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To compare the concentrations of two fluoroquinolones, ofloxacin (OFLX) and norfloxacin (NFLX), in the prostate glands of patients who underwent transurethral resection of the prostate (TUR-P) after oral ingestion of both drugs for surgical prophylaxis.Ten patients with clinical symptoms of benign prostatic hyperplasia undergoing TUR-P received 200 mg of both drugs per os simultaneously 2 hours before surgery. The concentrations of the drugs in the serum and prostate at the time of surgery were measured by high performance liquid chromatography. Patients' clinical characteristics were evaluated, including findings from transrectal ultrasonography of the prostate, prostate specific antigen concentration, renal function tests, and post-operative status.Two hours after administration, the mean serum concentration of OFLX was 4.14 +/- 0.64 mg/L (range 0.27-6.37) and of NFLX was 1.10 +/- 0.22 mg/L (range 0.02-2.1). The concentration of ORLX in prostatic tissue was 4.10 +/- 0.79 micrograms/g (range 1.70-6.37) and of NFLX was 2.22 +/- 0.57 micrograms/g (range 0.63-4.35). The ratio of the prostatic tissue concentration (P) to the serum concentration (S) was 2.11 for OFLX and 5.71 for NFLX. The concentrations of both drugs exceeded the minimum inhibitory concentration (MIC) for most gram-negative organisms, but NFLX may be unable to exceed the MIC90 of Enterobacter cloacae in some individuals. Leukocytosis and spiking fever developed after TUR-P in two of the 10 patients.Concentrations of OFLX were higher in both serum and prostatic adenoma tissues than those of NFLX (p0.001), while NFLX had better penetration into the prostate (P/S ratio) (p0.001). The results of this study indicated that the concentrations of both of these drugs exceeded the MIC for most gram-negative organisms.

In this study, we evaluated the efficacy of the polymerase chain reaction (PCR) in detecting urea-splitting microorganisms in desiccated urinary tract infection stones. Seventy-eight urinary tract stones were tested for the presence of Proteus mirabilis and Ureaplasma urealyticum by means of PCR with species-specific primers. Twenty-seven stone samples were composed of struvite and/or carbonate apatite (infection stone); 40 were calcium oxalate and/or calcium phosphate; seven were mixed, with struvite/carbonate apatite and calcium oxalate; and four were uric acid stones. PCR was performed with DNA extracted from pulverized stone pieces. Initial assays using the pulverized stone specimens spiked with microorganisms showed that PCR could not detect U. urealyticum at densities below 10(3) color changing units (CCU), or P. mirabilis at densities below 10(4) colony-forming units (CFU). PCR was negative for U. urealyticum and P. mirabilis in all metabolic stones from patients. P. mirabilis was detected by PCR in 10 of 34 patients with infection stones. Preoperative urine cultures grew P. mirabilis in three of these 10 patients, and were negative for P. mirabilis in the other seven. U. urealyticum was detected by PCR in stone samples from four patients, two of which were also PCR-positive for P. mirabilis. All four of these patients had infection stones: two had residual stones, and the other two had recurrence of urinary stones after their operations. These results demonstrate that microorganisms in urinary stones can be detected by PCR even when the voided urine culture is negative. Investigations into the role of bacterial infection in stone formation will require further improvements in the sensitivity of PCR assays for pathogen detection.

Thyroid papillary microcarcinoma has a notably benign clinical course among carcinomas. The occurrence of distant metastases is exceptional, but significantly increases the risk of mortality. We report the case of a 75-year-old woman with a 1.0 cm primary thyroid papillary microcarcinoma with skull metastases and brain invasion. The clinical presentation was a large mass over the occipital area which progressively grew over the course of 1 year. No thyroid nodule or lymph nodes were palpable. The metastatic mass and primary tumor were surgically removed. The serum thyroglobulin level was 163 ng/mL 1 month after surgery. There was no further management because the patient refused follow-up. She returned to the hospital 15 months later due to a seizure. The tumor had further extended into the brain tissue. Her condition progressively deteriorated and she died 2 months later due to uncontrollable seizures.

A retrospective review of 1,089 diabetes mellitus admitted to the metabolic ward of Chang Gung Memorial Hospital was performed to screen for malnutrition-related diabetes mellitus (MRDM). None of the patients fulfilled the MRDM criteria, although 20 patients with a body mass indexor = 15 kg/m2 were further analyzed. These patients presented with poor glycemic control and most had associated chronic diseases. C-peptide levels were0.8 ng/mL in 17 patients and undetectable in six patients. Two patients experienced diabetic ketoacidosis (DKA). Insulin treatment was required by 18 patients with a mean (+/- SD) dosage of 30 +/- 9 U/day. During follow-up of 14 of the patients for 9.8 +/- 4.3 months, HbA1c decreased significantly. Their mean body weight and body mass index increased significantly from 36.6 +/- 4.6 kg to 47.2 +/- 6.2 kg and 13.9 +/- 0.9 to 18.0 +/- 1.9 kg/m2, respectively. Careful attention should be paid to diabetic control and associated chronic illness in patients with severe undernutrition.

