Radiologic placement of gastrostomy/jejunostomy tubes in high-risk patients.
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Gastroscopy↗
Biomedical subjects
C S Ho
Publications and source records attributed to C S Ho.
Group I: choosing the appropriate method of placement of an enteral feeding tube in the high-risk population.
The traditional nasogastric/nasoenteric feeding tube is the preferred access device for short-term feeding (< 30 days), with delivery into the stomach suggested unless aspiration or motility abnormalities are present. Preference for a long-term access device is operator- and facility-dependent. Endoscopic or fluoroscopic placement is preferred as first choices over laparoscopic placement because of considerations of cost, need for general anesthesia, and need for operating room time. Gastrostomy is preferred over intestinal placement for long-term access unless problems with aspiration or motility abnormalities exist.
Critical Illness↗
Spontaneous knotting of a transgastric jejunostomy tube: case report.
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Equipment Failure↗
A proposal for a transfer standard for validating pulse oximeter sensors.
One method for validating a biosensor is through comparative assessment of the test sensor with a control sensor when both sensors are presented with the same inputs. In the case of adult pulse oximeter (SpO2) sensors, both sensors should ideally be placed on the same digit of the subject. However, at present, one SpO2 sensor interferes with another so that the two sensors are applied to two different digits, which may not be identical in SpO2 level. This article proposes a ring-shaped SpO2 sensor transfer standard that can be used on the same digit as the test sensor, based on the idea of timing, SpO2 is a slowly varying signal, while the two sensors can be gated to measure the same digit's SpO2 value very quickly. Hardware and software requirements for the transfer standard, and a statistical method for analyzing the data will be discussed. A method for the direct comparison of two SpO2 sensors using a "switch over" trial design will also be presented.
Adult↗
Urinary dopamine and noradrenaline outputs during oral salt loading in healthy Chinese subjects with a family history of hypertension.
1. Increased salt sensitivity has been reported in first-degree relatives of hypertensive patients. To determine if the enhanced effect of oral salt intake on blood pressure in such individuals is related to abnormal renal dopamine (DA) or sympathetic nervous system responses, we studied the effects of two different sodium intakes (20 mmol/day followed by 220 mmol/day each given for 5 days) on mean arterial pressure (MAP) and urinary excretion of sodium, free DA and noradrenaline (NA) in seven normotensive Chinese subjects with a family history of hypertension. We compared these results with those we have reported previously for normotensive subjects without a family history of hypertension. 2. There was a seven- to ten-fold increase in sodium excretion (P < 0.02). MAP increased from 80.1 +/- 2.5 to 83.1 +/- 2.1 mmHg (P < 0.05). A 23% increase in urine DA (P < 0.02) was seen on day 1. From day 2 to day 5, the increase in urine DA (12-15%) became attenuated and reached statistical significance only on days 2 and 5. There was no significant change in urinary NA output. 3. As in healthy Chinese subjects without a family history of hypertension, those with a family history showed an early but unsustained rise in urine DA during oral sodium loading. Such an increase was rather small compared to the increase in urine sodium, suggesting that renal DA only contributes partly to the natriuretic response. Unlike those with no family history, subjects with a family history showed an increase in blood pressure after oral salt loading, possibly because of inadequate suppression of sympathetic nervous system activity.
Adult↗
A case-control study of oral cancer in Changhua County, Taiwan.
Forty oral cancer patients identified consecutively in Changhua Christian Hospital between 1990 and 1992 were compared with 160 population-based controls, matched for sex, age, area of residence, and educational background. Betel quid chewing was positively associated with the risk of oral cancer with adjusted odds ratio of 58.4 (95% CI: 7.6-447.6). The greater the number of years of chewing betel quid, the higher the risk of oral cancer; the adjusted odds rations were 12.9, 93.7 and 397.5 for < 21, 21-40, and > 40 years of betel chewing as compared with the non-users. The risk also increased with the quantity chewed per day; the odds ratios for those chewing < 10, 10-20 and > 20 quids/day were 26.4, 51.2 and 275.6, respectively. These odds ratio estimates were all statistically significantly different from the null value of unity.
