The sparing effect of low-dose esmolol on sevoflurane during laparoscopic gynaecological surgery.

This double-blind, randomized, placebo-controlled study evaluated the sparing effect of esmolol on sevoflurane during laparoscopic gynaecological surgery in 54 patients between December 2009 and May 2010. The concentration of sevoflurane required to maintain adequate anaesthesia was determined. Patients received either a 0.5 mg/kg esmolol intravenous loading dose followed by infusion of 30 µg/kg per min or an identical volume of normal saline (placebo). During surgery the input concentration of sevoflurane was adjusted every 5 min to maintain systolic blood pressure within 15% of baseline and bispectral index at 50 - 60. Infusion of esmolol resulted in an 18.2% decrease in mean sevoflurane input concentration. Patients receiving esmolol had an earlier discharge from the postanaesthetic care unit and a lower mean fentanyl dose. In conclusion, intraoperative esmolol infusion decreased both the requirement for sevoflurane and postoperative administration of fentanyl.

Solanum nigrum produces nitric oxide via nuclear factor-kappaB activation in mouse peritoneal macrophages.

Nitric oxide (NO) is an antitumour molecule produced in activated macrophages and Solanum nigrum is a plant used in oriental medicine to treat tumours. In this study using mouse peritoneal macrophages, we have examined the mechanism by which Solanum nigrum regulates NO production. When Solanum nigrum was used in combination with 20 U/ml of recombinant interferon-gamma (rIFN-gamma), there was a marked cooperative induction of NO production. The increase in NO synthesis was reflected as an increased amount of inducible NO synthase (iNOS) protein. The production of NO from rIFN-gamma plus Solanum nigrum-stimulated peritoneal macrophages was decreased by treatment with N-monomethyl-L-arginine or N-tosyl-Phe chloromethyl ketone, an iNOS inhibitor. Additionally, the increased production of NO from rIFN-gamma plus Solanum nigrum-stimulated cells was almost completely inhibited by pretreatment with 100 micromol/l of pyrrolidine dithiocarbamate, an inhibitor of nuclear factor kappaB (NF-kappaB). Furthermore, Solanum nigrum increased activation of NF-kappaB. These findings suggest that Solanum nigrum increases the production of NO by rIFN-gamma-primed macrophages and NF-kappaB plays a critical role in mediating these effects.

Evaluation of fatigue in Parkinson's disease patients with stimulated single fiber electromyography.

OBJECTIVES: Fatigue is a disabling and dopa-resistant symptom in Parkinson's disease (PD). Pathological studies have shown that both peripheral and central cholinergic systems are involved in PD. Electrophysiological investigation showed decremental muscle responses following repetitive nerve stimulation (RNS). We hypothesized that fatigue in PD patients may be secondary to cholinergic defect at the neuromuscular level. MATERIAL AND METHODS: Twenty PD patients with disabling fatigue symptoms were enrolled. We used stimulated single fiber electromyography (s-SFEMG) to evaluate the neuromuscular junction of these patients. For every patient, at least 15 muscle fibers were tested at the rate of 10 Hz with the method described by Trontelj et al. The individual mean consecutive difference (i-MCD) was obtained from 100 constant consecutive single fiber potentials. The i-MCD values in each patient were averaged to obtain the mean MCD (m-MCD). RESULTS: None of the 20 PD patients with disabling fatigue symptoms had an m-MCD over 29 micros or more than 10% of the i-MCD values over 41 micros. The neuromuscular junction was intact in terms of normal jitter (expressed as MCD) and an absence of blocking. CONCLUSION: Our findings indicate that the cholinergic system at the neuromuscular level is not affected in PD patients with fatigue symptoms.

Molecular authentication of Panax ginseng species by RAPD analysis and PCR-RFLP.

In order to develop convenient and reproducible methods for the identification of ginseng drugs at a DNA level, randomly amplified polymorphic DNA (RAPD) and PCR-restriction fragment length polymorphism (PCR-RFLP) analyses were applied within Panax species. To authenticate Panax ginseng among ginseng populations, RAPD analysis was carried out using a 20 mer-random primer. The similarity coefficients among the DNA of ginseng plants analyzed were low, ranging from 0.197 to 0.491. In addition, by using PCR-RFLP analysis, very different fingerprints were obtained within Korean ginseng plants. These results suggest that these methods are able to authenticate the concerned Panax species. Broader application of this approach to authenticate other morphologically similar medicinal materials is rationalized.

