Double gaps metabolic acidosis and bilateral basal ganglion lesions in methanol intoxication.
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Acidosis↗
Biomedical subjects
S H Lin
Publications and source records attributed to S H Lin.
A prospective study of calcium metabolism in exertional heat stroke with rhabdomyolysis and acute renal failure.
Intensive training in a humid and warm environment can cause exertional heat stroke (ExHS) and rhabdomolysis (RBD) in military recruits. To investigate the role of vitamin D and monomeric calcitonin (CT) on the calcium metabolism in ExHS with RBD and acute renal failure (ARF), we studied 21 recruits with ExHS (mean age 21.4 years), 7 of which had ARF. Another 11 age-matched recruits with heat exhaustion (HE) and 11 healthy subjects were selected as controls. Our results showed that in 14 ExHS patients without ARF, mean serum creatinine (Cr) levels were significantly higher (151.16 vs. 106.08 mumol/l, p < 0.01), whereas serum osteocalcin (OC) levels were significantly lower (2.22 vs. 4.65 micrograms/l, p < 0.01) than in healthy controls. In 7 patients with ExHS and ARF, the mean serum Cr (774.38 vs. 105.20 mumol/l, p < 0.01), phosphorus (P) (2.26 vs. 1.26 mmol/l, p < 0.05), creatine phosphokinase (CPK) 274,143.97 vs. 85.78 IU/l, p < 0.05), intact parathyroid hormone (I-PTH) (299.81 vs. 18.66 ng/l, p < 0.05) and CT (13.58 vs. 6.63 ng/l, p < 0.01) levels on admission were significantly higher while the mean ionized calcium (iCa) levels were significantly lower than the healthy controls (0.9 vs. 1.18 mmol/l, p < 0.01). The mean serum 25-hydroxyvitamin D [25(OH)D] levels were not significantly different from healthy controls. However, mean serum 1,25-dihydroxyvitamin D [1,25(OH)2D] levels and the ratio of 1,25(OH)2D to 25(OH)D were significantly lower than healthy controls throughout the whole course of ARF. None of the 7 patients with ExHS and ARF developed hypercalcemia during the diuretic phase. Their mean serum I-PTH levels decreased significantly from 299 to 18 ng/l during the recovery phase (p < 0.05). Our study seems to suggest that the abnormal calcium metabolism in this unique patient group is in part caused by persistently decreased renal production of 1,25(OH)2D, although increased monomeric CT levels were associated with hypocalcemia. However, whether or not a causal relationship exists merits further investigation.
Acute Kidney Injury↗
Mannitol increases cerebral arteriovenous oxygen difference in patients undergoing craniotomy.
BACKGROUND: Monitoring the jugular venous oxygen saturation (SjVO2) and cerebral arteriovenous oxygen difference (AVDO2) is valuable in detecting cerebral ischemia. In the present study, we investigated the effect of mannitol on SjVO2 and AVDO2 in patients undergoing craniotomy. METHODS: We studied 25 ASA class II-III patients undergoing craniotomy. Anesthesia was induced with thiopental, fentanyl and vecuronium. Immediately after induction, a 16-gauge central venous catheter was placed in the internal jugular vein, ipsilateral to the lesion side with cephalic insertion and anchorage in the jugular bulb. Anesthesia was maintained with continuous infusion of fentanyl (10 micrograms/kg/h), 0.5-1% isoflurane in 60% oxygen (oxygen/air) and supplemental dose of vecuronium for muscle relaxation as needed. Samples of arterial and jugular venous blood were obtained for the measurements of SjVO2 and AVDO2 in the following time intervals: (1) normocapnia (PaCO2 38-40 mmHg); (2) hypocapnia (PaCO2 28-30 mmHg); and (3) 30 min after mannitol (0.5 g/kg) infusion. RESULTS: Hyperventilation resulted in a significant decrease in SjVO2 (96% patients) and increase in AVDO2 (88% patients). Hypocapnia followed by mannitol administration led to a further decrease and increase of SjVO2 and AVDO2 in 72% and 68% patients, respectively. CONCLUSIONS: Mannitol may produce a further reduction in SjVO2 accompanied by an increase in AVDO2, suggesting a reduction of cerebral blood flow (CBF) during hyperventilation. Therefore, it should be given cautiously in neurosurgical patients under hyperventilation.
