Paracrine interactions in adipose tissue development and growth.
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Adipocytes↗
Biomedical subjects
K L Wong
Publications and source records attributed to K L Wong.
Sequential therapy for diffuse proliferative and membranous lupus nephritis: cyclophosphamide and prednisolone followed by azathioprine and prednisolone.
A retrospective single-center cohort study was conducted on 35 patients with diffuse proliferative (WHO type IV) and/or membranous (type V) lupus nephritis (22 with type IV, 6 with type V, and 7 with type IV plus V) who had been treated with a sequential regimen comprising prednisolone and cyclophosphamide during active disease, followed by low-dose prednisolone and azathioprine maintenance. The follow-up period was 33.2 +/- 4.5 months. At presentation, 32 (91.4%) patients were nephrotic, and an abnormal serum creatinine level was noted in 14 (48.3%) patients with type IV changes. Cyclophosphamide was given for 26.8 +/- 2.8 weeks. 33 (94.3%) patients achieved complete or partial renal remissions: 77.3 and 22.7% of the type IV patients, 16.7 and 66.6% of the type V patients, and 14.3 and 71.4% of the type IV plus V patients, respectively (p < 0.0001 for type IV versus type V and for type IV versus type IV plus V). The duration of therapy before renal remissions and normalization of C3 were attained was similar among the three groups of patients. Disease relapse occurred in 4 (18.2%) of 22 IV patients and in 1 of the 5 type V patients in remission. Mortality was not observed, and none of the patients had an increase in serum creatinine level to double the baseline value. Adverse effects related to therapy included: hair loss (42.9%), transient amenorrhea (53.6%), leukopenia (11.4%), febrile episodes (14.3%), and herpes zoster(28.6%). We conclude that sequential use of prednisolone and cyclophosphamide followed by low-dose prednisolone and azathioprine can achieve favorable therapeutic results in the majority of patients with diffuse proliferative and/or membranous lupus nephritis, without excessive toxicities.
Adult↗
Extracellular matrix components secreted by microvascular endothelial cells stimulate preadipocyte differentiation in vitro.
Paracrine interaction between preadipocytes and microvascular endothelial cells may play a role in the regulation of adipose tissue growth. We report here a study of the effect of extracellular matrix factors secreted by microvascular endothelial cells, derived from adipose tissue, on preadipocyte differentiation in primary culture. Extracellular matrix components (EC) were prepared by differential centrifugation of medium conditioned by microvascular endothelial cells (CM). Preadipocyte differentiation was assessed by enumerating cells containing Oil-Red-O-stainable neutral lipids and by assaying cellular triacylglycerol (TG) content and glycerol-3-phosphate dehydrogenase (GPDH) specific activity. Both supernatant (containing soluble components) and pelleted (containing large complexes of EC) fractions of CM stimulated preadipocyte differentiation. When the supernatant fraction was used, the proportion of cells containing visible lipid droplets was 29% +/- 3% of total preadipocytes in the presence of extracellular complexes, as compared with 6% +/- 1% under control conditions. This differentiation induction was associated with fourfold increases in TG content and GPDH specific activity. Neither the supernatant nor the pelleted fraction of EC affected the maximal differentiation induced by hormonal stimulation in serum-supplemented or serum-free media. The major EC, fibronectin, laminin, and collagen IV, had no effect on differentiation when added individually to culture medium. Collection of CM under hyperglycemic (18 mmol/L glucose) compared with control (6 mmol/L glucose) conditions reduced the stimulatory effect of extracellular complexes by twofold, suggesting decreased or altered production by endothelial cells. The present findings demonstrate that microvascular endothelial cells release EC that promote preadipocyte differentiation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adipocytes↗
[Surgical patients' attitude towards anesthesia].
There are few studies assessing the degree of understanding of anesthesia among surgical patients in Taiwan. So we designed a questionnaire to explore patients' attitude toward anesthesia. 505 patients scheduled for routine surgery were included in this study. We found there were great differences between the patients in their attitude toward and understanding of anesthesia. It is clear that we must give much more attention to communicating clearly with our patients in this regard. Further detailed studies may be useful in revealing particular area of misunderstanding.
