Subarachnoid haemorrhage mimicking transient ST-segment elevation myocardial infarction.

Patients often present to the emergency department with loss of consciousness. The differential diagnosis of such condition may be difficult because of limited clinical information. The authors present a case of subarachnoid haemorrhage (SAH) with initial electrocardiographic (ECG) finding mimicking ST-segment elevation myocardial infarction (STEMI), which was confirmed to resolve in a follow-up study. Accurate and timely diagnosis of SAH-related ST-segment elevation was important, as the therapeutic strategy for SAH is completely different from that for STEMI. If the clinicians do not have other tools for diagnosis, the follow-up ECG may help us make a most possible diagnosis.

Detection of patients presenting with adverse drug events in the emergency department.

BACKGROUND: Adverse drug events (ADE) have been studied widely in hospitalised and emergency department (ED) patients. Less is known about the ED visits of drug-related injury in Taiwan. This study seeks to determine the incidence, risk and patient outcomes of ADE in an ED population. METHODS: We conducted a prospective observational cohort study of patients 18 years and older presenting to the ED of an urban, tertiary medical centre. ED visits between 1 March 2009 and 28 February 2010 identified by investigators for suspected ADE were further assessed by using the Naranjo Adverse Drug Reaction probability scale. Outcomes (ED disposition, injury severity and preventability) and associated variables (triage, gender, drug category, number of drugs, Charlson comorbidity index score and ADE mechanism) were measured. RESULTS: Of 58,569 ED visits, 452 patients (0.77%) had physician-documented ADE. 24% of patients with ADE were hospitalised with life-threatening conditions, with a mortality rate of 10.0%. The majority of ADE were considered preventable (73.4%), and the unintentional overdose was the most common cause. Cardiovascular agents accounted for the most ADE (25.8%) and consisted of 65.3% of ADE in patients aged 65,years and older. Risk factors for ADE-related hospitalisation were elderly age (odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1-3.4), severity of ADE (OR 6.9, 95% CI 3.3-14.5) and higher Charlson comorbidity index scores (OR 3.4, 95% CI 2.0-5.7). CONCLUSION: ADE-related ED visits are not uncommon in Taiwan and many cases are preventable. ED-based surveillance may provide useful information for monitoring outpatient ADE.

Polyphenol-enriched oolong tea increases fecal lipid excretion.

OBJECTIVE: To assess possibility of polyphenol-enriched oolong tea to reduce dietary lipid absorption in humans. DESIGN: Twelve healthy adult subjects, three males and nine females, aged (mean+/-s.d.) 22.0+/-1.8 years, respectively, were randomly divided into two groups. The participants were followed a double-blind placebo-controlled crossover design, including 7-day washout periods and 10-day treatment periods. During the treatment periods, subjects were given about 38 g of lipids from potato chips (19 g each within 30 min after lunch and dinner) and total 750 ml beverages (placebo- or polyphenol-enriched oolong tea) at three meals. Blood samples were collected for biochemical examination at days 8, 18, 25 and 35 of the study period. On the last 3 days of each treatment period, feces were collected to measure the excretion of lipids. RESULTS: Lipid excretion into feces was significantly higher in the polyphenol-enriched oolong tea period (19.3+/-12.9 g/3 day) than in the placebo period (9.4+/-7.3 g/3 day) (P < 0.01). Cholesterol excretion tended to increase in polyphenol-enriched oolong tea period (1.8+/-1.2 g/3 day) compared with that of placebo (1.2+/-0.6 g/3 day) (P = 0.056). CONCLUSIONS: The results of this study indicated that polyphenol-enriched oolong tea could increase lipid excretion into feces when subjects took high-lipid diet.

Tissue- and stage-specific expression of a soybean (Glycine max L.) seed-maturation, biotinylated protein.

A cDNA clone GmPM4 which encodes mRNA species in mature or dry soybean seeds was characterized. DNA sequence analysis shows that the deduced polypeptides have a molecular mass of 68 kDa. GmPM4 proteins have a relatively high amino acid sequence homology with a major biotinylated protein isolated from pea seeds, SBP65, but both of these proteins differ markedly from that of presently known biotin enzymes. The accumulation of GmPM4 mRNA is detectable in the leaf primodium and the vascular tissues of the hypocotyl-radicle axis of mature seeds, and the GmPM4 proteins are present at high levels in dry and mature soybean seeds, but not in fresh immature seeds. It degrades rapidly at the early stage of seed germination. These proteins are boiling-soluble and biotinylated when they are present endogenously in soybean seeds; however, the same recombinant protein expressed in Escherichia coli is boiling-soluble, but it is not biotinylated.

Pituitary apoplexy with intracerebral hemorrhage simulating rupture of an anterior cerebral artery aneurysm.

Pituitary apoplexy presenting with intracerebral hemorrhage into the left frontal lobe and lateral ventricle, simulating an anterior cerebral artery aneurysm rupture, is reported. No other cases of intracerebral hemorrhage caused by pituitary apoplexy have been found in a review of the English literature.

Differences in deoxycytidine metabolism in mouse and rat.

