Biomedical subjects

H C Lin

Publications and source records attributed to H C Lin.

At least 433 records · Page 24Linked to original sources

PubMedDate not supplied

Oesophageal perforation following endoscopic variceal ligation and balloon tamponade.

Endoscopic variceal ligation (EVL) related complication is rarely reported. A case is presented of a 74 year old man with oesophageal variceal bleeding who developed oesophageal perforation following EVL and balloon tamponade. An oesophageal wall defect was induced by EVL and tissue repair was hindered by decompensated liver reserve and shock status; concomitant balloon tamponade precipitated oesophageal perforation. The case is reported to draw attention to oesophageal perforation after concurrent use of balloon tamponade and EVL.

Aged↗

PubMedDate not supplied

Haemodynamic effects of a combination of propranolol and clonidine in patients with post-hepatitic cirrhosis.

The haemodynamic effects of a combination of propranolol and clonidine were evaluated in 20 patients with post-hepatitic cirrhosis. Haemodynamic measurements were taken before and 30 min after an intravenous injection of 0.1 mg/kg of propranolol. Thereafter, each patient was given an oral dose of 150 micrograms of clonidine and re-measured 60 min later. In this series, eight patients were defined as 'non-responders' (a decrease in hepatic venous pressure gradient of < 10%) after propranolol treatment. Of both the responders and non-responders, propranolol caused expected decreases in the cardiac index and heart rate while mean arterial pressure remained unchanged. Of the propranolol responders, a significant decrease in hepatic venous pressure gradient was observed. After the addition of clonidine, in both the responders and non-responders there was a further decrease in hepatic venous pressure gradient with a concurrent drop in mean arterial pressure, but cardiac index and heart rate remained unaltered. In conclusion, the combination of propranolol and clonidine in post-hepatitic cirrhotic patients enhanced the reduction of portal pressure achieved by propranolol alone. The beneficial effects of the combination of the two in the reduction of portal pressure appeared to be similar in both the propranolol responders and non-responders. However, the drop in mean arterial pressure following the addition of clonidine may be hazardous to cirrhotic patients.

Adrenergic alpha-Agonists↗

PubMedDate not supplied

A preliminary comparison of lidocaine and xylazine as epidural analgesics in ponies.

Xylazine (0.35 mg/kg) or lidocaine (0.35 mg/kg) was injected into the epidural space of six ponies to compare their effectiveness as epidural analgesics. Each pony received both treatments at 1 week intervals with the order of treatments randomized. Xylazine produced analgesia of significantly longer duration (247 +/- 58 minutes) than that produced by an equal dose of lidocaine (135 +/- 22 minutes). Mild transient ataxia of no clinical significance developed in all ponies with both treatments. Spinal cords were removed from two ponies and examined histologically. No discernible pathologic changes were noted.

Analgesia, Epidural↗

PubMedDate not supplied

The hemodynamic response of calves to tiletamine-zolazepam anesthesia.

Six isoflurane-anesthetized calves were instrumented for hemodynamic studies and allowed to recover from anesthesia. When the mean arterial blood pressure rose to 100 mmHg or when vigorous movement occurred, a 1:1 tiletamine-zolazepam mixture (4 mg/kg) was administered intravenously (IV). Values for cardiac output, cardiac index, stroke index, central venous pressure, and right ventricular stroke work index did not change significantly. Systolic, mean, and diastolic arterial blood pressures and systemic vascular resistance were significantly decreased below baseline at 5 minutes; they were significantly increased above baseline at 20 minutes and remained so throughout the 60 minute study. Changes in left ventricular stroke work index and rate pressure product were similar to those of arterial blood pressure and systemic vascular resistance, although they were not significant. Heart rate and pulmonary capillary wedge pressure decreased significantly but gradually returned to baseline at 40 minutes and then increased significantly above baseline by the end of the study. Minor venous-arterial shunting or perhaps mismatching of ventilation and perfusion appeared to have developed in the later stages of the study. This was reflected in a minor increase in the arterial partial pressure of carbon dioxide (PaCO2) and a decrease in the arterial partial pressure of oxygen (PaO2) and arterial pH. At the dose administered, the hemodynamic changes induced by tiletamine-zolazepam were minimal and were compatible with safe anesthesia in calves.