Adolescent↗
Sjögren's syndrome with amyloid A presenting as multiple pulmonary nodules.
A 29-year-old woman presented with diffuse pulmonary nodular amyloidosis and was subsequently diagnosed as having Sjögren's syndrome. We believe that this is the first case of Sjögren's syndrome presenting with secondary amyloidosis of the lung.
Amyloidosis↗
Amitriptyline inhibits neurite outgrowth in chick cerebral neurons: a possible mechanism.
Previous studies showed that amitriptyline (AMI), a tricyclic antidepressant, inhibited neurite outgrowth from chick embryonic cerebral explants and inhibited adenylyl cyclase activity in cerebral membrane preparations. In the present study, we have investigated the possibility that AMI may have additional effects on cellular metabolism and signal transduction that underlie AMI-mediated inhibition of neurite outgrowth. In vitro, AMI inhibited phospholipase C in a dose- and GTP-dependent manner in membranes from 8-day-old chick forebrain. Brain homogenates from 8-day-old chick embryos, treated in vivo for 6 days with AMI (20 micrograms/g/day), showed significant reductions in (1) phosphorylation of two polypeptides (49 and 105 kD), and (2) levels of three polypeptides (43, 53, and 92 kD). Western blots showed that the 43- and 53-kD polypeptides corresponded to actin and tubulin, respectively. Diolein and dilinolein, potent activators of protein kinase C, stimulated neurite outgrowth and reversed the inhibitory effects of AMI. Sphingosine, a protein kinase C inhibitor, significantly inhibited neurite outgrowth and eliminated the stimulatory effects of diolein and dilinolein on neurite outgrowth. These data suggest that AMI-mediated inhibition of neurite outgrowth involves multiple effects on cellular metabolism and signal transduction. A hypothesis consistent with our data is that AMI interferes in some manner with the action of G proteins in the signal transduction cascade.
Adenylyl Cyclases↗
B-cell and T-regulatory cell dysfunction in six Chinese children with hypogammaglobulinaemia.
We report six Chinese boys with hypogammaglobulinaemia. All but one had very low or undetectable circulating B-lymphocytes, two had reversed CD4/CD8 ratios (in one of whom this latter became normal), one had reduced lymphocyte proliferative responses to concanavalin A and pokeweed mitogen and three had deficient responses to OKT3. Generation of antibody-secreting cells in response to pokeweed mitogen was markedly defective in all patients. Co-cultures of purified lymphocyte subsets from the patients with those of normal donors revealed that in addition to B-cell deficiency seen in all patients, two had T-helper cell deficiency and two had T-suppressor cell hyperactivity. One of the latter patients was treated with cimetidine in an attempt to ablate histamine type 2 receptor-bearing suppressor cells: the absolute number of such cells was temporarily reduced but there was no concurrent correction of the functional hyperactivity. These studies point to the variable nature of T-regulatory cell deficiencies in hypogammaglobulinaemia.
Adolescent↗
Disseminated skeletal tuberculosis with skull involvement.
We report a patient with widespread osteolytic lesions, including extensive involvement of the skull, due to Mycobacterium tuberculosis. Response to treatment with antituberculosis drugs was slow with appearance of new lesions while on therapy despite a sensitive organism. Excision of diseased skull bone was eventually done, after which no new lesions appeared in the ensuing 14 months.
Adolescent↗
Resolution of membranoproliferative glomerulonephritis complicating angiofollicular lymph node hyperplasia (Castleman's disease).
