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Biomedical subjects

C L Lee

Publications and source records attributed to C L Lee.

At least 55 records · Page 3Linked to original sources
PubMed2000

Laparoscopic extraperitoneal sacrospinous suspension for vaginal vault prolapse.

BACKGROUND: A new laparoscopic sacrospinous suspension procedure is described for the correction of vaginal vault prolapse using an extraperitoneal approach. This is the first report in the literature of the extraperitoneal approach. METHODS: We reviewed 12 women who had been treated in our hospital using this technique because of vaginal vault prolapse. These women had undergone hysterectomies (10 abdominal; 2 vaginal) between 5 and 22 years previously (mean, 12 years). After pre-laparoscopic preparation, a 10-mm trocar with a 10-mm zero-degree telescope was placed into the Retzius space. Using a direct air-distended method with a 20 mmHg insufflation pressure, Retzius and para-rectal spaces were created. The sacrospinous ligament could be easily identified and confirmed. A permanent suture was then inserted from the sacrospinous ligament to the vaginal vault to ensure that there was no space in between. RESULTS: This procedure was followed for all 12 patients. There were no major complications during surgery. Eleven women had no recurrence of vaginal vault prolapse during a follow-up period of 1 to 3 years (mean, 2.2 years). One patient developed recurrent vaginal vault prolapse; however, she subsequently underwent a successful colposacropexy by laparoscopy 23 months after the initial surgery. CONCLUSION: We modified the traditional sacrospinous fixation laparoscopically, following principles to restore the correct anatomic position of the vault. Laparoscopic extraperitoneal sacrospinous suspension can eliminate the procedure of opening and closing the peritoneum and avoid interference with the intestine during surgery. It can be used as an alternative to traditional genital suspension surgeries.

Aged↗
PubMed2000

HLA-DQB1 genotyping with simple automated DNA sequencing and single-strand conformation polymorphism analysis.

BACKGROUND AND PURPOSE: Accurate human leukocyte antigen (HLA) typing is important for matching donors and recipients of bone marrow transplantation. Because HLA is highly polymorphic, HLA genotyping is also a valuable tool in forensic identification of humans. The primary objective of this study was to establish a simple, rapid, and economic HLA analysis system suitable for use in forensic applications. METHOD: We used the primer pair DB130 and CH29 to amplify the HLA class II DQB1 gene by polymerase chain reaction (PCR). The nucleotide sequences of the PCR products were analyzed with an ABI Prism 377 automatic DNA sequencer, with the aid of its systematic analytical procedure. Some genotypes were confirmed by single-strand conformation polymorphism (SSCP) analysis. RESULTS: We identified 15 alleles and 37 genotypes from 86 Taiwanese subjects. The most frequent allele was 03011 (27.9%) and the most frequent genotype was 03011/03011 (15.1%). Statistical analysis showed that the allelic diversity was 0.862 and the power of discrimination was 0.948. CONCLUSIONS: The results of this study indicate that the combined use of automated sequencing with only one primer pair and SSCP provides a simple, rapid, and economic tool for analyzing the DQB1 gene. Compared with other sequencing methods that use a set of multiple primers, this method has two advantages. First, it is simpler and faster, because the HLAB1 genotype can be determined in a single PCR reaction. Second, the use of only one primer set obviates the need for preferential annealing of any one primer set.

Forensic Medicine↗
PubMed1999

Comparison of invasive and noninvasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers.

BACKGROUND: Eradication of Helicobacter pylori infection has been shown to prevent recurrent bleeding from peptic ulcers. However, the detection rate for H pylori infection seems to be underestimated in this group of patients and has been scarcely investigated. METHODS: Eighty patients with bleeding peptic ulcer were studied for evidence of H pylori infection. Seventy-seven of these patients were enrolled as having H pylori infection after any one of the following 3 tests were positive: culture, histologic study, or any 2 of rapid urease test (CLO test), carbon 13-labeled urea breath test (UBT), and serologic examination. Fresh blood or blood-containing material in the gastric antrum was noted by panendoscopy in 22 patients (group A). In the remaining 55 cases there was no blood in the antrum (group B). RESULTS: The sensitivities of the CLO test, bacterial culture, histologic study, 13C-labeled UBT, and immunoglobulin G serologic test were 45.5%, 36.4%, 77.2%, 95.4%, and 100% in group A, respectively, and 70.9%, 40.0%, 70.9%, 92.7%, and 96.4%, respectively, in group B. There was a statistically significant difference between the sensitivities found for CLO test and 13C-labeled UBT (p < 0.05). Of these 5 tests, only the sensitivity of the CLO test showed a statistically significant difference between groups A and B (p < 0.05). A delayed positive CLO test result was recorded in 13 patients (3 in group A, 10 in group B). CONCLUSION: Noninvasive tests seemed to be more sensitive than invasive tests in detecting H pylori infection in patients with bleeding peptic ulcers. Blood in the antrum might reduce the sensitivity of the CLO test but have no effect on the other tests. The CLO test should be observed for more than 24 hours because of the possibility of a delayed positive result in some patients with bleeding peptic ulcers.

