Effects of alanine in patients with advanced primary biliary cirrhosis: preliminary report

When rats given d-galactosamine are then treated with the glucogenic amino acid alanine, their alanine aminotransferase (ALT) activity, total bilirubin level, and survival rate improve compared with when other amino acids are used. Here, we report a preliminary study of the clinical and pharmacological effects of alanine given to three patients with primary biliary cirrhosis (PBC). The patients were jaundiced and were in the end-stage of the disease. The treatment they had been receiving was continued while they were given 18 g of alanine per day for a planned 8 weeks. For all three patients, test results for total bilirubin, alkaline phosphatase, and ALT decreased by 25% or more from the base line at some time during treatment. The arterial ketone-body ratio increased. Two of the patients reported that their itching and fatigue lessened. Except for one patient given a second course, who reported nausea, adverse effects were not found. In end-stage PBC, alanine administration decreased the total bilirubin level and improved symptoms, so this compound may decrease jaundice in this disease. A long-term study of a larger group of patients is needed.     

Adult cerebral malaria in Zambia: preliminary report of clinical findings and treatment response

Fifty-six adult patients diagnosed as having 'cerebral malaria' were admitted and treated over a 4 month period. The presenting symptoms were similar to those of control patients with malaria without cerebral manifestations except that vomiting and convulsions were significantly more frequent and joint pains were less frequent in the cases than in the controls. Physical examination revealed significantly more frequent occurrence of nuchal rigidity, positive Kernig's sign, confusion, muteness, pallor and jaundice in the cases than controls, while splenomegaly was significantly more common in controls than cases. Laboratory data showed that cerebral malaria cases had significantly lower haemoglobin and significantly higher reticulocyte count and erythrocyte sedimentation rate than controls. There was no significant difference in the parasite density between the cases and controls. All patients were treated with 200 mg base of intravenous chloroquine in 250 ml of isotonic saline infused over 2 h and repeated 12 hourly till oral therapy was possible. This proved to be efficacious and the recovery rate was over 90%. Five patients died and the diagnosis was confirmed in three in whom autopsy was permitted. A simple staging system is proposed which retrospectively seems to have prognostic value. It is recommended that the validity of this system be tested prospectively.     

Abnormal regional cerebral blood flow in primary antiphospholipid antibody syndrome patients with normal magnetic resonance imaging findings. A preliminary report

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in primary antiphospholipid antibody syndrome (PAPS) patients. The patients had mild neuropsychiatric manifestations and normal brain magnetic resonance imaging (MRI) findings in this preliminary study. Fifteen such female PAPS patients were examined with Tc-99m ECD brain SPECT in order to evaluate the rCBF. In addition, serum anti-cardiolipin antibodies (ACA) and lupus anticoagulant (LA) were simultaneously measured for comparison. RESULTS: (a) Tc-99m ECD brain SPECT revealed hypoperfusion brain lesions in 12 (80%) of the PAPS patients. Pariental lobes were the most commonly involved areas. (b) 11 (73%) and 9 (60%) cases had positive ACA and positive LA, respectively. In addition, ACA and LA results were correlated to the Tc-99m ECD brain SPECT findings. Tc-99m ECD brain SPECT is a sensitive tool for detecting abnormal rCBF in PAPS patients with mild neuropsychiatric manifestations and normal brain MRI findings.     

High-dose etoposide in the treatment of relapsed primary brain tumors

Twenty-four patients with relapsed primary intracranial tumors were treated with high-dose etoposide (600-1000 mg/m2). All patients had received previous radiotherapy and 15 had had previous chemotherapy. The treatment was well-tolerated, with little toxicity. Only one patient showed a partial response, which was maintained for 78 weeks. Four patients had stable disease, for a median of 15 weeks. Etoposide failed to show useful activity in relapsed brain tumors.     

Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report.

Thirty-six transtracheal aspirates from 34 patients with chronic bronchitis and bronchiectasis were examined bacteriologically. Bacteria were isolated from 30 aspirates, 23 of which yielded pure culture. Anaerobic bacteria were found in three aspirates, all in pure culture. This preliminary report indicates a greater complexity of the microbial flora in chronic bronchitis and bronchiectasis than hitherto appreciated.     

