Evaluation of clinical and MR findings for the prognosis of spinal epidural haematomas.

AIM: The potential of MR and clinical findings of spinal epidural haematomas (SEHs), particularly the early MR findings, to help minimize delays in diagnosis, to aid prognosis and as a reference for conservative treatment, are evaluated. METHODS: Retrospectively 20 patients with SEHs (14 men and 6 women) were examined to record their neurological deficit, MR findings, management, clinical outcome, and interval between symptom onset and MRI or surgery. Two-tailed Fisher's exact test was used for these analyses. RESULTS: Of 8 patients with severe neurological deficit at the onset of symptoms, none had obvious clinical improvement after either surgical or conservative management. Of 12 patients with mild to moderate deficits, 11 (92%) showed improvement or recovery of clinical symptoms. T2-weighted images revealed myelopathy or infarction of the compressed spinal cord in 9 patients, 7 (78%) of whom had no improvement in neurological deficit with either conservative or surgical management. Images in 6 patients showed contrast enhancement in the haematomas. CONCLUSION: Poor clinical outcomes were observed mainly in those with severe neurological deficit and hyperintensity on T2-weighted images of the involved spinal cord. Surgery did not appear to improve outcome in many of these patients. In acute SEHs, MRI showed characteristic findings, such as contrast enhancement, which should not be confused with signs of inflammatory or neoplastic epidural disease.

Far lateral lumbar disc herniation.

BACKGROUND: Far lateral lumbar disc herniation is an uncommon condition that may compress the nerve root outside the vertebral canal and in its extraforaminal course. The traditional midline interlaminar approach for the exploration of far lateral lumbar disc herniation is often difficult because the intervertebral articulation obviates a direct view of the course of the extraspinal nerve. In this report, we present two surgical approaches for the treatment of far lateral lumbar disc herniation: the paramedian muscle-splitting microtechnique and the enlarged midline approach. METHODS: Eight patients with far lateral lumbar disc herniation were found among 160 lumbar disc operations in 160 patients. According to computed tomography results, we divided patients with far lateral lumbar disc herniations into two groups; the extraforaminal and foraminal groups. Clinical presentation, imaging studies and surgical approach were thoroughly reviewed. RESULTS: Three patients in the extraforaminal group underwent the paramedian muscle-splitting microtechnique. Two patients in the foraminal group underwent the enlarged midline approach. The other three were operated on before the introduction of the paramedian muscle-splitting microtechnique and the enlarged midline approach. One of these patients who underwent the traditional interlaminar approach with resection of the lateral portion of facet joint, received additional instrumentation and fusion for the prevention of further instability. All had good results and no further surgical treatment was necessary. CONCLUSIONS: The incidence of far lateral lumbar disc herniation was 5% of all surgically treated disc herniations at our institution. For the extraforaminal group, the paramedian muscle-splitting microtechnique is the surgical route of choice. For the foraminal group, the enlarged midline approach is better than the traditional, interlaminar approach in saving the facet joint and preventing postoperative instability.

Rhein affects arylamine N-acetyltransferase activity in Helicobacter pylori from peptic ulcer patients.

Arylamine N-acetyltransferase (NAT) activities with 2-aminofluorene and p-aminobenzoic acid were determined in the bacterium Helicobacter pylori collected from peptic ulcer patients. Cytosols or suspensions of H. pylori with or without specific concentrations of rhein co-treatment showed different percentages of 2-aminofluorene and p-aminobenzoic acid acetylation. The data indicate that there was decreased NAT activity associated with increased levels of rhein in H. pylori cytosols. Inhibition of growth studies from H. pylori demonstrated that rhein elicited dose-dependent bacteriostatic activity in H. pylori cultures: i.e. the greater the concentration of rhein, the greater the inhibition of growth to H. pylori. For the cytosol and intact bacteria examination, the apparent values of Km and Vmax were decreased after co-treatment with 40 microM rhein. This report is the first demonstration of rhein inhibition of arylamine N-acetyltransferase activity and rhein inhibition of growth in the bacterium H. pylori.

Ibuprofen inhibits arylamine N-acetyltransferase activity in the bacteria Klebsiella pneumoniae.

