C-reactive protein in the diagnosis of acute appendicitis.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
S M Wang
Publications and source records attributed to S M Wang.
Acute pancreatitis masquerading as testicular torsion.
A 40-year-old man presented with fat necrosis of scrotum as the complication of acute pancreatitis. Excessive fluid accumulation in the pancreas and the extrapancreatic spaces, including around the spermatic cord, was seen on computed tomography. Surgical specimen showed typical fat necrosis of tunica vaginalis and the spermatic cord. After the surgery, pain of the testicle subsided completely, without recurrence. From the clinical presentation alone, it had been difficult to differentiate this patient's condition from torsion of the spermatic cord.
Acute Disease↗
Alice in Wonderland syndrome caused by coxsackievirus B1.
Explore the source record for details and available documents.
Animals↗
Mechanism of hydrogen peroxide and hydroxyl free radical-induced intracellular acidification in cultured rat cardiac myoblasts.
After a transient ischemic attack of the cardiac vascular system, reactive oxygen-derived free radicals, including the superoxide (O2-.) and hydroxyl (.OH) radicals can be easily produced during reperfusion. These free radicals have been suggested to be responsible for reperfusion-induced cardiac stunning and reperfusion-induced arrhythmia. Hydrogen peroxide (H2O2) is often used as an experimental source of oxygen-derived free radicals. Using freshly dissociated single rat cardiac myocytes and the rat cardiac myoblast cell line, H9c2, we have shown, for the first time, that an intriguing pHiota acidification (approximately 0.24 pH unit) is induced by the addition of 100 micromol/L H2O2 and that this dose is without effect on the intracellular free Ca2+ levels or viability of the cells. Using H9c2 as a model cardiac cell, we have shown that it is the intracellular production of .OH, and not O2-. or H2O2, that results in this acidification. We have excluded any involvement of (1) the three known cardiac pHi regulators (the Na+-H+ exchanger, the Cl--HCO3 exchanger, and the Na+-HCO3 co-transporter), (2) a rise in intracellular Ca2+ levels, and (3) inhibition of oxidative phosphorylation. However, we have found that H2O2-induced acidosis is due to inhibition of the glycolytic pathway, with hydrolysis of intracellular ATP and the resultant intracellular acidification. In cardiac muscle and in skinned cardiac muscle fiber, it has been shown that a small intracellular acidification may severely inhibit contractility. Therefore, the sustained pHi decrease caused by hydroxyl radicals may contribute, in some part, to the well-documented impairment of cardiac mechanical function (ie, reperfusion cardiac stunning) seen during reperfusion ischemia.
Acidosis↗
Surgical treatment of peptic ulcer disease: changing patterns in the past 40 years.
During the past 40 years (1951-1990), 7,663 patients with peptic ulcer disease underwent surgical treatment at the National Taiwan University Hospital. A great change in patient characteristics and operative procedures was noted between the last 10 years and the previous three decades. There were 7,105 patients (92.7%) between 1951 and 1980, an average of 237 patients per year. However, only 558 patients received surgery in the last 10 years, an average of 56 patients per year. The proportion of female patients increased from 9.5% in the earlier period to 20.4% in the last 10 years; the average age of patients also increased. In the earlier period, the indications for surgery were hemorrhage (38.4%), perforation (36.1%), intractable pain (16.4%) and stenosis (9.1%). Perforation (89.2%) was the most common indication for surgical treatment in the last 10 years. Hemorrhage (4.9%), pain (4.1%) and stenosis (1.8%) were less common. There was no significant difference in surgical morbidity between the two periods. Primary subtotal gastrectomy (SG) accounted for 75.4% of operations in the earlier period, but vagotomy became the main treatment in the last 10 years, including highly selective vagotomy (HSV) (31.9%), and truncal vagotomy with drainage procedure (TV + D) (31.0%). The surgical mortality in the earlier period was 1.3% for SG, 1.8% for TV + D and 16.1% for simple closure. There was no significant change in ulcer location between the two periods. The overall mortality rate was higher in the last 10 years (5.2%) than in the earlier 30 years (2.7%) (p < 0.001). In follow-up studies, the satisfactory rate after operation was similar among patients receiving SG (89.8%), HSV (90.3%) and TV + D (91.1%) between 1977 and 1990.
Adolescent↗
Colorectal surgery using a biofragmentable anastomotic ring.
