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Biomedical subjects

C L Lee

Publications and source records attributed to C L Lee.

At least 37 records · Page 2Linked to original sources
PubMed2001

Laparoscopic diagnosis and management of Fitz-Hugh-Curtis syndrome: report of three cases.

Perihepatic adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface characterizes Fitz-Hugh-Curtis syndrome (FHCS). FHCS is an extrapelvic manifestation of pelvic inflammatory disease and usually refractory to medical treatment and surgical intervention. With the increased incidence of pelvic inflammatory disease, chronic pelvic pain and sequalae of the process are becoming more common. Herein, we report 3 patients with pelvic inflammatory disease in whom medical treatment failed initially and FHCS was diagnosed via laparoscopy. Laparoscopic lysis of pelvic and perihepatic adhesions, irrigation of the abdomino-pelvic cavity, and antibiotics treatment after surgery successfully relieved these patients' symptoms. FHCS is not a new syndrome but most gynecologists might neglect this condition. Laparoscopy is a less invasive procedure than exploratory laparotomy. We recommend laparoscopy in patients with lower abdominal and right upper quadrant discomfort when other organic disease has been ruled out and medical treatment has failed to relieve symptoms.

Adult↗
PubMed2001

An evaluative study of the effects of the implementation of UBSG on nurses' perceptions of professional governance.

Health care reform has been a major economic and political challenge in Taiwan. Successful implementation of change in hospitals requires managers to learn new skills. Unit-based shared governance (UBSG) is one innovation used to restructure health care organizations to promote the performance of professionals and to achieve goals for organizations. This research, conducted in a 150-bed community hospital, was a quasi-experimental study designed to evaluate the effectiveness of implementing UBSG. This article describes and compares the degree of nurses' perceptions of professional governance between a UBSG group (n = 29) and a control group (n = 24). The findings of this study indicate that the majority of UBSG respondents scored at a high level of participation in decision-making and professional practice (p < .05). Nurses in the UBSG group shared more in professional governance activities (p < .05). It is suggested that decentralized UBSG within a division of nursing can empower nurses. The study provides an empirical basis for implementing UBSG.

Adult↗
PubMed2001

[The effectiveness of implementing an unit-based shared governance model].

The purpose of the nonequivalent control group study was to establish a regional unit-based shared governance model. Fifty-three subjects distributing to experimental (n = 29) and control (n = 24) groups-age, working years, and education were matched statistically-were selected by "purposeful sampling" of Index of Professional Nurse Governance pretest mean scores from six units at a nursing department. Based on Martin's "systematic" evaluation model for shared governance, the study collected: (1) manager's and staff's perception of existing governance using open-ended questions, (2) measure of organizational efficiency using the IPNG and the Index of Working Satisfaction, and (3) the research team's assessment of the unit's willingness to continue this model in the future. The reliability and validity of the questionnaires were established. Intervention of the model was approximately four months, including: preparatory and evaluating phase: data was collected; educative phase: empowering managers and staff were educated in the shared governance concepts; implementing phase: shared governance team was built up. Two-tailed t and chi 2 tests were used to detect differences between the two groups. Results showed, after establishing the unit-based model, (1) an increase in the nursing professional governance and work satisfaction among nurses; (2) an enhanced partnership between managers and nurses; (3) staff nurses perceived increased autonomy, authority, and more frequently expressed their opinions to managers; (4) managers perceived their staff to have more potential competence, then task pushed effectively. The findings suggest that managers and nurses need to refine their professional roles based on the organizational mission, as well as to expand nurses' representation and participation in current organization-wide committees by trust and full delegation from their managers.

Female↗
PubMed2001

Three-dimensional ultrasonic images of normal fetus.

BACKGROUND: The purpose of this study was to assess the usefulness and feasibility of 3-dimensional (3D) ultrasound for routine fetal observation. METHODS: Eighty-five normal pregnancies with gestational ages of 20-36 weeks were studied. A conventional ultrasound scanner with a specially designed operation unit, frame memory, and 3D probe was the apparatus used in this study. The unit has a circuit board consisting of digital integrated circuit chips designed to make calculations of volume ray tracings for volume rendering in real time. For each fetus, scanning was performed with different levels of opacity in the equation for volume rendering. In areas where there was an inadequate amniotic fluid pocket to perform an adequate examination, the pregnant woman was asked to push the fetus to the opposite side by gently pressing on her abdomen. RESULTS: Face, limbs, and fingers which are difficult to visualize on conventional ultrasonography could be seen clearly. Extremely satisfactory images were obtained at between 24 and 34 weeks of gestation that produced sonographic pictures easily recognized even by laypersons. Beyond 34 weeks of gestation due to the relative decrease in the size of amniotic fluid pockets, and before 24 weeks of gestation due to frequent fetal movement, the soft tissue of fetuses is thin and its acoustic impedance is virtually the same as that of water, so surface-rendered images are less satisfactory. In addition, the anterior wall placenta, multiple pregnancies, and oligohydramnios made viewing even more difficult. CONCLUSION: Between 24 and 34 weeks of gestation, 3D ultrasound is a feasible and useful procedure for routine antenatal examination.

