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Biomedical subjects

C T Lee

Publications and source records attributed to C T Lee.

At least 73 records · Page 4Linked to original sources
PubMed1999

Hyperglycemic hyperosmolar non-ketotic syndrome in hemodialysis patients.

BACKGROUND: Hyperglycemic hyperosmolar non-ketotic syndrome (HHNK) is an emergency complication of diabetes mellitus. The conventional treatment modality often includes massive fluid supplementation. In maintenance hemodialysis patients, dehydration via the renal route may not occur, and fluid management is rather complicated. In this study, we investigated the precipitating factors, treatment modalities, clinical course and prognosis of HHNK patients who received maintenance hemodialysis. METHODS: From January 1988 through August 1998, 16 diabetic patients who had developed HHNK were enrolled. Eight of them were end stage renal disease (ESRD) patients on maintenance hemodialysis, and another group included 8 acute renal failure (ARF) diabetes mellitus patients who received their first hemodialysis during the HHNK episode. We retrospectively reviewed their medical charts and recorded each patient's age, treatment modalities, especially fluid supplementation, predisposing factors, and biochemical data during the HHNK episode. Complications and the final outcome were also recorded. RESULTS: There were no significant differences in biochemical data and patients' ages between the two groups (p > 0.05). The major predisposing factor for the ARF patients was infection, but irregular use of or discontinuing oral hypoglycemic agents (OHA) or insulin was the major predisposing factor for the ESRD patients. Less fluid supplementation was given in the ESRD group as compared to the ARF group and no deaths occurred in the ESRD group of patients. However, 6 patients expired in the ARF group of patients. CONCLUSION: Regular medical care, early diagnosis and recognition, and easier management of fluid administration explain the rather smooth course and better prognosis in the ESRD group of patients.

Acute Kidney Injury↗
PubMed1998

A synchrotron radiation beam-position monitor at the Taiwan Light Source.

A prototype photon-beam-position monitor has been designed, fabricated and tested at the Taiwan Light Source of the Synchrotron Radiation Research Center. Aluminium was chosen as the material of the blade electrodes due to its low atomic number and high thermal conductivity. The resolution of this photon-beam-position monitor was <+/-1 micro m. The sensitivity of the blade electrode has been measured in situ. Results of measurements for bending-magnet light and undulator light with different gaps are described.

Journal Article↗
PubMed1998

Abnormal vagal cholinergic function and psychological behaviors in irritable bowel syndrome patients: a hospital-based Oriental study.

Irritable bowel syndrome (IBS) patients in Western countries usually manifest autonomic nerve dysfunctions and abnormal psychological behaviors. The purpose of this study was to assess whether Oriental IBS patients with predominant bowel symptoms also exhibited similar abnormalities. We enrolled 40 IBS patients from the outpatient clinic and 20 controls with normal daily bowel habit for study. The IBS patients were further divided according to their predominant bowel habit: 20 were constipation-predominant and 20 were diarrhea-predominant. Sympathetic function was evaluated by sympathetic skin response (SSR) while vagal cholinergic function was determined by measuring R-R interval variation (RRIV) in electrocardiography during rest and deep breathing. Psychological parameters were assessed by scales of the Minnesota Multiphasic Personality Inventory (MMPI) and the Hopkins Symptom Checklist (HSCL-90). IBS patients, despite their bowel habit, showed normal SSR response. RRIV during deep breathing was significantly lower in constipation-predominant IBS patients than in controls or diarrhea-predominant IBS patients (16.5+/-3.1% vs 20.5+/-4.8% and 21.5+/-4.6%, P < 0.001). IBS patients also exhibited abnormal MMPI measuring scores on depression, hysteria, paranoia, and masculinity/femininity scales. In addition, they also had more severe psychological distress in the items of HSCL-90 measurement. In conclusion, vagal dysfunction characterizes Oriental constipation-predominant IBS patients seeking medical help. Abnormal psychoneurotic profiles also exist in these IBS patients, irrespective of their bowel habits.

Attitude to Health↗
PubMed1998

In vitro culture growth of erythroid progenitors and serum erythropoietin assay in the differential diagnosis of polycythaemia.

