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Biomedical subjects

F Lee

Publications and source records attributed to F Lee.

At least 37 records · Page 2Linked to original sources
PubMed2002

Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: prospective study.

OBJECTIVE: To evaluate the early outcomes of laparoscopic incisional hernioplasties using on-lay GORE-TEX DualMesh. DESIGN: Prospective study. SETTING: Medical centre of a regional hospital, Hong Kong. SUBJECTS AND METHODS: Between June 2000 and October 2001, 11 consecutive patients underwent attempted laparoscopic incisional hernioplasties at the University of Hong Kong Medical Centre. A prospective collection of perioperative data and assessment of postoperative outcomes was performed. RESULTS: Laparoscopic incisional hernioplasty was successfully performed for 10 (91%) patients. One patient was converted to open repair because of extensive adhesions within the peritoneal cavity. The overall mean operative time was 107 minutes. Five (45%) patients were found to have more than one hernial defect after reduction of the hernial contents. Eight (73%) patients were discharged within 2 days after operation. Postoperative morbidities included wound bruising (n=4), seroma (n=2), and prolonged suture site pain (n=1). All postoperative morbidities resolved spontaneously without intervention. With a mean follow-up of 3 months, no early recurrence was detected. CONCLUSION: Early outcomes of laparoscopic incisional hernioplasty utilising GORE-TEX DualMesh were promising. This technique confers the advantages of minimal access surgery and allows clear identification of multiple hernial defects. Extensive adhesion, which does not allow the establishment of pneumoperitoneum, is a condition that precludes the safe performance of laparoscopic repair.

Abdominal Pain↗
PubMed2001

A prospective trial of analgesia following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty.

BACKGROUND: The extraperitoneal instillation of bupivacaine has been shown to be superior to the use of a placebo for postoperative analgesia following endoscopic extraperitoneal inguinal hernioplasty. The objective of the present study was to compare the efficacy of postoperative analgesia by local wound infiltration to instillation of the extraperitoneal space with bupivacaine. METHODS: Between 1 September 1999 and 2 June 2000, a total of 100 patients who underwent unilateral endoscopic extraperitoneal inguinal hernioplasties were recruited to receive either local wound infiltration with 10 ml of 0.5% bupivacaine (group I, n = 50) or instillation of the extraperitoneal space with 40 ml of 0.25% bupivacaine after mesh placement (group II, n = 50). Daily postoperative pain was assessed by visual analogue pain score on a scale from 0 to 10 at rest and upon coughing. Total amount of oral analgesic consumed and clinical outcomes of the two groups were compared. RESULTS: A comparison of daily pain scores of the two groups at rest and upon coughing showed no significant difference (p = ns). The mean number of oral analgesic tablets consumed were 3.2 +/- 0.5 (SEM) and 3.3 +/- 0.5 (SEM) in groups I and II, respectively (p = ns). During follow-up, asympatomatic groin collections were more common in group II (n = 4) than group I (n = 2) (p = ns). CONCLUSIONS: Compared to local wound infiltration with bupivacaine, the extraperitoneal instillation of bupivacaine did not bestow any additional analgesic benefits. Therefore, the routine infiltration of skin incisions with bupivacaine is recommended after endoscopic extraperitoneal inguinal hernioplasty.

Adult↗
PubMed2001

Graft survival in a rhesus renal transplant model after immunotoxin-mediated T-cell depletion is enhanced by mycophenolate and steroids.