A novel renal complication was reported in a patient with angiofollicular lymph node hyperplasia (Castleman's Disease), who developed acute renal failure due to membranoproliferative glomerulonephritis. Renal biopsy showed marked mesangial hyperplasia, basement membrane thickening with subendothelial electron-dense deposits, interstitial plasma cell infiltration, and glomerular deposition of IgM and complement components. A resolution of systemic manifestations and an improvement in renal function followed prednisolone and azathioprine therapy. Disease relapse, with increasing proteinuria and the development of factor 8 inhibitor, occurred 3 months later. Sustained remission was achieved with prednisolone and cyclophosphamide therapy, which were given for 42 and 12 months, respectively. Renal biopsy during remission showed significant resolution of the mesangial hyperplasia and disappearance of interstitial plasmacytic infiltration as well as subendothelial electron-dense deposits.
Adult↗
Prognostic value of an abnormal signal-averaged electrocardiogram in patients with nonischemic congestive cardiomyopathy.
BACKGROUND: An abnormal signal-averaged ECG (SAECG) has predictive value for arrhythmic events in patients with coronary artery disease. The purpose of this study was to investigate whether an abnormal SAECG could provide prognostic information in patients with nonischemic dilated cardiomyopathy. METHODS AND RESULTS: We prospectively obtained SAECGs in 114 patients with dilated nonischemic cardiomyopathy. Twelve-lead ECGs, left ventricular ejection fractions, hemodynamic measurements, and peak exercise oxygen consumption (VO2) also were measured. An SAECG was defined as abnormal by any one of the three following criteria: filtered QRS duration > 120 msec, root-mean-square voltage in the last 40 msec < 20 microV, or duration < 40 microV > 38 msec at 40 Hz. Sixty-six patients had a normal SAECG, 20 patients had an abnormal SAECG, and 28 patients had bundle branch block (BBB). Mean follow-up was 10 +/- 5 months. Age, ejection fraction, peak VO2, pulmonary capillary wedge pressure, and cardiac index were not statistically different among the three groups. Use of antiarrhythmic drugs was similar among the three groups, although patients with BBB had more implantable defibrillators (p < 0.05). The incidence of previous atrial arrhythmias was similar for the three groups. Patients with abnormal SAECG or BBB had more past episodes of sustained ventricular tachycardia and/or sudden death episodes (n = 9) than patients with normal SAECG (n = 1) (p < 0.01). Prospectively, none of the 66 patients with normal SAECG died suddenly or had sustained ventricular arrhythmias. Two deaths occurred from progressive heart failure, and three patients required urgent transplant. In the 20 patients with an abnormal SAECG, four patients had sustained ventricular tachycardia, five patients died suddenly, two patients died from progressive heart failure, and one patient required urgent transplant. In the patients with BBB, four patients had sustained ventricular tachycardia, and four patients required urgent transplant. One-year event-free survival, i.e., absence of ventricular tachycardia and/or death, was 95% in patients with normal SAECG, 88% in patients with BBB, and only 39% in patients with an abnormal SAECG (p < 0.001). Multivariate analysis demonstrated that SAECG and New York Heart Association classification were independent predictors of survival. CONCLUSIONS: Patients with an abnormal SAECG had a statistically significant increase in sustained ventricular arrhythmias and/or death than did patients with a normal SAECG or BBB. This study demonstrates that an abnormal SAECG is a marker of past and future arrhythmic events in patients with nonischemic dilated cardiomyopathy. In contrast, patients with a dilated cardiomyopathy with a normal SAECG have an excellent prognosis with adverse outcome only from progressive heart failure.
Bundle-Branch Block↗
Rheumatoid nodules in the trachea.
We describe the first case of endotracheal rheumatoid nodules in a 45-year-old Chinese man with rheumatoid arthritis. He developed exacerbation of polyarthritis, new subcutaneous nodules and fibrosing alveolitis. At bronchoscopy, four whitish nodules were detected at the tracheal wall, and biopsy showed fibrinoid necrosis, palisaded inflammatory cell infiltrate and vasculitis, consistent with rheumatoid nodules. Both tracheal and subcutaneous nodules regressed with orally administered prednisone.
Arthritis, Rheumatoid↗
[Nifedipine in preeclampsia for cesarean section].
