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Biomedical subjects

C H Chang

Publications and source records attributed to C H Chang.

At least 343 records · Page 19Linked to original sources
PubMed1994

Immunosuppressive effects of azelastine hydrochloride on contact hypersensitivity and T-cell proliferative response: a comparative study with FK-506.

Azelastine hydrochloride (AZE) is an anti-allergic drug that inhibits the release of various chemical mediators from mast cells. We compared the immunosuppressive effects of AZE and FK-506 in vivo and in vitro. Topical application of AZE strongly inhibited the efferent phase of contact hypersensitivity, as did application of FK-506. In in vitro experiments, we found that 1) the suppression by AZE on interleukin (IL)-2 production from splenic T cells was partial and considerably large amounts of IL-2 were still produced, even in the presence of 10(-5) M of AZE, which was in sharp contrast to the observed marked inhibition of [3H]-TdR incorporation; 2) AZE significantly inhibited the phorbol myristate acetate-induced IL-2 responsiveness; 3) AZE did not inhibit the IL-2 receptor alpha expression of activated T cells; and 4) the significant inhibitory action was still observed even when AZE was added at 48 h after the initiation of culture. In regard to FK-506, we found that 1) FK-506 completely blocked the production of IL-2; 2) exogeneous IL-2 consistently restored the FK-506-induced inhibition; 3) FK-506 affected the phorbol myristate acetate-induced IL-2 responsiveness very little, if any; and 4) the significant suppression was observed only when FK-506 was added within 24 h after the initiation of culture. Thus, AZE exerts its in vitro immunosuppressive activity preferentially by interfering with the IL-2 responsiveness, with partial inhibition of IL-2 production. Conversely, FK-506 acts as a strong inhibitor of IL-2 production without a prominent effect on IL-2 responsiveness. The immunosuppressive activity of AZE shown in vitro may also be operative in vivo and may be applicable for topical use.

Administration, Topical↗
PubMed1994

University of Wisconsin solution extends lung preservation after prostaglandin E1 infusion.

University of Wisconsin (UW) solution has been demonstrated to enhance and extend the preservation of the hepatic, pancreatic, renal, and cardiac allografts. Prostaglandin E1 (PGE1), which has been used to produce pulmonary vasodilatation, has improved preservation in lung transplantation. Experiments were designed to evaluate their potential role in 24-h preservation of the allografts in lung transplantation. Thirty-six dogs underwent left lung transplantation. The donor lungs (n = 6 in each group) were flushed with UW solution (group 1 and 2) or modified Euro-Collins (EC) solution (group 3) after PGE1 infusion (500 micrograms). In group 1, donor lungs were transplanted immediately. Lung allografts of group 2 and 3 were cold stored (4 degrees C) in the same preservation solution for 24 h in the inflated state and then transplanted. The right pulmonary artery and right main bronchus were ligated 1 h after completion of the transplantation, forcing the recipient dogs to survive with the transplanted left lung. The recipients were ventilated with an inspired oxygen fraction of 0.4 and end-expiratory pressure 10 cm H2O. Two dogs died prematurely in group 3, whereas all dogs in group 1 and 2 survived the experimental period. The arterial oxygen tension and saturation and dynamic lung compliance were significantly higher in dogs of group 1 and 2. Transplanted lungs of group 1 and 2 had significantly lower pulmonary vascular resistance, alveolar-arterial oxygen difference, and wet/dry lung weight ratio. Histologically, pulmonary edema, congestion, sloughing of bronchial mucosa, and peribronchial and peripulmonary arterial hemorrhage were shown in lungs of group 3, but not in those of group 1 and 2. Airway mucosa and pulmonary vascular structure were well preserved in lungs of group 1 and 2. There was no significant difference between group 1 and 2 in lung functions, hemodynamics, or morphologic features. We concluded that PGE1 and UW solution could effectively extend lung preservation up to 24 h in this in vivo canine lung allotransplantation model.

Adenosine↗
PubMed1994

Reversal of refractory hypotension in septic shock by inhibitor of nitric oxide synthase.

Septic shock is a life-threatening condition that results from exposure to bacterial endotoxin. It is mediated by the release of cytokines. Some of these cytokines cause the release of vasoactive substances. We report the case of a 62-year-old male patient who received redo operation for replacement of the degenerative porcine aortic and mitral prostheses. High cardiac output shock developed on the seventh postoperative day with severe metabolic acidosis and oliguria. Systemic vascular resistance and mean arterial pressure elevated within 5 min and stabilized 60 min after the start of a single dose of intravenous administration of NG-monomethyl-L-arginine (50 mg), a potent and selective inhibitor of nitric oxide synthesis. These findings indicate that nitric oxide overproduction is an important contributor to refractory hypotension in high cardiac output septic shock. Our findings suggested the utilization of nitric oxide synthase inhibitor in the treatment of septic shock in humans.