BACKGROUND: Anti-CD3 immunotoxin (IT), a T-cell-depleting agent, prolongs survival of renal allografts in a rhesus monkey model without the need for long-term immunosuppression. In this study we sought to further prolong allograft survival by giving short-term conventional immunosuppression simultaneous with IT administration. METHODS: MHC class II mismatched, juvenile rhesus monkeys were paired as donor and recipient for renal transplantation. Recipients received two to three daily doses of IT starting on the day of transplantation. Additional immunosuppression was given for no more than 60 days. Graft function was monitored by serum creatinine and renal biopsies. Flow cytometry was used to monitor T-cell recovery. RESULTS: Graft survival time (GST) in animals receiving IT was prolonged compared with controls with 50% of IT-treated monkeys surviving >100 days. Animals treated with IT plus mycophenolate mofetil (MMF) and steroids had significantly enhanced GST (mean GST, 305 days) compared with those treated with IT alone (mean GST, 94 days). In contrast, addition of cyclosporine or 40-O-[2-Hydroxyethyl]rapamycin did not significantly increase graft survival time. A comparison among animals from all treatment groups with short (<100 days) and long (>100 days) GST demonstrated that those with the shorter GST had a higher blood T-cell count 2 weeks after transplantation. Full recovery of CD4+ T cells required longer than 6 months. CONCLUSIONS: A combination with MMF and steroids given for 4 days after renal allograft transplantation significantly increases GST in IT-treated monkeys. We hypothesize that MMF and steroids suppress the initial T-cell activation mediated by IT.

Animals↗
PubMed2001

Enhancement of the immunity to foot-and-mouth disease virus by DNA priming and protein boosting immunization.

Subunit vaccination is effective in eliciting humoral responses to a variety of viral antigens, however, it has not generated persistent protective immunity to foot-and-mouth disease virus (FMDV). In this study, we observed that priming mice with a DNA plasmid encoding VP1 of the FMDV O/Taiwan/97 capsid protein followed by boosting with a VP1 peptide conjugate (P29-KLH) resulted in production of not only high titers of antibodies but also antibodies with FMDV neutralizing activities. Moreover, the mice immunized in this manner cleared the virus from their sera in FMDV challenge experiments. Mice subjected to DNA plasmid priming and P29-KLH protein boosting had relatively higher ratio of IgG2a/IgG1 than those primed and boosted with P29-KLH conjugate. Addition of an oligodeoxynucleotide (ODN) containing immunostimulatory cytosine-phosphate-guanosine (CpG) motifs to P29-KLH conjugate also induced a higher ratio of IgG2a/IgG1 and significantly higher titer of neutralizing antibodies. These results indicate that treating animals with DNA plasmids priming and FMDV antigen(s) boosting may elicit immunity to FMD and this immune response may be augmented by CpG ODN.

Amino Acid Sequence↗
PubMed2001

Phase I bioequivalency study of MitoExtra and mitomycin C in patients with solid tumors.

BACKGROUND: This study compares serum pharmacokinetics, urinary excretion patterns, and relative bioequivalencies of single doses of MitoExtra (ME; SuperGen, San Ramon, CA) and mitomycin C (MMC). METHODS: Thirty-five patients were entered into this open-label, single-institution, crossover study with 2 treatment arms. Each patient received alternating courses of ME and MMC as 15 mg/m(2) single intravenous doses via a short intravenous infusion. Patients were sequentially assigned to receive either ME or MMC as their first treatment course. The courses were given in 6-week intervals and could be repeated up to 4 times in patients with responding disease. Pharmacokinetic parameters were analyzed during the first two courses of therapy. RESULTS: The noncompartmental pharmacokinetic analysis conducted on serum and urine data obtained from patients who received both ME and MMC indicates that the kinetic disposition of these two formulations is similar. This is evident when the mean (+/- standard deviation) values of the various pharmacokinetic parameters are compared. There were no significant differences in any of the kinetic parameters obtained between treatments in all patients examined. The statistical evaluation conducted on the 25 patients that completed both arms of the 2-way pharmacokinetic crossover demonstrates that ME is bioequivalent to MMC. Hematologic and nonhematologic toxicities were similar between the two treatments. There were three clinically significant infusion-related complications associated with MMC administration and none associated with ME. CONCLUSIONS: The similar pharmacokinetics of MMC and ME suggest complete release of MMC from the hydroxypropyl-Beta-cyclodextrin carrier contained in the ME formulation. Further studies are needed to define the pharmacodynamics, toxicity, and efficacy of this drug-carrier complex.

2-Hydroxypropyl-beta-cyclodextrin↗
PubMed2001

Early detection of reverse transcriptase activity in plasma of neonates infected with HIV-1: a comparative analysis with RNA-based and DNA-based testing using polymerase chain reaction.