Age Factors↗
Urinary dopamine outputs do not rise in healthy Chinese subjects during gradually increasing oral sodium intake over 8 days.
1. All previous studies on the effects of changes in sodium intake on the renal dopamine (DA) response (increase in urinary DA output) have used sudden, large changes in oral sodium intake. The present study was designed to study the role of renal DA and the suppression of sympathetic nervous system activity in the natriuretic response to step-wise, gradual increases in sodium intake. 2. Seven healthy, male Chinese subjects (23-25 years) were studied. During the 12-day study period (day -3 to 8), subjects were given the same basic diet containing 1900 calories, 75 g protein, 20 mmol sodium and 45 mmol potassium. From days 1 to 8, subjects also received 'Slow sodium' tablets (Ciba-Geigy) equivalent to 50 mmol on day 1, 100 mmol on day 2, 150 mmol on day 3,200 mmol on day 4, 250 mmol on day 5, and 300 mmol on days 6 to 8. Body weight was recorded and blood pressure was measured after lying supine for 10 min in the morning before breakfast on entry and at the end of the low and high sodium intake periods. Urine was collected for 24 h on day -3 and from days 0 to 8 for the measurement of sodium, potassium, creatinine, free DA and free noradrenaline (NA). 3. After 4 days of sodium restriction, mean arterial pressure (mean +/- SEM) had decreased from 83.0 +/- 1.3 to 79.4 +/- 0.5 (P < 0.05) and body weight from 70.2 +/- 3.1 to 68.3 +/- 3.0 (P < 0.02). Following sodium loading, MAP and body weight did not change, but pulse rate had decreased from 64.1 +/- 2.8 to 57.4 +/- 2.6 (P < 0.02). 4. There was a 13-fold increase in sodium excretion (P < 0.02) by the last day of the high sodium intake period. There were no significant changes in urine volume and urinary excretion of potassium, creatinine and free DA throughout the high sodium intake period. In contrast, there was a 19.9-26.5% decrease in urine NA 4 and 6 days after the start of the increase in sodium intake. 5. Healthy Chinese subjects do not have a renal DA response to gradually increasing sodium intake over an 8-day period. Any tendency to hypervolaemia-related rises in blood pressure during the high sodium intake period may be partly offset by a reduction in sympathetic nervous system activity.
Adult↗
[Clinical experience in interscalene brachial plexus block combined with Ho's method of C3-4 block for shoulder and proximal upper extremity surgeries].
BACKGROUND: Brachial plexus block, first performed in 1889 by Halsted, has been widely used for surgery of shoulder and upper third of upper extremity. But the level of block is inadequate for surgery of the deeper tissue. If high volume of local anesthetic (40 ml) is used to block C3-4, complications like Horner's syndrome and phenic nerve palsy would be frequent. The landmark of C-3 and C-4 nerve root is difficult to identify. The purpose of this study was to design a new method to block easily the C-3 and C-4 nerve roots for surgery of shoulder deep tissue. METHODS: Sixty-five patients with ASA physical status I-III and age from 15 to 65 yr were studied. They included 42 male and 23 female patients who received interscalene brachial plexus block together with Ho's method of C-3, C-4 block in the space of 10 mon since 1985. The Ho's point which circumscribes the landmark for C3-4 block is a point at which the outer margin of the external jugular vein intersects the sternocleidomastoid muscle. In this technique we punctured the skin with a needle vertically at the chosen point until it touched the anterolateral side of the C-4 transverse process, normally, not deeper than 1.25 cm. This block was usually done for surgery of the shoulder and upper third of upper extremity. We used 0.5% bupivacaine 10 ml combined with 2% lidocaine 10 ml for interscalene brachial plexus block and 2% lidocaine 10 ml only for C3-4 block. RESULTS: Only 3 out of total 65 blocks failed. For these 3 cases we shifted the regimen from nerve block to general anesthesia. The successful rate was 95.4%. One case was initially planned for general anesthesia. However, difficult intubation was encountered due to masseter muscle spasm/rigidity during anesthetic induction. Three days later, this case was successfully anesthetized with this block. BP, EKG, and SaO2 did not differ preoperatively and intraoperatively. If the operation time is limited to 3 h, the result has always been satisfactory. CONCLUSIONS: Interscalene brachial plexus block combined with Ho's method of C3-4 block is technically safe and economical for patients receiving shoulder and proximal third of upper extremity surgery. We must make selection of patients carefully and exclude those whose anatomical landmarks are difficulty identified. As such, good result is expected.