Amino Acid Oxidoreductases↗
PubMed1994

Human dermal papilla cells and outer root sheath cells: no follicular differentiation in nude mice and chicken embryos.

Human scalp specimens were incubated in 5 U/ml dispase solution at 4 degrees C overnight before the isolation of dermal papillae and follicle epithelium. This pretreatment not only facilitated the attachment and cell outgrowth of dermal papillae but also made it easier to pluck out hairs with intact follicle epithelium. The outer root sheath cells were released from the follicle epithelium and grown on a feeder layer of mitomycin C-treated human dermal fibroblasts. The subcultured outer root sheath cells were grown in a serum-free medium. When the mixtures of early-passage dermal papilla cells and outer root sheath cells were injected into the subcutis of nude mice, an epidermal cyst surrounded by layers of fibrous tissue was found in three weeks. No hair follicles were found when the mixtures were implanted onto the chorioallantoic membrane of nine-day-old chicken embryos. A keratinized mass lying on the chorionic epithelium with or without smaller similar masses in the chorioallantoic membrane was found in eight days. No hair follicle-like structure could be found. Possible factors contributing to the failure to undergo follicular differentiation in this study are discussed.

Animals↗
PubMed1994

Imaged thoracic resection of a huge mediastinal tumor--role of extended incision and the use of conventional instruments.

Intrathoracic lesions are usually removed through conventional thoracotomy. The long incision and the spreading of the rib usually results in much pain and interference of chest wall mechanics. Today, with the development of imaged thoracic surgery (combination of thoracoscope and video optics), major procedures can be performed through small incisions. However, indications are greatly limited due to lack of suitable instrumentation and restricted space of the trocar channel especially when a huge intrathoracic tumor is encountered. In this selected report, we demonstrate a successful procedure using extended incision and conventional instruments in imaged resection of a huge cystic intrathoracic tumor. The procedure offers the benefit of safe, easy and fast manipulation. The patient had an uneventful postoperative course and was discharged on the fourth postoperative day.

Female↗
PubMed1994

Bowel perforation--a fatal complication following renal transplantation: a report of two cases.

From May 1983 to January 1993, 162 patients received renal transplantation at Taichung Veterans General Hospital. Two patients developed bowel perforation after this surgery. One was proved at 21 days and another, at 13 days after renal transplantation. Both patients died as a direct result of the perforation. From a review of literature, the average incidence is 2.7%, and the average mortality rate is 56.5%. Because of this high mortality rate, a high clinical suspicion, prompt and adequate surgical intervention, reduction of immunosuppressive agents and effective antibiotic coverage should contribute to a decline in mortality.

Adult↗
PubMed1994

Surgical treatment of acute type A aortic dissection with an intraluminal sutureless graft.

The surgical treatment of acute type A aortic dissection remains a great challenge to all cardiac surgeons. From January 1991 to June 1993, 21 consecutive patients (13 men and eight women, aged 34 to 74 years) underwent emergency operations to repair acute type A aortic dissection, with the aid of hypothermic circulatory arrest. The intima tear was located in the ascending aorta in 13 patients, in the aortic arch in five patients, and in the descending aorta in three patients. The dissected ascending aorta was replaced with sutureless, intraluminal vascular grafts in all 21 patients. The intima tears in the aortic arch of five patients were primarily repaired. Modified Cabrol's shunts were created in seven patients for hemostasis, and Dacron grafts were used to wrap the ascending aorta in 18 patients. Retrograde cerebral perfusion during circulatory arrest was performed on 15 patients. The circulatory arrest time was 37 +/- 10 minutes (mean +/- SD). All patients survived the operation and regained consciousness in the early postoperative period without neurologic deficit. Post-treatment follow-ups (mean, 18.2 months) were completed in all patients except one, who died 12 months after the operation as a result of a traffic accident. All of the surviving patients are doing well without any further aortic operations. Our experience suggests that surgical repair of the acute type A aortic dissection can be a simple and safe procedure if sutureless intraluminal grafts are used and hypothermic circulatory arrest and retrograde cerebral perfusion are utilized.

Acute Disease↗
PubMed1994

Endothelium dysfunction in cardiovascular diseases.

