Visualization of suppressed thyroid tissue by Tc-99m MIBI.

The authors describe a case of suppressed normal thyroid tissue in a patient with autonomous toxic nodule, which was visualized by a Tc-99m MIBI thyroid scan without thyrotropin (TSH) stimulation. The findings suggest that Tc-99m MIBI can be a substitute for conventional thyroid imaging using I-131 to visualize suppressed normal thyroid tissue without TSH stimulation and its side effects.     

Endogenous corticosterone rather than dietary sucrose as a modulator for intestinal sucrase activity in artificially reared rat pups

The effects of sucrose and corticosterone on the expression of intestinal sucrase activity in preweanling rat pups were studied using an artificial rearing (AR) technique. When AR rat pups were isocalorically fed diets containing lactose or sucrose, or a carbohydrate-free diet from d 12-16, jejunal and ileal sucrase and maltase activities were induced to similar levels in all AR rats, whereas ileal lactase activity was precociously decreased. In separate experiments, enzyme activities were measured in ileal isografts subcutaneously implanted in littermates at birth. In AR rats fed the lactose diet, these isografts showed sucrase and maltase activities comparable with those of host ileum and also to isografts from AR rats fed the sucrose diet. In contrast, lactase activity was significantly higher in isografts than host ileum in all AR rats. Serum corticosterone levels were significantly elevated in AR rats for 24 h after intragastric cannular implantation. Precocious expression of ileal sucrase activity occurred in corticosterone treated, but not in untreated, adrenalectomized AR rats. In conclusion, dietary sucrose has no specific role in enhancing intestinal sucrase activity, and endogenous corticosterone is responsible for the induction of sucrase activity in AR rats.     

Hypertension due to co-existing paraganglioma and unilateral adrenal cortical hyperplasia

A rare case of combined unilateral adrenal hyperplasia and paraganglioma is reported. A 27-year-old woman presented with hypertension, palpitation, dizziness, and headache for about 3 months. Elevated plasma aldosterone with low renin and a high level of urine vanillylmandelic acid (VMA) were found. Computed tomography showed a microadenoma of the left adrenal gland and a well demarcated left retroperitoneal para-aortic mass. Adrenal vein sampling for aldosterone and renin levels suggested left adrenal lesion. Surgical removal of the left adrenal gland and para-aortic mass was performed. Pathologic examination of the resected left adrenal gland showed adrenal cortical hyperplasia and the left retroperitoneal para-aortic mass showed a paraganglioma. Postoperatively, blood pressure, plasma renin, aldosterone and urine VMA all returned to within normal ranges. The possible relationship of these two diseases is discussed.     

Mucocutaneous manifestations in 22 consecutive cases of primary HIV-1 infection

Summary Twenty-two consecutive patients presenting with symptomatic human immunodeficiency virus 1 (HTV-1) seroconversion were studied. Most of the patients had a glandular fever-like illness.
All patients had fever and pharyngitis, and eight of them also suffered from ulcers of the oral, genital or anal mucosa. Uniform skin eruptions were observed in 17 of the 22 patients. The exanthem consisted of varying numbers of macular or maculopapular lesions that were oval or rounded in shape, ranging from a few millimetres to 1 cm in diameter. The lesions were distributed on the upper thorax in all cases, and were particularly profuse in the collar region. The face forehead and scalp were involved in most cases, but the eruption was sparse or absent at the periphery of the extremities. In the majority of patients, the exanthem appeared after 2 or 3 days of fever. The exanthem developed during the first day, persisted for 5-8 days, and then cleared concurrently with the general recovery of the patients.
Histopathological studies of skin punch biopsy specimens from four patients showed a sparse lymphocytic cell infiltrate distributed around vessels of the dermal superficial plexus. The infiltrates predominantly consisted of equally represented T-helper/inducer and T-suppressor/cytotoxic cells. A vacuolar aberration of basal layer cells was found in two of the four eases studied histologically. The microscopic findings correspond to the histopathological patterns seen in toxieodermia and in the interface dermatitis of morbilliform viral exanthems. The exanthem is a frequent and characteristic sign of primary HTV infection, which is further indicated if mucosal ulcers are present.     