Adult↗
Isolated vertiginous dysequilibrium due to bilateral caudal cerebellar infarction.
We present a 74-year-old woman who developed a sudden onset of vertigo, vomiting, and axial retropulsion without limb ataxia. A clinical diagnosis of acute peripheral labyrinthine lesion was made initially. However, magnetic resonance imaging demonstrated a small infarct area involving the caudal part of the cerebellar vermis and medial cerebellar hemispheres on both sides. We emphasize that a cautious attitude should be taken in managing patients with isolated vestibular dysfunction, especially in aged person or those associated with stroke risk factor.
Aged↗
Effect of calcitriol treatment on psoriasis in hemodialysis patient: a case report.
The case of a 67-year-old man who has had psoriasis with multiple joints involvement for 30 years and renal failure for 1 year is described. He was admitted because of uremic symptoms and exacerbation of psoriasis. Hypocalcemia and low serum active 1.25(OH)2D3 were also observed. Hemodialysis, oral 1.25(OH)2D3 and CaCO3 supplement were employed. Interestingly, the psoriasis strikingly improved. The relationships among psoriasis, renal failure, 1.25(OH)2D3, serum calcium level and dialysis are discussed.
Aged↗
Fibromuscular dysplasia associated with intracranial giant aneurysm: report of a case.
Although the correlation between fibromuscular dysplasia (FMD) and intracranial aneurysm is well established, the combination of FMD with a giant aneurysm is rare. This paper reports a patient with extracranial FMD associated with a giant intracavernous aneurysm compromising the trigeminal and abducens nerve. A review of the literature uncovered only four documented cases of FMD with concurrent giant intracranial aneurysms. The present case adds further weight to the argument for including FMD in the differential diagnosis list when confronted with a patient with a giant intracranial aneurysm. Absence of adequate collaterals in this patient eliminated ligation as a treatment strategy for the aneurysm.
Adult↗
Dissociation of the restoration of copulatory behavior and the testicular morphology in old male rats with fetal brain grafting.
Improvement of copulatory activity has been reported in aged male rats bearing the fetal preoptic area (POA), however, whether the fetal POA graft has any effect on the gonad of aged male rats has not been established. In the present study, the testicular histology and the sexual behavior were studied in 20 old (18-19 months) Long-Evans male rats after fetal brain transplantation. Animals were divided into three groups: (1) POA-grafted group (n = 6): fetal POA neurons were grafted into the POA, (2) COR-grafted group (n = 7): fetal cerebral cortex tissue was grafted into the POA and (3) SHAM-grafted group (n = 7): the POA of rats received glucose-saline injection. Thirty days after the grafting, only those bearing POA graft showed an increase in mount frequency and intromission frequency. Sixty days after fetal brain grafting, testicular morphology was examined. Testicular volume was measured and paraffin sections (8 microns) of the testis were stained with Hematoxylin-Eosin. Seminiferous tubular diameter and epithelial height were analyzed quantitatively. No significant changes in testicular volume, seminiferous tubular diameter and epithelial height were observed in all three groups. The shrunk testicular morphology in the aged male rats cannot be restored by fetal POA grafting. These results suggest that copulatory behavior and testicular morphology may be dissociated in old male rats.
Aging↗
Prescribing patterns in primary health care in Taiwan.
To identify the prescribing patterns in public group practice centers (GPCs), 84,453 prescription sheets written by primary care physicians in 168 GPCs during the period from December 7-12, 1992, were collected and analyzed. The average number of drugs per script was 4.3 and the ratio of drug to total medical expense was 44%. The 5 most common diagnoses were, in a descending order, upper respiratory tract infection, skeletomuscular and joint disease, hypertension, functional gastrointestinal disorder (including peptic ulcer) and diabetes mellitus. The top 5 most commonly dispensed drug categories were antacids and anti-ulcer drugs, anti-cough and anti-cold preparations, vitamins, simple analgesics and non-steroidal anti-inflammatory drugs, accounting for 48.8% of total prescriptions. In view of the frequency of relevant diagnoses, the overuse of antacids, vitamins, intravenous nutrient and electrolyte solutions, anti-cold preparations and antibiotics was apparent, as was that of drugs of questionable pharmacological value. These data indicate that polypharmacy is a widespread phenomenon and confirms our long-term concern over irrational drug use in GPCs in Taiwan. Both administrative and educational intervention should be implemented to improve prescribing quality at the primary health care level.