Ibuprofen, one of the nonsteroidal anti-inflammatory drugs, inhibited arylamine N-acetyltransferase activity of Klebsiella pneumoniae both in vitro and in vivo. The NAT activities of Klebsiella pneumoniae were inhibited by ibuprofen in a dose-dependent manner both in vitro and in vivo. In vitro, the NAT activity was 0.675 +/- 0.028 nmol/min/mg of protein for the acetylation of 2-aminofluorene. In the presence of 8 mM ibuprofen, the NAT activity was 0.506 +/- 0.002 nmol/min/mg of protein for the acetylation of 2-aminofluorene. In vivo, the NAT activity was 0.279 +/- 0.016 nmol/min/10(10) colony forming units (CFU) for the acetylation of 2-aminofluorene. In the presence of 8 mM ibuprofen, the NAT activity was 0.228 +/- 0.008 nmol/min/10(10) CFU for the acetylation of 2-aminofluorene. The inhibition of NAT activity by ibuprofen was shown to persist for at least 4 h. For in vitro examination, the values of apparent Km and Vmax were 1.08 +/- 0.05 mM and 9.17 +/- 0.11 nmol/min/mg of protein, respectively, for 2-aminofluorene. However, when 8 mM of ibuprofen was added to the reaction mixtures, the values of apparent Km and Vmax were 1.19 +/- 0.01 mM and 6.67 +/- 0.11 nmol/min/mg of protein, respectively, for 2-aminofluorene. For in vivo examination, the values of apparent Km and Vmax were 1.24 +/- 0.48 mM and 4.18 +/- 1.06 nmol/min/10 x 10(10) CFU, respectively, for 2-aminofluorene. However, when 8 mM of ibuprofen was added to the culture, the values of apparent Km and Vmax were 0.95 +/- 0.29 mM and 2.77 +/- 0.37 nmol/min/mg protein, respectively, for 2-aminofluorene, respectively. This report is the first finding of ibuprofen inhibition of arylamine N-acetyltransferase activity in a strain of Klebsiella pneumoniae.

Evidence for arylamine N-acetyltransferase activity in the bacterium Helicobacter pylori.

N-Acetyltransferase activities with p-aminobenzoic acid and 2-aminofluorene were determined in Helicobacter pylori from gastroduodenal disease patients. The N-acetyltransferase activity was determined using an acetyl CoA recycling assay and high pressure liquid chromatography. The N-acetyltransferase activities from a number of Helicobacter pylori samples were found to be 0.91 +/- 0.12 nmole/min/mg protein for the acetylation of 2-aminofluorene and 0.75 +/- 0.22 nmole/min/mg protein for the acetylation of p-aminobenzoic acid. The apparent K(m) and V(max) values obtained were 1.10 +/- 0.08 mM and 2.34 +/- 0.14 nmol/min/mg protein for 2-aminofluorene, and 0.92 +/- 0.09 mM and 2.08 +/- 0.16 nmol/min/mg protein for p-aminobenzoic acid. The optimal pH value for the enzyme activity was 6.0 for both substrates tested. The optimal temperature for enzyme activity was 37 degrees C for both substrates. The N-acetyltransferase activity was inhibited by iodacetamide: at 0.25 mM iodacetamide, activity was reduced 50% and 1.0 mM iodacetamide inhibited activity more than 90%. Among a series of divalent cations and salts, Cu2+ and Zn2+ were demonstrated to be the most potent inhibitors. Among the protease inhibitors, only ethylenediaminetetraacetic acid significantly protected N-acetyltransferase. Iodoacetic acid, in contrast to the other agents, markedly inhibited N-acetyltransferase. This is the first demonstration of acetyl CoA:arylamine N-acetyltransferase activity in Helicobacter pylori.

Intraoperative monitoring of skin temperature changes of hands before, during, and after endoscopic thoracic sympathectomy: using infrared thermograph and thermometer for measurement.

