The serum uric acid and related cardiovascular risk factors in south Taiwan

Hyperuricemia has been shown to be related to cardiovascular morbidity and mortality. Uric acid is a metabolic product synthesized from nucleic acids, amino acids and the Krebs cycle, reflecting a multiple metabolic associations in humans. The relation between uric acid and various cardiovascular metabolic parameters in Asians has rarely been reported on. In this study, we report the relationship between uric acid and various cardiovascular risk factors in 1,027 healthy Taiwanese adults living in Alien, an agricultural town in subtropical South Taiwan. Serum uric acid levels increased in proportion to age in women, but not in men. There were age and gender-specific correlations between uric acid and various cardiovascular metabolic parameters. Triglycerides and creatinine levels were two independent factors predicting serum uric acid levels in men, while only creatinine predicted uric acid levels in women of all age groups. Processes that influence the metabolism of uric acid and its association with other metabolic parameters differs by gender and age.     

Abbreviated duration of superheat-and-flush and disinfection of taps for Legionella disinfection: lessons learned from failure

One medical center in southern Taiwan faced an outbreak of nosocomial Legionnaires' disease; a total of 81 suspected cases were detected during an 8-month period. Baseline environmental surveillance showed that 80% of the distal sites in intensive care units (ICUs) were positive for Legionella pneumophila. Superheat-and-flush was selected for hospital water supply disinfection because it required no special equipment, and it can be initiated expeditiously. We conducted 2 episodes of superheat-and-flush based on the published recommendations from the Department of Health, Taiwan; US Centers for Disease Control and Prevention; and American Society of Heating, Refrigerating, and Air-Conditioning Engineers. Both flushes failed to control colonization of Legionella in the hospital water supply. The rate of distal sites positive for Legionella in wards and ICUs was 14% and 66%, respectively, 10 days after the second flush. The effect of replacement of faucets and showerheads in ICUs appeared to be insignificant in colonization of Legionella. The application of superheat-and-flush for flush duration of 5 minutes was ineffective. Superheat-and-flush may not be economic for a large medical center because it could be costly and labor intensive.     

The effect of combination therapy with propylthiouracil and cholestyramine in the treatment of Graves' hyperthyroidism

OBJECTIVE: The study aims to evaluate the efficacy of combination therapy with propylthiouracil (PTU) and cholestyramine in the treatment of Graves' hyperthyroidism. BACKGROUND: Thyroxine (T4) is metabolized mainly in the liver by conjugation to glucuronides and sulphates that enter the enterohepatic circulation. Thyrotoxic patients have an abnormal increase in thyroid hormone in their enterohepatic circulation. Previous studies on combination therapy with methimazole and cholestyramine for Graves' hyperthyroidism have shown it to be an effective adjunctive treatment. In this study, we examined the efficacy of combination therapy with PTU and cholestyramine in the treatment of Graves' hyperthyroidism. METHODS: Thirty patients with newly diagnosed Graves' hyperthyroidism were randomly divided into two groups: group I (n = 15) received PTU 100 mg twice a day, propranolol 40 mg twice a day and cholestyramine 4 g twice a day for 4 weeks; group II (n = 15) received PTU 100 mg twice a day and propranolol 40 mg twice a day for 4 weeks. The therapeutic efficacy was determined by serum total triiodothyronine (TT3), free thyroxine (FT4) and TRAb levels at baseline, and at the end of 2 and 4 weeks during the study period. RESULTS: There was no significant difference in baseline thyroid function parameters. At the end of 2 and 4 weeks of the study period, serum TT3 and FT4 levels of group I were significantly lower than those of group II. No significant differences in the TRAb level were found between the two groups. CONCLUSION: Cholestyramine contributed to a more rapid and complete decline in thyroid hormone levels in patients with Graves' hyperthyroidism. It was thus proved to be an effective and well-tolerated adjunctive therapy.     

Extraordinarily high F-18 FDG uptake caused by radiation necrosis in a patient with nasopharyngeal carcinoma

A false-positive F-18 FDG PET scan caused by osteoradionecrosis and inflammation in patients with nasopharyngeal carcinoma (NPC) has been reported. The standard uptake values (SUVs) in these false-positive cases are always below 6 and decrease with time. This report is concerned with a false-positive result with extraordinarily high F-18 FDG uptake, which increased on the delayed 3-hour image. A 63-year-old man with NPC underwent surgical removal and radiotherapy (7400 cGy) in July 2003. In October 2003, the CT scan showed a large soft tissue mass over the nasopharynx. Tumor recurrence was suspected. F-18 FDG PET scan showed an FDG-avid lesion over the nasopharyngeal region with a maximum SUV of 28.8 at 1 hour that increased to 30.4 at 3 hours. Biopsy was performed and the histopathologic examination showed only necrotic tissue and no evidence of tumor cells. Radiation necrosis was diagnosed. No evidence of tumor recurrence was noted during the 10-month follow-up period.     