BACKGROUND: We assessed the in vitro culture growth of erythroid progenitors [burst forming unit-erythroid (BFU-E)] and serum erythropoietin (EPO) levels in different groups of polycythaemia to determine the discriminative power in differential diagnosis of polycythaemia. METHODS: We used the methylcellulose culture technique to study the growth of endogenous erythroid colonies (EECs) and EPO-dependent BFU-E from bone marrow (BM) and/or peripheral blood (PB) cells from 40 patients with polycythaemia vera (PV), 13 with secondary polycythaemia (SP), 19 with pure erythrocytosis (PE), five with PE and PV evolution later (PE-PV), and 12 with relative polycythaemia (RP). The serum EPO levels were measured by radioimmunoassay before treatment in 47 patients, 23 SP patients, 19 PE patients, five PE-PV patients and 16 RP patients, as well as after treatment in 38 PV patients, five PE-PV patients and 12 PE patients. RESULTS: The results of the erythroid progenitor culture assay showed that the numbers of EPO-dependent BFU-E in BM did not differ significantly among groups. The PB BFU-E were significantly higher in PV than in SP or PE, and no statistical difference were found among patients with SP, PE and RP. There was a correlation between BM BFU-E and PB BFU-E in the individual PV and PE patients. EECs were present in all BM and PB cultures of untreated and phlebotomy-treated PV and PE-PV patients, but were absent in 6 of 17 PV patients who had received cytotoxic therapy. EECs were not found in SP, PE and RP. PB could substitute for BM in the EEC or the BFU-E assay. Both pretreatment and post-treatment serum EPO levels of PV and PE-PV were similar, which were significantly lower than SP, PE or RP. The serum EPO levels in treated PV or PE-PV patients who had normal haematocrit values were not significantly different from those in untreated patients. In contrast, the phlebotomy-treated PE patients had significantly higher serum EPO values than untreated PE patients. In the differentiation between PV and PE, the sensitivity, specificity, positive predictive value and negative predictive value of post-treatment serum EPO levels at a cut-off level of < or = 9 UL-1 were 74%, 92% and 52% respectively. The discriminative power of post-phlebotomy serum EPO levels was even higher with a positive predictive value of 80% and negative predictive value of 92% for the prediction of PV evolution in patients with pure erythrocytosis of unknown origin. CONCLUSION: The present study showed that apart from EEC assay, the post-phlebotomy serum EPO level was a sensitive and specific parameter in the differential diagnosis of polycythaemia, in particular for the identification of PV among patients with unclassifiable polycythaemia.

Adult↗
PubMed1998

Topical eucalyptus oil poisoning.

Eucalyptus oil is well documented as being extremely toxic if ingested. We report a case of systemic eucalyptus oil toxicity from topical application. A 6-year-old girl presented with slurred speech, ataxia and muscle weakness progressing to unconsciousness following the widespread application of a home remedy for urticaria containing eucalyptus oil. Six hours following removal of the topical preparation her symptoms had resolved, with no long term sequelae.

Administration, Topical↗
PubMed1998

Non-surgical therapy for the patients with advanced non-small cell lung cancer.

Radiation therapy (RT) and chemotherapy have been the two main treatment modalities for advanced non-small cell lung cancer (NSCLC). New techniques in RT, including hyperfractination and 3-dimensional conformal RT (3-DCRT), have changed conventional RT, which has been regarded as standard modality for locally advanced NSCLC. Introduction of cisplatin into chemotherapeutic regimens for NSCLC has changed the status of chemotherapy to standard therapy for patients with stage IV or stage IIIb with effusion. Radiation therapy or chemotherapy alone have already showed their limitations, even although they could improve the survival of NSCLC patients. Combined treatments with these two have become powerful alternatives for patients with unresectable and locally advanced NSCLC. Sequential or concurrent chemoradiotherapy could improve the response rate and survival rate without a remarkable increase in toxicities. Gene therapy is a novel therapeutic approach based on molecular oncology and tumour immunology. The practical contribution of gene therapy to clinical oncology is still minimal. From the research data, gene therapy has shown its potential to become a new treatment modality or to lead us to as yet undiscovered novel approaches to the treatment of lung cancer.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

The significance of syphilis serology tests on long-term hemodialysis patients.