The long-term response to levodopa in dopa-responsive dystonia.

We report the long-term response to levodopa in 20 patients with dopa-responsive dystonia (DRD). We found an inverse correlation between the daily dose of levodopa and duration of treatment (r=-0.59, P<0.01). Mild dyskinesias were present in 20% of our patients. Dyskinetic patients were on a higher dose of levodopa than non-dyskinetics. Dyskinesias responded to a reduction in levodopa, with no deterioration in motor function. We propose that the dopamine turnover might decrease with time, which would lead to a decrease in the requirement for levodopa and the occurrence of dyskinesias late in the course of DRD.

Inhibitory effect of immunoglobulin E production by jin-deuk-chal (Siegesbeckia orientalis).

Elevated levels of immunoglobulin (Ig) E are associated with immediate-type allergic reactions. Jin-deuk-chal is the whole plant of Siegesbeckia orientalis (SO) sL Immunization of mice with small amounts of protein antigens on alum results in several fold increases in total plasma IgE, much of it specific for the immunizing antigen. In the present study, we investigated the effect of Siegesbeckia orientalis (SO) on IgE production. SO inhibited the plasma levels of IgE induced by antigens. The effects of SO on the interleukin (IL)-4-dependent IgE response by mouse whole spleen cells were studied. IL-4 dependent IgE production of lipopolysaccharide (LPS)-stimulated whole spleen cells was inhibited by SO. In addition, using U266B I human IgE-bearing B cells, we found that SO inhibited the production of IgE activated by LPS plus IL-4. These results suggest that SO have antiallergic activity by inhibition of IgE production from B cells.

Effect of allergina on mast cell-mediated allergic reactions.

The herbal formulation ALLERGINA has been used against allergic inflammation disease for generations, and still occupies an important place in traditional medicine in Korea. In this study, we investigated the effect of ALLERGINA by oral administration in mast cell-mediated anaphylaxis responses. ALLERGINA dose-dependently inhibited compound 48/48-induced systemic anaphylaxis with doses of 10(-2) to 5 g/kg 1 h before orally administered. Of special note, ALLERGINA inhibited systemic anaphylaxis completely with doses of 1 g/kg and 5 g/kg. ALLERGINA (1 g/kg) also inhibited passive cutaneous anaphylaxis by 84%. ALLERGINA dose-dependently inhibited histamine release from rat peritoneal mast cells. When ALLERGINA (0.01 mg/ ml) was added, ALLERGINA inhibited the production of tumor necrosis factor-alpha and interleukin-6, 80% and 26%, respectively in anti-dinitrophenyl IgE antibody-stimulated mast cells. Our studies provide evidence that ALLERGINA may be beneficial in the treatment of allergic inflammation diseases.

Effect of Vitex rotundifolia on immediate-type allergic reaction.

We investigated the effect of aqueous extract of Vitex rotundifolia (L.) (Verbenaceae) fruits (VRFE) on the immediate-type allergic reactions in vivo and in vitro. VRFE (10(-4)-1.0 g/kg) dose-dependently inhibited systemic allergic reaction induced by compound 48/80. When VRFE was employed in a systemic allergic reaction test, the plasma histamine levels were reduced in a dose-dependent manner. VRFE (5x10(-1) and 1.0 g/kg) inhibited passive cutaneous anaphylaxis activated by anti-dinitrophenyl (DNP) IgE. VRFE (10(-3)-1.0 mg/ml) also dose-dependently inhibited the histamine release from the rat peritoneal mast cells (RPMC) by compound 48/80 or anti-DNP IgE. Moreover, VRFE (10(-3) mg/ml) had a significant inhibitory effect on anti-DNP IgE-induced tumor necrosis factor-alpha production from RPMC. These results suggest that VRFE may be beneficial in the regulation of immediate-type allergic reaction.

Midbrain hemorrhage presenting with trochlear nerve palsy.