Female↗
PubMed2001

Endoscopic ultrasonography to study the causes of extragastric compression mimicking gastric submucosal tumor.

BACKGROUND AND PURPOSE: Many reports have confirmed that endoscopic ultrasonography (EUS) can differentiate gastric submucosal tumor from extragastric compression, but only a few specifically concentrated on EUS in identifying the causes of external compression. MATERIALS AND METHODS: From May 1993 to May 2001, we used EUS in 238 patients to diagnose gastric submucosal tumor or external compression. We excluded 183 patients who had submucosal tumors and analyzed the remaining 55 patients with extragastric compression. Malignant causes of external compression were proved by surgery or biopsy. Benign causes of external compression were proved by other imaging examinations (abdominal ultrasound, computerized tomography, angiography) or surgery. Patients with external compression caused by normal organs were followed up with repeated upper gastrointestinal endoscopy or EUS. RESULTS: The stomach was compressed by normal extragastric organs in 32 patients (spleen 10, splenic vessel 6, gall bladder 9, liver 3, pancreas 3, and intestine 1), by benign pathologic lesions in 12 patients (liver cyst 7, liver hemagioma 2, splenic cyst 1, pancreatic cyst 1, pancreatic cystadenoma 1) and by malignant tumors in 5 patients (hepatoma 1, liver metastasis from colon cancer 2, pancreatic cystadenocarcinoma 1 and lymphoma of spleen 1). In the remaining six patients, neither submucosal tumor nor external compression was found during EUS examination and the external compression was considered transient. CONCLUSION: When an extragastric compression mimicking submucosal tumor is detected by upper gastrointestinal endoscopy, EUS is indicated to identify the cause of extragastric compression.

Adolescent↗
PubMed2000

Preferential reduction of Na+/K+ ATPase alpha3 by 17beta-estradiol influences contraction frequency in rat uteri.

One beta1 and two alpha (alpha1 and alpha3) isoforms of Na+/K+-ATPase exist in rat uteri. Previous immunocytochemistry studies have suggested that the alpha3 isoform may be involved in calcium regulation indirectly. Estrogens are known to both modulate Na+/K+-ATPase activities in non-uterine tissues and suppress spontaneous uterine contractions in rats. Thus the purpose of this study was to examine the correlation between estrogens-modulated uterine contraction and the expression of Na+/K+-ATPase alpha3 isoform in rats. After 1-, 2-, and 4- day treatments with 17beta-estradiol (E2, 5 microg/ml/kg, s.c., daily), the diameter of uterine horn was measured. The contraction force of uterine strips was measured by standard muscle bath apparatus. The protein abundance and enzyme activity of Na+/K+-ATPase in rat uteri were measured by Western blot analysis and ATPase assay, respectively. One day of E2 decreased both contraction frequency and alpha3-protein expression without the change in uterine diameter, enzyme activity or other isoforms. Two days of E2 reduced contraction frequency, the enzyme activity, as well as alpha3- and beta1- protein abundance but increased alpha1-protein and uterine diameter. Four days of E2 elicited similar effects as two days of E2, but did not affect alpha1-protein abundance. In conclusion, E2 elicits differential effects on isoform expression. After 1-day treatment with 17beta-estradiol, the decrease in the expression of alpha3 and beta1 without a change in Na+/K+-ATPase activity suggests that some isoform other than beta1 exist in rat uteri. The positive correlation between the reduction of alpha3-and the decrease of contraction frequency suggests the involvement of alpha3 isoform in uterine oscillation.

Animals↗
PubMed2000

Spine loss and other dendritic abnormalities in epilepsy.

