Rose spots and trichinosis--report of a case.
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Adult↗
Biomedical subjects
K K Pun
Publications and source records attributed to K K Pun.
Hepatitis B induced glomerulonephritis, fact or fiction?
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Adult↗
Effects of propranolol and metoprolol on glucose, cyclic AMP and insulin responses during pharmacologic hyperglucagonemia in hemodialysis patients.
Propranolol-induced hypoglycemia in hemodialysis patients has been increasingly recognized. We studied the effects of a nonselective beta-blocker (propranolol) and a beta 1-selective-blocker (metoprolol) on glucose metabolism during pharmacologic hyperglucagonemia in these patients. cAMP and insulin responses to glucagon were noted to be significantly higher in all patients after dialysis. This may possibly be due to the removal of a dialyzable factor suppressing these responses. However, despite a similar cAMP response, patients on propranolol had significantly lower glucose response than those not receiving beta-blocker before and after dialysis. While patients on metoprolol also had impaired glucose response before dialysis, this significantly improved after dialysis possibly due to the removal of active metabolite(s). Results suggest that metoprolol has less interference on glucose response to glucagon than propranolol in hemodialysis.
Adult↗
A case of invasive penicilliosis in Hong Kong with immunologic evaluation.
A 53-yr-old Chinese sailor developed prolonged pyrexia with unresolved lobar pneumonia, cervical lymphadenopathy, generalized subcutaneous abscesses, and pericardial effusion. Penicillium marneffei was isolated from pericardial fluid and subcutaneous pus and was demonstrated on histologic sections of lymph nodes and lung tissue. The penicilliosis was treated successfully with amphotericin B, ketoconazole, and 5-fluorocytosine. Subsequently, he also developed other T-lymphocyte-related opportunistic infections such as disseminated cutaneous herpes zoster and chronic osteomyelitis of sternum caused by Salmonella typhimurium. He was also a chronic carrier of cytomegalovirus. Further investigations showed that he had persistent depression of T-lymphocyte function and enhancement of B-lymphocyte activity, the cause of which was undetermined.
Abscess↗
Cardiac tamponade after intracardiac injection.
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Aged↗
Effects of propranolol and hemodialysis on the response of glucose, insulin, C-peptide and cyclic AMP to glucagon challenge.
Hypoglycemia is frequently reported in hemodialysis patients on propranolol. We studied the influence of propranolol on carbohydrate metabolism in sixteen hemodialysis patients (eight on propranolol and eight not) with pre-dialysis oral glucose tolerance tests (OGTT) and pre- and post-dialysis glucagon tests. Propranolol was shown to have significant suppressive effect on the insulin response during OGTT. With glucagon challenge pre- and post-dialysis, despite a similar cAMP response, patients on propranolol had significantly lower glucose response than those not receiving propranolol and it is postulated that this is due to post-receptor post-cAMP inhibition of hepatic glycogenolysis. Moreover, while the glucose response in patients not on propranolol significantly increased after dialysis, no significant change was found in patients on propranolol. The significantly higher C-peptide, insulin and cAMP responses to glucagon challenge in the hemodialysis patients as compared to normal controls may be due to delayed clearance of glucagon, and the further increased responses after dialysis may be due to the removal of a dialyzable factor suppressing these responses.
Adult↗
Retroperitoneal fibrosis associated with schistosoma japonicum infestation--an immunologically mediated disease?
A patient with S. japonicum infestation of the liver presented with acute renal failure due to retroperitoneal fibrosis, together with the presence of low complement levels, anti-nuclear and anti-DNA antibodies. Renal failure responded to intravenous bolus methylprednisone and later definitive surgery, with complement levels returning to normal after the acute episode. The findings are consistent with the hypothesis that retroperitoneal fibrosis may be a local manifestation of a systemic immune disease, in which the associated S. japonicum infestation may have a role.
Acute Kidney Injury↗
Successful treatment of neurocysticercosis with low-dose praziquantel.
A patient with neurocysticercosis was successfully treated with praziquantel. The clinical improvement was paralleled by the resolution of cerebral lesions as revealed by computerized tomography. This case study demonstrates the success of praziquantel and the effectiveness of low-dose regime in treatment of neurocysticercosis.
Brain Diseases↗
Acute intravascular hemolysis due to accidental formalin intoxication during hemodialysis.
A patient accidentally exposed to formalin during hemodialysis developed acute intravascular hemolysis. In vitro study showed that formalin has direct oxidant action on red blood cells. Formalin intoxication should be recognized as a cause of acute hemolysis during hemodialysis and is not invariably fatal, provided further exposure is stopped in time and the complications prevented.
Adult↗
The first documented outbreak of trichinellosis in Hong Kong Chinese.
