Erotomania in Thai patients: a study of 20 cases

The study presented included 20 Thai erotomanic patients, 16 women and 4 men. The age at the onset of delusion ranged from 15 to 45 years with a median age of 23 years. The majority of the patients suffered from secondary erotomania, whereas, primary erotomania was diagnosed in three cases. Bipolar affective disorder represents the most common diagnosis associated with this delusion, followed by schizoaffective disorders. Two patients were sisters. The occurrence of intrafamilial cases is unusual and has not been reported previously. Most love objects are of the opposite gender. Only in one instance, was erotomania found in a lesbian context. Teachers and medical doctors are at increased risk for attracting individuals prone to erotomania.     

Warfarin-induced spondyloarthropathy with pseudotumor-like appearance. A case report

STUDY DESIGN: This case report illustrates an unusual complication of chronic warfarin administration. OBJECTIVES: The presurgical determination that the destructive process at L1-L2 was not infection or neoplasm involved the recognition that there was instability at this level resulting from chronic stress fractures. SUMMARY OF BACKGROUND DATA: Periosteal or osseous hemorrhagic masses (pseudotumors) have been well described in patients with hemophilia. To the authors' knowledge, this is the first reported case of this well-known phenomenon occurring in the axial skeleton as a consequence of warfarin administration. METHODS: Serial radiographic studies of the lumbar spine were available showing a progressive destructive lesion at L1-L2 and coinciding with the initiation of warfarin anticoagulation after aortic valve replacement. RESULTS: The destructive mass was demonstrated surgically to represent a large partially solidified chronic hematoma. CONCLUSIONS: Patients with stress fractures of the posterior arch and subsequent instability may be subject to development of such a spondyloarthropathy. Recognition of this unusual potential complication of warfarin therapy would prevent an incorrect diagnosis of tumor or infection. Early recognition of its occurrence could lead to early spinal stabilization.     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging

OBJECTIVE: To investigate using magnetic resonance imaging (MRI) the part played by flexor and extensor tenosynovitis and synovitis of the metatarsophalangeal (MTP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in producing the "sausage-like" aspect of spondyloarthropathy (SpA) toe dactylitis. METHODS: Twelve sausage-like toes and corresponding contralateral toes of 7 consecutive patients meeting Amor criteria for SpA were studied by MRI. RESULTS: All dactylitic toes showed fluid collections in the flexor synovial sheaths on MRI. Due to the sheath distension the plantar bone to skin distance was significantly increased (p < 0.05) in the dactylitic toes compared to normal contralateral toes. Peritendinous soft tissues were not involved since these were significantly thicker (p < 0.05) in normal toes. Extensor synovial sheaths were involved in only 4 dactylitic toes. Of the 36 joints of the 12 dactylitic toes only 2 MTP joints showed capsule distension. Considering MRI as the "gold standard", examination showed 100% sensitivity and specificity for flexor sheath involvement but lacked sensitivity for extensor synovial sheaths and showed a low specificity for joint capsule distension. CONCLUSION: Like finger dactylitis, toe dactylitis may also be due to flexor tenosynovitis and synovitis of MTP, PIP, and DIP joints may not be a required condition for sausage-shaped appearance. Extensor tenosynovitis may be present in addition to flexor tenosynovitis. Physical examination is a sufficient method for diagnosing toe dactylitis.     

抗敏感牙膏缓解牙本质敏感的临床试验研究

目的:评价有效成分为5.53%(质量分数)柠檬酸钾的抗敏感牙膏缓解牙本质敏感的效果.方法:采用随机、对照、双盲的研究方法.牙本质敏感的评价采用冷空气喷吹法,在常温下,距离牙面1 cm处气枪吹压缩空气,受试者确认是否敏感,采用数字化疼痛评判法(visual analogue scale,VAS)记录受试者的敏感程度.按照临床试验研究受试者纳入和排除标准纳入受试者.基线时纳入受试者67人,按照性别和年龄组将纳入的受试者分层随机分为试验组和对照组,试验组36人,对照组31人.试验组使用含5.53%(质量分数)柠檬酸钾的抗敏感牙膏,对照组使用空白对照牙膏,每天刷牙两次,每次至少1 min,在基线、4周、8周时分别回访受试者.结果:65名受试者完成了8周的临床试验研究,57名受试者(试验组31人,对照组26人)符合研究过程的各项要求,其资料用于结果评价.从基线到8周评价期间,试验组和对照组受试者的冷刺激敏感VAS值和主观敏感VAS值均显著减少,试验组和对照组受试者从基线到4周冷刺激敏感VAS值的变化差异有统计学意义(P<0.05),从基线到8周时主观敏感VAS值的变化在两组间差异也有统计学意义(P<0.05).结论:临床试验结果表明含有5.53%柠檬酸钾的抗敏感牙膏可有效缓解牙本质敏感.     