BACKGROUND: Syphilis is a sexually transmitted disease. Blood transfusion and blood contact are also routes of infection. Patients on long-term hemodialysis are at risk during their therapy. The aim of this study is to investigate the incidence of syphilis in hemodialysis patients, possible nosocomial infection and methods of treatment. MATERIALS AND METHODS: A total of 556 uremic patients on maintenance hemodialysis at our hospital on June 1996 were enrolled in the study. They all received syphilis screening tests. The rapid plasma reagin (RPR) test was used as the primary screening tests and Treponema pallidum hemagglutination assay (TPHA) test as the confirmation test. According to the test results, patients were classified into false and true-positive groups. The titer of both tests were recorded. The patients in the true-positive group were further divided into the untreated and treated group depending on whether they had already received treatment. The serial change of RPR test titer of the treated group was reviewed. RESULTS: Thirty-one patients (5.6%) had positive RPR test results and 10 patients (1.8%) had false-positive results. The titers of both RPR and TPHA tests were rather low in the positive groups. Most of the confirmed syphilis patients were asymptomatic and diagnosed serologically. In the treated group, the RPR test titer did not show significant decline and no seroconversion was noted after treatment. CONCLUSION: We observed that infectious syphilis patients exist in our hemodialysis unit and survey for this disease is necessary. The titers of both positive RPR and TPHA tests are low. Most diagnosed patients had latent syphilis, and serologic response to treatment is probably the same as in general population.

Aged↗
PubMed1998

Sharpening the Sharpened Romberg.

The Sharpened Romberg Test (SRT) is a test of balance commonly used in Diving Medicine. Interpretation of an abnormal test can be confounded by several factors. This study was conducted to further evaluate the usefulness of the SRT. In the first part of the study, naval and civilian volunteers in a Naval Base were recruited as subjects. The SRT scores were recorded in two separate trials; once in the morning (4 attempts) and once in the evening (4 attempts) to evaluate the effect of practice on the SRT. In the second part of the study immediate pre- and post-dive scores in a group of divers were measured to evaluate: (1) the effect of decompression; (2) the effect of the normal post-dive fatigue; and (3) the vestibular effect of swaying after a boat ride. Comparisons were also made between the distributions of the SRTs of the normal subjects and those of a retrospective group of DCI patients treated at the Slark Hyperbaric Unit, Royal New Zealand Navy Hospital (RNZNH), Auckland. The SRT was found to have an early learning effect. Second attempts were significantly better than the first (p<0.001) within the same trial. However this learning effect plateaued by the third and fourth attempts. No difference was found between trials (morning and evening). There was a post-dive decline in the scores of the first attempts only (p<0.05). Subsequent second to fourth attempts were not affected by diving. The practice effect is only evident between the first and second attempts within the same trial but not between trials. The pre- and post-dive data showed that the SRT was not affected by decompression, post-dive fatigue or the vestibular sensation of swaying that is commonly experienced after a boat ride. Comparison of the distributions between controls and DCI patients showed a bimodal pattern. Fifty-four percent (54%) of the DCI patients had 'normal' scores (60 seconds), while 14% had scores between 16-35 seconds and 32% scored less than 15 seconds. In contrast, 95% of the control groups had 'normal' scores while 5% scored between 16-35 seconds. Therefore, accepting a score of less than 40 seconds as being "abnormal" will give the SRT a sensitivity of 46%, specificity of 95% and predictive value of 82%.

Adolescent↗
PubMed1998

Factors related to adolescents' perceptions of treatment outcomes in an adolescent health clinic.

To determine factors related to adolescents' perceived treatment outcomes of their health problems in an adolescent health clinic located at a college hospital, 246 adolescent patients between the ages of 11 and 21 who visited the clinic twice or more during the period January 1994 to December 1995 were included in this study. Information concerning adolescents' sociodemographic characteristics, family function, office visits and health problems of first visits was collected by reviewing subjects' medical and other clinic-related records. In addition, a structured questionnaire was mailed to assess subjects' satisfaction with physicians and the environment and services provided by the clinic as well as their perceived treatment outcomes. 148 patients completed the questionnaire, a response rate of 60.2%. Most of the respondents were in late-stage adolescence (71.0%) and were in school (71.0%). About half of respondents had normal family function, while the other half had moderate or severe family dysfunction. Most of the health problems of respondents were acute (64.2%) and were biological (76.4%) conditions. Most of the respondents were satisfied with the various characteristics of physicians except confidentiality emphasized by the physicians, while many fewer respondents were satisfied with the environment and services provided by the clinic. Family function, physicians' respect toward the adolescents, and the adolescents' satisfaction with the services provided in general were the factors significantly related to adolescents' perceived treatment outcomes based on a stepwise, multiple logistic regression analysis. We conclude that efforts to provided could result in better adolescent perceived treatment outcomes.