OBJECTIVE: To investigate the roles of the second and third thoracic spinal segments in the preganglionic sympathetic innervation of the hand, and to compare skin temperature changes between thenar and other parts of palm before, during, and after endoscopic thoracic sympathectomy. DESIGN: Twelve patients, four women and eight men, with severe palmar hyperhydrosis underwent endoscopic thoracic sympathectomy. The T3 segment was identified and dissected first, followed by T2 segment extirpation. Skin temperature changes of the hand were assessed by thermograph and thermometer simultaneously before, during, and after sympathectomy. Sympathetic skin responses were undertaken 1 day preoperatively and followed up 6 months postoperatively. SETTING: An electrophysiological laboratory and operating room in a national medical center. SUBJECTS: Twelve patients who sustained a profound degree of palmar hyperhydrosis. INTERVENTIONS: Skin temperature differences of the hands were measured by infrared thermograph and thermometer before, during, and after endoscopic thoracic sympathectomy. MAIN OUTCOME MEASURES: Group's average temperature differences, and sympathetic skin response (all or none response). RESULTS: The T2 spinal segment is thought to be the main source of sympathetic outflow to the sweat glands of the hand. The group's average temperature changes were significantly higher at the 2nd through 5th fingers' tips than at the thenar after completion of T2 extirpation (p < .005). CONCLUSIONS: Intraoperative monitoring of palmar skin temperature, as judiciously measured by infrared thermograph, yields useful information about the locations of the sympathetic segments and confirmation of their entire ablation by endoscopic thoracic sympathectomy.

Glycyrrhizic acid inhibits arylamine N-acetyltransferase activity in Klebsiella pneumoniae in vitro.

Glycyrrhizic acid, one of the proposed chemopreventive drugs, was used to inhibit arylamine N-acetyltransferase (NAT) activity in Klebsiella pneumoniae, both in cytosol and intact bacteria. The NAT activity was measured by using high-performance liquid chromatography to assay the amounts of 2-acetyl-aminofluorene and remaining 2-aminofluorene. The NAT activity in K. pneumoniae was inhibited by glycyrrhizic acid in a dose-dependent manner. The cytosol NAT activities were 0.675 +/- 0.028 nmol min(-1) mg(-1) protein for the acetylation of 2-aminofluorene without glycyrrhizic acid and 0.367 +/- 0.008 nmol min(-1) mg(-1) protein with 8 mM glycyrrhizic acid. The NAT activities measured from intact bacteria were 0.308 +/- 0.018 nmol min(-1) 10(-10) colony forming units for the acetylation of 2-aminofluorene without glycyrrhizic acid and 0.236 +/- 0.005 nmol min(-1) 10(-10) colony forming units in the presence of 8 mM glycyrrhizic acid. The inhibition of NAT activity by glycyrrhizic acid was demonstrated to remain for at least 4 h. The apparent Km and Vmax values calculated from cytosol NAT were 1.08 +/- 0.05 mM and 9.09 +/- 0.11 nmol min(-1) mg(-1) protein, respectively, for 2-aminofluorene. In the presence of 8 mM glycyrrhizic acid, the apparent Km and Vmax values were 0.15 +/- 0.01 mM and 0.95 +/- 0.11 nmol min(-1) mg(-1) protein, respectively, for 2-aminofluorene. In intact bacteria, the apparent Km and Vmax values were 1.28 +/- 0.48 mM and 4.08 +/- 1.06 nmol min(-1) 10(-10) colony forming units, respectively, for 2-aminofluorene. However, in the presence of 8 mM glycyrrhizic acid, the apparent Km and Vmax values were 0.67 +/- 0.09 mM and 1.82 +/- 0.37 nmol min(-1) 10(-10) colony forming units, respectively, for 2-aminofluorene. Taking these results together, the NAT activity in K. pneumoniae was inhibited by glycyrrhizic acid both in cytosol and intact bacteria. This study provides the first evidence to demonstrate that glycyrrhizic acid inhibits bacterial NAT activity.

The effect of vitamin C on N-acetyltransferase activity in Klebsiella pneumoniae.