Improvement in the performance of the adaptive neighborhood contrast enhancement technique based on entropy

This paper presents an improved adaptive-neighborhood-contrast-enhancement (ANCE) method for the improvement of medical image quality. The ANCE method consists of computing the local contrast around each pixel using a variable neighborhood whose size depends on the statistical properties around the given pixel. The obtained contrast image is then transformed into a new contrast image using a contrast enhancement function. Finally, a contrast-enhanced image is obtained by applying inverse contrast transform to the previous step. This technique provides the advantages of enhancing or preserving image contrast while suppressing noise. However, it does have a drawback. The performance of the ANCE method largely depends on how to determine the parameters used in the processing steps. The present study proposes a novel method for optimal and automatic determination of several parameters using entropy. To quantitatively compare the performance of the proposed method with that of the ANCE method, computer-simulated images are generated. The output-to-input SNR level and the mean squared error are used as comparison criteria. Results demonstrated the superiority of the proposed method. Moreover, we have applied our new algorithm to echocardiograms and mammograms. Our results showed that the proposed method has the potential to become useful for improving the image quality of medical images.     

Tc-99m(V)-DMSA in wound infection after closure of an ileostomy

We present a 71-year-old man who underwent closure of an ileostomy and had a fever seven days post surgery. Both Tc-99m(V)-dimercaptosuccinic acid (DMSA) and gallium-67 citrate scans showed increased tracer accumulation in the right lower quadrant of the abdomen. Tc-99m(V)-DMSA scintigraphy can be a rapid alternative tool in the detection of wound infection in patients after ileostomy closure.     

Simultaneous development of bilateral retrobulbar and intradural spinal masses following donor lymphocyte infusions for acute lymphoblastic leukemia relapsing after bone marrow transplantation

The authors describe a 6-year-old boy with acute lymphoblastic leukemia in relapse after bone marrow transplantation. Complete remission was obtained after reinduction chemotherapy followed by donor lymphocyte infusions. Ten months later, right-sided proptosis and exotropia developed, with back pain and leg paralysis. Computed tomography revealed bilateral orbital masses. Magnetic resonance imaging demonstrated abnormal signal intensity in the T4-6 vertebral bodies and an intradural mass on the left posterior side of the spinal canal. Although bone marrow aspiration was negative, orbital mass biopsies revealed CD10-positive lymphoblasts. Chimerism analysis of bone marrow and peripheral blood showed full donor alleles. Local radiotherapy and chemotherapy resulted in neurologic improvement.     

Impact of duration of cryopreservation of spermatozoa obtained through testicular sperm extraction on intracytoplasmic sperm injection

Cryopreservation of testicular spermatozoa is feasible for patients suffering obstructive or nonobstructive azoospermia. A stndardized intracytoplasmic sperm injection procedure using frozen-thawed testicular tissue gives rise to fertilization and cleavage rates, which appear not to be affected by the duration of the period of cryostorage.     

T allele for VEGF gene-460 polymorphism at the 5'-untranslated region: association with a higher susceptibility to endometriosis

OBJECTIVE: To investigate whether vascular endothelial growth factor (VEGF) gene 5'-UTR-460 polymorphism could be used as a marker of susceptibility to endometriosis. STUDY DESIGN: Women were divided into 2 groups, endometriosis (n = 122) and nonendometriosis (n = 131). Polymorphisms for VEGF were detected by polymerase chain reaction and BstUI (New England Biolabs, Beverly, Massachusetts) restriction enzyme analysis. Genotypes and allelic frequencies between the groups were compared. RESULTS: Proportions of different VEGF polymorphisms in the groups were significantly different. Proportions of cuttable (C) homozygote/heterozygote/ uncuttable (T) homozygotefor VEGF in the groups were 0/44.3/55.7% and 0/63.4/36.6%, respectively. A higher percentage of T/F homozygote and T allele was present in the endometriosis population. The proportions of C/T alleles in the groups were 22.1/77.9% and 31.7/68.3%, respectively. CONCLUSION: T/T homozygotes and the T allele of the VEGF-460 gene are associated with a higher risk of endometriosis. Heterozygotes and C allele are related to the lower risk of endometriosis formation. VEGF polymorphism likely contributes to the pathogenesis of endometriosis and may become a useful markerfor predicting endometriosis susceptibility.     

Short-term postoperative GnRH analogue or danazol treatment after conservative surgery for stage III or IV endometriosis before ovarian stimulation: a prospective, randomized study

OBJECTIVE: To assess the effect of short-term use of a gonadotropin releasing hormone (GnRH) analogue for 3 months before ovarian stimulation in patients with stage III and IV endometriosis after conservative surgery. STUDY DESIGN: Eleven patients were randomly selected to receive intramuscular injections of GnRH analogue, leuprolide acetate (3.75 mg), every 28 days, or 400 mg danazol orally 2 times per day for 3 months before ovarian stimulation after conservative laparoscopic or laparotomy surgeryfor stage III and IV symptomatic endometriosis (group 1), as compared with 30 patients who had received no postoperative treatment with GnRH analogue or danazol but underwent ovarian stimulation immediately after thefirst menses within 3 months postoperatively (group 2). RESULTS: Although the number of oocytes retrieved and number of embryos per cycle were significantly higher in group 1, the pregnancy rate per cycle in group 1 was not significantly different from that in group 2 (18% vs. 20%). The cumulative pregnancy rate at 12 months was 54.5% and 56.7% in group 1 and group 2, respectively. With regard to recurrence of disease after 24 months of follow-up, group 2 had a statistically significantly higher recurrence rate (13.3%) than did group 1 (0%). CONCLUSION: Short-term use of GnRH analogue before ovarian stimulation in women with stage III or IV endometriosis confers no definite benefits on pregnancy rates per cycle when compared with patients who received ovarian stimulation within 3 months after conservative surgery.