Bone-marrow macrophages from both rat and mouse release deoxycytidine derived from phagocytosed nuclei. Mouse plasma contains no detectable deoxycytidine (less than 0.1 microM), whereas the concentration in rat plasma is 18 microM. Enzyme assays of tissue extracts show that both mouse and rat spleen contain high deoxycytidine kinase activity. Mouse organs, including kidney, liver and lung, also have deoxycytidine deaminase activity. In contrast, rat tissues have virtually no deoxycytidine deaminase activity. Lack of deaminase provides an explanation for the presence of deoxycytidine in rat plasma. Cytotoxicity assays show that cultured mouse lymphoid cells grown in undialysed rat serum are more resistant to cytotoxic effects of deoxyadenosine than are those cells grown in dialysed rat serum. The results suggest that a major difference in deoxycytidine metabolism between mouse and rat may account for discrepancies in the pharmacological response of the two animals to certain nucleoside compounds.

Macromolecular interactions of [14C-ring]melphalan in blood.

The pharmacokinetics and macromolecular interactions of [14C-ring]melphalan (L-PAM) in blood were studied in rats following a single oral dose (20 mg/kg, 0.1 mCi/kg). Radioactivity levels were monitored in blood over a period of 72 hr. The highest levels of radioactivity were observed at 2 hr. The decline of radioactivity from the blood was biphasic with T1/2 alpha = 7 hr and T1/2 beta = 75 hr. The radioactive species in plasma corresponded to unchanged L-PAM and its two known hydrolytic products 4,2-hydroxyethyl 2-chloroethylamino-L-phenylalanine (L-MOH) and 4-[bis(2-hydroxyethyl)amino]-L-phenylalanine (L-DOH). In addition, four other major, previously unknown, metabolites of L-PAM were detected in plasma. At 72 hr, most of the radioactivity was bound to macromolecular components, 26% to plasma macromolecules and 62% in red blood cells. Covalent binding to blood cells was mainly to membrane proteins. Binding to hemoglobin and other soluble components of the red cells was also observed, with a 5000-fold greater affinity for membranes. These studies suggest extensive interaction of melphalan, or its metabolites, with membrane and soluble proteins of red blood cells.

Tissue distribution and macromolecular interactions of 14[C-ring] melphalan in the rat.

The kinetics of uptake and elimination, covalent binding, and macromolecular interactions of 14[C-ring] melphalan was studied after a single oral dose (20 mg/kg, 0.1 mCi/kg) in normal rats. Peak radioactivity level in tissues was observed at 2-4 h after administration. Uptake of label in most tissues was rapid, with a t1/2 of less than 1 h. Elimination was biphasic. Tissues of the gastrointestinal tract showed the most rapid rates of elimination, with t1/2 beta of 13, 24, 18, and 19 h for stomach, duodenum, and small and large intestines, respectively. Bone marrow also showed a fast rate of elimination of radioactivity, with a t1/2 beta of 30 h. Tissues with the slowest rates of elimination were skin, eye, spleen, pancreas, and lung, with t1/2 beta of 333, 241, 149, 122, and 109 h, respectively. Covalent binding studies showed that melphalan, or its metabolites, bound irreversibly to all tissue macromolecular fractions. The percentage of covalently bound radioactivity increased with time in all tissues except kidney and eye, reaching up to 70%-80% of the total radioactivity remaining at 72 h. Elimination of covalently bound radioactivity was slower in the DNA fractions of the tissues of the gastrointestinal tract and heart compared with the elimination rate from lipid, protein, or RNA fractions. Slow elimination rates of 14[C-ring] melphalan equivalents from the protein fraction were observed in the skin, eye, and brain. Accumulation, rather than elimination, of radioactivity in this fraction was most prominent in the pancreas. In the bone marrow accumulation of radioactivity was observed in the lipid fraction.

Quantitative analysis of melphalan and its major hydrolysate in patients and animals by reversed-phase high-performance liquid chromatography.

The detection of 4-bis-(2-hydroxyethyl)amino-1-phenylalanine (L-DOH) in blood samples taken from patients after treatment with melphalan [4-bis-(2-chloroethyl)amino-1-phenylalanine, L-PAM] suggests that the quantification of this major hydrolysate of L-PAM can be of considerable importance in L-PAM chemotherapy. A reversed-phase high-performance liquid chromatographic procedure has been developed for the quantitative analysis of both L-PAM and L-DOH in biological samples, with a detection sensitivity of 0.1 ppm. This method provides a distinct separation of L-PAM (retention time 12 min) and L-DOH (retention time 6.5 min), with no interference from the biological background (retention time 1.4--3 min).

High steady-state levels of uric acid produced in rats by dietary training and potassium oxonate.

To reduce the inherent variability in serum uric acid levels of animals allowed ad libitum exposure to food containing potassium oxonate and uric acid, male Sprague-Dawley rats were trained to eat their daily food allotment in a 1.25-hr period each morning. After training the rats were fed a food mixture containing 5% potassium oxonate and 2% uric acid (w/w each). Serum blood levels of uric acid reached a steady state within 2 hr; these levels were maintained for an additional 4 hr. It is believed that the stomach emptying rate is a zero-order process under these experimental conditions.

Diurnal variation in serum uric acid of rats fed potassium oxonate.

The uric acid plasma levels produced in rats fed a hyperuricemic diet including uric acid and potassium oxonate are highly variable and do not attain steady-state blood levels. The levels are dependent on the time of day that the blood was collected.

In vitro photodecomposition of uric acid in presence of riboflavin II.

In vitro studies on the photodecomposition of uric acid in the presence of the monosodium salt of riboflavin 5'-phosphate in buffers at various pH values, in methanol, and in human plasma are reported. The decomposition rate increased with increasing pH and was independent of solvent or buffer species. The mechanism appears to be an energy transfer process involving triplet riboflavin and single oxygen. Riboflavin-enhanced photodecomposition of uric acid occurred in vitro in hyperuricemic human plasma.