Studies of neurons from human epilepsy tissue and comparable animal models of focal epilepsy have consistently reported a marked decrease in dendritic spine density on hippocampal and neocortical pyramidal cells. Spine loss is often accompanied by focal varicose swellings or beading of dendritic segments. An ongoing excitotoxic injury of dendrites (dendrotoxicity), produced by excessive release of glutamate during seizures, is often assumed to produce these abnormalities. Indeed, application of glutamate receptor agonists to dendrites can produce both spine loss and beading. However, the cellular mechanisms underlying the two processes appear to be different. One recent study suggests NMDA-induced spine loss is produced by Ca2+-mediated alterations of the spine cytoskeleton. In contrast, dendritic beading is not dependent on extracellular Ca2+; instead, it appears to be produced by the movement of Na+ and Cl- intracellularly and an obligate movement of water to maintain osmolarity. A decrease in dendritic spine density was recently reported in a model of recurrent focal seizures in early life. Unlike results from other models, dendritic beading was not observed, and other signs of neuronal injury and death were absent. Thus, additional mechanisms to those of excitotoxicity may produce dendritic spine loss in epileptic tissue. A hypothesis is presented that spine loss can be a product of a partial deafferentation of pyramidal cells, resulting from an activity-dependent pruning of neuronal connectivity induced by recurring seizures. The dendritic abnormalities observed in epilepsy are commonly suggested to be a product and not a cause of epilepsy. However, anatomical remodeling may be accompanied by alterations in molecular expression and targeting of both voltage- and ligand-gated channels in dendrites. It is conceivable that such changes could contribute to the neuronal hyperexcitability of epilepsy.

Animals↗
PubMed2000

Late coil migration due to thrombolysis after successful implantation of a coil for persistent ductus arteriosus.

Transcatheter coil occlusion of persistent ductus arteriosus (PDA) is now a widely accepted treatment for PDA. However, late complication might occur due to thrombolytic treatment during the interventional period. We discuss a case with late coil migration due to thrombolysis after successful implantation of a coil. It should be emphasized that early thrombus formation is important for successful closure of PDA shunt using coil.

Ductus Arteriosus, Patent↗
PubMed2000

Concentrations of chlorobenzenes, hexachlorobutadiene and heavy metals in surficial sediments of Kaohsiung coast, Taiwan.

This work analyzes surface sediment samples collected from 40 stations along the Kaohsiung coast in southern Taiwan for chlorobenzenes (CBs), hexachlorobutadiene (HCBD) and heavy metals (Cu, Zn, Pb, Cd, Ni, Fe, Mn and Cr). The highest CBs concentrations are recorded in station T7-15 (about 10 km west off the outlet of Da-lin-pu ocean outfall pipe), with total di-, tri-, tetra-, penta- and hexa-chlorobenzenes concentrations of 290.5, 117.1, 64.5, 15.7 and 22.3 ng/g, respectively. The major pollution source of HCBD is most likely located in the Tso-yin ocean outfall field; while the Dah-lin-pu ocean outfall field and Kao-ping Chi estuary, located in the southern portion of Kaohsiung coast, are the major contributors of hexachlorobenzene. The concentration of CBs congeners correlate fairly well with each other, as do metals. However, concentrations of organics (CBs and HCBD) did not correlate with metals. This finding implies that the pollution characteristics of organics and heavy metals in this highly utilized coastal zone markedly differ from each other.

Butadienes↗
PubMed2000

Radical laparoscopic surgery for carcinoma of the cervical stump.

Traditionally, most women with cervical stump cancer underwent radiation therapy, as radical surgery was considered difficult. Given our success performing laparoscopic-assisted radical vaginal hysterectomy, we modified that technique to treat two women with carcinoma of the cervical stump. At follow-up of 14 and 17 months, respectively, both patients were free of recurrence.

Adenocarcinoma↗
PubMed2000

Laparoscopic-assisted vaginal myomectomy.

STUDY OBJECTIVE: To evaluate the safety and efficacy of combined laparoscopic and vaginal approach in dealing with uterine myomas. DESIGN: Retrospective case study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Thirty-one women with symptomatic fundal and/or posterior wall uterine myomas. INTERVENTION: Laparoscopic-assisted vaginal myomectomy performed by one of the authors from July 1996 to December 1998. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD operating time, blood loss, and length of hospital stay were 79.19+/-18.31 minutes, 150.00+/- 103.28 ml, and 3.10+/-0.75 days, respectively. No patients developed serious complications, and only two minor complications occurred. CONCLUSION: After laparoscopic inspection and location of uterine myomas, dealing with posterior and fundal uterine myomas by the vaginal route makes hemostasis and uterine repair easier than by purely laparoscopic approach.

