BACKGROUND:To evaluate the effects of sphenopalatine artery electrocautery for the treatment of recurrent posterior epistaxis.METHODS:Nine patients were enrolled in the study. Seven patients had hypertension, two had diabetes, two received irradiation for nasopharyngeal carcinoma, one had congestive heart failure and one was a heavy drinker. Three patients needed blood transfusion for profound blood loss. The sphenopalatine artery electrocautery was performed transnasally with endoscope. After the sphenopalatine foramen was identified through dissecting the mucosa of middle meatus posteriorly one centimeter from the choana, the neurovascular bundle in the sphenopalatine foramen was cauterized.RESULTS:Most operations can be performed within fifty minutes with minimal blood loss under local anesthesia. One patient developed minor epistaxis 2 months after surgery, and the bleeding was controlled with medical treatment. The other patients had no recurrent epistaxis after surgery. Thus, epistaxis was well controlled in all patients without complications. The follow-up duration was 2 to 14 months after surgery, with a mean duration of 10 months.CONCLUSIONS:Transnasal sphenopalatine artery electrocautery is a simple, effective and safe method for the treatment of posterior epistaxis.
BACKGROUND:Epistaxis is a common disease. That is usually self-limited and controlled by extemal compression. However, posterior epistaxis is occasionally complicated and needs hospitalization. The aim of this study is to analyze the etiology of epistaxis that requires hospitalization, and present the results of the treatments.METHODS:From June 1997 to May 1999, 44 patients admitted under diagnosis of epistaxis were retrospectively investigated. Among these patients, 7 were admitted twice for epistaxis. The demographics, administrative history, post-history and associated diseases, treatment and complications were analyzed. Noninterventional treatment comprised of nasal packing and local electrocauterization; interventional treatment included surgery and embolization.RESULTS:The mean age of the patients enrolled was 53.4 years. Men outnumbered women in a rate of 3:1. The mean length for hospital stays was 8.1 days for noninterventionally-treated patients, 11.8 days for interventionally-treated patients. Emergency room visit prior to admission was noted in 68.6% of the patients. Hypertension, nasopharyngeal carcinoma (NPC) after radiotherapy, a history of nasal operations and smoking were four major associated diseases. The failure rate to control the epistaxis was 26.7% for noninterventional treatments and 16.7% for interventional treatments. The complication rate was 2% for the entire study, and the mortality rate was 7.8%. All the mortal patients were post-irradiation NPC patients with internal carotid artery bleeding.CONCLUSIONS:Most epistaxis patients can be managed in a noninterventional manner. Interventional treatment is only warranted in those whose epistaxis persists after adequate noninterventional treatment. For internal carotid artery epistaxis in NPC patients, embolization should be performed as soon as possible.
BACKGROUND:We evaluated the diagnostic efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in the differential diagnosis of Cushing's syndrome and compared it with the standard high-dose dexamethasone suppression test.METHODS:Twelve healthy volunteers and 30 with Cushing's syndrome (12 Cushing's disease and 18 adrenal Cushing's syndrome) were enrolled. Plasma ACTH and cortisol levels were measured before and after an intravenous bolus of 100 microg oCRH. Plasma and urinary free cortisol were determined after standard 2-day high-dose dexamethasone suppression.RESULTS:Basal cortisol in 12 patients with Cushing's disease and 18 with adrenal Cushing's syndrome were higher than the control group (21.4 +/- 0.1 microg/dl vs. 22.3 +/- 0.5 microg/dl vs. 9.1 +/- 1.5 microg/dl; p < 0.01). In Cushing's disease, basal plasma ACTH value was significantly higher than those with adrenal disease (61.1 +/- 1.4 pg/ml vs. 6.2 +/- 4.5 pg/ml; p < 0.01). After oCRH, plasma ACTH and cortisol significantly increased, with a mean of 2.0 +/- 0.2-fold (range 1.0-2.4) and 1.6 +/- 0.1-fold (range 1.1-2.1), respectively over the basal values in patients with Cushing's disease, and 11 (90%) attained a significant ACTH (1.5-fold) or cortisol (1.2-fold) response. All except 2 (89%) with adrenal Cushing's showed no apparent change in response to oCRH. Dexamethsone suppressed urinary free cortisol by 90% in 8 (67%) with Cushing's disease, but all (100%) with adrenal Cushing's syndrome were resistant. No patient with Cushing's disease was refractory to oCRH and dexamethasone, while none with adrenal Cushing's syndrome was responsive to both. Combination of both tests could achieved a specificity of 100% for Cushing's disease and adrenal Cushing's, when these 2 tests gave concomitant positive or negative results, respectively.CONCLUSIONS:The oCRH test is a reliable examination in the differential diagnosis of Cushing's syndrome and is comparable to the high-dose dexamethasone test. A highest discrimination could be achieved when both are used.