Adult↗
PubMed1999

Negative CLOtest pellet can be reused.

BACKGROUND: The CLOtest is based on the production of ammonia from urea in the presence of urease. In theory, substrate that has not been consumed in a negative test can be reused. METHODS: We collected negative CLOtest pellets after their first use and stored them at room temperature. Whenever a CLOtest was needed during endoscopy, two biopsy specimens were taken from the antrum. One specimen was tested with a new CLOtest and the other with one that had been used previously. Time to color change was observed in paired tests. RESULTS: We used 216 previously used CLOtest pellets with biopsy specimens obtained from 317 patients. Of the paired tests, 204 matched positive and 108 tested negative. Only 5 paired tests had discrepant results. Three had positive results only with a new CLOtest, and 2 were positive only with the reused test. In positive paired tests, there was significant linear correlation in log-transformed color change time between reused and new tests (p < 0.001). Ninety-two percent of previously used pellets were reused fewer than three times before they yielded a positive color change; the interval to this occurrence ranged from 2 to 15 days. Compared with the new CLOtest, the sensitivity of the reused CLOtest was 98. 6% and the specificity was 98.2%. CONCLUSIONS: A negative CLOtest kept at room temperature can be reused within a short period of time, in circumstances in which there are environmental and economic considerations to be taken into account.

Biopsy↗
PubMed1999

Endoscopic management of injured bowel using the automatic stapler.

Bowel injury is a rare but potentially fatal complication of laparoscopy if it is unrecognized at the time of the procedure. Once a bowel injury is identified, it must be repaired by either laparoscopy or laparotomy. The Endo GIA 30 stapler is effective for achieving large-vessel hemostasis and facilitating laparoscopic procedures, and is reported safe for laparoscopic hysterectomy. It was used successfully in two women to repair extensive bowel injuries.

Adult↗
PubMed1999

Localized measurement of kinase activation in oocytes of Xenopus laevis.

We have combined a rapid cytoplasmic sampling technique with capillary electrophoresis to measure the activation of protein kinase C (PKC) in a small region (approximately 60 microm) of a Xenopus oocyte. The phosphorylation of a fluorescent PKC substrate was measured following addition of a pharmacological or physiological stimulus to an oocyte. When substrates for cdc2 kinase (cdc2K), PKC, and protein kinase A (PKA) were comicroinjected into an oocyte, all three substrates could be identified on the electropherogram after cytoplasmic sampling. With this new method, it should be possible to measure simultaneously the activation of multiple different kinases in a single cell, enabling the quantitative dissection of signal transduction pathways.

Amino Acid Sequence↗
PubMed1999

Disclosure of the diagnosis of HIV/AIDS to children born of HIV-infected mothers.

HIV disease in perinatally infected patients is now treated as a chronic illness of childhood. The effective use of highly active anti-retroviral therapy has contributed to the improvements in the prognosis of this illness. As this population matures, the issue of disclosure of diagnosis becomes more significant and part of their comprehensive medical care. The importance of disclosure relates directly to medication adherence, treatment compliance, sexual exploration, fears associated with premature death, and the child's developing autonomy. disclosure of HIV disease to an infected child poses complex issues, such as transmissibility, maternal guilt, more than one family member with the virus, and the potential for social stigma and isolation, among others. A change in perspectives is currently taking place regarding the process of disclosure, whereby it may be approached as a gradual discussion process over the life of the child. A method of gradual and partial disclosure to the child with consistent support by a multi-disciplinary team of providers has been a successful strategy for many children cared for at the New York Hospital-Cornell University Medical Center. Of 73 perinatally HIV-infected children who are 6 years of age or older, 41% have had complete disclosure and another 19% are partially disclosed. Continuous communication and negotiation among the members of the team, which includes the parents and caregivers, are vital to the gradual process leading to complete disclosure.

Child↗
PubMed1999

Publication trends of vegetarian nutrition articles in biomedical literature, 1966-1995.