Adult↗
PubMed2000

Ceftazidime-resistant Klebsiella pneumoniae bloodstream infection in children with febrile neutropenia.

OBJECTIVES: To evaluate prevalence of ceftazidime-resistant Klebsiella pneumoniae (CRKP) in the pediatric oncology unit of University Hospital, Kuala, Lumpur, and to identify differences between febrile neutropenic pediatric patients with CRKP and ceftazidime-sensitive K. pneumoniae (CSKP) bacteremia. MATERIALS AND METHODS: Febrile neutropenic patients treated between January 1996 and December 1997 at the pediatric oncology unit of University Hospital, Kuala Lumpur, were prospectively studied. Empirical antibiotic therapy consisted of ceftazidime and amikacin. Those who developed K. pneumoniae bacteremia were identified, and clinical features analyzed. Ceftazidime-resistance was documented via disk-diffusion testing. Production of extended-spectrum beta-lactamase (ESBL) was inferred on the basis of synergy between ceftazidime and amoxicillin-clavulanic acid. The different features between the two groups and variables associated with the development of CRKP bacteremia were analyzed using chi-square and t-tests and calculation of odds ratios. A multivariate analysis was used to identify independent factors for CRKP development. RESULTS: Ceftazidime-resistance was seen in 51.6% of all K. pneumoniae isolates, and all these isolates were inferred to be ESBL producers. All isolates were sensitive to imipenem. Susceptibility to gentamicin was 90.5%. The mean continuous hospital stay prior to the detection of bacteremia was 13.7 days overall, but significantly longer in the CRKP group (21.9 d) compared to the CSKP group (4.3 d) (P = 0.003). Children with CRKP were more likely to have received antibiotics in the 2 weeks prior to detection of bacteremia (87.5% of cases) than the CSKP group (20.0% of cases) (P = 0.0008). Sepsis-related mortality was higher in those with CRKP (50.0%) than in the CSKP group (13.3%) (P = 0.02). Patients who did not receive CRKP-directed antibiotics within 48 hours of admission were more likely to have a fatal outcome than those who did (P = 0.009). Logistic regression analysis identified use of third-generation cephalosporins 2 weeks prior to presentation and a hospital stay of 2 weeks or more as independent risk factors for development of CRKP. CONCLUSIONS: More than half of total K. pneumoniae isolated from blood cultures in the unit were ceftazidime-resistant. Children with febrile neutropenia with prolonged hospital stay and recent prior antibiotic exposure are at high risk of developing CRKP bacteremia. Mortality was significantly higher in this group. Early commencement of appropriate antibiotics (e.g., imipenem with or without gentamicin), according to susceptibility study results, may be beneficial in such circumstances.

Anti-Bacterial Agents↗
PubMed2000

A Monte Carlo dosimetry-based evaluation of the 7Li(p,n)7Be reaction near threshold for accelerator boron neutron capture therapy.

Advanced methods of boron neutron capture therapy (BNCT) use an epithermal neutron beam in conjunction with tumor-targeting boron compounds for irradiation of glioblastomas and metastatic melanomas. A common neutron-producing reaction considered for accelerator-based BNCT is 7Li(p,n)7Be, whose cross section increases very rapidly within several tens of keV of the reaction threshold at 1.88 MeV. Operation in the proton energy region near threshold will have an appreciable thick target neutron yield, but the neutrons produced will have relatively low energies that require little moderation to reach the epithermal range desirable for BNCT. Because of its relatively low projected accelerator cost and the portability of the neutron source/target assembly, BNCT based on the near-threshold technique is considered an attractive candidate for widespread hospital use. A systematic Monte Carlo N-Particle (MCNP) investigation of the dosimetric properties of near-threshold neutron beams has been performed. Results of these studies indicate that accelerator proton energies between 1.93 and 1.99 MeV, using 5 cm of H2O moderator followed by thin 6Li and Pb shields, can provide therapeutically useful beams with treatment times less than one hour and accelerator currents less than 5 mA.

Beryllium↗
PubMed2000

Characteristics of Vibrio parahaemolyticus O3:K6 from Asia.

