Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan.

Stenotrophomonas maltophilia has become an important nosocomial pathogen in immunocompromised patients in Taiwan. Patients with underlying diseases such as diabetes, uremia, and solid malignancy are extremely vulnerable to this organism. S. maltophilia bacteremia has a mortality rate of up to 62% if appropriate antibiotics are not instituted early. Knowledge of the risk factors for infection as well as local susceptibility patterns is helpful in determining which patients should receive empirical antibiotics active against S. maltophilia. This study assessed the characteristics of 50 episodes of S. maltophilia bacteremia in 48 patients admitted between March 3, 1999 and May 21, 2003. The new fluoroquinolone levofloxacin showed promising in vitro activity against S. maltophilia in view of the increasing resistance of isolates to trimethoprim-sulfamethoxazole. For patients at risk for S. maltophilia infection, such as those receiving mechanical ventilation in the ICU or those with multiple vascular access devices, the need for antimicrobial agents to which S. maltophilia is normally sensitive should be considered in selecting empiric therapy.     

Transvaginal sonography in the morphological and functional assessment of segmental dilation of the distal ureter.

Primary megaureter presents a spectrum of findings ranging from mild, clinically unimportant, stable ureterectasis to severe, progressive obstructive hydroureteronephrosis. We report a patient with a double uterus and ipsilateral renal dystrophy. A previous imaging study had revealed a double uterus and obstructed left hemivagina, into which a single vaginal ectopic ureter inserted. On follow-up intravenous urography 8 years later, the left kidney was non-functioning, and there was segmental dilation of the distal right ureter. Transvaginal sonography with real-time scanning and Doppler were useful in exploring the morphological and functional status of this dilated distal ureter.     

烤瓷贴面修复20例临床观察

目的评价烤瓷贴面的修复效果。方法选择20例患者制作烤瓷贴面92个。复诊时对烤瓷贴面的边缘适合性,边缘着色及颜色进行评价;同时采用牙龈出血指数和菌斑指数评价治疗前后的牙周状况。观察时间为12～18个月。结果5颗牙烤瓷贴面失败,成功率为95.7%;烤瓷贴面治疗前后牙龈出血指数无显著性差异(P>0.05),治疗后菌斑指数降低(P<0.01)。结论烤瓷贴面具有较好的治疗效果。     

益气活血汤对老年肺心病心衰患者血液流变学的影响

目的探讨益气活血汤对老年肺心病心衰患者血液流变性的影响。方法将48例肺心病心衰患者随机分为两组,均采用常规西医治疗,治疗组加用益气活血汤;观察两组治疗前后血液流变学指标变化情况。结果治疗组治疗前后比较,各项血液流变学指标改变差异有显著性,对照组治疗前后比较无统计学意义;治疗组各项指标与对照组比较差异有显著性。结论益气活血汤对肺心病心衰有改善血液流变性的作用。     

High level of tumor necrosis factor alpha activity of plasma and serum from acute phase hemorrhagic fever with renal syndrome]

The level of TNF-alpha activity of plasma and serum from HFRS acute phase patients was investigated. The level of TNF (tumor necrosis factor) activity of plasma and serum from acute phase patients was higher than that of plasma and serum from convalescent phase patients or from normal group. The higher TNF activity of plasma or serum from acute phase patients was due to TNF-alpha, because the TNF activity was almost completely inhibited by polyclonal mouse serum against rHuTNF-alpha. Also, the increase in TNF-alpha positive ratio of PBMC from acute phase HFRS patients was found as compared to convalescent phase patients or to normal group. All these results strongly suggest that high level of TNF-alpha activity of plasma and serum may be involved in the development of clinic symptoms and pathological lesions during the course of HFRS disease.     

Medical Cure of a Brainstem Abscess and Serial Brainstem Auditory Evoked Potentials

The brainstem abscess of a nine-year-old girl with tetralogy of Fallot was cured after six weeks of parenteral antibiotic therapy, without surgical intervention. Serial studies of brainstem auditory evoked potentials were undertaken until the patient was clinically normal. To the authors' knowledge, this is only the second medically cured case reported in the literature, and it is the first case studied with serial brainstem auditory evoked potentials. If the clinical status allows, medical treatment of a brainstem abscess with appropriate antibiotics could be tried before surgical intervention such as stereotactic aspiration for reducing the mass.     