During the past 10 years, it has become obvious that endothelium regulates vasomotion, modulates hemostasis, influences vascular permeability, and controls blood vessel growth. The role of endothelium in modulating vasomotor tone is mediated by the releasing of a number of potent vasoactive compounds, including endothelium-derived relaxing factors (one of which is either nitric oxide or a compound that releases nitric oxide), vasoactive prostaglandins, endothelium-derived hyperpolarizing factor, and a number of constricting factors (such as thromboxane A2, endothelin, superoxide anion, L-arginine-dependent products etc.). This role of the endothelium is dramatically changed by several disease processes, including diabetes mellitus, cerebrovascular disease, and so on. Abnormalities of endothelial regulation of vascular tone may contribute to a number of clinical syndromes, including atherosclerosis, hypertension, septic shock syndrome, and many others. Endothelium dysfunction, characterized by altered synthesis or release of these relaxing factors along with maintained or facilitated synthesis or release of contracting factors, can lead to various pathological conditions such as thrombosis, vasospasm, and hypertension. Better understanding of the exact nature of endothelial dysfunction, including the role played by endothelium-derived vasoactive factors, may provide a basis for novel therapies in these vasculopathies.

Cardiovascular Diseases↗
PubMed1994

Video-assisted thoracic surgery. The Chang Gung experience.

Thoracoscopy has assumed a major role in the management of a variety of surgical diseases of the chest. This technique, which was primarily devised for diagnostic purposes, has subsequently come to be used for therapeutic applications in most centers today. In this report we review 300 cases of therapeutic thoracic procedures in which a video-assisted technique was used. We describe mainly our own experience and the basic approach strategies we found helpful in the video-assisted procedures. No complications or deaths were attributable to these procedures. Our conclusions were as follows: (1) Video-assisted thoracic surgery can be as effective therapeutically as many formal thoracotomy. (2) Excellent exposure can be obtained by the use of double-lumen endotracheal tubes. (3) Video-assisted thoracic surgery is an excellent alternative treatment for pneumothorax, blebs, and bullous disease. (4) Video-assisted thoracic surgery allows safe, complete, visually guided wedge resection of lung lesions, lobectomy, pericardiectomy, removal of mediastinal tumor, esophagectomy, and reconstruction of the thoracic esophagus. (5) Video-assisted thoracic surgery also allows management of a broad scope of other general thoracic diseases such as empyema, pleural effusion, and chest trauma (hemothorax), as well as cancer staging. (6) Video-assisted thoracic surgery will not compromise the primary diagnostic and therapeutic goals set forth for the patient. (7) Because conventional instruments and extended manipulation incisions can be used, video-assisted thoracic surgery offers the promise of expediency, safety, minimal discomfort, less postoperative pain, quick functional recuperation, excellent cosmetic healing, shortened stays in the hospital, and therefore savings in cost. Accordingly, we are now using video-assisted thoracic surgery to treat the majority of patients with surgical diseases of the chest.

Adolescent↗
PubMed1994

Protection of the brain by retrograde cerebral perfusion during circulatory arrest.

Hypothermic circulatory arrest is commonly used to facilitate repair of complex congenital heart defects and aortic lesions and for complex neurosurgical procedures. However, extended periods of circulatory arrest may impair cerebral metabolism and cause ischemic injury. Retrograde cerebral perfusion has been applied recently in aortic surgery to protect the brain. From January 1991 to December 1993, 29 patients underwent emergency operations to repair acute type A aortic dissection with the aid of hypothermic circulatory arrest. Six patients received hypothermic circulatory arrest without retrograde cerebral perfusion with a rectal temperature of 16.4 degrees +/- 0.9 degrees C (mean +/- standard error of the mean, group 1). Retrograde cerebral perfusion during hypothermic circulatory arrest was performed in 15 patients with a rectal temperature of 15.9 degrees +/- 0.5 degrees C (group 2) and in eight patients with a rectal temperature of 21.7 degrees +/- 0.8 degrees C (group 3). The hypothermic circulatory arrest times were 25 +/- 4, 42 +/- 4, and 63 +/- 6 minutes, respectively (p < 0.05). The cardiopulmonary bypass times were 173 +/- 5, 184 +/- 7, and 143 +/- 6 minutes, respectively (p < 0.05). All patients survived the operation and regained consciousness with no neurologic defects. Follow-up (mean 23.2, 14.5, and 5.1 months, respectively) was complete in all patients except one. This patient, from group 2, was killed in a road traffic accident 12 months after the operation. Our experience suggests that retrograde cerebral perfusion can effectively protect the brain from ischemic injury and extend the safe period of hypothermic circulatory arrest. With the aid of retrograde cerebral perfusion, prolonged circulatory arrest can probably be performed safely with moderate hypothermia.

Adult↗
PubMed1994

Comparison of five modalities in localization of primary aldosteronism.