Plasma viral load from 71 HIV-1-infected neonates was measured by using Amp-RT, an ultrasensitive quantitative reverse transcriptase (RT) assay and by nucleic acid sequence-based amplification (NASBA), an RNA-based quantitative assay. Results were then compared with those obtained from detection of proviral DNA in peripheral blood mononuclear cells (PBMCs) by polymerase chain reaction (PCR) using Turnbull analysis. At 5 days of life, 50% of neonates were positive by Amp-RT, 30% were NASBA positive, and 20% were DNA-PCR positive. Through the first 12 days of life, Amp-RT was more sensitive than either NASBA or DNA-PCR in detecting HIV-1 infection. Amp-RT values correlated well with NASBA RNA values, with an overall Pearson's r = 0.63 (95% confidence interval [CI], 0.40-0.78). In proportional hazards analysis of infants aged 14 to 61 days (N = 31), a one-log increase in RNA-based viral load was associated with a > fivefold risk of disease progression when using the U.S. Centers for Disease Control and Prevention (CDC) clinical Category C (CDC-C) or death as an endpoint (p =.014). Kaplan-Meier analysis of these data found that RNA viral loads were able to predict disease progression using CDC-C/death as an endpoint (p = .013). Early quantitative viral load measurements may assist clinicians in diagnosing HIV-1 infection, stratifying risk of disease progression, and implementing a treatment plan using highly active antiretroviral therapy for infants within the first few weeks of life.

Black or African American↗
PubMed2001

Determinant factors of pain after ambulatory inguinal herniorrhaphy: a multi-variate analysis.

Pain is common after inguinal herniorrhaphy. The objective of our study was to evaluate the significance of various clinical factors on the level of post-operative pain after ambulatory inguinal herniorrhaphy. Between January, 1996 and December, 1998, 239 ambulatory inguinal hernia repair patients were recruited. Operative techniques included nylon darn (n = 152), modified Bassini repair (n = 56), and prolene mesh hernioplasty (n = 30). Linear analogue pain scores--ranging in value from 0 to 10--were assessed by telephone interviews on the first and third post-operative days. Uni-variate and multi-variate analyses were performed to identify the significant independent determinant factors affecting the severity of post-operative pain. Clinical factors studied were age, sex, operative technique, hernia anatomy and post-operative complication(s). By uni-variate analysis, patients of age < or = 50 years and indirect inguinal hernia were associated with a significantly higher pain score on the first postoperative day 1. On post-operative day 3, patients of age < or = 50 years, with an indirect inguinal hernia and modified Bassini repair reported a significantly higher pain score. Following inguinal herniorrhaphy, multiple regression analysis showed that age was the only independent predictive factor of pain score on post-operative days 1 and 3. In conclusion, post-operative pain was not affected by surgical technique, sex, hernia anatomy and post-operative morbidity. Only age had a significant influence on the post-operative pain score following ambulatory inguinal herniorrhaphy. Therefore, the age of a patient should be taken into consideration when prescribing post-operative analgesics.

Age Factors↗
PubMed2001

Intra-articular lipoma with osteochondroid metaplasia in the knee joint.

We describe a case of lipoma with osteochondroid metaplasia in the knee joint. Although the location of the lesion and radiographic findings were unusual, computed tomography and magnetic resonance imaging were useful in characterizing adipose, cartilaginous and osseous tissue components within the lesion.

Humans↗
PubMed2001

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate.

OBJECTIVES: To define the potential role of cryosurgical ablation of the prostate (CSAP) as a treatment option for patients with localized prostate carcinoma (PCA), we performed a retrospective outcomes analysis of a large database of patients undergoing CSAP constructed from five institutions and compared this with matching outcomes from contemporary reports of patient outcomes after radiotherapy. METHODS: A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of their clinical features. Biochemical-free survival (BFS), post-CSAP biopsy results, and post-CSAP morbidities were calculated and recorded. RESULTS: The median follow-up for all patients was 24 months. The percentages of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0.5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%. Morbidities included impotence in 93%, incontinence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 40% nonapproved). CONCLUSIONS: For each risk group, the 5-year BFS and positive biopsy rate after CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-related results comparable to those reported for patients undergoing radiotherapy.