A 40-year-old normotensive man suddenly developed diplopia, tinnitus and a burning sensation on the left side of his body while driving a motorcycle. He did not complain of headache, nausea or vomiting. Neurologic examination revealed left trochlear nerve palsy and impaired pinprick, temperature and joint position sensation of the left limbs. There was no ptosis or motor deficit. He had a mild bleeding diathesis due to alcoholic liver cirrhosis. Computerized tomography and magnetic resonance image of the brain disclosed hemorrhages in the right midbrain tectum and the left temporal lobe. After nine months of observation, there was nearly complete recovery of symptoms, except for mild residual diplopia. From a literature review, only nine case of midbrain tectal hemorrhage involving the inferior colliculus have been reported. These patients had a unique clinical presentation. Diplopia due to trochlear nerve palsy, either unilateral or bilateral, was present in all of the cases. Tinnitus and sensory disturbance contralateral to the lesion side were very common. Only three patients had risk factors for hemorrhage, including bleeding diathesis, hypertension and vascular anomalies. In the majority of patients, no underlying causes were detected. The outcome was favorable with conservative treatment.

Clinical manifestations of 20 Taiwanese patients with paroxysmal kinesigenic dyskinesia.

INTRODUCTION: We compared the clinical manifestations and response to medications between familial and sporadic patients with paroxysmal kinesigenic dyskinesia (PKD), and also between patients with autosomal dominant (AD) and autosomal recessive (AR) inheritance. MATERIAL AND METHODS: This retrospective cohort study included 9 familial and 11 sporadic Taiwanese patients with PKD diagnosed during a 10-year period at one of two hospitals. The mean duration of follow-up was 3.8 +/- 2.7 years. Each patient was interviewed and their medical records, as well as videotape recordings of PKD attacks in 6 patients, were used for analysis. Patients were treated with either carbamazepine or phenytoin, and the efficacy of sodium valproate was tested in 5 patients. RESULTS: No single distinguishing feature in terms of clinical manifestations or therapeutic response was found to differentiate among familial, and sporadic cases, or between AD and AR inheritance. Carbamazepine and phenytoin were superior to sodium valproate in treating both familial and sporadic PKD patients, and both drugs resulted in almost complete remission of attacks. CONCLUSION: Our findings indicate that the sporadic and familiar forms of PKD, as well as the AR and AD inherited types, are similar in terms of clinical manifestations and response to treatment. The functional status and prognosis of our Taiwanese patients suggest that PKD is a relatively benign entity.

Ischemic stroke in a young woman with ovarian hyperstimulation syndrome.

We present a case of right middle cerebral artery occlusion after a controlled ovarian hyperstimulation regimen and cryopreserved embryo transfer (ET) in a previously healthy 22-year-old woman. The patient suffered from nausea and progressive abdominal distension 8 days after ET. Under the diagnosis of ovarian hyperstimulation syndrome, she was treated with hypertonic solution, albumin infusion, and paracentesis, with some improvement. Left hemiparesis and dysarthria occurred suddenly on the fourth day of hospitalization, 11 days after ET. The neurologic deficits progressed to complete hemiplegia within a few hours. Computed tomography of the head showed infarction in the territory of the right middle cerebral artery. Magnetic resonance angiography revealed occlusion of the main trunk of the right middle cerebral artery. Laboratory studies showed leukocytosis with neutrophil predominance and a hypercoagulable state. The pregnancy was terminated because of progressive tachycardia, dyspnea, and increased abdominal girth despite supportive treatment. The neurologic deficits remained stationary at the time of discharge. This case emphasizes that the recent advent of ovulation induction and assisted reproductive techniques is a newly recognized cause of devastating cerebral infarction in otherwise healthy women.

A specific shifting deficit in Parkinson's disease: a reversal shift of consistent stimulus-response mappings.