We documented publication trends of vegetarian nutrition articles in biomedical literature between 1966 and 1995 using the National Institutes of Health MEDLINE bibliographic database. The publication rate of vegetarian articles increased steadily during the 3 decades, from an average of <10/y in the late 1960s to 76/y in the early 1990s. After adjusting for the total number of articles indexed in MEDLINE annually, we found that publication of vegetarian nutrition articles increased dramatically, by 4-fold, during the 1970s and reached an oscillating plateau during the 1980s. In the early 1990s, the proportion of vegetarian nutrition articles 8 articles per 1000 vegetarian nutrition articles and approximately 20 per 100000 articles indexed by MEDLINE. Non-nutrition journals have progressively published a larger share of all vegetarian articles in the biomedical literature during the period studied. The nature and study design of published vegetarian research has changed over the years as well. The proportion of original research and review articles increased whereas case series and letters to the editor decreased. Reports of epidemiologic studies of vegetarians with longitudinal designs have superseded cross-sectional designs in number and proportion. In 40% of all publications, preventive and therapeutic applications of vegetarian diets constituted the major themes of vegetarian articles in the decade of 1986-1995. However, 20 y earlier the main focus was on the nutritional adequacy of vegetarian diets. The progressive change in the themes of vegetarian nutrition publications is interpreted as a shift in the role of vegetarian diets in human nutrition.

Bibliometrics↗
PubMed1999

Laparoscopically assisted full thickness skin graft for reconstruction in congenital agenesis of vagina and uterine cervix.

In patients with agenesis of the vagina and cervix but with a functional endometrium, the traditional treatment is hysterectomy with construction of a neovagina. We report successful treatment by laparoscopically assisted full thickness skin graft for reconstruction in a patient with congenital agenesis of the vagina and uterine cervix concomitant with haematometra and ovarian endometrioma in a 12 year old girl. Postoperatively, the vaginal skin graft healed well, and menstruation first appeared 4 weeks later. In our opinion, a combined laparoscopic and vaginal procedure with full thickness skin graft is an efficacious alternative in managing such genital defects.

Cervix Uteri↗
PubMed1999

Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar.

A case of laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar is reported. A 30 year old woman was admitted to our hospital for profuse vaginal bleeding 2 weeks after an abortion had been performed. A urine pregnancy test was positive. Abdominal ultrasound revealed a well-encapsulated bulging mass over the lower anterior uterine wall measuring 7x5 cm. Hysteroscopy revealed retained gestational tissue in the lower corpus despite a normal uterine cavity. An incision was made over the most prominent area of the mass by operative laparoscopy. Dark reddish tissue suggestive of the products of conception was removed using grasping forceps. One-layer of continuous endoscopic sutures along the affected uterine wall was made with 1-0 Prolene. Laparoscopy enabled the successful treatment of an unruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient's reproductive capability.

Adult↗
PubMed1999

Laparoscopic hemi-hysterectomy in treatment of a didelphic uterus with a hypoplastic cervix and obstructed hemivagina.

Maldevelopment of the Müllerian duct system may result in various urogenital anomalies including didelphic uterus with a hypoplastic cervix and obstructed hemivagina. We report a patient with this anomaly who was treated by laparoscopic hemi-hysterectomy and hysteroscopic resection of hemivagina. A 17 year old patient who had complained of vaginal pus-like discharge on and off for 1 year was diagnosed by MRI to have a double uterus with obstructed right hemivagina and ipsilateral renal agenesis. After hysteroscopic identification of hypoplasia of the right uterine cervix, laparoscopic resection of the right uterus and right Fallopian tube and hysteroscopically assisted resection of the vaginal septa were performed successfully. From our experience, combined laparoscopy and hysteroscopy may be an efficacious alternative in the management and diagnosis of Müllerian anomalies.

Adolescent↗
PubMed1999

Ribotyping of Vibrio parahaemolyticus isolates obtained from food poisoning outbreaks in Taiwan.

Vibrio parahaemolyticus is a prevalent food-borne pathogen in Taiwan, Japan and other Asian countries. This work presents a novel ribotyping method for the molecular epidemiological examination of this pathogen. Genomic DNA was fragmented by HindIII digestion and hybridized with cDNA probe for Escherichia coli 16S and 23S RNA genes. A total of 121 isolates obtained from outbreaks during 1992 and 1994 in Taiwan were characterized by this ribotyping method. Four to seventeen restricted fragments were visualized in these isolates. After hierarchical cluster analysis, these isolates were grouped into thirty different ribotypes. In addition, A3, A7, E3 and F1 were the major ribotypes, consisting of 22.3, 13.2, 9.1, and 8.3% of the isolates, respectively. A, E, F, G and B were the major groups, consisting of 46.2, 14.0, 9.1, 6.7, and 6.7% of the isolates, respectively. The discriminatory ability of this ribotyping method, as determined by Simpson's index of diversity, was 0.93, which closely resembled that of a previously reported pulsed-field gel electrophoresis method.