Adolescent↗
PubMed1998

Early recognition of unsuspected malignant hyperthermia and successful management of serve myoglobinuric renal failure in subsequent rhabdomyolysis: a case report.

Malignant hyperthermia (MH) is a rare inherited disorder of skeletal muscle, its inheritance being autosomal dominant and its mutant gene located on chromosome 19. MH is occasionally observed during general anesthesia when using some special triggering agents. In the susceptible patient, it presents with a fulminant skeletal muscle hypermetabolic crisis and proceeds to serve rhabdomyolysis. Once rhabdomyolysis is established, acute renal failure is not an inevitable consequence, yet it is the fatal complication if the condition is not appropriately managed. We describe a case of acute renal failure in the setting of rhabdomyolysis in unsuspected MH, resulting in full recovery after intermittent hemodialysis. In this case, we emphasize the importance of early recognition of MH and the favorable prognosis of subsequent myoglobinuric renal failure if treated appropriately.

Acute Kidney Injury↗
PubMed1998

High-grade mucoepidermoid carcinoma of the breast: case report.

Mucoepidermoid carcinoma of the breast is very rare. Only 14 cases have been reported in the English language literature. All of these patients were women with ages ranging from 46 to 72 years. Five of the cases involved high-grade mucoepidermoid carcinomas and 9 were low-grade. All of the patients with low-grade mucoepidermoid carcinoma were disease-free in the follow-up period. Four patients with high-grade mucoepidermoid carcinoma died from the disease 7 to 30 months after surgery and all 4 were found to have distant metastasis. The case of mucoepidermoid carcinoma of the breast discussed here was histopathologically high-grade. The patient has remained disease-free 4 years after modified radical mastectomy and adjuvant chemotherapy. Diagnose of mucoepidermoid carcinoma of the breast is more difficult than mucoepidermoid carcinoma in the salivary gland due to possible confusion with metaplastic carcinoma or squamous cell carcinoma. Special histological stains are definitely needed for differential diagnosis.

Breast Neoplasms↗
PubMed1997

Bringing mind-body medicine into the mainstream.

Centuries-old concepts concerning the mind's influence on the body are being examined with renewed interest. As awareness of the health benefits of being able to voluntarily control vital aspects of the metabolic state increases, and as our understanding of the underlying molecular mechanisms of such control also increases, mind-body medicine may move further into the mainstream of Western medical practices.

Adult↗
PubMed1997

Genetic immunotherapy of established tumors with adenovirus-murine granulocyte-macrophage colony-stimulating factor.

Increased local production of granulocyte-macrophage colony-stimulating factor (GM-CSF) by genetically modified tumor cells can induce specific antitumor cellular immunity. We constructed a recombinant adenovirus expressing murine GM-CSF and tested it for therapeutic efficacy in a syngeneic murine lung cancer model system. In vitro transduction of Lewis lung carcinoma cells with adenovirus-mGM-CSF suppressed tumor formation in syngenic mice (C57BL/6), and transduced and irradiated Lewis lung carcinoma cells induced regression of pre-established wild-type tumors without in vitro selection for transductants. Low, but significant, levels of specific antitumor cytotoxic T lymphocytes (CTL) were observed in mice inoculated with GM-CSF but not with reporter virus-transduced tumor cells. GM-CSF-transduced cells induced the accumulation of dendritic cells at the site of tumor, consistent with a mechanism involving improved tumor antigen presentation. These data suggest that transduction of tumor cells with recombinant GM-CSF adenovirus may be an effective and practical cancer gene therapeutic strategy.

Adenoviridae↗
PubMed1997

Using prostate-specific antigen to eliminate the staging radionuclide bone scan.