Two experiments were designed to investigate effects of cueing upon aptitude for shifting by patients with Parkinson's disease. Subjects executed in alternation two different components of a task set over successive items in a list. We compared the costs of shifting when the stimulus ensemble remained constant from trial to trial ("uniform" lists), with the case in which a change of stimulus ensemble cued each shift of task ("mixed" lists). Shift costs with mixed lists were significantly smaller than those with uniform lists (Exp. 1, ns = 12). This suggests that patients with Parkinson's disease can benefit from cues about the stimulus ensemble in performing tasks. Patients' shifting performance was different from that of controls only in a reversal-shift condition of the previously consistent stimulus-response mappings (Exp. 2, ns = 12). This result suggests that patients with Parkinson's disease suffer from a specific but not a general deficit in ability to shift.

Object-based and location-based shifting of attention in Parkinson's disease.

Research into Parkinson's disease has made much use of the precuing paradigm developed by Posner to examine patients' ability to shift visuospatial attention. The majority of studies indicate that patients with Parkinson's disease have significantly reduced shift costs when compared with normal controls. This reduction in costs is ascribed to abnormal maintenance of attention resulting from Parkinson's disease. We know that visual attention is not directed to spatial locations alone but that it may also be directed to object representations. To date, however, it has not been clear whether the reduced shift costs apparent in Parkinson's disease patients are evident only on spatial locations or on both spatial locations and object representations. Therefore, in the current study we have adopted a new technique with a view to studying both location-based and object-based attentional components within the same paradigm. Our results with 17 patients with Parkinson's disease suggest, at least in the early stages, patients do not show deficits in maintenance of attention to the miscued source of stimulation as reflected in their normal magnitude of cuing effect related to shifting between locations and between objects. 14 normal persons were control subjects.

Genetic polymorphism of monoamine oxidase B and susceptibility of Parkinson's disease.

BACKGROUND: Monoamine oxidase B (MAO-B) may play a role in the progression and cause of Parkinson's disease (PD), given consideration of the biochemistry and pathophysiology of the disease, and experiments on primates and humans. Assuming that the structural gene determines enzyme activity, an association study was undertaken to examine MAO-B genetic polymorphisms and look for the unique MAO-B gene alleles which occurred at a higher frequency in PD patients. METHODS: Sixty-five PD patients, diagnosed according to the criteria set by a Core Assessment Program for Intracerebral Transplantations Committee, and 108 healthy controls were enrolled in this study. Genomic DNA was extracted from peripheral leukocytes by using a puregene kit. Polymerase chain reaction (PCR) was used to amplify the MAO-B genome. The PCR products were screened by restriction enzyme Hae III digestion and analyzed by single-stranded conformational polymorphism (SSCP). RESULTS: Two bands with different mobility shifts, defined as MAO-B allele 1 and allele 2, were observed in SSCP analysis. Neither genotypes nor allelic frequencies of MAO-B showed a significant difference between PD patients and controls in our study. CONCLUSIONS: Polymorphism of MAO-B genome was demonstrated in this study. It failed to show an association of a genetic marker with PD. However, this did not necessarily exclude the MAO-B locus from playing a role in causing PD because a polymorphism different from the one evaluated here may show some disease association.

Visuospatial orienting of attention in Parkinson's disease.

Orienting attention to visual stimuli was studied in 13 patients with Parkinson's disease whose responses were compared to those of a matched control group using a cued reaction-time task which measured cost and benefit effects of orienting of attention. Both groups were screened to exclude dementia, psychiatric disease, and other neurological abnormalities. Although Parkinson patients showed overall slow mean reaction time, responses showed a pattern of cost and benefit effects similar to that of the control group. The results suggested that Parkinson patients are not impaired on visuospatial orienting of attention on this task.

Precued shifting of attention between cognitive sets in Parkinson patients.

The precueing paradigm developed by Posner has been used to examine visuospatial shifting of attention. In the current study, we modified such a paradigm so that it could be studied in nonvisuospatial domains and its component processes of disengagement, movement, and engagement could be analyzed in a similar fashion to the visuospatial domains. 14 patients with Parkinson's disease and 14 normal controls matched for age, sex, handedness, and years of education served as subjects. The speed of shifting attention was measured using the cost and benefit analysis. Analyses showed an over-all slowness in reaction time of patients with Parkinson's disease compared to the control group but without a concomitant slowness to engage, shift, and disengage their attention.

Multiresolution multiresource progressive image transmission.