A variety of serovars of the food-borne pathogen Vibrio parahaemolyticus normally cause infection. Since 1996, the O3:K6 strains of this pathogen have caused pandemics in many Asian countries, including Taiwan. For a better understanding of these pandemic strains, the recently isolated clinical O3:K6 strains from India, Japan, Korea, and Taiwan were examined in terms of pulsed-field gel electrophoresis (PFGE) typing and other biological characteristics. After PFGE and cluster analysis, all the O3:K6 strains were grouped into two unrelated groups. The recently isolated O3:K6 strains were all in one group, consisting of eight closely related patterns, with I1(81%) and I5(13%) being the most frequent patterns. Pattern I1 was the major one for strains from Japan, Korea, and Taiwan. All recently isolated O3:K6 strains carried the thermostable direct hemolysin (tdh) gene. No significant difference was observed between recently isolated O3:K6 strains and either non-O3:K6 reference strains or old O3:K6 strains isolated before 1996 with respect to antibiotic susceptibility, the level of thermostable direct hemolysin, and the susceptibility to environmental stresses. Results in this study confirmed that the recently isolated O3:K6 strains of V. parahaemolyticus are genetically close to each other, while the other biological traits examined were usually strain dependent, and no unique trait was found in the recently isolated O3:K6 strains.

Anti-Bacterial Agents↗
PubMed2000

Characterization of Vibrio parahaemolyticus isolates obtained from foodborne illness outbreaks during 1992 through 1995 in Taiwan.

Vibrio parahaemolyticus is an important foodborne pathogen in Taiwan and many other Asian countries. A total of 371 isolates of V. parahaemolyticus collected from patients involved in foodborne illness outbreaks in Taiwan from 1992 to 1995 were characterized. These isolates had typical biochemical characteristics and only 4% were urease positive. The most frequently isolated serovars were O5:K15 (18.5%), O4:K8 (16.2%), O3:K29 (12.5%), O1:K56 (8.3%), O2:K3 (6.5%), and O4:K12 (6.0%). Most of the isolates were susceptible to nalidixic acid, tetracycline, tobramycin, cephalothin, and gentamicin. About 10% of the isolates were resistant to seven or more antibiotics. Approximately 92.4% of these V. parahaemolyticus showed beta-hemolysis on Wagatsuma blood agar plate and approximately 62.1% of these isolates exhibited detectable amounts of thermostable direct hemolysin. Most of the isolates examined exhibited two copies of tdh genes on the 1.3- and 2.5-kb HindIII-digested chromosome fragments with several variations on other fragments. A pulsed-field gel electrophoresis (PFGE) subspecies typing scheme was used to analyze these domestic isolates and the O3:K6 strains from Japan, Korea, and Taiwan. Fifty seven patterns were differentiated with A, B, C, E, and H being the major domestic types (cumulatively 76% of isolates), while O3:K6 strains (PFGE type I), abruptly occurring since 1996, were genetically distant from the major domestic types.

Animals↗
PubMed2000

Survival rate for liver cancer in Taiwan.

BACKGROUND: There is no nationwide population-based study of the survival rate for liver cancer in Taiwan. Consequently, the true rate of liver cancer survival is unknown. Our aim was to determine the survival rate for liver cancer patients in Taiwan. METHOD: The Taiwan Cancer Registry was searched for liver cancer cases in 1987 and 2,558 cases were found. Of these, 485 lacked an identification number, 29 lacked documentation of age, 33 were metastatic, nine lived in Kinmen and Lienkiang Hsien of Fukien Province leaving 2,002 to be studied. With the help of identification numbers, we linked our cases with the Death Registry of the Department of Health, Executive Yuan, ROC, for the 1987 to 1992 period and calculated the five-year survival rate using actuarial life tables. For analyzing factors affecting the five-year survival rate, multivariate analysis with the Cox proportional hazards model was used. RESULTS: Of the 2,002 patients, 752 were diagnosed histopathologically and 1,250 patients were diagnosed clinically. A total of 15% of patients survived for five years or longer after diagnosis. Of those diagnosed histopathologically, 17% survived for five or more years, and of those diagnosed clinically, 13% survived for five or more years. The sex, age, residential area and ethnic origin did not affect the five-year survival rate significantly. Only diagnosis type affected the five-year survival rate significantly (p < 0.05). The 660 pathologically diagnosed liver cancer patients had a better survival rate than the 1,250 patients diagnosed clinically. CONCLUSIONS: The overall five-year survival rate for liver cancer in Taiwan was 15%. The prognosis for liver cancer patients in Taiwan is still unfavorable. The aim is to persuade affected patients to accept treatment.

Adolescent↗