Biomarkers, Tumor↗
PubMed2001

Outpatient ureteroscopy: predictive factors for postoperative events.

OBJECTIVES: To identify risk factors that can predict the postoperative events of outpatient ureteroscopy. METHODS: The data of 329 consecutive patients who underwent outpatient ureteroscopy from January 1996 to July 2000 were analyzed. Patient selection for outpatient surgery was based solely on their general medical status and social factors. Eighty-three percent of the procedures were therapeutic ureteroscopy. The reported postoperative events included sleep disturbances, postoperative pain score, emesis, unplanned admission, and other complications. These were compared with the various patient and operative factors. Multivariate analysis was performed to identify the predictive factors for different postoperative events. RESULTS: The overall success rate of ureteroscopic access to the pathologic site was 99.7%. Most of the therapeutic ureteroscopy performed was ureteroscopic lithotripsy (93%), with a stone-free rate of 91%. Ninety-seven percent of the operations were completed within 90 minutes, and 98% of patients were fit for discharge within 5 hours. Female patients reported more symptoms on the way home (25.8% versus 16%, P = 0.047) and more postoperative emesis (14.4% versus 2.1%, P <0.001). The postoperative pain score on day 1 was higher if the operation had lasted more than 60 minutes (2.4 versus 1.5, P = 0.002). Patients who received postoperative stenting had a higher postoperative pain score on day 3 (1.1 versus 0.4, P <0.001) and a higher complication rate compared with those who required no postoperative stenting (16.8% versus 4%, P <0.001). No predictive factors for unplanned admission were identified. CONCLUSIONS: Ureteroscopy can be successfully performed in an outpatient setting. Although the early postoperative pain was associated with nature of the operation (which could not be changed), the subsequent postoperative pain and complications were associated with ureteral stenting, which could be reduced by selective stenting. Unplanned admissions could not be predicted.

Ambulatory Surgical Procedures↗
PubMed2001

Clinical factors influencing return to work after ambulatory inguinal herniorrhaphy in Hong Kong.

Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguinal hernia repair in Hong Kong. A total of 271 consecutive ambulatory inguinal hernia repairs were performed at a day surgery centre from December 1995 to December 1998. The convalescent period prior to resuming work was analysed by multi-variate analysis with respect to significant clinical variables. A sick leave of 3 weeks was adequate for most patients following uncomplicated ambulatory inguinal hernia repairs. Factors associated with early return to work included age </=50 years, indirect inguinal hernia and sedentary occupation. Occupation was the only independent factor affecting the duration of time off work on multi-variate analysis.

Journal Article↗
PubMed2001

Do situational expectations produce situational inferenes? The role of future expectations in directing inferential goals.

Little is known about the conditions that lead observers to adopt different inferential goals in the context of their everyday lives. Four studies examined whether future expectations created situational inferential goals. In 2 quasiexperimental studies, students made more situational inferences for targets in their expected future careers. In 2 experiments, situational expectations were manipulated, and participants made more situational inferences when they expected to be in the same situation as the target. This tendency was stronger when observers devoted minimal cognitive effort to their inferences, suggesting that when observers have situational expectations, making situational inferences is less effortful than making dispositional inferences.

Adolescent↗
PubMed2001

GIPC and GAIP form a complex with TrkA: a putative link between G protein and receptor tyrosine kinase pathways.