A clinical study of dialysis-related osteoarthropathy in long-term hemodialysis patients

Amyloid osteoarthropathy has been seen frequently in long-term hemodialysis (HD) patients, in which the bone X-ray examination reveals characteristic cystic radiolucency (CRL) of the carpal bone, shoulder joint, hip joint and knee joint, and destructive spondylarthropathy (DSA) of cervical vertebrae. To clarify the clinico-pathological significance of CRL and DSA in HD-related amyloidosis, we investigated the grade and frequency of CRL or DSA and these relationship with age, HD duration, primary diseases, osteoarticular symptoms and blood analysis in 817 HD patients (492 male and 325 female, age: 52.6 + 15.5 years, dialysis duration: 6.8 + 5.4 years). The number of cases with osteoarticular symptoms increased with the prolongation of HD duration. CRL and DSA were observed even in patients without osteoarticular symptoms: 26.7% for carpal bone, 26.2% for shoulder joint, 17.3% for hip joint and 22.2% for DSA. The grade and frequency of CRL and DSA also increased in accordance with age and HD duration. In patients with CRL of the carpal bone, shoulder CRL was noticed in 39.7%, hip CRL in 25.8%, and DSA in 14.3% of cases, respectively, and these frequencies increased with the prolongation of HD duration. In the carpal CRL negative group, shoulder CRL was noticed in 14.6%, hip CRL in 7.5%, and DSA in 6.0%, respectively. Although there was no relationship between CRL or DSA and serum beta 2-MG level in any of the cases, the serum beta 2-MG level was lower in patients with HD showing shoulder CRL (+2) and DSA (+) for more than 16 years. No significant relationship was noticed between CRL or DSA and serum C-PTH and aluminum level. These results suggested that aging was related to CRL or DSA formation in dialysis-related amyloidosis. The findings also suggested that systemic bone X-ray examination should be considered in patients with carpal bone CRL, high-age patients and long-term HD patients even without osteoarticular symptoms.     

Intraoral candida in Thai diabetes patients

Type X collagen expression in intervertebral disc of young adult beagle dogs (n = 10) was studied. Type X collagen was immunostained mainly pericellularly in the central area of the vertebral endplate, but interterritorial staining there was also present. Annulus fibrosus and nucleus pulposus did not usually stain for type X collagen. However, immunostaining of nucleus pulposus for type X collagen with a simultaneous expression of collagen alpha1(X) mRNA was observed in one dog. A weak staining was observed in two other animals with a weak collagen alpha1(X) mRNA signal. In annulus fibrosus, lamellar staining was observed in two dogs. In three animals, type X collagen mRNAs were observed in the outer edge of the annulus fibrosus, but immunohistochemical staining did not always correlate with in situ hybridization signals. In conclusion, intervertebral disc type X collagen was mainly expressed in the cartilaginous endplate. In some apparently healthy animals there was type X collagen expression in the nucleus pulposus and also in the annulus fibrosus.     

Intermittent hydronephrosis. A clinical study in 23 pediatric patients

BACKGROUND: It is difficult to diagnose intermittent hydronephrosis and to decide the indication of surgical intervention. We investigated 23 cases of intermittent hydronephrosis. METHODS: From 1978 to 1995, a total of 23 patients were diagnosed as intermittent hydronephrosis in our institution. We inspected their clinical features and treatment which had been performed to them. RESULTS: Our study comprised 21 boys and 2 girls, whose mean age was 6 year old. Their chief complaint was intermittent flank pain (left: 21, right: 1, bilateral: 1) accompanied with gross hematuria (30%) and vomiting (39%). When they were asymptomatic, an excretory urogram revealed only mild pelvic dilatation without calyceal distension and kinking of ureteropelvic junction. Split renal function study by RI showed no difference between the affected side and the normal side except one case. When pelvic or calyceal enlargement was confirmed on ultrasonography while they were symptomatic, surgery was indicated. Surgery was performed in 17 cases (74%) including dismembered pyeloplasty in 14 cases, resection of aberrant vessel in 1, relocation of lower pole renal vessel in 1 and nephrectomy in 1. In surgical and histological view points, intrinsic stenosis was seen in 10 cases, extrinsic obstruction caused by aberrant vessels was seen in 4 and ureteral polyp was seen in 3 (bilateral polyp in 1 case). CONCLUSION: They had no more symptoms after operation. Of 23 among followed up cases without surgery, we experienced 2 cases unexpectedly advancing irreversible hydronephrotic change after the last attack, 1 case of gradually progressing hydronephrotic change and 1 case of severe renal dysfunction after many attacks. Therefore intermittent hydronephrosis should be followed up carefully.     