Traditionally the radionuclide bone scan has been the cornerstone of prostate cancer staging. Previous widespread use of bone-scan imaging was certainly reasonable, even in the asymptomatic patient, as clinicians had no methodology to predict who would or who would not have osseous metastases. Now, in the era of PSA testing, clinicians do have a timely, cost-effective method to determine those patients who are highly unlikely to have osseous metastases. As evidenced by several clinical studies noted previously, a radionuclide bone scan should not be obtained in staging the asymptomatic, newly diagnosed prostate cancer patient with a serum PSA level less than or equal to 10 ng/mL. Incorporation of clinical stage and tumor grade does not significantly improve the predictive value of PSA. Those patients with bone discomfort, however, should undergo bone imaging, regardless of the serum PSA level. Similarly, the serum PSA level may be used to avoid unnecessary bone-scan imaging in the patient with recurrent prostate cancer following definitive treatment. At this time, we do not have enough clinical information to determine the optimal PSA level that will predict precisely which patients will have osseous metastases. From the above reports, however, and the present authors' clinical experience, it would seem reasonable to avoid bone-scan imaging if the post-radical prostatectomy serum PSA level is not more than 2 ng/mL. No absolute data are available about recurrence after radiation therapy or for men being managed with watchful waiting. In an attempt to clarify this issue, there is currently a clinical study underway at the University of Michigan. This study assesses the minimum serum PSA elevation that necessitates bone imaging in restaging the asymptomatic patient with recurrent prostate cancer after radical surgery or definitive radiation therapy. The radionuclide bone scan continues to be the gold standard for the detection of osseous metastases in prostate cancer. Nevertheless, it is unnecessary in the specific situations outlined above. Serum PSA testing allows the physician to refine the use and application of this imaging study, thus providing an opportunity to eliminate expensive and time-consuming studies that ultimately do not contribute additional information. The national economic impact of doing so is tremendous.

Bone Neoplasms↗
PubMed1997

Prediction of clinical course in patients with idiopathic erythrocytosis by endogenous erythroid colony assay but not by serum erythropoietin levels.

We studied the in vitro culture growth of bone marrow and blood erythroid progenitors and serum erythropoietin (EPO) levels by radioimmunoassay in 24 patients with idiopathic erythrocytosis (IE). All patients had an increased red blood cell (RBC) mass and lacked a cause of secondary polycythemia, but did not fulfill the diagnostic criteria of polycythemia vera (PV). Marrow and blood cultures were obtained simultaneously; the results of endogenous (EPO-independent) erythroid colony (EEC) growth were parallel in both cultures. EECs were present in five patients, all of them developed PV 3 to 48 months later. The EEC number did not correlate with the time to the progression of PV. In contrast, none of the 19 EEC-negative patients had PV evolution during a median follow-up period of 38 months. Three of the five IE patients in whom EECs formed displayed vascular complications during their clinical course compared with three of 19 patients who did not have EEC. The serum EPO levels were variable: low in five, normal in 14, and high in five patients. Serial measurements of serum EPO levels in three of five patients who had high initial levels showed persistently elevated values; the underlying cause of the increased EPO production could not be defined during a follow-up period of more than 36 months. Of the five patients who subsequently developed PV, two had low serum EPO levels and three had normal values at initial evaluation. Serum EPO levels did not correlate with the occurrence of thrombotic complications. Our results show that serum EPO levels have limited value in determining the underlying cause of IE and cannot predict the clinical course of patients with IE, whereas the assessment of EEC in bone marrow or blood can identify IE patients who will have PV evolution.

Adult↗
PubMed1996

Antitumor effects of an adenovirus expressing antisense insulin-like growth factor I receptor on human lung cancer cell lines.

Insulin-like growth factors (IGFs) are often essential for the maintenance of the malignant phenotype, and in lung cancer the IGF-I receptor (IGF-Ir) is often expressed at high levels. Stable transfection of antisense plasmids expressing the first 300 bp of the IGF-Ir reduces the tumorigenicity of a variety of tumor cell lines and has been reported to induce systemic antitumor effects on established, non-gene-modified tumors in animal model systems. We have constructed an adenovirus expressing an antisense IGF-Ir (Ad-IGF-Ir/as) in an attempt to develop these observations into a clinical therapeutic approach. A single transduction by Ad-IGF-Ir/as (at a multiplicity of infection of 10:1) decreased the IGF-Ir number by about 50% in human lung cancer cell lines NCI H460 and SCC5, as measured by an 125I-labeled IGF-I competitive binding assay. After the transduction of these human lung cancer cell lines by Ad-IGF-Ir/as, the soft agar clonogenicity was reduced by 84%. The i.p. treatment of nude mice bearing established i.p. NCI H460 cells resulted in prolonged survival compared to that of nude mice treated with a reporter virus. These results suggest that Ad-IGF-Ir/as has a therapeutic effect on established human lung cancer xenografts and may represent an effective and practical cancer gene therapy strategy.

Adenoviridae↗