Biomedical subjects
C Leung
Publications and source records attributed to C Leung.
Clinical and echocardiographic follow-up of patients previously treated with dexfenfluramine or phentermine/fenfluramine.
CONTEXT: Use of anorexigen therapy is associated with valvular abnormalities, although there is limited information on long-term changes in valvular regurgitation following discontinuation of these agents. OBJECTIVE: To evaluate changes in valvular regurgitation, valve morphology, and clinical parameters 1 year after an initial echocardiogram in patients previously treated with dexfenfluramine or phentermine/fenfluramine and in untreated controls. DESIGN AND SETTING: A reader-blinded, multicenter, echocardiographic and clinical 1-year follow-up study at 25 outpatient clinical sites. PATIENTS: A total of 1142 obese patients (1466 participated in the initial study) who had follow-up echocardiogram; all but 4 had a follow-up medical history and physical examination. Follow-up time from discontinuation of drug to follow-up echocardiogram for 371 dexfenfluramine patients was 17.5 months (range, 13-26 months) and for 340 phentermine/fenfluramine patients was 18.7 months (range, 13-26 months) after discontinuation of drug therapy. MAIN OUTCOME MEASURE: Change in grade of valvular regurgitation and valve morphology and mobility. RESULTS: Echocardiographic changes in aortic regurgitation were observed in 8 controls (7 [1.7%] had decreases; 1 [0.2%] had an increase); 29 dexfenfluramine patients (23 [6.4%] had decreases; 6 [1.7%] had increases; P<.001 vs controls); and 15 phentermine/fenfluramine patients (4.5% all decreases; P =.03 vs controls). No statistically significant differences were observed when treated patients were compared with controls for changes in medical history, physical findings, mitral regurgitation, aortic or mitral leaflet mobility or thickness, pulmonary artery systolic pressure, ejection fraction, valve surgery, or cardiovascular events. CONCLUSION: Progression of valvular abnormalities is unlikely in patients 1 year after an initial echocardiogram and 13 to 26 months after discontinuation of dexfenfluramine and phentermine/fenfluramine.
An unusual presentation of urinary retention.
Patients with urinary retention frequently present to the emergency department (ED) for evaluation and treatment. Urinary retention is seen most often in males secondary to mechanical causes. However, other etiologies must be considered. We present an unusual case of a 35-year-old male who developed postcoital urinary retention secondary to urogenital diaphragm spasm.
Intrafallopian egg replacement without IVF back-up.
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Synthesis, secondary structure and folding of the bend region of lung surfactant protein B.
Previous theoretical analysis of the primary structure of lung surfactant protein SP-B indicates a disulfide-linked, hydrophobic midsequence that forms a hairpin-like motif. Here, we experimentally investigate the secondary structure of the disulfide-stabilized bend region by synthesizing two 12-residue analogs of the SP-B midsequence. The native peptide has the same sequence for residues 35 to 46 as native human SP-B, while, in the second mimic peptide, Leu40 and Val41 were replaced with D-Ser and L-His. Both peptides contain cysteine residues at the N- and C-terminus (Cys35 and Cys46, respectively). Oxidation/reduction experiments with fast atom bombardment mass spectrometry showed mass shifts of approximately 2 daltons, consistent with the oxidized peptides existing in solution as monomers, each with one internal disulfide bond (Cys35-Cys46). Since circular dichroism and Fourier-transform infrared measurements show that both peptides assume turn conformations in structure-promoting solvents such as trifluoroethanol (TFE), a structural model is proposed in which Cys35 and Cys46 are brought in close apposition through an internal bend in the peptide. Consistent with this model are electron spin resonance (ESR) results of the mimic peptide nitroxide spin-labeled at Cys35 and Cys46. For the double spin-labeled mimic peptide in TFE. ESR spectra indicated broadening characteristic of either radical interactions or decreased mobility, or both. Increases in radical interactions for the double spin-labeled mimic peptide would be expected for Cys35 and Cys46 approaching within 14 A in structure-promoting solvents, while decreases in spin-label mobility could be due to the formation of a loop. Based on these observations with peptide analogs, residues 35 to 46 probably form a similar bend in the full-length protein.