Luminal non-selective cation and outwardly rectifying chloride channels in cultured strial marginal cells from gerbil

Ionic channels located on the luminal side of strial marginal cells (MCs) of gerbil in culture were investigated using the patch-clamp technique. Two types of channels were identified. The most frequently recorded single-channel activity corresponded to a non-selective cation (NSC) channel with a conductance of 23.7 ± 0.2 pS (n = 18) in symmetrical NaCl conditions. The channel was activated by internal Ca²⁺ and inhibited by internal adenine nucleotides and flufenamic acid. Spontaneous activity of NSC channels was found in 16% of the cell-attached patches and with a very high density (9 ± 2 levels/patch, n = 28) in 100% of the excised patches. An outwardly rectifying chloride (ORC) channel was also identified in 14% of the patches but only after excision. The channel exhibited at 0 mV a unit conductance of 26.8 ± 1.3 pS (n = 8) and a strong outward rectification in symmetrical NaCl conditions, and the open probability increased with depolarization. The luminal NSC channel and the ORC channel evidenced in this study might participate in the production of endolymph. Although extrapolation of the presents results to the in vivo situation should be made with caution, this study suggests that culture of strial MCs may be a suitable model for investigation of endolymph physiology.     

Effects of a Self-Management Asthma Educational Program in Taiwan Based on PRECEDE-PROCEED Model for Parents with Asthmatic Children

This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self-management asthma education based on the PRECEDE-PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, doctor-patient communication, and self-management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, and self-management behaviors significantly improved after the self-management asthma educational program based on PRECEDE-PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow-up. The experimental group was better than the control group in knowledge, children's cooperation, and self-management behaviors at the 3-month follow up, as well as in knowledge and children's cooperation at the 6-month follow-up. 2) In both the experimental and control groups, the educational program had a good impact on the health outcome. The average degree of drug use was reduced from 2.7 to 2.1. The number of visits was reduced from 4.75 to 3.55 per half year in the experimental group, and from 5.8 to 3.48 in the control group. The severity of asthma was reduced from 2.7 to 2.1. The signs/symptoms of asthma decreased, school absenteeism was reduced, and exercise ability improved after education at the 6-month follow-up in both groups. From the results of this study, the theory-based educational program had a good effect on self-management behaviors. From the repeat measurement analysis, we can understand the changing trend of the determinants, behaviors, and outcome indicators. The trend indicated that educational effects were sustained for at least 3 months, with some for 6 months. In order to maintain the educational effects, further specific series of educational programs can be designed based on the patterns of self-management behavior stages every 6 months. The effects of health outcomes may show significant differences using longer follow-up times in future clinical trials.     

Necrotizing enterocolitis in infants: clinical outcome and influence on growth and neurodevelopment.

BACKGROUND AND PURPOSE: Necrotizing enterocolitis (NEC) is a gastrointestinal emergency in neonates. Whether NEC affects infants' growth and development is controversial. The purpose of this study was to explore the clinical characteristics and outcome and to assess the effect of NEC on growth and neurodevelopment in infants. METHODS: A total of 80 neonates admitted to the neonatal intensive care unit from January 1991 to April 2002 with definite, advanced NEC, including 48 with modified Bell's stage II and 32 with stage III. Sixty six of the patients were premature. Very low birth weight (VLBW) preterm infants without NEC were used as matching controls for the 15 infants with VLBW. The growth and neurodevelopment of patients and controls were assessed using the Bayley Scales of Infant Development-II and compared at 6 and 18 months of corrected age. RESULTS: NEC developed an average of 27.7 days after feeding began. The most common initial signs were abdominal distension, decreased activity, hematochezia, and abdominal tenderness. Thirty four patients (43%) required surgical intervention. Three infants developed short bowel syndrome after surgical resection. The overall mortality was 24% (19/80) and was mostly associated with extensive bowel involvement and NEC-related sepsis or multiple organ failure. Of the surviving 61 infants, 12 (20%) developed intestinal strictures, 2 in the ileum, 6 in the colon, and 4 in both ileum and colon. Compared with controls, the VLBW infants with NEC were shorter and had delayed psychomotor development at 18 months of corrected age. Mental development, however, did not differ significantly. CONCLUSIONS: Intestinal stricture was the most common gastrointestinal complication in this series of infants with NEC. Besides the bowel sequelae, VLBW infants who survive NEC are at risk for impairment of growth and neurodevelopment.     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.