This review article summarizes recent studies on myofascial trigger point (MTrP) to further clarify the mechanism of MTrP. MTrP is the major cause of muscle pain (myofascial pain) in clinical practice. There are multiple MTrP loci in an MTrP region. An MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is the site from which pain, referred pain (ReP), and local twitch response (LTR) can be elicited by needle stimulation. Sensitive loci are probably sensitized nociceptors based on a histological study. They are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is the site from which spontaneous electrical activity (SEA) can be recorded. Active loci are dysfunctional endplates since SEA is essentially the same as endplate noise (EPN) recorded from an abnormal endplate as reported by neurophysiologists. Both ReP and LTRs are mediated through spinal cord mechanisms, demonstrated in both human and animal studies. The pathogenesis of MTrPs appears to be related to the integration in the spinal cord (formation of MTrP circuits) in response to the disturbance of the nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. Methods usually applied to treat MTrPs include stretch, massage, thermotherapy, electrotherapy, laser therapy, MTrP injection, dry needling, and acupuncture. The mechanism of acupuncture is similar to dry needling or MTrP injection. The new technique of MTrP injection can also be used to treat neurogenic spasticity.
Epidural lipomatosis is an uncommon disorder defined as a pathologic overgrowth of normal epidural fat. It is most often associated with administration of exogenous steroids of variable duration and dose. However, it can occur in the absence of exposure to steroids. We report two cases of spinal epidural lipomatosis following more than 20 years of steroid use due to asthma. Pathologic compression fracture due to osteoporosis and acute cord compression syndrome were found in these 2 cases. After emergent decompressive laminectomy and fusion surgery, neurological function recovered. From a review of literature, most patients received decompressive laminectomy surgery. But in our additional cases, we performed decompressive laminectomy and fusion surgery which might prevent further spinal deformity and improve the spinal stability, then patients' symptoms subsided completely. Therefore, decompression surgery and fusion surgery may be necessary in patients with symptomatic spinal epidural lipomatosis with compression fracture.
Phthiriasis palpebrarum is an unusual cause of blepharoconjunctivitis and may easily be overlooked because of the failure of physicians to recognize Phthirus pubis. We report a case of a 30-year-old woman with persistent itching in the left eyelid which was unsuccessfully treated under the diagnosis of allergic blepharoconjunctivitis. Careful ophthalmic examination revealed seven bugs with multiple red pinpoint excretions and numerous small translucent oval eggs (nits) coating the eyelashes. The patient was successfully treated with mechanical removal of all the lice and nits from the eyelashes. The specimen proved histopathologically to be the Phthirus pubis infestation. The Phthirus pubis infestation is usually associated with poor hygiene in overcrowded or undeveloped country. However, it may become a notable problem because of frequent traveling and commercial activities across the different countries.