Cardiovascular outcomes in patients with primary aldosteronism after treatment

BACKGROUND: Experimental and human studies demonstrate that long-term exposure to elevated aldosterone levels results in cardiac and vascular damage. METHODS: We investigated long-term cardiovascular outcomes in patients with primary aldosteronism after surgical or medical treatment. Fifty-four patients with or without evidence of adrenal adenomas were prospectively followed up for a mean of 7.4 years after treatment with adrenalectomy or spironolactone. Patients with primary aldosteronism were compared with patients with essential hypertension and were treated to reach a blood pressure of less than 140/90 mm Hg. The main outcome measure was a combined cardiovascular end point comprising myocardial infarction, stroke, any type of revascularization procedure, and sustained arrhythmias. RESULTS: At baseline, the prevalence of cardiovascular events was greater in primary aldosteronism (35%) than in essential hypertension (11%) (odds ratio, 4.61; 95% confidence interval, 2.38-8.95; P< .001), with odds ratios of 4.93, 4.36, and 2.80 for sustained arrhythmias, cerebrovascular events, and coronary heart disease, respectively. Blood pressure during follow-up was comparable in the primary aldosteronism and essential hypertension groups. Ten patients in the primary aldosteronism group and 19 in the essential hypertension group reached the primary end point (P= .85). Cox analysis indicated that older age and longer duration of hypertension were factors independently associated with the cardiovascular end point. Cardiovascular outcome was comparable in patients with aldosteronism treated with adrenalectomy vs aldosterone antagonists (P= .71). CONCLUSION: Primary aldosteronism is associated with a cardiovascular complication rate out of proportion to blood pressure levels that benefits substantially from surgical and medical treatment in the long term.     

Electrocardiographic findings in patients with primary dysmenorrhea

IntroductionPrimary dysmenorrhea (PD), which is characterized by painful menstrual cycles, is one of the common clinical problems in young adult women. The aim of this study was to investigate the risk of cardiac arrhythmias in PD patients by using the electrocardiographic (ECG) parameters.MethodsForty patients diagnosed with PD and 30 age-matched normal controls were included in this study. ECGs were performed by using 12-leads with 10 mV amplitude and 25 mm/sec velocity. P and QT waves were manually marked along the isoelectric line. P maximum, P minimum, QT maximum and QT minimum were measured on the surface 12-leads ECG, and the P wave and QT dispersions were calculated.ResultsThere was not any significant correlation of P wave dispersion and QT dispersion between the age, sex, body mass index, hemoglobin, fasting blood glucose or any other laboratory parameters. P wave dispersion was significantly longer in the PD group than the control group (61.4 ± 19 msec versus 57 ± 14 msec, P = 0.01). The P minimum duration was significantly shorter in the PD group compared with the control group (36 ± 16 msec versus 41 ± 9 msec, P = 0.03). QT dispersion was significantly higher in the PD group compared with normal controls (76 ± 23 msec versus 58 ± 16 msec, P = 0.02).ConclusionThese results show that PD can be associated with cardiac arrhythmias, especially atrial fibrillation, by increasing P wave dispersion and ventricular arrhythmia risk because of an increased QT interval.     

Donepezil treatment in Alzheimer's disease patients with and without cerebrovascular lesions: A preliminary report

Aim: Donepezil has not been evaluated in Korean patients with Alzheimer's disease (AD) for up to 1 year. The objectives of this study were to evaluate the differential efficacy of donepezil in Korean AD patients with and without concomitant cerebrovascular lesions (CVL). Methods: This study was a 48‐week open‐label trial of donepezil in patients with probable AD of mild to moderate severity. CVL were evaluated through magnetic resonance imaging (MRI) findings within 3 months. Efficacy analyses were performed for cognitive, behavioral and functional outcome measures. Results: Concomitant CVL were documented in 35 (30.7%) of the patients on MRI. Seventy‐nine (69.3%) of the patients were considered not to have concomitant CVL. The mean Mini‐Mental State Examination scores of both patients with and without CVL showed improvement at each evaluation. However, there was no statistical difference in improvement between the groups. Conclusion: The presence of CVL should not deter clinicians from treating AD with donepezil. Geriatr Gerontol Int 2011; 11: 90–97.     

93例原发性心脏肿瘤的临床特点及手术治疗效果分析

目的：总结原发性心脏肿瘤的临床特点及手术治疗效果。方法：选择2000年1月-2010年6月手术治疗的93例原发性心脏肿瘤患者进行回顾性分析。结果：根据病理分型为：良性粘液型77例,占82．8％,良性非粘液型6例,占6．5％,恶性肿瘤10例,占10．7％。88例患者患者仍存活,2例患者于术后8个月、12个月死亡,3例患者于术后2年10个月后死亡。结论：原发性心脏肿瘤临床少见,一旦明确诊断,应立即手术,良性肿瘤效果较好,恶性肿瘤手术效果差。