To compare the efficacy of the biofragmentable anastomotic ring (Valtrac-BAR, Davis and Geck, Medical Device Division, Danbury, CT, USA) with conventional anastomotic techniques, 30 patients who underwent colorectal surgery from August 1993 to March 1995 were retrospectively studied. The use of the BAR was also compared with conventional techniques including hand-sewn sutures in 30 patients and an end-to-end anastomosis (EEA) stapler in 24 patients. There were 17 men and 13 women in the BAR group with ages ranging from 37 to 80 years, 18 men and 12 women in the hand-sewn group with ages ranging from 41 to 82 years and 14 men and 10 women in the EEA group with ages ranging from 38 to 72 years. Surgical indications included: 25 colon cancers and five rectal cancers in the BAR group; 27 colon cancers and three rectal cancers in the hand-sewn group; and six colon cancers and 18 rectal cancers in the EEA group. There was no conversion to other anastomotic methods. Most of the patients tolerated a low-residual diet from the fifth post-operative day. No clinical leakage or stricture was noted. Only seven patients were aware of the passage of BAR fragments. The mean hospital stay was 14.1 days. There were no significant differences among these techniques in the return of bowel function, the incidence of surgical complications, including anastomotic leakage, or the length of hospitalization. BAR anastomosis was more time efficient than conventional techniques. Our results confirmed that BAR was an ideal sutureless alternative for anastomosis in colorectal surgery.
Adult↗
A lipid droplet-specific capsule is present in rat adrenal cells: evidence from a monoclonal antibody.
We have used a monoclonal antibody, A2, to study the structure and function on the lipid droplet capsule in steroidogenic adrenal cells. This antibody reacts with a 160-kD protein found in the rat adrenal cortex. Immunofluorescence microscopy shows a dominant rim pattern, which surrounds individual lipid droplets and is distinct from the filamentous vimentin staining. The boundary of lipid droplets in steroidgenic Leydig cells and 3T3 adipocytes is also immunostained by this antibody. The strong association of the 160-kD protein with the lipid droplet is demonstrated by its resistance to Triton X-100 extraction. Stimulation of steroid secretion by adrenocorticotropin results in the detachment of this protein from the lipid droplet and its movement to the cytosol. These findings suggest that the translocation of this 160-kD protein from lipid droplet surface to cytosol on stimulation might be important in facilitating the binding of cholesterol ester hydrolase to the surface of lipid droplets, as proposed for adipocytes, during lipolytic stimulation.
3T3 Cells↗
Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans.
BACKGROUND: The mechanisms of blood flow during closed-chest cardiopulmonary resuscitation (CPR) in humans have been debated since the technique was first described in 1960. Two competing models, the cardiac pump theory and the thoracic pump theory, have been proposed, and some investigators have used mitral valve position during the downstroke of chest compression to distinguish between them. Previous studies using either transthoracic or transesophageal echocardiography have yielded conflicting results, and there have been few, if any, hemodynamic or echocardiographic studies on pulmonary venous flow (PVF) during CPR. METHODS AND RESULTS: In this study, transesophageal two-dimensional and pulsed Doppler echocardiography were used to study mitral valve position and flow, together with PVF, in 20 adult patients undergoing manual CPR. In the 17 patients who could be analyzed, the mitral valve closed in 5 patients (group 1) during chest compression but stayed open or opened further in the remaining 12 patients (group 2). Peak forward mitral flow occurred during the release phase in group 1 but during the compression phase in group 2. During chest compression, PVF occurred in the forward direction (from the pulmonary vein to the left atrium) in 8 of the group 2 patients (group 2a) and in the backward direction (from the left atrium to the pulmonary vein) in all group 1 patients and the remaining 4 patients in group 2 (group 2b). The downtime (time from collapse to CPR) was significantly shorter (P < .05) for those in group 1 (7.0 +/- 4.4 minutes) than in groups 2a (19.8 +/- 7.7 minutes) and 2b (17.8 +/- 6.8 minutes). CONCLUSIONS: Transesophageal echocardiography performed during manual CPR in humans disclosed three different patterns of mitral valve position and PVF during chest compression. The presence of an opened mitral valve with forward mitral flow and backward pulmonary venous flow during chest compression in a small number of subjects underscores this heterogeneity in blood flow and suggests the possible existence of a "left atrium pump" in addition to the currently known "left ventricle pump" and "chest pump" mechanisms.
Adult↗
Mouse interleukin-2 receptor alpha gene expression. Interleukin-1 and interleukin-2 control transcription via distinct cis-acting elements.