BACKGROUND:Enucleation of pancreatic tumor has the potential risk for damage of the main pancreatic duct. Benign tumors located in the neck or body of the pancreas are usually removed by left (spleno-) pancreatectomy or pancreatoduodenectomy. Standard pancreatic resection may result in serious loss of normal pancreatic parenchyme and impairment of pancreatic function. The aim of this study is to evaluate the results of segmental pancreatectomy, a limited resection of the midportion of the pancreas, in patients with benign tumor of the pancreas.METHODS:Four patients with benign tumor over pancreatic neck or body were treated with segmental pancreatectomy after pathological confirmation by frozen section. The proximal stump was closed and distal stump was anastomosed with a Roux-en-Y pancreaticojejunostomy. Clinical evaluation, routine blood sugar, stool fat examination and abdominal ultrasonography were performed for their follow up.RESULTS:Segmental pancreatectomy was satisfactory in these four patients. The pathologic examinations revealed serous cystadenoma. No mortality was noted. Minor pancreatic fistula was found in three of them and was treated conservatively. No obvious exocrine insufficiency was noticed. One patient had diabetes mellitus before operation, which was persisted postoperatively.CONCLUSIONS:Segmental pancreatectomy is a safe and effective alternative to major pancreatic resection in selected patients with benign tumor of the pancreas. This procedure has a surgical risk similar to that of the standard operation, but preserves more pancreatic tissues, which may prevent pancreatic function impairment.
BACKGROUND:Hearing loss is a prevalent chronic problem among adults of all ages. Early identification and intervention for hearing loss will reduce the magnitude of functional disability. Hearing screening is an important item of physical examination. The purpose of this study is to evaluate the validity of hearing screening by means of the portable screening pure-tone audiometer and distortion-product otoacoustic emissions (DPOAE) measurement.METHODS:This prospective study recruited 64 subjects visiting Taipei Veterans Hospital for physical examination. They underwent hearing tests performed with screening pure-tone audiometer, DPOAE and conventional pure-tone audiometer. The results of conventional pure-tone audiometry were used for "gold standards" and the normal auditory function was defined as the threshold less than or equal to 20 dB. Compared with the "gold standards," we used kappa statistic to assess the agreement of hearing results measured with screening pure-tone audiometer and DPOAE.RESULTS:For screening pure-tone audiometry, the kappa values at the 5 tested frequencies (0.5, 1, 2, 4, 8 kHz) ranged from 0.79 to 0.93 and the agreement with the gold standards was classified as "excellent." The sensitivity, specificity and test accuracy values ranged from 91.8-98.5%, 88.0-96.3% and 89.8-96.9%, respectively. For DPOAE measurement, the kappa values at the 3 tested frequencies (1, 2, 4 kHz) ranged from 0.62 to 0.78. The agreement was classified as "good" at 1, 4 kHz and "excellent" at 2 kHz. The sensitivity, specificity and test accuracy values ranged from 91.7-98.5%, 62.3-86.8% and 81.3-89.1%.CONCLUSIONS:We recommend a hearing screening measured at 0.5, 1, 2, 4, 8 kHz with screening pure-tone audiometer in a simple-type soundproof chamber and performed by a screening assistant. The DPOAE measurement may be used as an auxiliary tool to provide more information for early identification and differential diagnosis of hearing loss in clinical application.
BACKGROUND:Dental plaque has been suggested as a permanent reservoir of Helicobacter pylori (H. pylori) and a potential source of reinfection. The aims of this study were to investigate the presence of H. pylori in both dental plaque and the stomach and to evaluate the therapeutic effect of triple therapy on H. pylori in dental plaque.METHODS:Dental plaque and gastric biopsy samples were obtained from 65 patients with dyspeptic symptoms for endoscopic examination. The prevalence of H. pylori in dental plaque and stomach was determined with rapid urease test, histologic examinations and polymerase chain reaction assay based on the primer pair derived from the cagA gene of H. pylori. Triple therapy was administered to patients infected with H. pylori. H. pylori status was re-evaluated after eradication therapy.RESULTS:Prior to treatment, H. pylori was found in the stomach in 38 of 65 (58%) patients and in dental plaque in 28 of 65 (43%) patients. The coexisting infection rate of H. pylori in both stomach and dental plaque was 74%. After triple therapy, H. pylori was eradicated from the stomach in 32 of 38 (84%) patients, but only 2 of 28 (7%) patients with coexisting H. pylori infections of stomach and dental plaque showed the elimination of H. pylori from dental plaque.CONCLUSIONS:The high coexisting infection rate of H. pylori in both stomach and dental plaque implies that dental plaque can serve as another reservoir of H. pylori. H. pylori in dental plaque was hardly eradicated by triple therapy. Dental plaque may be a potential source for recrudescence of gastric infection after successful systemic therapy.