A clinical study of multistage isoproterenol tilt table test for patients with unexplained syncope]

The present study examined whether eliprodil (SL 82.0715), an N-methyl-D-aspartate (NMDA) receptor antagonist acting on the polyamine sites induced expression of the 70 kDa heat shock protein (HSP70) in the rat brain. Whereas the NMDA channel blocker MK801 consistently induced HSP70 in posterior cingulate and retrosplenial cortices, eliprodil had no such effects even at the highest dose (50 mg/kg, intraperitoneally), supporting the idea that injury to the cerebrocortical neurones by NMDA receptor antagonists is probably related to specific sites of the receptor. Furthermore, eliprodil, given immediately after injection of MK801, blocked the effects of MK801 on HSP70. The result is discussed in terms of high affinity of eliprodil for the sigma receptor.     

A clinical study of persistent hypotension in patients on chronic hemodialysis

In order to clarify the pathogenesis of hypotension seen in the patients on chronic hemodialysis, we studied the vascular reactivity to exogenous vasoactive substances and the change of plasma ANP level during hemodialysis treatment. The vascular responsiveness to intravenously infused norepinephrine was decreased in hemodialysis patients, particularly in hypotensive group, compared with healthy controls (< 0.05). The blood pressure response to angiotensin II was also diminished significantly in hypotensive patients, compared with normotensive patients (p < 0.05). The plasma ANP concentration before and after each hemodialysis treatment was not different statistically between hypotensive and normotensive patients. Furthermore, the change of plasma ANP concentration was not correlated with the blood pressure change during each hemodialysis procedure. These findings suggest that the decrease of vascular responsiveness may be a factor for causing persistent hypotension in patients on chronic hemodialysis, and that the plasma ANP level is not responsible for the pathogenesis of hypotension.     

Comparative clinical study of patients with Parkinson disease and essential tremor

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.     

A study of patients with Nelson''s syndrome

Tooth development is regulated by a reciprocal series of epithelial-mesenchymal interactions. Bmp4 has been identified as a candidate signalling molecule in these interactions, initially as an epithelial signal and then later at the bud stage as a mesenchymal signal (Vainio et al. [1993] Cell 75:45-58). A target gene for Bmp4 signalling is the homeobox gene Msx-1, identified by the ability of recombinant Bmp4 protein to induce expression in mesenchyme. There is, however, no evidence that Bmp4 is the endogenous inducer of Msx-1 expression. Msx-1 and Bmp-4 show dynamic, interactive patterns of expression in oral epithelium and ectomesenchyme during the early stages of tooth development. In this study, we compare the temporal and spatial expression of these two genes to determine whether the changing expression patterns of these genes are consistent with interactions between the two molecules. We show that changes in Bmp-4 expression precede changes in Msx-1 expression. At embryonic day (E)10.5-E11.0, expression patterns are consistent with BMP4 from the epithelium, inducing or maintaining Msx-1 in underlying mesenchyme. At E11.5, Bmp-4 expression shifts from epithelium to mesenchyme and is rapidly followed by localised up-regulation of Msx-1 expression at the sites of Bmp-4 expression. Using cultured explants of developing mandibles, we confirm that exogenous BMP4 is capable of replacing the endogenous source in epithelium and inducing Msx-1 gene expression in mesenchyme. By using noggin, a BMP inhibitor, we show that endogenous Msx-1 expression can be inhibited at E10.5 and E11.5, providing the first evidence that endogenous Bmp-4 from the epithelium is responsible for regulating the early spatial expression of Msx-1. We also show that the mesenchymal shift in Bmp-4 is responsible for up-regulating Msx-1 specifically at the sites of future tooth formation. Thus, we establish that a reciprocal series of interactions act to restrict expression of both genes to future sites of tooth formation, creating a positive feedback loop that maintains expression of both genes in tooth mesenchymal cells.     

Congestive heart failure in patients with valvular aortic stenosis. A clinical and echocardiographic Doppler study

The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening < or = 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 +/- 6.5 vs. 45.5 +/- 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 +/- 1.6 vs. 14.9 +/- 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 +/- 1.9 vs. 1.2 +/- 0.85, p < 0.01, and 122 +/- 66 vs. 190 +/- 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.     

A clinical study of inhibition of secondary cataract with heparin

Extracapsular cataract extraction with posterior chamber lens implantation was performed on 47 eyes with senile cataract of which 25 eyes were in the control group and 22 eyes were irrigated with heparin solution (25U/ml) in the operation, the drug group. Postoperatively, 2 eyes with hyphema were found in the drug group, but the deposition of fibrin and cells on the anterior lenticular surface and the posterior capsular opacification were significantly less than those in the control group. 3 months after the operation, the mean visual acuity in the drug group was 0.70 +/- 0.26 markedly higher than that in the control group, 0.54 +/- 0.28 (P < 0.05).     