We have shown that interleukin-1 (IL-1) and IL-2 control IL-2 receptor alpha (IL-2R alpha) gene transcription in CD4-CD8- murine T lymphocyte precursors. Here we map the cis-acting elements that mediate interleukin responsiveness of the mouse IL-2R alpha gene using a thymic lymphoma-derived hybridoma (PC60). The transcriptional response of the IL-2R alpha gene to stimulation by IL-1 + IL-2 is biphasic. IL-1 induces a rapid, protein synthesis-independent appearance of IL-2R alpha mRNA that is blocked by inhibitors of NF-kappa B activation. It also primes cells to become IL-2 responsive and thereby prepares the second phase, in which IL-2 induces a 100-fold further increase in IL-2R alpha transcripts. Transient transfection experiments show that several elements in the promoter-proximal region of the IL-2R alpha gene contribute to IL-1 responsiveness, most importantly an NF-kappa B site conserved in the human and mouse gene. IL-2 responsiveness, on the other hand, depends on a 78-nucleotide segment 1.3 kilobases upstream of the major transcription start site. This segment functions as an IL-2-inducible enhancer and lies within a region that becomes DNase I hypersensitive in normal T cells in which IL-2R alpha expression has been induced. IL-2 responsiveness requires three distinct elements within the enhancer. Two of these are potential binding sites for STAT proteins.
Animals↗
Breast cancer angiogenesis: a quantitative morphologic and Doppler imaging study.
BACKGROUND: Tumor growth and metastases require the development of new vessels (angiogenesis). Angiogenesis, assessed by microvessel count using immunocytochemical stain of endothelial cells, has been shown to predict metastases and correlate with early death. Recently developed color Doppler mapping can detect the "tumor flow signals" in breast cancer and help to distinguish it from benign lesions. The question is, does this tumor vascularization assessed by color Doppler mapping correlate with the angiogenesis assessed by immunocytochemistry? METHODS: Eighty-four patients admitted for breast surgery were studied. The final diagnosis was made by pathology for 52 malignancies and 32 benign lesions. The color Doppler mapping of the breast lesion was made preoperatively. The following parameters were assessed: (a) vessel location (peripheral or central); (b) density of color Doppler signals; and (c) maximum systolic velocity. Tumor angiogenesis was assessed by microvessel count under light microscopy using the platelet/endothelial cell adhesion molecule antibodies (CD31) method. The correlation between maximum velocity and microvessel count of breast cancer was examined. The clinical significance of maximum flow velocity of breast cancer with various clinicopathologic factors was assessed. RESULTS: Color signals were detected in 48 cases of 52 malignancies (92%). All tumors demonstrated signals at the periphery of the lesion but in only 13 (27%) were the signals detected within the tumor. Color signals were scored as + + or + + + in 44 (92%) patients. Pulsed wave blood flow was shown in all these 48 tumors, with maximum velocities varying from 4 to 36 cm/s. Among the 32 benign lesions, color signals were detected in 10 (31%) and all were peripheral and scored subjectively as +. Evaluation of these color Doppler mapping parameters shows no significant correlation with microvessel counts using CD31 monoclonal antibodies. However, there was a positive association (p < 0.05) between nodal metastases and higher tumor flow velocity in T1 (< 2 cm) breast tumors but not in larger tumors. CONCLUSION: Although the color Doppler mapping has been shown to be useful in distinguishing benign from malignant breast lesions, the intensity of signal and velocity of flow had no correlation with the extent of angiogenesis of breast cancer. The presence of high-flow tumor signal in early breast carcinoma is significantly associated with the presence of axillary lymph node metastases.
Adult↗
Variceal bleeding due to segmental portal hypertension caused by chronic pancreatitis.
Explore the source record for details and available documents.
Adult↗
Splenic abscess: a diagnostic pitfall in the ED.
Splenic abscess, with its rare incidence and various misleading clinical manifestations, usually is a diagnostic pitfall in the modern emergency department. The most frequently seen symptoms and signs are fever, abdominal pain and tenderness over left upper quadrant, splenomegaly, leucocytosis, and left lower chest abnormalities. Four cases were collected during the past five years. On admission, one patient manifested symptoms mimicking a perforated peptic ulcer and the other three patients presented clinical and roentgenographic signs suggestive, but non-specific, for splenic abscess. In two cases, the diagnosis was based on sonography followed by computed tomography (CT). In one case, the splenic abscess was only visualized by CT. They all survived after splenectomy and appropriate antibiotic therapy. Culturing disclosed the offending organisms to be Escherichia coli, Pseudomonas aeruginosa, a Salmonella species, and Streptococcus viridans. These nonspecific clinical pictures should be thoroughly investigated, and CT, the most sensitive diagnostic tool, should be used whenever splenic abscess is suspected. Early diagnosis and timely treatment reduce the morbidity and mortality associated with splenic abscess.
Abdominal Pain↗
The cis-acting elements controlling mouse IL-2R alpha transcription.
Explore the source record for details and available documents.
Animals↗
Pulmonary nocardiosis in a child with systemic lupus erythematosus: report of a case.