BACKGROUND:Remnants of thyroid tissue are always present after surgery performed for thyroid cancer, and their ablation with I-131 is associated with decreased recurrence rates and probably increased survival. Administration of a single dose in excess of 50 mCi of I-131 requires hospitalization. In an attempt to obviate the necessity for hospitalization, the ablative dose was divided into three fractions given at weekly intervals. The purpose of this study was to assess the effectiveness of this approach.METHODS:We retrospectively analyzed the success rate of ninety-nine patients from 1995 to 1999 with thyroid carcinoma who received fractionated dose of ablation. Iodine-131 whole body scan was done 6 months after ablation to evaluate treatment efficacy. In addition, measurement of serum thyroglobulin (Tg) was obtained in 81 patients.RESULTS:"Successful ablation" has been defined as the absence of all residual thyroid uptake in the I-131 whole body scan. Ablation of thyroid remnants was successful in 71 of 99 (71.7%) patients (papillary cell type 89%; follicular cell type 53%). In 54 patients with negative I-131 whole body scan, 39 patients had undetectable serum Tg, and 11 patients were with serum Tg level below 10 ng/ml. In 27 patients with positive I-131 whole body scan, 15 patients had undetectable serum Tg.CONCLUSIONS:We suggest that the use of fractionated doses of 1-131 is a reasonable approach to ablation therapy. Tg measurement appears to be superior to I-131 whole body scan in follow-up of patients with differentiated thyroid carcinoma. However, Tg measurement can certainly not replace I-131 whole body scan. A combined application of I-131 whole body scan and Tg radioimmunoassay is thus advisable.
BACKGROUND:Chronic peritoneal dialysis (CPD) is the most commonly used method of pediatric dialysis. The preservation of peritoneal membrane function is essential for successful peritoneal dialysis. Two main factors are responsible for long-term loss of membrane function. Peritonitis, the major complication of CAPD, can be life-threatening and lead to more rapid failure of the technique. The other factor is continuous exposure of peritoneal membrane to bioincompatible dialysis solutions. To investigate the role of repeated peritonitis on peritoneal membrane function, we performed a retrospective study to elucidate the association between peritonitis episodes and peritoneal membrane solute transport characteristics.METHODS:From 1996-2000, 32 pediatric peritoneal dialysis patients were included in this study. According to the peritonitis occurrence frequency, 8 patients were divided into HPO group (peritonitis occurrence rate > or = 5 times/year), and 24 patients were divided into LPO group (peritonitis occurrence rate < or = 1 time/year). The mean age of study patients was 13.95 +/- 5.27 years. The peritoneal equilibration test was performed to evaluate the peritoneal membrane dialyzing function.RESULTS:The mean duration of peritoneal dialysis was 3.31 +/- 1.08 years. The change of peritoneal solute transport (AD/P), computed by subtraction of 4-hour D/P at baseline PET study from that at the last follow-up PET study, showed significant difference (p < 0.05) between HPO (-0.234 + 0.074) and LPO (-0.040 +/- 0.079) groups of children. There was also a significant correlation between repeated peritonitis occurrence and PET deterioration(p < 0.05). The relative risk was 2.63.CONCLUSIONS:Children with frequent peritonitis occurrence have significant decreasing peritoneal solute transport and decreasing PET scaling in follow-up period.