The diameter and sphericity of alginate-poly-L-lysine-alginate microcapsules, which was determined by the size and shape of calcium alginate microspheres, affected durability and biocompatibility of microcapsules and the result of transplantation. The commonly used airjet spray method generated microspheres with wide variation in diameter and sphericity. In order to overcome these drawbacks, we designed a field effect microparticle generator which established a stable electric field. This generated calcium alginate microspheres with an adjustable diameter (range, 50-350 microns). Factors which influenced the diameter and sphericity of microspheres included the percentage of alginate, field strength, speed of extrusion of alginate, needle gauge, field distance, and cell density in sodium alginate. The conditions used for microencapsulation of rat, pig, and human islets were 5500-6500 volts, 22 gauge needle with blunt end, 1-cm field distance, 1.5% sodium alginate, and 0.57 mL/min extrusion speed. These combinations would give most of the islet-containing microcapsules a diameter of 300-450 microns when alginate microspheres were incubated with calcium chloride solution for a total of six minutes. If individual cells (eg, NS-1) were microencapsulated, a larger gauge needle resulted in smaller microcapsules. Field strength of 6500 volts at a distance of 1 cm did not change the doubling time of NS-1 myeloma cells. By using the electric field microparticle generator, encapsulated cells were distributed around the periphery of the microspheres and thus improved the oxygen and nutrient supply of these encapsulated cells.

We investigated both sodium-lithium countertransport (Na-Li CT) and ouabain-sensitive sodium transport (Na pump) of erythrocytes in healthy subjects (group A), patients with non-insulin-dependent diabetes (NIDDM) without nephropathy (group B), patients in the proteinuric stage (group C), and those in the renal insufficiency stage (group D). Erythrocytes from all four groups had a similar initial water and ionic content and were loaded with similar degrees of Li and Na for efflux studies. There were no significant differences in erythrocyte Na-Li CT or Na pump among the four groups. However, the maximal rate of Na-Li CT was significantly higher in a group of subjects with essential hypertension when compared with groups A, B and C, consistent with the view that there is a genetic marker for essential hypertension. Ouabain-insensitive Na efflux (Na leak) of erythrocytes was found to be significantly higher in group D than in groups A or B. Also, a significant positive correlation existed between Na leak and urine protein levels of the subjects studied. Our results thus indicate that in contrast with insulin-dependent diabetic patients (IDDM) where an elevated Na-Li CT is observed, with diabetic nephropathy, Na-Li CT in NIDDM is apparently not associated with nephropathy; rather the ouabain-insensitive Na efflux appears to be correlated with the stages of nephropathy in NIDDM. The association suggests that the rate of ouabain-insensitive Na efflux may provide an index for assessing the degree of nephropathy in NIDDM patients.

To understand pancreatic beta cell function in patients with non-insulin-dependent diabetes, we analyzed C-peptide response to glucagon in 101 nonketotic patients with onset of diabetes at over 25 years of age and duration of diabetes of more than one year. The fasting serum C-peptide values (FCP), maximal incremental (delta CP) and 6-minute (6'CP) serum C-peptide values after 1 mg of intravenous glucagon administration were not related to age at diagnosis (r = 0.12, 0.06 and 0.10, respectively), duration of diabetes (r = 0.15, 0.05 and 0.10, respectively), fasting plasma glucose concentrations (r = 0.01, 0.18 and 0.12, respectively) or glycohemoglobin (HbA1c, r = 0.13, 0.22 and 0.16, respectively). In contrast, they showed a clear positive correlation with body mass index (BMI, r = 0.36, 0.52 and 0.41, p0.001). In order to evaluate the beta cell function in patients with different responses to treatment modalities, a subgroup of 45 patients was divided into three groups: diet successes (DS, n = 14), oral hypoglycemic agent (OHA) successes (OS, n = 19) and OHA failure (OF, n = 12). Among the three groups, patients in the OF group had the longest duration of diabetes (9.4 +/- 1.9 years) and the lowest BMI (19.3 +/- 1.0 kg/m2). Serum C-peptide responses to glucagon were different in the three study groups. Patients in the DS group had the highest response and patients in the OF group had the lowest response. However, the differences in mean FCP, delta CP and 6'CP among the three groups were not statistically significant, and there was a wide overlap of individual C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate the disease association with HLA-DR 3/4 heterozygotes, 1,074 subjects, who had been analyzed consecutively for HLA-DR antigens for organ transplantation or to study the disease association with HLA from June 1984 to June 1986, were enrolled in this study. Of these subjects, 278 had diabetes, 168 were healthy controls or donors, and 628 had other diseases. Of the 1,074 subjects, 35 subjects (3.2%) were DR 3/4 heterozygotes and 1,039 subjects (96.7%) were non-DR 3/4 heterozygotes. Among the 35 DR 3/4 positive subjects, 23 were diabetic (65.7%), two were healthy donors (5.7%), 10 had other diseases (28.5%) such as recurrent abortion (n = 3), hepatoma (n = 2), Graves' disease (n = 1), idiopathic hypoparathyroidism (n = 1), IgA nephropathy (n = 1), uveitis (n = 1) and gout (n = 1). Among the 23 DR 3/4 positive diabetics, 19 (82.6%) had insulin-dependent diabetes mellitus (IDDM), three (13.0%) had non-insulin-dependent diabetes mellitus (NIDDM), and one (4.3%) had maturity onset diabetes of the young (MODY). When these DR 3/4 positive diabetics were compared with the other disease and control/donor groups, significant increases in the relative risk were seen for IDDM patients (RR = 32.61, 43.80, respectively, p0.001). No significant association could be seen for NIDDM and MODY patients. In those non-diabetic patients positive for DR 3/4, there was no significant association with DR 3/4 heterozygotes. These findings suggest that: 1) DR 3/4 positive subjects are highly associated with IDDM; and 2) there is no significant association of DR 3/4 with NIDDM, MODY and other non-diabetic diseases.