Indomethacin promotes germinal matrix microvessel maturation in the newborn beagle pup.

BACKGROUND AND PURPOSE: Although indomethacin has been demonstrated to prevent germinal matrix and intraventricular hemorrhage in clinical and animal studies, the mechanism of action of this agent to prevent hemorrhage remains unclear. Previous studies have demonstrated both that the microvessels in the germinal matrix of newborn beagle pups undergo basement membrane maturation during the first 4 postnatal days and that indomethacin may promote laminin deposition in tumor cell culture systems. METHODS: We employed the newborn beagle pup model to test the hypothesis that indomethacin may stimulate laminin deposition in germinal matrix microvessels. Newborn pups were randomized to receive either 0.1 mg/kg/dose i.p. indomethacin or an equal volume of saline diluent. Pups received doses of study medication once a day for 1, 2, or 3 days and were studied on postnatal days 1, 2, 3, or 4. Pups were anesthetized and systemically perfused with buffered formalin; the brains were removed and prepared for immunohistochemical study. RESULTS: Sections stained with Bandeiraea lectin demonstrated that there was no difference in germinal matrix vessel density among the postnatal ages studied; similarly, there were no differences in vessel density between saline- and indomethacin-treated animals at any postnatal age. Quantification of germinal matrix stained intensity by confocal microscopy demonstrated significant increases in indomethacin-treated pups for both laminin staining at postnatal days 2 (p = 0.05) and 3 (p = 0.0009) and type V collagen staining at postnatal day 2 (p = 0.011). Although staining for beta 1 integrins increased across postnatal ages, there were no differences between saline- and indomethacin-treated animals. CONCLUSIONS: These data suggest that indomethacin may stimulate basement membrane deposition in the germinal matrix microvessels of newborn beagle pups to prevent germinal matrix and/or intraventricular hemorrhage.     

Triflavin, an Arg-Gly-Asp containing snake venom peptide, inhibits aggregation of human platelets induced by human hepatoma cell line

Triflavin, an Arg-Gly-Asp (RGD)-containing peptide, purified from snake venom of Trimeresurus flavoviridis, inhibits human platelet aggregation through the blockade of fibrinogen binding to fibrinogen receptors associated with glycoprotein IIb/IIIa complex. In this report, we examined the effect of triflavin on tumor cells (human hepatoma J-5)-induced platelet aggregation (TCIPA) of heparinized platelet-rich plasma (PRP). ADP-scavenger agents, apyrase (10 U/ml) and creatine phosphate (5 mM)/creatine phosphokinase (5 U/ml) did not inhibit TCIPA while hirudin (5u/ml) completely inhibited it. J-5 cells initially induced platelet aggregation, then blood coagulation occurred. J-5 cells concentration-dependently shortened the recalcification time of normal as well as Factor VIII, IX-deficient human plasmas, while it was inactive at shortening the recalcification time of Factor VII-deficient plasma, suggesting J-5 cells induced platelet aggregation through activation of extrinsic pathway, leading to thrombin formation as evidenced by the amidolytic activity on S-2238 by expressing tissue factor-like activity. Triflavin inhibited TCIPA in a dose-dependent manner (IC₅₀, 0.02 μM). When compared on molar ratio, triflavin was approximately 30,000 times more potent than GRGDS (IC₅₀,0.58 mM). On the other hand, GRGES showed no significant effect on TCIPA, even its concentration was raised to 4 mM. Additionally, the monoclonal antibodies, raised against glycoprotein IIb/IIIa complex (i.e., 7E₃ and 10 E₅) inhibited J-5 TCIPA. In conclusion, we suggest the inhibitory effect of triflavin on J-5 TCIPA may be chiefly mediated by the binding of triflavin to the fibrinogen receptor associated with glycoprotein IIb/IIIa complex on platelet surface membrane.