BACKGROUND:[corrected] Pneumosinus dilatans (PSD) is a rare condition. It has been reported in association with spheno-orbital meningioma, optic nerve sheath meningioma, orbital fibro-osseous diseases and intracranial meningioma, but never with orbital neurilemmoma. We report 4 cases of orbital neurilemmomas in association with PSD, and stress the importance of PSD in cases of orbital neurilemmomas. METHODS:We reviewed the hospital chart, and found 324 orbital tumors were found from 1974 to 1996. Eight consecutive cases of pathology-proven primary orbital neurilemmoma were studied. Clinical features, es pecially computed tomography (CT) scan, were completely reviewed to find the co-existence of orbital neurilemmoma and pneumosinus dilatans. RESULTS:Four cases (50%) among 8 cases of pathology-proven orbital neurilemmomas were found to have pneumosinus dilatans in their CT scan. All these four cases were extraconal tumors. Representative CT scan showed enlarged, aerated sinus with thinning of the affected sinus walls. Ethmoidal, frontal and maxillary sinuses were the most frequently affected. CONCLUSIONS:Pneumosinus dilatans is commonly associated with primary orbital neurilemmoma.
BACKGROUND:Indomethacin, an NSAID capable of inhibiting the effect of both cyclooxygenase and lipooxygenase, has been reported to repress the growth of breast cancer, skin cancer and head & neck cancer, etc. Inhibition in the some cell lines of oral squamous cell carcinoma (OSCC) has also been reported. The purpose of this study was primarily to explore the cellular response of human OSCC lines after indomethacin or retinoic acid (RA) treatment and its correlation to apoptosis phenomenon.METHODS:Five human OSCC cell lines--KB, SCC15, SCC25, OEC-M1 and OC2--were used for this in vitro study. By direct cell number counting, the cellular response was observed under incremental indomethacin concentrations of 50 microM, 100 microM, 200 microM and 400 microM, in order to select the most appropriate concentration for further study. Then 200 microM indomethacin and all-trans RA at 1 microM were used in the 2nd experiment to explore the intensity of their inhibitory effects individually and potential synergistic inhibition when exerted together. While in the 3rd part, TdT-mediated-dUTP nick-end labeling (TUNEL) method was used for in situ apoptosis assay to see if the apoptosis rate varied with these two agents.RESULTS:All 5 cell lines constantly showed growth suppression with positive dosage effect of indomethacin. Synergistic inhibition by combined treatment of indomethacin and RA was seen in RA responsive lines of SCC15 and SCC25, whereas other RA-resistant clones showed no synergism of this combined treatment. The in situ detection of apoptosis by TUNEL assay revealed a significantly higher ratio of apoptotic cells in the indomethacin/RA treated SCC15 and SCC25 than in controls.CONCLUSIONS:The study provides the value of further exploration on the mechanism of how indomethacin inhibiting cancer cell growth and how RA-sensitive OSCC cell lines are synergistically suppressed by conjoint treatment of RA and indomethacin. This study also highlights the value to see how the apoptotic pathway responds differently to the indomethacin/RA treatment.
BACKGROUNDColorectal cancer is one of the most common cancers in Taiwan, as in the other part of the world. Surgical intervention is the best treatment of choice, yet some patients still developed distant metastasis after primary lesions were controlled. Metastasectomy is reported to improve the survival. This retrospective study was carried out to evaluate the relationship between the prognostic factors of lung metastasectomy and patient survival.METHODSFrom 1981 to 2000, 68 patients undergoing complete lung metastasectomy in our section were studied. The prognostic factors influencing survival were analyzed, and the survival analysis was made with Kaplan-Meier method and compared by log-rank test.RESULTSThere was no surgical mortality in our series. The 5-year survival was 36.1%. None of parameters such as age, sex, stage of primary colorectal cancer, surgical method, size, number of metastatic deposits and disease free interval showed to relate with the survival.CONCLUSIONSWe concluded that lung metastasectomy for colorectal cancer is safe and effective to improve the survival. Since there were no significant factors influencing the survival, there should be no absolute contraindication against resectable pulmonary metastasis after primary lesions were adequately controlled.