The patients with preeclampsia undergoing emergent cesarean section is always a challenge to an anesthesiologist, because severe hypertensive response after laryngoscopy and tracheal intubation may result in life-threatening complication such as cerebral hemorrhage. Most of these patients receive magnesium sulfate for the prevention of convulsion. An ideal anti-hypertensive drug for preeclampsia should be effective, limited fall in blood pressure, rapid onset, maintaining uteroplacental blood flow, and less maternal and fetal side effects. We studied the efficacy of 10 mg sublingual nifedipine in attenuating the pressor response to intubation. We were also concerned about whether this calcium antagonist may inhibit uterine contraction and increase intra and postpartum hemorrhage when it is used with magnesium sulfate and general anesthesia. There were thirty-three patients in our study (16 in nifedipine group and 17 in control group). This study revealed that nifedipine attenuate the hypertensive response effectively. Uterine contraction response to oxytocic drugs was quite well in both groups. There was no significant difference in blood loss between nifedipine and control group. And no severe maternal and fetal adverse effect.
Adult↗
[Anesthetic management of intraoperatively diagnosed pheochromocytoma--a case report].
Pheochromocytoma is a catecholamine secreting tumor originating from the adrenal medulla (up to 90%), or from the chromaffin tissue along the paravertebral sympathetic chain. The hallmark of pheochromocytoma is paroxysmal hypertension associated with diaphoresis, headache, tremulousness, and palpitations. The triad of diaphoresis, tachycardia, and headache in hypertensive patients is highly suggestive of pheochromocytoma. Other symptoms like flushing, nausea, vomiting, personality changes, and visual disturbances may however cast doubt on the diagnosis of pheochromocytoma. Death resulting from pheochromocytoma is usually due to congestive heart failure, myocardial infarction, or intracerebral hemorrhage. Although less than 0.1 percent of patients with hypertension have a pheochromocytoma, nearly 50 percent of the mortality with unsuspected pheochromocytoma occurred during anesthesia and surgery or parturition. Patients of unsuspected pheochromocytoma have higher risk for surgery, because some mandatory pre-op medical treatments might have been ignored. It is also a challenge to anesthesiologists to handle unsuspected hypertensive crisis during anesthesia and surgery. We presented such a case of unexpected Pheochromocytoma which was mis-diagnosed by the surgeon and was treated as an ordinary adrenal gland tumor and was scheduled for surgical operation. When the patient was undergoing excision of the tumor, manipulations of the tumor initiated an tremendous elevation of the blood pressure. Upon reviewing her history of normotension with visual disturbance, nausea and restlessness, she was immediate treated as with a pheochromocytoma. Appropriate managements were applied to control her abnormally high fluctuating blood pressure with success and with no complications or adverse effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenal Gland Neoplasms↗
Pattern of SLE in Hong Kong Chinese: a cohort study.
One hundred and fifty six Chinese patients with Systemic Lupus Erythematosus (SLE) were studied prospectively over 50 months. The patients in the retrospective group (Group I) were diagnosed before and in the prospective group (Group II), at the time of entry into the study. The overall female to male ratio was 25:1 with mean age at onset (+/- SD) of 26 +/- 9.9 years. Neurological manifestation as the presenting feature was rare (3%), and none of the untreated patients presented with infection. Anti-nuclear antibody (ANA) was positive in 94% and anti double stranded-DNA antibody (anti DNA) 65%. New manifestations developed in 34 patients (26%) and 218 episodes of relapses occurred in 100 patients with a rate of 0.042 relapse per patient month. Five patients died during the study period with a 5 year survival of 97% and 10 year survival of 94% in the cohort. There was no significant difference in survival between Group I and Group II patients at 50 months (p = 0.72).
Adolescent↗
Is routine preanesthetic hemoglobin test necessary in minor pediatric surgery?