This study was designed to assess the effect of vitamin C on arylamine N-acetyltransferase (NAT) activity in Klebsiella pneumoniae by using HPLC to measure the acetylation of 2-aminofluorene (2-AF) with and without vitamin C. Two assay systems were performed, one with intact bacterial cell suspensions, the other with S-9 fractions (9000g supernatant). It was found that vitamin C promoted NAT activity in K. pneumoniae in a dose-dependent manner in both systems. 4 and 8 mM vitamin C were selected for further studies in S-9 fractions and intact cell systems, respectively. Through a 4-hr time course study, vitamin C promoted the N-acetylation of 2-AF in both assay systems, but, the longer the reaction time lasted, the lower the promotion rate. In the kinetic studies, vitamin C increased the value of Km from 0.42+/-0.03 mM to 2.43+/-0.87 mM in S-9 fraction assays and from 0.54+/-0.03 mM to 0.85+/-0.18 mM in intact cell assays. Vitamin C also increased the apparent Vmax values from 3.5 +/-0.08 to 39.66+/-9.81 nmol/min/mg protein in S-9 fraction assays, and from 1.28+/-0.06 to 4.88+/-0.87 nmol/min/10(10) CFU in intact cell assays, for acetylation of 2-AF. In the presence of vitamin C, the NAT activity was increased from 0.58+/-0.06 to 1.34+/-0.02 nmol/min/mg protein in S-9 fractions, and from 0.18+/-0.02 to 0.40+/-0.02 nmol/min/10(10) CFU in intact cells, for acetylation of 2-AF. From the present study, it is concluded that vitamin C does promote the N-acetylation of 2-AF in K. pneumoniae. This is a first report suggesting that oral vitamin C may be involved in modifying the mutagenicity/carcinogenicity of ingested arylamines through enhancing the NAT activity of human enteric bacteria. This interaction should be pursued in future in vivo studies.

Clinical experience of neurosurgical reconstruction in anterior skull base lesions.

BACKGROUND: Surgery of the anterior skull base confronts with the life-threatening risks of infection and cerebrospinal fluid (CSF) leakage, especially after extensive tumor resection. Avoidance of these complications demands a good intraoperative reconstruction. The technical feasibility has been demonstrated in previous reports. A judicious rationale of surgical principle is investigated in review of our patients and other series. METHODS: Fourteen cases underwent neurosurgical procedures involving the anterior skull base by the authors between June 1992 and January 1994. Five patients with trauma, 1 with inflammation, and 8 with space-occupying lesion were included. The modality of skull base reconstruction and patients' outcome were evaluated. RESULTS: Eleven of these cases accepted reconstructive procedures to some extent including pericranium, lyodura, tissue glue, bone graft and muscle flaps. Four cases of traumatic CSF leakage were successfully repaired after anterior skull base reconstruction. One case with traumatic optic neuropathy restored vision after surgical optic nerve decompression. A rhinogenic infected discharging sinus was cured with pedicle island flap obliteration. Space-occupying lesions in 8 cases were totally removed without postoperative wound infection, CSF leakage, or meningitis, of which 2 cases of malignancy recurred 7 and 5 months after operation respectively. The follow-up period was from 5 to 26 months with a mean of 14 months. CONCLUSIONS: Meticulous reconstruction with different possibilities of closure is the cornerstone of anterior skull base surgery, in spite of its difficulties and needs for extensive resection. Combined craniofacial resection could achieve "en bloc" or radical excision of "inoperable" anterior skull base lesions confidently with low morbidity and mortality based on skillful reconstructive techniques.

Hepatitis B and hepatitis C among institutionalized psychiatric patients in Taiwan.

To investigate the seroprevalence of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) in a psychiatric institution in Taiwan, where hepatitis B virus (HBV) is hyperendemic, a total of 780 patients with psychiatric disorders were studied. Enzyme-linked immunosorbent assays (ELISA) were used for testing HBsAg and anti-HCV. The prevalence of HBsAg was higher than that of anti-HCV among these patients (18.1% vs. 6.8%, P < 0.0001). The HBsAg carrier rate in these patients was consistent with that of the general population, with a trend for HBsAg carrier rate to be lower in the aged and in females. In contrast, the prevalence of anti-HCV was higher in these patients than in general population. Anti-HCV positivity was found more frequently in patients who had received blood transfusion previously (24% vs. 6.4%, P < 0.05). The majority (92%) of patients with positive anti-HCV did not have a history of apparent parenteral exposure. The prevalence of anti-HCV increased significantly with duration of the psychiatric disorder. The prevalence of anti-HCV also tended to increase with duration of hospitalization but without reaching statistical significance. These findings suggest that these institutionalized psychiatric patients contract hepatitis B, as does the general population in Taiwan, and they should be considered as a specific risk group for hepatitis C infection.