NGF initiates the majority of its neurotrophic effects by promoting the activation of the tyrosine kinase receptor TrkA. Here we describe a novel interaction between TrkA and GIPC, a PDZ domain protein. GIPC binds to the juxtamembrane region of TrkA through its PDZ domain. The PDZ domain of GIPC also interacts with GAIP, an RGS (regulators of G protein signaling) protein. GIPC and GAIP are components of a G protein-coupled signaling complex thought to be involved in vesicular trafficking. In transfected HEK 293T cells GIPC, GAIP, and TrkA form a coprecipitable protein complex. Both TrkA and GAIP bind to the PDZ domain of GIPC, but their binding sites within the PDZ domain are different. The association of endogenous GIPC with the TrkA receptor was confirmed by coimmunoprecipitation in PC12 (615) cells stably expressing TrkA. By immunofluorescence GIPC colocalizes with phosphorylated TrkA receptors in retrograde transport vesicles located in the neurites and cell bodies of differentiated PC12 (615) cells. These results suggest that GIPC, like other PDZ domain proteins, serves to cluster transmembrane receptors with signaling molecules. When GIPC is overexpressed in PC12 (615) cells, NGF-induced phosphorylation of mitogen-activated protein (MAP) kinase (Erk1/2) decreases; however, there is no effect on phosphorylation of Akt, phospholipase C-gamma1, or Shc. The association of TrkA receptors with GIPC and GAIP plus the inhibition of MAP kinase by GIPC suggests that GIPC may provide a link between TrkA and G protein signaling pathways.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Evolution of endogenous retrovirus-like elements of the woolly mammoth (Mammuthus primigenius) and its relatives.

Endogenous retrovirus-like elements characterizable by a leucine tRNA primer (ERV-Ls) are reiterated genomic sequences known to be widespread in mammals, including humans. They may have arisen from an ancestral foamy virus-like element by successful germ line infection followed by copy number expansion. However, among mammals, only primates and rodents have thus far exhibited high copy number amplification and sequence diversification. Conventionally, empirical studies of proviral amplification and diversification have been limited to extant species, but taxa having good Quaternary fossil records could potentially be investigated using the techniques of "ancient" DNA research. To examine evolutionary parameters of ERV-Ls across both time and taxa, we characterized this proviral class in the extinct woolly mammoth (Mammuthus primigenius) and living elephants, as well as extant members of the larger clade to which they belong (Uranotheria, a group containing proboscideans, sirenians, hyraxes, and their extinct relatives). Ungulates and carnivores previously analyzed demonstrated low copy numbers of ERV-L sequences, and thus it was expected that uranotheres should as well. Here, we show that all uranothere taxa exhibit unexpectedly numerous and diverse ERV-L sequence complements, indicating active expansion within this group of lineages. Selection is the most parsimonious explanation for observed differences in ERV-L distribution and frequency, with relative success being reflected in the persistence of certain elements over a variety of sampled time depths (as can be observed by comparing sequences from fossil and extant elephantid samples).

Animals↗
PubMed2001

Outpatient holmium laser lithotripsy using semirigid ureteroscope. Is the treatment outcome affected by stone load?

OBJECTIVES: To compare the outcome of outpatient ureteroscopic laser lithotripsy (URSL) for ureteral stone larger than 10 mm in longest diameter (group 1) with those less than or equal to 10 mm (group 2). METHODS: 134 patients with solitary ureteral stone were treated by outpatient URSL. No exclusion criteria with regards to stone size, level or composition were applied. Semirigid ureteroscopy and holmium-YAG laser lithotripsy was performed under general anaesthesia as outpatient procedure. Radiological follow-up by intravenous urogram was performed 3 months postoperatively. Patients' demographic data, stone parameters, operative details and treatment outcome were collected prospectively and compared between the two groups. RESULTS: Among the 134 ureteral stones, 41(31%) were larger than 10 mm. Group 1 contained more upper and middle ureteral stones than group 2 (68 vs. 40% p = 0.001). Operating time was significantly longer for group 1 (68.9 vs. 46.8 min, p<0.001) and postoperative stenting rate was higher (83 vs. 60%, p = 0.01). There was no difference between the groups in terms of 3 months stone clearance rate (92.7 vs. 91.4%, p = 0.8). Complication rate was higher in group 1 (22 vs. 5.4%, p = 0.004) especially for lower stones (46.2 vs. 5.4%, p = 0.001) but most of which were minor complications that were treated conservatively. One patient in group 1 (2.4%) developed ureteral stricture at the longstanding stone impaction site despite postoperative stenting. The stricture resolved subsequent to balloon dilatation. CONCLUSIONS: URSL can treat stones larger than 10 mm in longest diameter at all levels safely and effectively in an outpatient setting.

Adult↗
PubMed2001

The fear factor.

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Creativity↗