Adult↗
Influence of metabolic acidosis on serum 1,25(OH)2D3 levels in chronic renal failure.
Metabolic acidosis has been shown to alter vitamin D metabolism. There is also evidence that calcium may modulate 1,25(OH)2D3 by a parathyroid hormone (PTH)-independent mechanism. To investigate the effect of rapid correction of chronic metabolic acidosis on serum 1,25(OH)2D3 levels by free calcium clamp in chronic renal failure, 20 patients with mild to moderate metabolic acidosis (mean pH 7.31 +/- 0.04) and secondary hyperparathyroidism (mean intact PTH 156.47 +/- 84.20 ng/l) were enrolled in this study. None had yet received any dialysis therapy. Metabolic acidosis was corrected by continuous bicarbonate infusion for 3-4 h until plasma pH was around 7.4, while plasma ionized calcium was held at the preinfusion level by calcium solution infusion during the entire procedure. The plasma pH, bicarbonate, total CO2, sodium, and serum total calcium levels were significantly increased while serum concentrations of alkaline phosphatase and albumin were significantly decreased after bicarbonate infusion. The plasma ionized calcium, potassium, serum magnesium, inorganic phosphorus, and 25(OH)D levels showed no significant change before and after bicarbonate infusion. The serum 1,25(OH)2D3 levels were significantly increased (38.66 +/- 11.77 vs. 47.04 +/- 16.56 pmol/l, p < 0.05) after correction of metabolic acidosis. These results demonstrate that rapid correction of metabolic acidosis raises serum 1,25(OH)2D3 levels in vitamin D-deficient chronic renal failure patients, and may underline the importance of maintaining normal acid-base homeostasis in the presence of secondary hyperparathyroidism in chronic renal failure.
Acidosis↗
Androgen regulation of cell adhesion molecule gene expression in rat prostate during organ degeneration. C-CAM belongs to a class of androgen-repressed genes associated with enriched stem/amplifying cell population after prolonged castration.
Androgen is required for maintaining the differentiated state of prostatic epithelium, and that cell adhesion molecules play active roles in controlling the development of epithelial cells. However, little is known about the regulation of cell adhesion molecules during prostate development. In this study, we demonstrated that the expression of an epithelial cell adhesion molecule, C-CAM, in rat ventral prostatic epithelium are repressed by androgen. A similar regulatory pattern was also observed in the seminal vesicle but not in other androgen-dependent organs (the coagulating gland and the dorsolateral prostate), or other organs (the liver and kidney). These observations suggest that regulation of C-CAM expression by androgen is tissue-specific. Unlike the other androgen-repressed genes associated with apoptosis, which have transient expression patterns, the elevated level of C-CAM in the ventral prostate persisted for more than 30 days postcastration, suggesting that C-CAM belongs to a class of androgen-repressed genes which are not associated with apoptosis. Immunohistochemical study detected C-CAM on the apical surface of secretory epithelium in control rats; castration resulted in an altered localization of C-CAM expression from columnar epithelium to cuboidal basal epithelium. Taken together, the up-regulation and altered expression pattern of C-CAM in ventral prostatic epithelium by androgen deprivation may be associated with the enriched epithelial stem/amplifying cell population in degenerated ventral prostate. These observations suggest that C-CAM may play an active role in the process of prostatic epithelial differentiation.
Adenosine Triphosphatases↗
Effects of intravenous calcitriol on lipid profiles and glucose tolerance in uraemic patients with secondary hyperparathyroidism.