BACKGROUND: The best response to surgical treatment of primary aldosteronism occurs in patients with an aldosterone-producing adenoma (APA), so pre-operative localization of the lesion is necessary. METHODS: A comparison was made of five localizing modalities-computed tomography (CT) of the adrenal gland, magnetic resonance imaging (MRI), dexamethasone suppression-131I-19-cholesterol adrenal scintiscan (DS, NP-59 adrenal scan), adrenal venography (venography) and adrenal venous sampling for aldosterone content (AVS) in 22 patients (12 women, 10 men) with primary aldosteronism; all had undergone operative confirmation within the past 9 years. The age at diagnosis ranged from 27 to 67 years (mean: 39.7). RESULTS: Unilateral adrenalectomy resulted in normal blood pressure without medication in 63.6% (14/22), and in improvement in 36.4% (8/22). Correct localization of the lesion was obtained in 95% (20/21) by CT, 100% (7/7) by MRI, 80% (12/15) by DS,NP-59 adrenal scan, 100% (6/6) by AVS and 78% (7/9) by venography. CONCLUSIONS: This experience would advocate CT of the adrenals as the initial means of localizing an APA on an outpatient basis because it is comfortable, safe, inexpensive and gives immediate results. The major role of MRI in the evaluation of adrenal adenoma should be complementary to CT. DS, NP-59 adrenal scan can be an adjuvant method for localization if CT scan results are not definitive. Adrenal venous catheterization with blood sampling for aldosterone content could be reserved for patients whose biochemical finging suggests the presence of an APA, and for whom CT or MRI of the adrenals and DS, NP-59 adrenal scan are inconclusive.

Adrenal Glands↗
PubMed1994

Intractable nontuberculous mycobacterial keratitis successfully treated by penetrating keratoplasty--3 cases report.

Since the first diagnosis of nontuberculous mycobacterial keratitis in Taiwan on 1983 by Chen et al., we have collected another 70 cases. Although most of the cases were difficult to treat medically, almost all cases healed before optical penetrating keratoplasties were performed. But, three of these cases responded poorly to medical treatment with sporadical relapse. Finally, penetrating keratoplasties (PKP) were performed on these three cases. These three cases were all males, aged 48, 27, and 35 respectively. The durations from the onset to receiving PK were 10, 4, and 6 months. All had histories of corneal trauma and all cases responded poorly or inconsistently to topical amikacin, erythromycin and antituberculous drugs. Histopathological examination of the diseased corneas in the first chronic case showed granuloma formation in the area of ulcer base. The second case presented lymphocyte clustering in the subepithelial region. The third case, which was operated in a relatively inflamed stage, had lymphocytes infiltrating the whole layer of the cornea. The results of PKP in the three eyes were therapeutically and optically successful, though the second case failed in the first penetrating keratoplasty due to acute tissue failure without recurrent infection. The best corrected visual acuities in the three eyes, postoperatively, were 20/25, 20/40, and 20/100 respectively. With the successful experience of these three cases, we suggest that performing PKP for intractable nontuberculous mycobacterial keratitis at an early stage may reduce the duration of the patients' suffering.

Adult↗
PubMed1994

The changes of ocular axial length and corneal curvatures after scleral buckling for retinal detachment.

As myopia plays an important role in the pathogenesis of retinal detachment, alterations of refractive components after scleral buckling procedures for retinal detachment may be an important factor for retinal redetachment. To find out the refractive change following retinal detachment surgery, we prospectively followed up the alterations of corneal curvature, and axial components (axial length, anterior chamber depth, lens thickness, and vitreous length) of 44 eyes of rhegmatogenous retinal detachment before and after operations. The procedures consisted of encircling scleral buckling (12 eyes) and segmental scleral buckling (32 eyes). All patients were followed for 6 months postoperatively. The corneal curvatures were measured with a keratometer, the axial length and axial components were measured with an A-scan ultrasonography. The methods and materials used in operation were recorded in detail to correlate with the refractive changes. The corneal curvature showed a trend to flatten early after operation (the 1st week), and gradually reversed to steepening. But, the difference was statistically significant only at the K2 (vertical meridian) in the 1st postoperative week and the K1 (horizontal meridian) in the 4th postoperative week. Lengthening of eyeballs were noted in the encircling group (12 eyes), but only the elongation in the 1st postoperative week was statistically significant. While in segmental buckling group, the axial length of the eyeballs was transiently shortened. The shortening was significant in the 2nd, 4th, and 6th week after operation. The reduction of eyeball's axial length was related to the shortening of vitreous length and shallowing of anterior chamber.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Use of Gore-Tex sling in brow suspension procedure.