This paper presents a new progressive image transmission (PIT) design algorithm in which the resolution and resources (rate or distortion and storage size) at each transmission stage are allowed to be prespecified. This algorithm uses the wavelet transform and tree-structured vector quantizer (TSVQ) techniques. The wavelet transform is used to obtain a pyramid structure representation of an image. The vector quantizer technique is used to design a TSVQ for each subimage so that all the subimages that constitute the image at the current stage can be successively refined according to the resources available at that stage. The resources assigned to each subimage for the successive refinement is determined to optimize the performance at the current stage under the resource constraints. Normally, the resource constraints at each stage are determined by the specification of the transmission time or distortion for image data and the storage complexity of the TSVQ. The resolution at each stage is determined/specified according to the application or as part of the design process to optimize the visual effect.

Alpha-thalassemia minor and neonatal hyperbilirubinemia.

Infants on this island are known to have higher incidences of neonatal hyperbilirubinemia and alpha-thalassemia minor than Caucasians. In order to investigate the correlation between these two conditions, we collected a total of 110 newborns with alpha-thalassemia minor delivered at the National Taiwan University Hospital during the period from January 1985 through February 1988 for this retrospective study. The infants in the study group were ascertained to have the condition by the presence of Hb Bart's with a concentration from 3% to 13%, in the cord blood. None of them had glucose-6-phosphate dehydrogenase (G6PD) deficiency. For each study infant, two control infants were selected. Criteria for enrollment in the control group were: (1) same sex; (2) absence of G6PD deficiency; and (3) birth time as close as possible to that of the study infant, with the 1st control born before the study infant and the 2nd control after. The timing of bilirubin quantitation was based on clinical judgement of jaundice by the pediatricians and phototherapy was started as indicated. Gestational age, birth weight, and rates of preterm delivery, low birth weight infants and low Apgar scores were comparable between the study and control groups. On day 3 after birth, the incidence of hyperbilirubinemia (bilirubin level over 10 mg/dl) was significantly lower in the study group than in the control group (0.9% vs 9.5%, Fisher's exact probability = 0.0012). However, the difference was not significant later. The incidence of phototherapy was also significantly lower in the study group (20%) than in the control group (31%).(ABSTRACT TRUNCATED AT 250 WORDS)

Tubal cyst following tubal sterilization: a delayed complication.

Clinical pictures and histopathological findings in 15 patients of tubal cyst following tubal sterilization were analyzed. The interval between tubal sterilization and occurrence of tubal cyst was 10 years (ranged from 4 to 21 years). Clinically 8 cases (53%) suffered from lower abdominal pain, 5 cases (33%) from hypermenorrhea coexistent with uterine myoma and 2 cases (13%) from irregular menstruation. Five out of 9 patients with ultrasound examination were suspected to have tubal cyst before operation. The size of tubal cyst ranged from 1.5 to 9.0 cm in diameter with mean 3.4 cm. Eleven were unilateral and 4 were bilateral. Histologically they showed flattened mucosal epithelial cells with absence of epithelial plica, compression atrophy of muscular layer, suture stitch or granuloma and intact fimbria with clear serous fluid. Thus, the differential diagnosis of adnexal cyst in patients with a past history of tubal sterilization should include tubal cyst.

PIP: Clinical pictures and histopathological findings of tubal cyst in 15 patients following tubal sterilization were analyzed. The interval between tubal sterilization and occurrence of tubal cyst was 10 years (range from 4-12 years). Clinically, 8 cases (53%) suffered from lower abdominal pain, 5 (33%) from hypermenorrhea coexistent with uterine myoma, and 2 cases ¿13%¿ from irregular menstruation. 5 of 9 patients who underwent ultrasound examination were suspected of having tubal cysts prior to operation. The size of the tubal cysts ranged from 1.5- 9.0 cm in diameter with a mean of 3.4 cm. 11 were unilateral and 4 were bilateral. Histologically, these cysts showed flattened mucosal epithelial cells with the absence of epithelial plica, compression atrophy of muscular layer, suture stitch or granuloma, and intact fimbria with clear serous fluid. Thus, the differential diagnosis of adnexal cyst in patients with a past history of tubal sterilization should include tubal cyst.