Gallstone dissolution with chenodeoxycholic acid. A clinical study

Out of 95 patients with radiolucent gallstones who enrolled in a clinical study with chenodeoxycholic acid (CDC) for gallstone dissolution 75 patients with cholecystolithiasis completed 12 months of treatment. As a side effect 31% of patients reported intermittent diarrhea which did not cause cessation of therapy or missing of work. The incidence of biliary colic was markedly decreased during treatment in comparison to the rate in the year before. From more than 20 laboratory values checked before start and every 3 months during therapy only aminotransferases increased up to 3 fold in 20% of patients. gamma-GT elevated in 31% of patients before treatment improved in half of these patients during therapy. Gallstone dissolution defined as 30% or more diminution of the gallstone area on comparable x-rays occurred in 40% of patients. Analysis of factors showed that gallstones above 2 cm in diameter did not dissolve. When the dose of CDC was retrospectively related to body weight a success rate of 68% was found in the group taking more than 13 mg CDC/kg/day. The lithogenic index determined at 6 and 12 months had significantly decreased after 6 months in patients with success. This study demonstrates that medical dissolution of gallstones with chenodeoxycholic acid should be performed in patients with radiolucent stones of less than 2 cm in diameter and with a dose above 13 mg CDC/kg body weight/day. Under these conditions the success rate is above 60% accompanied by minimal side effects.     

Comparative studies of quality and bioavailability of methotrexate in Thai patients with rheumatoid arthritis

The bioavailability of the two generic methotrexate oral preparations (Emtrexate, Pharmachemie Company, Holland and Methotrexate Remedica, Remedica, Cyprus as the test preparations), were compared to the innovator (Methotrexate Lederle, Lederle, U.S.A. as the reference) in 10 patients with rheumatoid arthritis. A single 7.5 mg oral dose of each preparation was given to the subjects in a randomized, double-blind, three-period crossover design with a 1 week washout period. Serum methotrexate concentrations were determined by using Fluorescence Polarization Immunoassay (Abbott TDx). No significant differences in pharmacokinetic parameters (AUC, Cmax, and Tmax) were observed between the test and reference preparations. The mean and 90 per cent CI of the ratio Emtrexate/Methotrexate Lederle and Methotrexate Remedica/Methotrexate Lederle of the Cmax, AUC0-8, and AUC0-alpha were 0.93 (0.87-1.00), 0.9 (0.82-0.98), 0.88 (0.79-0.99) and 0.97 (0.93-1.02), 0.95 (0.90-0.99), 0.94 (0.86-1.02), respectively. These values were well within the acceptable bioequivalence range of 0.8-1.25. The mean and 90 per cent CI of Tmax difference between Emtrexate-Methotrexate Lederle and Methotrexate Remedica-Methotrexate Lederle also overlapped the stipulated bioequivalence range of the Tmax differences of +/- 0.25 hour. Thus, Emtrexate and Methotrexate Remedica were considered bioequivalent to the reference Methotrexate Lederle regarding the rate of absorption and the extent of absorption.     

A study of self poisoning with oral salbutamol--laboratory and clinical features

A review of 35 patients > 60 years of age with odontoid fractures showed that a type II injury (Anderson and D'Alonso) was the most common fracture pattern (82% of cases). On the basis of mechanism of injury and sex incidence, we deduced that osteopenia is a contributory factor in the occurrence of odontoid fractures. A fall in a domestic setting was the cause in 53%. The peg was posteriorly displaced in 88% of type II fractures, and primary union occurred in 23%. The incidence of concomitant spinal cord injury with type II fractures was higher in older patients than it was in those < 60 years of age. The outcome for these patients was largely determined by their neurological status at presentation. Myelopathy as a late complication of nonunion was not observed in nine patients with an average follow-up of 21 months. The data suggest that vigorous attempts to secure both primary union and a sound arthrodesis for non-union are questionable in the elderly except in unusual circumstances.     

Macrophage tissue infiltration, clinical symptoms, and signs in patients with lumbar disc herniation. A clinicopathological study on 179 patients

It is postulated that in addition to nerve-root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. The clinical relevance of the histologically described inflammatory infiltrates is, however, not clearly defined [8, 22]. It was the aim of this study to assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histological results were compared to prospectively obtained clinical data. Disc specimens of 179 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a visual analogue scale for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical workup no statistically significant correlation between the histological evidence of macrophage infiltrates and the pain grading scale or the clinical data could be found. In our study there is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimen and the obtained clinical data.