to POBA. However, in the presence of long lesions, no difference was found among the devices.     

Plasma level of tumor necrosis factor in disseminated intravascular coagulation

The plasma level of tumor necrosis factor (TNF) was determined in 20 normal individuals, 52 patients with disseminated intravascular coagulation (DIC), 22 pre-DIC patients, and 39 non-DIC patients. TNF was not detected in the normal subjects, and the level was very low in non-DIC patients. However, the TNF level was significantly elevated in DIC patients, and it was moderately increased in pre-DIC patients shortly before the onset of DIC. This increase in circulating TNF may be associated with DIC. TNF was higher in DIC associated with solid cancer than in DIC associated with leukemia or sepsis. The increase in plasma TNF level was mildly correlated with DIC score, and it was significantly increased in patients with poor prognosis. However, the plasma TNF level in DIC patients with organ failure was not significantly different from those without organ failure. We conclude that the increase in circulating TNF reflects the pathogenic factors in DIC rather than being a consequence of organ failure due to DIC.     

Identification of Potential Regulatory Regions in the Renin Gene

Circadian blood pressure (BP) variation were studied in patients with renovascular hypertension (RVH) and primary aldosteronism (PA). Ambulatory BP (ABP) was monitored every 5 min for 24 hrs in a ward setting in 23 patients with PA and 17 patients with RVH (13 patients with unilateral renal arterial stenosis and 4 with bilateral stenosis). In patients with RVH, ABP was monitored before and after treatment with a converting enzyme inhibitor or percutaneous transluminal angioplasty. Plasma renin activity (PRA) was high before percutaneous transluminal angioplasty in almost all patients with RVH and low in those with PA. Ordinary circadian BP variation, i.e. nocturnal fall and diurnal rise in BP, was confirmed in the patients with unilateral or bilateral renal artery stenosis. Percutaneous transluminal angioplasty successfully normalized both BP and PRA in those with RVH. Normal circadian BP variation was observed in those with RVH before the treatment with a converting enzyme inhibitor or percutaneous transluminal angioplasty as well as during treatment with the former and after treatment with the latter. Circadian BP variation in the patients with RVH was affected by the pathogenesis of renal artery stenosis alone, i.e, fibromuscular hyperplasia and atherosclerosis; with fibromuscular hyperplasia normal circadian BP variation was observed, while with atherosclerosis, nocturnal BP fall was restricted or eliminated. Circadian BP variation in those with PA before and after excision of adrenal adenoma was essentially similar to that in normal subjects and essential hypertensive patients. From these it seems that in patients with RVH or PA, circadian BP variation is not affected by hypertension per se or by pathogenesis of hypertension.     

Treadmill exercise test in children with cardiomyopathy and postmyocarditic myocardial hypertrophy

Summary The treadmill exercise test with the Bruce protocol was performed in three patients with postmyocarditic myocardial hypertrophy (PMH) and ten patients with cardiomyopathy, including three with dilated cardiomyopathy (DCM), five with hypertrophic obstructive cardiomyopathy (HOCM), and two with hypertrophic and nonobstructive cardiomyopathy (HCM). The endurance time was below the normal level in all but one case and was normal or near normal in the three cases with PMH. ST depression was observed in five cases, none of which were of HCM. A marked increase in amplitude of the negative phase of the P wave in V₁ was observed in one patient with DCM. The response of blood pressure during the exercise was abnormal in patients with DCM and HCM but was normal in PMH.     

Myasthenia Gravis Presenting with Myasthenic Crisis Mimicking Status Asthmatics

A 23-year-old woman was transferred to our hospital due to exacerbating dyspnea with wheeze. After admission, we started mechanical ventilation immediately, and she was diagnosed with status asthmatics. On the following day, she was able to be weaned from the ventilator. However, she required re-intubation because of an unstable respiratory condition just after extubation. Detailed neurological investigations identified blepharoptosis and muscle weakness with easy fatigability. An edrophonium test was positive. Anti-acetylcholine receptor antibody was detected in her serum. She was finally diagnosed with myasthenia gravis and successfully treated with neostigmine and a low-dose corticosteroid.     