1. Secondary hyperparathyroidism in chronic renal failure may contribute to abnormalities of lipid metabolism and glucose tolerance. Amelioration of secondary hyperparathyroidism has been reported to mitigate the hyperlipidaemia and improve glucose tolerance experimentally. 2. The effect of the partial suppression of hyperparathyroidism by intravenous calcitriol on lipid levels and glucose tolerance was studied in 15 haemodialysis patients with secondary hyperparathyroidism. All received intravenous calcitriol 1 microgram at the end of haemodialysis thrice weekly for eight weeks. Oral glucose tolerance test and plasma lipid profiles including triglyceride, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apoprotein A-I and apoprotein B were determined simultaneously before and after eight weeks of therapy. 3. Before calcitriol treatment, uraemic patients with secondary hyperparathyroidism displayed a significant higher triglyceride and a significant lower HDL-C and apoprotein A-I as well as marked glucose intolerance with an increment of the area below the glucose curve when compared with healthy control subjects. 4. After eight weeks of calcitriol treatment, there was a significant decrement in serum intact parathyroid hormone (476.45 +/- 48.33 versus 191.37 +/- 30.17 ng/l, P < 0.001) and plasma triglyceride (2.24 +/- 0.34 versus 1.80 +/- 0.29 mmol/l, P < 0.05) as well as a significant increment of plasma apoprotein A-I (38.13 +/- 2.14 versus 44.19 +/- 2.18 mumol/l, P < 0.05), whereas there was no significant change in serum total cholesterol, LDL-C, HDL-C, and apoprotein B.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Imerslund-Grasbeck syndrome in a Chinese family with distinct skin lesions refractory to vitamin B12.
Two brothers in a Chinese family with selective malabsorption of vitamin B12 associated with proteinuria (Imerslund-Grasbeck syndrome) presented with widespread mottled skin pigmentation, termed poikiloderma. In contrast to anaemia, this pigmentary disturbance remained unresponsive to vitamin B12 replacement. This is different from the reported hyperpigmentation sometimes seen in vitamin B12 deficiency which is reversible following treatment. As far as is known, an irreversible and persistent skin disorder has not been reported in this syndrome before.
Adult↗
Cell CAM 105 isoform RNA expression is differentially regulated during rat liver regeneration and carcinogenesis.
Cell CAM 105 (C-CAM) is a member of the carcinoembryonic antigen family and has been characterized as a rat hepatocyte cell-cell adhesion molecule via antibody activity. Two isoforms have been cloned and differ primarily in the length of the cytoplasmic domain. Despite extensive structural studies, little is known about their function and regulation in vivo. We have examined C-CAM expression during rat liver regeneration and hepatocarcinogenesis. Steady-state C-CAM RNA varied less than 3-fold during regeneration with subtle changes in the isoform ratio both before and after hepatocyte division. In liver tumors and transformed cells derived from tumors, however, large-scale decreases were observed in C-CAM RNA with wide variations in isoform ratios. In general, RNA decreases were reflected at the protein level. Our data suggest whereas down-regulation and alterations in C-CAM isoform ratio are transient during regulated liver growth, they are permanent in malignancy and may modulate hepatocyte adhesion.
Animals↗
Effects of age on open-field behavior of male rats.
As age advances, the performance of animal behavior declines gradually. The purpose of this study was to investigate the onset of age-related changes in open-field behavior of rats from a wide age spectrum. Male Long-Evans rats, ranging from 2 to 22 months, were placed in an open-field apparatus during the dark phase for a cumulative period of 28 min. Data were collected for the following parameters of open-field behavior: horizontal activity (HA), total distance (TD), stereotypy count (SC), vertical activity (VA), movement time (MT) and margin time (MGT). The highest value of HA, TD, SC and MT was found in rats at the age of 3 months. After 3 months, the values for these parameters gradually declined, subsequently reaching statistical significance by 6 months (HA, TD and SC) or 8.5 months (MT) of age. Maximum activity of VA occurred at 8.5 months of age and thereafter gradually declined with increasing age, however, no significantly statistical difference was reached as compared to the highest value. In contrast, the values for MGT gradually declined after 2 months of age, thereby reaching statistical significance by 11 months of age. These results indicate that the onset of age-related decline in open-field behavioral parameters can differ and the age-related changes in open-field behavior depends on observational parameters.
Age Factors↗
[Dose measurement and risk evaluation in intraoral periapical radiography].
To measure the absorbed dose and evaluate the radiation risk of patient from full mouth series intraoral dental radiography, we used the LiF thermoluminescent dosimeters (TLD-100 chips) to detect the radiation dose of patients and RT-HUMANOID phantom as well. We also used water phantom and extracted human teeth to simulate the oral cavity and measure the absorbed dose of tooth while the intraoral dental radiography was taken. The average absorbed dose of skin near the thyroid gland of patient is 72.2 mu Gy from full mouth series intraoral radiograph with 14 dental films (speed D) using Gendex Panelipse II X-ray machine (75-80kVp, 15mA, 0.25s, FSD = 34-36 cm) with neck shield protection, and the radiation risk of thyroid gland of stochastic effect is estimated to be 3.6 x 10(-8). We also calculated the effective atomic number of enamel and dentin for obtaining the conversion factor of tooth. Four sets of figures were drawn to express the absorbed dose in water phantom and tooth in some different exposure conditions.