BACKGROUND:Adequate surgical treatment of hypoglycemia caused by benign diffuse islet cell disease (BDICD) is not associated with predictable results. Arterial stimulation and venous sampling (ASVS) has been reported to establish the diagnosis of BDICD, as well as serve as a guide to resection. The purpose of this study is to determine the efficacy of this method for the treatment of benign diffuse islet cell disease.METHODS:We retrospectively reviewed 38 adults with symptomatic hyperinsulinemic hypoglycemia treated by a single surgeon from 1982 to 1998. Nine of them had pathologic evidence of BDICD. We demonstrated the clinical presentations, serum level of fasting blood sugar, insulin and C-peptide before and after operations, pathological results, and outcomes of distal pancreatectomy in 5 patients and ASVS-guided pancreatectomies in 4 patients with BDICD.RESULTS:Five patients (4 females and 1 male) who received distal pancreatectomy (Group 1) were aged from 19 to 75, and were culled from a group of 30 patients with spontaneous hyperinsulinemic hypoglycemia. Two had the multiple endocrine neoplasia (MEN) 1 syndrome. The follow-up was from 7 to 16 years. Three patients (including 1 MEN 1 patient) became diabetic. Another 1 is euglycemic, and the other MEN 1 patient developed recurrent disease. Four patients (2 males and 2 females, Group 2), found in a group of 8 patients with hyperinsulinemic hypoglycemia, had ASVS-guided pancreatectomies. Their ages ranged from 29 to 69 years. The area of the pancreas supplied by the splenic artery was removed in all patients. Follow-up from half to 2 years showed that all the patients had normal fasting levels of glucose, normal levels of insulin and C-peptide, and no more hypoglycemic attacks.CONCLUSIONS:Arterial stimulation venous sampling is a useful guide for pancreatectomy to treat adult patients with BDICD. Data from this small sample of patients suggest that the results may be superior to those obtained by "blind" distal pancreatectomy.
BACKGROUND Higher blood pressure level in the normotensive range is a major predictor of the development of hypertension. The purpose of the present study was to investigate the risk factor profiles among different normotensive categories according to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). METHODS This community-based survey was conducted in five counties of Kinmen from 1991 to 1995. We analyzed the data of fasting blood sugar, insulin, total and high-density lipoprotein cholesterol, triglyceride, blood urea nitrogen, creatinine, body mass index (BMI), and waist circumference from 6,372 normotensive respondents (2511 men and 3861 women), who were categorized into three groups (High Normal, Normal, and Optimal) by JNC VI classification. RESULTS By univariate analysis, significant differences among the groups were shown in fasting blood sugar, insulin, triglyceride, total cholesterol, BMI and waist circumference in both male and female population. By multiple stepwise logistic regression analysis, High Normal Group had significantly higher percentage of obesity (OR = 2.96, 95% CI = 1.77 4.13 in men; OR = 2.81, 95% CI = 2.16 - 3.34 in women) than Optimal Group. Normal Group had more obesity (OR = 2.01,95% CI = 1.09 - 3.70 in men; OR = 1.73, 95% CI = 1.31 - 2.30 in women) than Optimal Group, and High Normal Group had more obesity (OR = 1.81, 95% CI = 1.05 - 2.92 in men; OR = 1.45,95% CI = 1.06 - 2.08 in women) than Normal Group. CONCLUSIONS Normotensive subjects in the higher blood pressure categories had worse risk factor profiles. Obesity was the most important and consistent determinant of higher blood pressure categories.