A variety of materials have been employed for brow suspension surgery for ptosis. Gore-Tex (expanded polytetrafluoroethylene ePTFE) has been used as vascular prosthesis. We have used cylinder Gore-Tex in brow suspension surgery for 15 ptotic eyelids (11 patients), including 10 eyes (8 patients) of congenital ptosis, 1 eye of traumatic ptosis in a young male, and 4 eyes (2 patients) of myogenic ptosis in elderly patients. All of the eyelids had minimal or absent levator muscle function, and drooped to cover the visual axes. The surgical technique for the 10 congenital ptotic eyelids was a modified Fox's method. The remaining 5 adult eyelids were operated by a modified Crawford's method, with interlocking of the two suspension bands at the lower apex of each triangle and direct suturing of the bands to the tarsal plate. The use of Gore-Tex in brow suspension makes it easy to adjust the height and contour of the operated eyelids. Patients were followed-up from 2 to 16 months (average 9.1 months) postoperatively. The only complication was granuloma formation at the most upper knot area in 5 patients (6 eyelids), one of which also had granuloma at the ipsilateral fornix with the Gore-Tex band cutting through the conjunctiva. One eyelid drooped due to knot granuloma and infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Why are children hospitalized? The role of non-clinical factors in pediatric hospitalizations.

OBJECTIVE: Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization. DESIGN: Small area and population-based regression analysis. SETTING: The 72 hospital service areas of Maine, New Hampshire, and Vermont. STUDY POPULATION: The 589,290 (1989) children of Maine, New Hampshire, and Vermont < 15 years of age with 120,806 discharges during 1985 through 1989. MEASUREMENT AND MAIN RESULTS: Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant (P < .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence. CONCLUSIONS: The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.

Adolescent↗
PubMed1994

RNA transcription in porcine skeletal muscle nuclei during postnatal development.

Postnatal developmental pretranslational regulation of skeletal muscle alpha-actin gene expression was investigated. Northern blot analysis of skeletal muscle alpha-actin and beta-tubulin mRNA from 1- and 28-day-old pigs indicated that there are developmental increases in alpha-actin mRNA abundance (P < 0.03) and no significant changes in beta-tubulin mRNA (P > 0.1). A system for isolation of nuclei from porcine skeletal muscle and for transcriptional "run-on" analysis was established in order to investigate the regulatory mechanism of developmental changes in porcine skeletal muscle protein. Skeletal muscle nuclei were isolated from longissimus dorsi (LD) muscle of 1- and 28-day-old pigs by adapting a method to isolate nuclei from cardiac muscle. Results from a [3H]-UTP incorporation assay indicate that these nuclei preparations have the capacity to synthesize RNA and attain maximum incorporation after 40-45 min at 26 degrees C. Messenger RNA syntheses from skeletal muscle nuclei from 1- and 28-day-old pigs were not significantly different (P > 0.25). All nascent tRNA, rRNA, and mRNA in the nuclei were elongated since [3H]-UTP incorporation was reduced after addition of 0.05 micrograms/ml alpha-amanitin to the transcription mixture. Transcription "run-on" assay results indicated that more (P < 0.02) skeletal muscle alpha-actin pre-mRNA was synthesized in the 28-day-old pig skeletal muscle nuclei than in the 1-day-old pig skeletal muscle nuclei. These results indicate that the relative increase in skeletal muscle alpha-actin mRNA observed in the older animals was due, at least in part, to an increase in the transcriptional activity of the skeletal muscle alpha-actin gene.

Actins↗
PubMed1993

Structural requirements of mastoparan for activation of membrane-bound guanylate cyclase.

Mastoparan activated membrane-bound guanylate cyclase and potentiated the effect of atrial natriuretic factor (ANF) and ATP on guanylate cyclase activity in rat lung membranes. Mastoparan is a cationic, amphiphilic tetradecapeptide with an amidated carboxyl terminus. It takes the alpha-helical conformation upon interacting with the membrane. Several analogs were synthesized to study the role of the positive charges, the carboxyl amino group and the alpha-helical conformation of mastoparan in the activation of guanylate cyclase. The results showed that substitution of the C-terminal amide group of mastoparan with a carboxyl group significantly reduced its potency on the activation of guanylate cyclase. Replacement of three lysine residues of mastoparan with aspartic acid or serine residues completely abolished the stimulatory effect of mastoparan. When the alanine at position 10 of mastoparan was substituted by a proline, the resulting analog had no effect on guanylate cyclase activity. These results demonstrate that the positive charges and the helical structure of mastoparan are critical determinants for the activation of guanylate cyclase.

Amino Acid Sequence↗