Adolescent↗
Unrestricted availability of a plasma paracetamol assay service resulting in an increased number of inappropriate requests.
Previously, prior approval from the on-call chemical pathologist was required in our hospital for plasma paracetamol measurements. However, since May 1992, there have been no restrictions on ordering this assay. We have assessed the consequences of this policy change by comparing the number and appropriateness of requests for plasma paracetamol measurements in Chinese patients admitted to our hospital with acute poisoning over two six-month periods (July-December) in 1991 and 1993. Requests were considered appropriate if paracetamol ingestion was suspected or unknown drugs were ingested. The number of patients having plasma paracetamol concentrations assayed increased from 51 in 1991 to 141 in 1993 (176%). The corresponding increase in the number of Chinese patients admitted to two of our eight general wards with poisoning was estimated to be 93%. The proportion of 'appropriate' plasma paracetamol measurements dropped from 55% in 1991 to 21% in 1993. Eight patients had plasma paracetamol concentrations above the recommended treatment line; they were all from the group in whom the requests were appropriate. Three of the 135 patients in the group with 'inappropriate' requests were found to have slightly elevated but far from toxic plasma paracetamol concentrations. Unrestricted availability of plasma paracetamol measurements resulted in an increase in the number of inappropriate requests.
Acetaminophen↗
Percutaneous gastrostomy and gastrojejunostomy: additional experience in 519 procedures.
PURPOSE: To assess the efficacy and safety of radiologically guided percutaneous placement of gastrostomy and gastrojejunostomy catheters. MATERIALS AND METHODS: Over 6 years, 562 referred patients were considered for gastrojejunostomy or gastrostomy procedures. In 43 cases (7.7%), the procedure was not performed because of overlying viscera, high position of the stomach, or massive ascites. In 478 patients, 519 procedures were performed. RESULTS: Of 507 attempted gastrojejunostomy procedures, 482 (95.1%) were successful, 14 (2.8%) catheters could not be advanced through the pylorus and necessitated gastrostomies, and 11 (2.2%) were technical failures. Twelve gastrostomy tubes were placed for decompression, with a 100% success rate. Thirty-day follow-up data were available for 457 procedures: The 30-day mortality rate was 17.1% (71 of 416 patients). There were two gastrostomy-related deaths. The overall major and minor complication rates were 1.3% and 2.9%, respectively. CONCLUSION: Percutaneous gastrostomy and gastrojejunostomy are safe and effective methods of providing short- or long-term enteral nutrition or upper gastrointestinal tract decompression.
Catheterization↗
The clinical value of screening for paracetamol in patients with acute poisoning.
In this retrospective study, we determined the clinical value of screening for paracetamol in 294 Chinese patients with acute poisoning presenting to the general medical wards at the Prince of Wales Hospital between January 1992 and June 1993. Of the 86 patients suspected of having ingested paracetamol, eight had levels above the recommended 'treatment line'. Of the 208 patients with no suspected paracetamol ingestion, four were found to have elevated but non-toxic plasma levels. The incidence of missed, potentially serious paracetamol poisoning in our patients with no suspected paracetamol ingestion is extremely uncommon. Routine screening of all patients with acute poisoning for toxic plasma paracetamol concentrations is therefore not indicated and should never be a substitute for thorough history taking and physical examination.