Nocardiosis is an uncommon complication in children with systemic lupus erythematosus (SLE). This is a case report of pulmonary nocardiosis in a 13 year-old girl with SLE, who presented with fever, chest pain and tachypnea. She had been treated with steroids and cytotoxic agents for five months. Nocardia asteroides was isolated from a surgical specimen culture. The pulmonary nocardiosis was treated by surgical excision in combination with trimethoprim-sulfamethoxazole. Nocardia sp should be considered as a possible agent of infection in immunocompromised patients, especially those treated with corticosteroids at the time of infection.
Adolescent↗
Surgical treatment of gastric adenocarcinoma: the role of lymph node dissection.
In this retrospective study, 652 patients who had curative resections for gastric cancer from 1977 to 1991 were reviewed to evaluate improvements in gastric cancer surgery and the influence of the extent of lymphadenectomy on survival. The patients were grouped into three time periods: 1977 to 1981, 1982 to 1986 and 1987 to 1991. The percentage of patients with early gastric cancer increased from 17.7% during 1977 to 1981, to 24.3% during 1987 to 1991. The average number of dissected lymph nodes was 7.5 +/- 8.1 during 1977 to 1981 and 16.4 +/- 10.3 during 1987 to 1991, when more radical lymphadenectomy was adopted. Total gastrectomies increased from 10.9% to 25.9% in the same time periods while combined visceral resections increased from 26.7% to 38.1%. Operative mortality decreased from 5.0% to 1.7%. The overall 5-year survival rate increased from 34.8% to 59.4%. In subgroup analysis, significant improvement of the 5-year survival rate was noted in the following groups: patients with stage I, II and III tumors but not stage IV; both proximal and distally located tumors; tumors with or without lymph node metastases; T1 and T2 but not in T3 and T4 (cancer invasion beyond the serosa). The decreased surgical mortality in recent years suggests that curative resection with extensive lymph node dissection can now be safely performed. Radical gastrectomy with extended lymphadenectomy may be adopted in gastric cancer resection for better control of regional disease.
Adenocarcinoma↗
Interaction of arachidonic acid with ligand binding sites of the N-methyl-D-aspartate receptor in rat hippocampal membranes.
Ararchidonic acid, an important oxygenated metabolites of 20-carbon polyunsaturated fatty acid in cell membrane, has been implicated in potentiating the N-methyl-D-aspartate (NMDA) receptor, receptor of glutamate subtype receptors, mediated neurotransmission. We have tested the possibility that arachidonic acid may directly interact with the NMDA receptor by examining the ligand binding to this receptor/channel complex in hippocampal membrane preparation. Micromolar concentrations of arachidonic acid significantly increased both the association and dissociation of [3H]TCP binding but had no effect on the pre-equilibrated [3H]TCP binding. Arachidonic acid had no effect on the Kd and Bmax of [3H]TCP binding. Arachidonic acid also had no effect on the NMDA-displaced [3H]glutamate binding and [3H]glycine binding. In addition, docosahexanoic acid (DHA) potentiated [3H]TCP binding with similar features. However, oleic acid did not affect [3H]TCP binding. This study indicates that arachidonic acid potentiates the NMDA receptor-mediated response by directly increasing the activation of NMDA receptor-gated ion channel.
Animals↗
Pharmacological evidence for a lack of role for protein kinase C in staurosporine-induced morphological changes in embryonic Xenopus myocytes.
Staurosporine, an inhibitor of protein kinases, induced outgrowth of cultured embryonic Xenopus myocytes. The outgrowing membrane elicited by staurosporine was stained uniformly with fluorescein isothiocyanate-phalloidin. Pretreatment with microfilament-disrupting agents but not microtubule inhibitors inhibited staurosporine-induced membrane outgrowth. Microfilament assembly is thus required for the action of staurosporine. Protein kinase C activators did not antagonize the membrane outgrowing effect of staurosporine. Furthermore, none of H-7 (1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride), H-8 (N[2-(methylamino)ethyl]-5-isoquinoline sulfonamide), sphingosine, phloretin, genistein or calmidazolium induced any significant morphological changes of embryonic myocytes, indicating that tyrosine kinases, protein kinase C, protein kinase A or calmodulin-dependent protein kinases may not be involved in the membrane outgrowing action of staurosporine. Total protein content of myocytes was not altered by staurosporine and protein or RNA synthesis inhibitors did not inhibit the membrane outgrowth induced by staurosporine. Furthermore, membrane outgrowth induced by staurosporine was less pronounced in older cultured myocytes or myocytes acutely isolated at later stages of tadpoles, indicating that there is different developmental susceptibility to the action of staurosporine.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
Adenocarcinoma of the transverse colon manifested as acute cholecystitis.
Explore the source record for details and available documents.
Acute Disease↗