Bacterial Typing Techniques↗
PubMed1999

Molecular typing of Vibrio parahaemolyticus isolates, obtained from patients involved in food poisoning outbreaks in Taiwan, by random amplified polymorphic DNA analysis.

Vibrio parahaemolyticus is one of the most important food-borne pathogens in Taiwan, Japan, and other countries with long coastlines. This paper reports on the development of a new random amplified polymorphic DNA (RAPD) method for the molecular typing of this pathogen. The 10-mer primer 284 (5'-CAG GCG CAC A-3') was selected to generate polymorphic amplification profiles of the genomic DNA at an annealing temperature of 38 degrees C. A total of 308 clinical isolates of V. parahaemolyticus collected during food poisoning outbreaks in Taiwan, mostly occurring between 1993 and 1995, plus 11 environmental and clinical reference strains were analyzed by this RAPD method. A total of 41 polymorphic RAPD patterns were recognized, and these patterns were arbitrarily grouped into 16 types (A to P). Types A, B, C, D, and E were the major types, and subtypes C3, C5, E1, B1, D2, and A2 were the major patterns. The major types were phylogenetically more closely related to each other than to any of the minor types.

DNA, Bacterial↗
PubMed1999

Chinese characters: semantic and phonetic regularity norms for China, Singapore, and Taiwan.

Cognitive models of language processing in English are founded on norms for word properties, but their universality is now being explored across different writing scripts and subject groups. Although Chinese characters are popular for this comparative work, their salient properties remain ill defined or poorly controlled. We describe how norms for semantic and phonetic regularity in Mandarin can be calibrated on a regional basis. The rating data that we present from China, Singapore, and Taiwan also illustrate why the diversity of both oral and written forms of Chinese should be considered in future empirical work.

China↗
PubMed1999

Endoscopic ultrasonography in the differential diagnosis of giant gastric folds.

Giant gastric folds (or large gastric folds) are found in both benign and malignant diseases, and differential diagnosis with either upper gastrointestinal X-ray or endoscopy is difficult. Sometimes, even endoscopic biopsy cannot establish a definitive diagnosis. Recently, endoscopic ultrasonography (EUS) has been used to study giant gastric folds. We performed EUS in 25 patients with giant gastric folds that had been detected with upper gastrointestinal X-ray or endoscopy. The definitive diagnoses were confirmed by histopathology, other examinations, or long-term follow-up. The final diagnoses of these 25 patients were gastric varices in eight, gastric lymphangiectasis in one, gastritis in four, gastric carcinoma (scirrhous type) in six, and gastric lymphomas in six. All patients with gastric varices had anechoic tortuous varicose veins in the submucosal layer. EUS images of gastric lymphangiectasis were similar to those of gastric varices. EUS revealed regular gastric wall thickening of the second (mucosa) and third (submucosa) layers in all cases of gastritis. The fourth (muscularis propria) layer was intact in the only case of mucosa-associated lymphoid tissue lymphoma (MALToma), but not in the other five cases of gastric lymphoma. The second and third layers of this MALToma were irregular in thickness and heterogenous in echogenicity, different from the characteristic EUS findings in gastritis. The fourth layer was markedly thickened only in malignant conditions. Differentiation of gastric cancer from lymphoma with EUS was difficult because of overlapping EUS findings. In conclusion, EUS is indicated for the differential diagnosis of giant gastric folds. In addition, it avoids the risk associated with biopsy of gastric varices.

Adult↗
PubMed1999

Vaginoscopy using hysteroscope for diagnosis of vaginal bleeding during childhood: case report.

Vaginal bleeding is an uncommon and alarming symptom for children, and serious underlying causes should be excluded. Though vaginal bleeding during childhood was mostly associated with precocious puberty, the physician should keep in mind that local vaginal lesions such infectious vaginitis, vaginal trauma, and vaginal foreign bodies frequently present vaginal bleeding. A 10-year-old girl who denied any traumatic injuries or sexual abuse presented with profuse vaginal bleeding. She had normal development milestones and had no signs of thelarche or adrenarche. Her hymen was intact and the basal measurements of sex hormones including tyrotropic hormone and thyroxine were all within reference ranges. Finally, a laceration of the vaginal wall was found by vaginoscopy using a hysteroscope under general anesthesia and treated using gauze packing. We must emphasize the importance of vaginoscopy and examination under anesthesia in a child with vaginal bleeding to exclude local vaginal lesions. In addition, vaginoscopy using a hysteroscope makes the examination efficient and cost effective.

Child↗