Acetaminophen↗
Enamel pitting in childhood tuberous sclerosis.
Dental enamel pitting was studied as a diagnostic sign of pediatric tuberous sclerosis (TSC). Thirteen patients aged 2.5 to 18 years with varying degrees of TSC were evaluated. They were checked for the presence of enamel pitting by the use of two to three drops of dental plaque disclosing stain which was applied to the labial surfaces of dry teeth. This technique provides a remarkable color contrast allowing for the detection of many small and subtle enamel pits. A control group of 39 unrelated patients without TSC were also examined. A total of 77% of TSC patients (10/13) revealed enamel pitting, compared with 13% of controls. The distribution of enamel pitting among TSC patients and normal controls of each sex was statistically significant. The total number of enamel pits in each patient varied from 1 to 26 and increased with age; 90% of the teeth with enamel pitting displayed one to two pits per tooth. The youngest patient with enamel pitting was 5 years old. The simplicity of this test and the high probability of pitting in TSC make the examination useful in the assessment of patients in whom the diagnosis of this serious genetic disease is being considered.
Adolescent↗
Effects of economic hardship on adolescent self-esteem: a family mediation model.
The purpose of this study was to investigate the relationship between economic hardship, family relationships, and adolescent self-esteem in a sample of 387 midwestern families. The results of LISREL analyses showed that economic hardship had an adverse effect on adolescent self-esteem, and that this effect was primarily mediated through the parent-adolescent relationship. The data also indicated that the marital relationship was negatively affected by economic hardship, but there was no direct relationship between parents' marital relationship and adolescents' self-esteem. The findings of this study are consistent with the theory that economic hardship reduces affective parental support and may thus convey a negative appraisal of the adolescent thereby lowering his or her self-esteem.
Adolescent↗
The clinical value of screening for salicylates in acute poisoning.
In this retrospective study, we evaluated the clinical value of screening for salicylates in 347 patients with acute poisoning presenting to the Prince of Wales Hospital, Hong Kong, between January 1992 and June 1993. In 83 patients (24%), ingestion of salicylates was suspected; the incidence of elevated plasma salicylate concentrations (> 0.1 mmol/L) in those who had taken identifiable drugs, unidentifiable drugs but known type, or topical medicaments was 71%, 16% and 61%, respectively. In 264 patients (76%), ingestion of salicylates was not suspected, and of these, 3 had elevated (0.2-0.4 mmol/L) plasma salicylate concentrations. Routine screening for salicylates in all patients with acute poisoning in Hong Kong appears unnecessary, especially as many authorities consider that 1 of the main indications for treating salicylate poisoning is clinical evidence of toxicity. Restricting plasma measurements to only those suspected of having ingested salicylates would have saved up to 76% of requests. All physicians should be aware of the high salicylate content of some Chinese proprietary topical medicaments.
Acute Disease↗
Urinary dopamine and noradrenaline outputs during large acute changes in oral salt intake in healthy Chinese subjects.
1. In order to investigate the role of renal dopamine and sympathetic activity in the natriuretic response to oral sodium loading in Chinese subjects, we studied the effects of two different sodium intakes (20 followed by 220 mmol day-1 each given for 5 days) on mean arterial pressure (MAP) and the urinary excretion of sodium, dopamine (DA) and noradrenaline (NA) in eight healthy subjects. 2. MAP did not change. There was an eight- to ninefold increase in sodium excretion (P < 0.01). An 8-17% increase in urinary DA (P < 0.05) over the first 3 days, and a 22% decrease in urine NA (P < 0.05) on the last day of the high sodium intake were seen. 3. The relatively small increase in urinary DA, despite an eleven-fold increase in sodium intake from a state of marked sodium deprivation, may suggest that, in healthy Chinese subjects, the renal DA mechanism only contributes partly to the acute natriuretic response. Furthermore, the renal DA response appeared to be attenuated during the period of high sodium intake. 4. There is no evidence from the present study that a reduction in sympathetic activity plays an important role in the acute natriuretic response to sodium loading in this group of subjects.
