Ultrasonography and Color Doppler Imaging of Metastatic Pulmonary Choriocarcinoma

Chest ultrasound and color Doppler flow imaging were used to assess the pulmonary nodule of a 24-year-old pregnant woman with dyspnea and hemoptysis. The ultrasonogram showed multiple hypoechoic subpleural nodules. Color Doppler imaging of the nodules revealed characteristics of high vascularity and high blood flow. A percutaneous needle aspiration under ultrasonic guidance confirmed the diagnosis of choriocarcinoma.#C 219322

Expression of Integrins in Human Cultured Mesothelial Cells: The Roles in Cell-to-Extracellular Matrix Adhesion and Inhibition by Rgd-Containing Peptide

Integrins play key roles in cell-to-cell and cell-to- extracellular matrix (ECM) adhesion. We investigated integrin expression on pleural mesothelial cells (PMCs) and the inhibitory effect of arginine-glycine- asparate (RGD)- containing peptide on the adhesion of PMCs to fibronectin and collagen. Using flow cytometry and immunostaining. PMCs freshly isolated from pleural effusions and one mesothelial cell line were screened for different integrins. Intact pleural tissue was evaluated by immunohistochemistry. The adhesion of Met-5A cells to fibronectin and collagen types I . III and IV was assayed with prior treatment of various concentrations of glycine-arginine-glycine-aspartate-serine (GRGDS). On primary PMCs, alpha2, alpha3, alpha5, beta1, beta3 and alphav beta3 were highly expressed (> 70%); alpha1 expression was intermediate (30-70%); and alpha4 and alpha6 expressions were low (3, alpha5, alpha6 and beta1 were highly expressed (>70%); alpha 1 was intermediate (30-70%); and alpha2, alpha4, beta3 and alphav beta3 were low (3. There was no statistically different expression in various disease states ( transudate vs. exudate, benign vs. malignant). The inhibitory effect of GRGDS peptide on Met-5A cell adhesion to all four matrix proteins was dose -dependent

Nodular Amyloidosis of the Lung and the Breast Mimicking Breast Carcinoma with Pulmonary Metastasis

Nodular amyloidosis of the breast and lung is a rare condition of unknown aetiology, The disease runs a benign course, but offers a diagnostic problem due to nonspecific histological features, We describe the case of a 56 year old woman with a 5 year history of multiple nodules of both lungs and left breast, clinically mimicking breast carcinoma with pulmonary metastasis,To our knowledge, this is the first case of cytologically proven amyloidosis diagnosed by ultrasound-guided percutaneous transthoracic fine-needle aspiration of pulmonary nodules

台灣某大學醫學中心最近之結核菌抗藥性型態， 1998-2002

BACKGROUND AND PURPOSE: During 1998-2002, most specialized tuberculosis ( TB) hospitals in Taiwan were closed; as a result, more TB patients are being managed in general hospital settings. This study investigated the prevalence, patterns and risk factors of drug-resistant Mycobacterium tuberculosis at a university hospital in the 5 years after decentralization of the TB administrative and clinical control infrastructure which occurred during the implementation of the national health insurance system in Taiwan. METHODS: A total of 1411 initial isolates of M. tuberculosis from specimens collected during January 1998 through December 2002 were tested for drug susceptibility of first-line anti-TB drugs using the agar proportional method . RESULTS: The numbers of newly diagnosed culture-positive TB patients increased from 139 in 1998 to 380 in 2002. The drug resistance pattern of M. tuberculosis among these isolates was as follows: 268 (19.0%) strains were resistant to isoniazid, 86 (6.1%) to rifampin, 221 (15.7%) to ethambutol, 141 (10.0%) to streptomycin, and 430 (30.5%) to 1 of these 4 drugs. Multidrug resistance (MDR), i.e., resistance to at least rifampin and isoniazid, was observed in 72 isolates (5.1%). Of the 1411 patients, isolates from patients with age or = 65 years (57/781, 7.3% vs 15/630, 2.4%; p < 0.001 ). In the analysis of risk factors for MDR, patients with MDR isolates had a significantly higher incidence of previous TB history , anti-TB therapy , longer duration of symptoms, cavitary lesions in chest X-ray, and mortality. CONCLUSION: A dramatic increase in cases of TB among patients treated at this university hospital was seen after the decentralization of the TB control infrastructure in Taiwan. The prevalence of drug resistance in isolates from culture-positive TB patients was 30.5% and the prevalence of MDR was 5.1%

Variations in the Nramp1 Gene and Susceptibility of Tuberculosis in Taiwanese

SETTING: National Taiwan University Hospital, Taipei, Taiwan . OBJECTIVE: To study the variations in the NRAMP1 gene using five genotypes (274C/T, 577-18G/A, A318V, D543N and 3' untranslated region [UTR]), and the susceptibility of tuberculosis and HIV infection in Taiwanese. DESIGN: The study sample included 49 patients with tuberculosis, 48 healthy control subjects and 60 HIV-infected patients. The polymerase chain reaction (PCR) products amplified from their genomic DNA were subjected to restriction enzyme digestion and were analysed using agarose gel electrophoresis. RESULTS: A318V was not polymorphic ill the studied population. Only D543N and 3'UTR were more heterozygous. In 274 C/T and 577-18G/A, the allele frequencies showed the predominant type to be the homozygous patterns C/C (94%) and G/G (94%), respectively. There were no statistically significant differences between the tuberculosis patients and the healthy control subjects. Despite the high susceptibility to Mycobacterium tuberculosis in HIV-infected patients, genotypic frequencies in the HIV-positive patients were not significantly different between tuberculous (n = 29) and non- tuberculous patients (m = 31). In comparison with previous studies, there were significant differences between different ethnic groups in allele frequencies for 274C/T, D543N and 3'UTR. CONCLUSION: The allele and genotype of NRAMP1 polymorphism among Taiwanese differed from those of Caucasians, Africans and Hispanics. No allelic associations were identified between the NRAMP1 alleles and tuberculosis susceptibility

Clinical Features and Predictors of a Complicated Treatment Course in Peripheral Tuberculous Lymphadenitis

Background/PurposeThere remains uncertainty regarding the treatment strategy for patients with peripheral tuberculous lymphadenitis (pTBL) in areas endemic for tuberculosis. The purpose of this study was to demonstrate the clinical features and assess the predictors of a complicated treatment course in pTBL. Methods: A retrospective analysis of 97 pTBL patients from January 1995 through to December 2004 was conducted. Patient characteristics with and without a complicated treatment course, defined as prolonged treatment (> 9 months) and/or relapse, were compared for determining the predictors.ResultsThe disease occurred predominantly in females (57.7%) with a mean age of 37. Most patients (72%) were asymptomatic. Cervical nodes were the most common (72%) manifestations. Fifty-six patients completed a 6-9 month course of therapy without relapse; 28 had a prolonged but complete treatment course, and 13 relapsed within a mean of 8.5 months after treatment (range, 3-42 months; median, 7.8 months). Of 97 pTBL patients, six had enlarged or newly appeared lymph nodes during treatment. Multivariate analysis indicated that low body mass index and bilateral cervical nodes were independent determinants of a complicated treatment course with the odds ratios of 1.2 (95% CI, 1.01-1.41; p = 0.042) and 3.9 (95% CI, 1.08-14.0; p = 0.038), respectively.ConclusionThis study found that pTBL is more likely to occur in young female patients. For patients who present with bilateral cervical nodes and low body mass index, a prolonged treatment course to ensure disease control should be considered