The value of preanesthetic assessment of anemia and analysis of the hemoglobin level prior to a minor pediatric surgery has been recently questioned in some reports. This study was to retrospectively analyse 8859 pediatric patients who underwent minor surgery in the period from January 1987 to December 1990 in our hospital. They were all ASA class I-II in physical status with age ranging from one month to 19 years. Those patients with their hemoglobin values determined at other laboratories or hospitals in spite of our recognition and those suspected of having an immune or oncologic disease were excluded from this study. The mean hemoglobin value of the patients under study was 12.99 +/- 0.82 g/dl. 0.62% of the patients (55) were found to have hemoglobin values less than 10 g/dl which were similar to the results obtained by Wood et al (0.7%) in 1981 and Roy et al (0.5%) in 1990. Among the 55 anemic patients, 41 (74.5%) were at the age between 2 to 4 months (within the physiologic anemic period of infancy). Sampling of blood for routine preanesthetic hemoglobin determination which caused discomfort and pain was often rejected by pediatric patients and struggle for escape also upset the children very much. Based on the results from our analysis, we suggest that in healthy pediatric patient scheduled for minor surgery routine hemoglobin test could be excluded. Hemoglobin test is selectively performed in a patient is anemic or under suspicious circumstances. The value and shortcomings of selective hemoglobin test before surgery require further evaluation.
Adolescent↗
Thyroid functions in patients treated with interleukin-2 and lymphokine-activated killer cells.
Treatment of malignant disease with interleukin-2 and lymphokine-activated killer cells activates autoreactive T lymphocytes, stimulates release of cytokines and induces expression of HLA-class II antigens by tumour cells. We studied eight patients with hepatocellular carcinoma treated with a total of 16 courses of recombinant human interleukin-2 and lymphokine-activated killer cells and observed them for features of autoimmune thyroid disease. During the course of treatment there were significant decreases in total serum T4 and T3 and free thyroxine levels, but no change in TSH levels when all patients were analysed as a group. This was due to a number of factors including suppression of thyroid hormone release, haemodilution during interleukin-2 infusion and actual removal of thyroid hormones from the circulation during leukapheresis. Thyroid hormones returned to normal levels during resting period. One patient subsequently developed compensated hypothyroidism (normal total T4, total T3 and free T4 but elevated TSH) and four patients had features of 'sick euthyroid syndrome' (low total T4, total T3 or free T4 but normal TSH). None of the patients studied developed antibodies to thyroglobulin or microsomes. In contrast, no abnormality of thyroid function was seen in any of the nine subjects who received no active treatment. In conclusion, thyroid dysfunction was associated with immunotherapy of malignant disease with interleukin-2 and lymphokine-activated killer cells. This may arise from direct hormonal effects of the cytokines on thyroid hormone production.
Adult↗
[Intramuscular meperidine for the prevention of shivering in spinal anesthesia].
Intravenous meperidine 25mg has been employed effectively to treat shivering following regional anesthesia and general anesthesia. The study was designed to evaluate the effectiveness of intramuscular meperidine for the prevention of shivering in spinal anesthesia. The series consisted of 60 patients who were divided into 2 groups with 30 patients in each, undergoing lower abdominal or lower extremity surgery. All patients were given diazepam 0.1mg/kg i.v. for anxiolysis when they came to the operating room. In a double blind and randomized fashion, patients in the study (meperidine) group received meperidine 25mg IM (= 0.5ml). In the control group 0.9% N/S 0.5ml IM was given instead. All patients received spinal anesthesia 15 minutes later. Measurement of the levels of sensory loss to pinprick was made. The ambient temperature and the rectal temperature were continuously monitored to evaluate the effect of the change in body temperature on shivering during operation. The degree and the occurrence of shivering were carefully evaluated and recorded by a blind-trust observer. There was no significant difference in maximal analgesic level, ambient temperature and change of rectal temperature during operation between the groups. Shivering occurred in 17 patients (56.7%) in the saline group with an onset time of 7.9 +/- 2.5min following spinal anesthesia. In the meperidine group, shivering occurred only in 3 patients (10%) with an onset time of 54 +/- 29.5min after spinal anesthesia. There was a significantly lower incidence of shivering in the meperidine group than in the saline group (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen↗
Successful survival from massive air embolism and circulatory arrest during cardio-pulmonary bypass.
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Cardiopulmonary Bypass↗