Administration, Oral↗
Percutaneous fluoroscopically guided removal of dysfunctioning ureteral stents.
PURPOSE: To present the authors' experience with fluoroscopically guided percutaneous removal of dysfunctioning ureteral stents and to discuss the technique and instrumentation used. MATERIALS AND METHODS: Over 6 years, stent or stent fragment extraction procedures were performed in 20 patients. Indications included stent misplacement or migration, stent fracture, difficult retrograde exchange, stent occlusion, and removal prior to percutaneous ureteroscopy. Twelve extractions were performed as two-stage procedures and eight as one-stage procedures. A rigid forceps passed through a 12-F sheath was the preferred instrument for extraction. Other instruments used successfully included snares and flexible forceps. RESULTS: Seventeen procedures were successful: Eight stents were removed with rigid forceps, seven with flexible forceps, and two with snares. Three procedures were unsuccessful: In two, the stent could not be grasped because there was intervening renal pelvic mucosa, and in one, clotted blood surrounded the stent. There were no undue complications. CONCLUSION: This procedure is highly successful when appropriate technique and instruments are used.
Adult↗
Assessment of hemodynamic changes in rat stomachs by laser Doppler velocimetry and reflectance spectrophotometry. Effects of ethanol and prostaglandin E2 under ischemic and congestive conditions.
One of the ulcerogenic mechanisms by which ethanol induces mucosal lesions in the stomach is the depression of gastric mucosal blood flow (GMBF). The goal of this study was to determine whether lesion formation is the result of vascular ischemia alone or ischemia combined with congestion. The aims of this study were to answer this question by evaluating the relationship between GMBF, oxygen saturation (ISO2) and hemoglobin volume (IHb) in the gastric mucosa under the influences of ethanol and prostaglandin E2 (PGE2) in the ischemic and congestive states, using a laser Doppler flowmeter and tissue spectrum analyzer. Ligation of the gastric celiac artery or vein markedly decreased the GMBF and the ISO2 level. The former procedure also reduced but the latter increased the IHb level. Ethanol administration produced effects similar to venous ligation, i.e. vascular stasis with ischemia. There was a negative correlation between GMBF and severity of lesion formation after ethanol administration. However, at the lesion site all the hemodynamic parameters were significantly reduced, indicating that a necrotic condition had occurred. PGE2 preincubation (25 micrograms) elevated GMBF, ISO2 and IHb levels. It also alleviated the reduction of blood flow induced by ethanol and increased the recovery rate of GMBF and ISO2 after the release of arterial or venous ligation. It is concluded that the decrease in blood flow due to ethanol is probably caused by constriction of venules rather than arterioles inside the mucosa, and this effect could lead to vascular congestion. PGE2 probably dilates both arterioles and venules in the gastric mucosa and thereby increases the blood flow in the gastric mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
The effect of salt loading on the urinary excretion of dopamine and sodium transport inhibitor in the rat.
1. The temporal relationship between the excretion of dopamine and sodium transport inhibitor (STI) during salt loading was examined in the rat. 2. Urine samples were collected before and during salt loading (given as 18 g/l NaCl solution to replace drinking water) for the measurement of sodium, creatinine, dopamine and STI in 6 female rats. Dopamine was measured by HPLC and STI was extracted and measured by its ability to inhibit purified Na+, K(+)-ATPase enzyme. 3. Urinary sodium and STI (expressed in relation to creatinine) on day 1 of salt loading were 4.6 and 4.2 times respectively of the control values. Urinary excretion of dopamine did not increase significantly until day 2 when it was 21% higher. 4. The excretion of STI paralleled that of sodium excretion whereas the excretion of dopamine lagged behind. 5. We conclude that salt loading increases STI and dopamine and that the increase in STI precedes that of dopamine.
Animals↗