An outbreak of trichinellosis occurred in a Chinese family after the ingestion of inadequately cooked pork. Diagnosis was established by the demonstration of antibodies against Trichinella spiralis larval antigen by crossed immunoelectrophoresis and enzyme-linked immunosorbent assays, and living larvae in muscle biopsy. The main presenting symptom of these patients was pyrexia. Typical clinical features of Trichinella infection such as periorbital edema and severe myalgia were either minimal or absent. A history of having eaten insufficiently cooked meat is thus extremely important for correct diagnosis. We believe that this is the first documented report of a Trichinella outbreak in Chinese living in Hong Kong.
Adult↗
Parathyroid hormone-activated phosphoinositide degradation and calcium channels in human dermal fibroblasts.
Previous studies have shown that there are two types of parathyroid hormone (PTH) receptors on human dermal fibroblasts. We evaluate the effects of PTH on intracellular cyclic AMP, calcium and phosphoinositides in order to define the effector systems of the PTH receptors. The results show that PTH stimulates cyclic AMP accumulation in the human dermal fibroblasts with half-maximal effect at 1-5 nM. PTH also increases intracellular calcium as measured by the technique using Fura-2 fluorescent dye and stimulates phosphoinositide degradation as evaluated by column chromatography. The half-maximal effect on AMP occurred at 5 nM, while those effect on calcium and phosphoinositide turnover occurred at 500 nM of PTH. The results show that cyclic AMP, intracellular calcium and phosphoinositides are second messengers for PTH in human dermal fibroblasts. These results provide further evidence to support the concept of heterogeneity of the PTH receptor and its effector system.
Biological Transport↗
Humoral hypercalcemia of hepatocellular carcinoma associated with elevated levels of parathyroid-hormone-related-peptide.
Parathyroid-hormone-related-peptide (PTHrP) has been shown to be important in the pathogenesis of hypercalcemia of malignancy. The malignancies most commonly associated with hypersecretion of PTHrP include squamous cell carcinoma and breast cancer. The pathogenesis of hypercalcemia associated with hepatocellular carcinoma was evaluated in this study. Two male patients with hepatocellular carcinoma were found to have severe hypercalcemia at initial presentation. PTHrP was measured with radioimmunoassay in these two patients before treatment as well as in nine other patients with hepatocellular carcinoma but without hypercalcemia. The levels were markedly elevated in the two patients with hypercalcemia (29.3 and 32.1 pM), but were less than 5 pM in the nine patients without hypercalcemia. These results suggest that PTHrP was important in the pathogenesis of hypercalcemia associated with hepatocellular carcinoma in these men.
Journal Article↗
Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine.
Total body and regional bone mineral density (BMD) levels were determined in 26 premenopausal women with Hashimoto's thyroiditis receiving long-term physiological doses of levothyroxine sodium replacement therapy. The BMD levels of each patient were compared with the mean of the BMD levels of age-matched normal controls. The mean levothyroxine sodium dose was 111 +/- 6 micrograms/d, and the mean duration of treatment was 7.5 +/- 5.3 years (range, 1 to 24 years). Dietary calcium intake was similar in both groups, as were serum thyroxine, triiodothyronine, free thyroxine index, and thyrotropin levels. Women receiving the levothyroxine treatment had normal total body BMD levels but had significantly lower BMD levels at the femoral neck (-5.7%), femoral trochanter (-7.0%), Ward's triangle (-10.6%), both arms (right, -7.8%; left, -8.9%), and pelvis (-4.9%). In contrast, lumbar spine BMD levels were similar in the two groups. There was no correlation between the total body or different regional BMD levels and the duration or dosage of levothyroxine treatment or thyroid function test results. However, the z score of the femoral neck of these patients showed a significant negative correlation with their serum free thyroxine index levels. We conclude that patients receiving physiological doses of levothyroxine may have decreased bone density. Thyroid functions in patients receiving long-term levothyroxine treatment should be closely monitored and bone densitometry should be performed in patients at risk for osteoporosis.
Adolescent↗
Analgesic effect of intranasal salmon calcitonin in the treatment of osteoporotic vertebral fractures.
Spinal collapse is a painful complication of osteoporosis. In this study, the analgesic effect of salmon calcitonin, administered intranasally (200 IU per day), was assessed in 18 patients with acute collapse of one to four vertebrae. Pain was evaluated by a descriptive pain scale (ie, Keele's) as well as by the daily consumption of analgesic drugs. When compared with placebo, intranasal salmon calcitonin significantly relieved pain and occasioned a decrease in the consumption of analgesic drugs. No major side effects were reported by the patients under study.
Administration, Intranasal↗