BACKGROUND:Before embarking on a clinical human pancreas transplantation program we sought a canine animal model with enteric drainage to refine our technical skills, to evaluate the surgical risks and to study the rejection pictures under modern triple immunosuppression therapy.METHODS:Twenty donor-recipient pairs of unrelated mongrel dogs underwent pancreaticoduodenal allotransplantation with enteric drainage. All dogs were immunosuppressed by triple therapy with prednisolone, cyclosporine (Neoral) and mycophenolate mofetil (MMF). Rejection grade and surgical risk were evaluated.RESULTS:Group 1 included 10 (50%) dogs surviving at least 14 days. In group 2 surviving less than 14 days, the median survival was 5.5 days, ranging from 1 day to 13 days. The most common complications were duodenal stump leakage and wound infection. Duodenal stump leakage eventually led to mortality in 3 dogs of group 2. Two (in group 2) of the 3 wound infections became too severe to control and caused death. There were 2 dogs complicated with graft necrosis and 2 with graft vascular thrombosis individually, which all resulted in death. Other fatal complications included 1 chyle leakage, 1 intraabdominal abscess and 1 pneumonia individually. Ninety percent in each group developed rejection. Severe rejection developed in 5 (50%) dogs in group 2 (grade 4 and 5), p = 0.033, as compared with none in group 1. The rejection in most cases (90%) of group 1 was mild to moderate, with 4 grade 3, 3 grade 2 and 2 grade 1.CONCLUSIONS:Canine pancreas allotransplantation with enteric drainage is a feasible animal model to achieve survival longer than 14 days in 50% cases studied. Duodenal stump leakage was the most common fatal complication in this model. Severity of rejection was closely associated with posttransplant fatal complications and played a crucial role in determining the dog survival.
BACKGROUND:We have previously shown that an increase in NO activity activated ATP-sensitive potassium channel (K(ATP)) and shortened action potential duration (APD) in an endotoxic shock model. Because the increase in NO production and the decrease of APD appear to be downstream late events in endotoxic shock, we hypothesized that a common signaling pathway might mediate these effects.METHODS:Using a guinea pig model of endotoxic shock, we investigated the effect of genistein and tyrphostin AG 556 on the cardiac action potential. Adult Hartley guinea pigs (300 to 450 gm) were randomized into 2 treatment parts. In the chronic treatment part, guinea pigs were randomized to receive daily subcutaneous injection of one of the five agents: saline, genistein, tyrphostin AG 556, daidzein, and vehicle for 10 days. In the acute treatment part, these agents were administered by intraperitoneal injection 1 hour before endotoxic shock. The animals were then anesthetized and mechanically ventilated, and underwent 6-hour endotoxic shock or sham experiment.RESULTS:In the chronic treatment part, the plasma nitrate concentration, myocardial guanosine 3',5'-cyclic monophosphate (cGMP) content, and APD at 90% repolarization (APD90) of papillary muscle showed no difference in the five groups before endotoxic shock. After 6-hour endotoxic shock, the elevation of plasma nitrate concentration and myocardial cGMP content was found significant in the control, the daidzein, and the vehicle groups, but was blunted in the genistein and the tyrphostin groups. The shortening of APD90 of papillary muscle was also significant in the control, the daidzein, and the vehicle groups, but blunted in the genistein and tyrphostin groups. There were similar findings in the acute treatment part, except the weaker effect of genistein and tyrphostin.CONCLUSIONS:Genistein and tyrphostin AG 556, either administered chronically or acutely, significantly attenuate the cardiac APD shortening in endotoxic shock, presumably through the decrease in the plasma nitrate and the cardiac cGMP production. It is suggested that tyrosine kinase signaling plays an important role in the modulation of APD in endotoxic shock.
BACKGROUND:Intra-extracranial hemangiopericytomas (HPCs) are rare vascular neoplasms. This paper reports the clinical manifestations, histopathological features, diagnosis, treatment, and outcomes of HPCs.METHODS:We reviewed three patients with intracranial HPC and one patient with HPC of the scalp who were surgically treated at Taichung Veterans General Hospital between 1989 and 1999.RESULTS:All four patients underwent surgery and postoperative radiotherapy. After surgery, three patients showed improvement compared with their preoperative neurological function. Two patients had recurrent tumors, one patient was well and free from tumor recurrence, and one patient was lost during follow-up.CONCLUSIONS:Clinical presentation and radiographic appearance of intracranial HPC can be indistinguishable from meningioma. Intracranial HPC is an aggressive neoplasm with malignant potential. Both benign and malignant variations of HPC of the scalp exist. The principal treatment is surgical excision. Survival is influenced by more aggressive primary resection and by postoperative radiotherapy. Recurrences are common. Metastases may be multiple and can develop in many organs and systems.