Primary aortoduodenal fistula treated successfully with surgery in a patient with Takayasu's arteritis.

Takayasu's arteritis was originally described as a systemic inflammatory arterial disease presenting with occlusive changes. However, it has also been known to cause aneurysm formation. In this report, a patient with Takayasu's arteritis was found to have an aortoduodenal fistula. An emergency operation was carried out with resection of the saccular aneurysm and the fistula. The aorta was reconstructed with a prosthetic graft and the duodenum repaired. A pedicled omental flap was placed between the aorta and the duodenum. The postoperative recovery was uneventful, there was no evidence of persistent bleeding, and the patient was well at the 3-year follow-up. This is the first case in the English language literature of a primary aortoduodenal fistula treated successfully with surgery in a patient with Takayasu's arteritis.     

Schedule-dependency assessments of ribonucleoside diphosphate reductase inhibitors when used in combination with platinum compounds plus cyclophosphamide in the treatment of advanced L1210 leukemia.

Each of three ribonucleoside diphosphate reductase inhibitors was used as a third drug in combination with selected antitumor platinum (Pt) agents and cyclophosphamide (CY) in the treatment of advanced L1210 leukemia in C57BL/6 x DBA/2 mice. Each was synergistic with the various Pt plus CY combinations but the effect was highly schedule dependent. The collective cure rate was 68% when hydroxyurea (HU) was given as a single injection with Pt plus CY; the cure rate was 15% when HU was administered on a divided-dose schedule with Pt plus CY. The collective cure rate was 53% when guanazole was given as a single injection with Pt plus CY, but was only 8% when it was given on a divided-dose schedule with Pt plus CY. The effect of 4-methyl-5-amino-1-formylisoquinoline thiosemicarbazone, when used as a third drug with the various Pt plus CY regimens, was not schedule dependent as assessed by the collective cure rate. A therapeutic synergy between CY and each of the three ribonucleoside diphosphate reductase inhibitors was also observed.     

HETEROGENEITY OF THE POLYCYSTIC OVARY SYNDROME: CLINICAL, ENDOCRINE AND ULTRASOUND FEATURES IN 556 PATIENTS

This paper reports an analysis of the clinical, endocrine and ultrasound data within a population of 556 patients with ultrasound-diagnosed polycystic ovaries. Compared with those not so affected, hirsutism was associated with a higher mean serum testosterone concentration, infertility was associated with higher mean gonadotrophin concentrations, obesity was associated with a higher mean serum testosterone concentration, hyperprolactinaemia was associated with a lower mean serum testosterone concentration and smaller ovaries, alopecia was associated with lower mean serum LH and testosterone concentrations, and acanthosis nigricans was associated with obesity and a raised mean serum testosterone concentration. The heterogeneity illustrates the limitations in the use of specific clinical or endocrine criteria as requirements for the diagnosis of the polycystic ovary syndrome.     

Evaluation of the formation of esophageal varices by per-rectal portal scintigraphy

Portal circulation in patients with liver diseases was evaluated by 99mTc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in the without, and also in the cirrhotic patients with encephalopathy than in those without. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices.     

A case of giant esophageal leiomyoma successfully resected by endoscopic submucosal dissection followed by retrieval via laparotomy

A 30-year-old woman with chest discomfort at swallowing and occasional vomiting was referred to our department with a diagnosis of esophageal submucosal tumor. CT visualized a mass 70 mm in diameter in the middle esophagus. Esophagogastroduodenoscopy revealed a pedunculated submucosal tumor, and endoscopic resection was considered. As the size of the tumor was so large, retrieval of the resected specimen via the stomach following incision, laparotomy was planned. En bloc resection by endoscopic submucosal dissection with a Hook-knife was performed. Retrieval of the resected specimen was carried out as planned. The specimen, which was 53×48×43mm in size with a distinct margin, was diagnosed as leiomyoma derived from the muscularis mucosae histologically. Her postprocedural course was uneventful. Endoscopic resection can be chosen when an esophageal submucosal tumor is pedunculated with abundant mobility, making it possible to avoid invasive surgery.