Humans↗
Asymptomatic sacral arachnoid cyst in a patient with ankylosing spondylitis.
A sacral arachnoid cyst was found incidentally in a patient with ankylosing spondylitis. The clinical manifestations were perithecal bony erosions and thecal sac displacement while no associated neurological deficit was detected. This peculiar situation is of special interest as cauda equina syndrome invariably presented in such clinical complex. The pathogenesis of the arachnoid cyst remains unclear. And surgical intervention is only indicated in patients with evidence of nerve root compression.
Arachnoid Cysts↗
Effect of intravenous calcitriol on platelet intracellular calcium in uremic hemodialysis patients with secondary hyperparathyroidism.
BACKGROUND: To investigate the effect of the reversal of hyperparathyroidism on platelet intracellular free calcium ([Ca2+]i) by pharmacological parathyroidectomy with intravenous calcitriol in uremic patients with secondary hyperparathyroidism (2 degrees HPT). METHODS: Serum concentrations of intact parathyroid hormone (I-PTH) were measured by two-site immunometric assay, and platelet [Ca2+]i was assessed using the fluorescent indicator fura-2. Fifteen hemodialysis patients with 2 degrees HPT and serum I-PTH 4 times greater than the normal upper limits, were selected for treatment with intravenous calcitriol 1 microgram thrice weekly for one month. RESULTS: An increase of serum I-PTH (449.17 +/- 52.35 vs 32.52 +/- 1.95 pg/ml) and elevated platelet [Ca2+]i (139.49 +/- 8.78 vs 74.70 +/- 6.48 nM/L) was observed in uremic patients with 2 degrees HPT. Serum I-PTH levels were significantly correlated with platelet [Ca2+]i in uremic patients with 2 degrees HPT (r = 0.736, p = 0.002). The serum I-PTH levels decreased from 449.17 +/- 52.35 to 221.27 +/- 35.66 pg/ml (p < 0.001) and platelet [Ca2+]i fell from 139.49 +/- 8.78 to 97.86 +/- 7.25 nM/L (p < 0.001) after treatment. Fall in platelet [Ca2+]i was related to concomitant reduction in PTH levels (r = 0.572, p = 0.026). CONCLUSIONS: It was concluded that an increase in cytosolic calcium in uremia may be at least in part induced by PTH. Besides, intravenous calcitriol can provide an effective way to suppress elevated serum I-PTH and attenuate platelet free calcium in uremia with 2 degrees HPT.
Adult↗
Hyperparathyroidism, glucose tolerance and platelet intracellular free calcium in chronic renal failure.
Disturbance in the vitamin D/parathyroid hormone (PTH) axis may be important in the pathogenesis of glucose intolerance and insulin resistance in uraemia. To investigate possible relationships between hyperparathyroidism, intracellular free calcium ([Ca2+]i), and glucose tolerance in chronic renal failure, we measured serum intact PTH (I-PTH) by two-site immunometric assay, platelet [Ca2+]i using the fluorescent indicator fura-2, and plasma glucose and insulin after 14 h overnight fast and at 30, 60 and 120 min following a 75 g oral glucose load, in 18 chronic haemodialysis patients with elevated serum I-PTH. Calcitriol (1 microgram) was administered parenterally at the end of each dialysis session for four weeks. This significantly decreased serum I-PTH (p < 0.001) and platelet [Ca2+]i (p < 0.01). Uraemic patients initially showed marked glucose intolerance, with increased area below the glucose curve compared to healthy controls, but after 4 weeks of calcitriol treatment, this effect was significantly decreased, and there was a significant rise in the area under the insulin curve after glucose load. The insulinogenic index also increased significantly after calcitriol treatment. These data suggest that calcitriol treatment of haemodialysis patient with secondary hyperparathyroidism is associated with increased insulin secretion in response to glucose challenge, and that this change is linked to the decrease in intracellular free calcium.
Adult↗