Anesthesia↗

PubMedDate not supplied

Anesthesia in sheep with propofol or with xylazine-ketamine followed by halothane.

OBJECTIVE: This study evaluates the clinical usefulness and anesthetic effect of propofol, and compares these effects with those of xylazine-ketamine-halothane anesthesia in sheep. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS OR SAMPLE POPULATION: Fourteen healthy adult male sheep. METHODS: Sheep were randomly assigned to two different drug regimens: (1) Bolus injection of propofol (3 mg/kg, intravenously [i.v.]) followed by continuous intravenous infusion and (2) xylazine (0.11 mg/kg, i.v.) and ketamine (2.2 mg/kg, i.v.) for induction followed by halothane anesthesia. Heart rate, respiratory rate, and arterial blood pressures were monitored during anesthesia. Venous blood samples were collected for blood gas analysis. Quality of induction and recovery were also recorded. RESULTS: The average dose of propofol used to induce and maintain anesthesia was 6.63 +/- 2.06 mg/kg and 29.3 +/- 11.7 mg/kg/hr (0.49 +/- 0.20 mg/kg/min), respectively. The duration of propofol anesthesia was 45.3 +/- 13.2 minutes and recovery to standing occurred in 14.7 +/- 5.7 minutes. Sheep receiving xylazine-ketamine-halothane were anesthetized for 35.9 +/- 4.0 minutes and recovery to standing occurred within 28.5 +/- 7.5 minutes. Sheep anesthetized with propofol had a significantly higher heart rate, diastolic blood pressure and Pvo2, and a lower Pvco2 at 30 minutes and lower BE at 15 and 30 minutes than sheep anesthetized with xylazine-ketamine-halothane. CONCLUSIONS: Propofol anesthesia was characterized by a smooth induction, effective surgical anesthesia and rapid recovery which was comparable to anesthesia with xylazine-ketamine-halothane. CLINICAL RELEVANCE: Propofol may be indicated in situations when it is desirable to maintain anesthesia with an intravenous infusion followed by a rapid recovery in healthy sheep.

Anesthesia, Inhalation↗

PubMedDate not supplied

Effects of carbon dioxide insufflation combined with changes in body position on blood gas and acid-base status in anesthetized llamas (Llama glama).

OBJECTIVE: To study the combined effects of intra-abdominal CO2 insufflation with changes in body position during laparoscopy in xylazine-ketamine-halothane anesthetized llamas. STUDY DESIGN: Prospective, controlled study. ANIMALS: Nine castrated, male llamas weighing 114 +/- 23 kg, 3 to 13 years old. METHODS: Three llamas (preliminary study [PS] group) were used to study the effect of right, lateral, dorsal, and left lateral recumbency on gas exchange and acid-base status. The other six (experimental study [ES] group) were used to study the combined effects of changes in body position and CO2 insufflation to an intraabdominal pressure of 10 to 12 mm Hg. Heart rate, respiratory rate, and indirect arterial blood pressures (systolic [SAP], mean [MAP], and diastolic [DAP]) were recorded every 5 minutes during anesthesia. Arterial blood gases (PaO2 and PaCO2) and acid-base status (pHa and HCO3-) were measured immediately after induction of anesthesia and before each change of position. RESULTS: In the PS group, significant decreases in SAP, MAP and PaCO2 and increases in PaO2 and pHa were observed when the llamas were turned from right lateral to dorsal recumbency. Values for HCO3- were lower than the postinduction values, but they remained unaffected by the changes in position. In the ES group, values for MAP were significantly lower when the llamas were placed in dorsal and left lateral recumbency than those observed during right lateral recumbency. Arterial O2 tension during right lateral recumbency was lower but returned to preinsufflation values when the llamas were placed in the dorsal position. All llamas recovered uneventfully within 30 minutes after termination of anesthesia. CONCLUSIONS: Insufflation of CO2 and changing body position induce minor and transient changes in cardiovascular and respiratory function. CLINICAL RELEVANCE: Laparoscopy with mild intra-abdominal CO2 insufflation (10 to 12 mm Hg) can be used safely in spontaneously breathing llamas anesthetized with xylazine, ketamine, and halothane.

Acid-Base Equilibrium↗

PubMedDate not supplied

Ventral abdominal approach for laparoscopic ovariectomy in llamas.

OBJECTIVE: To evaluate a technique for laparoscopic ovariectomy by a ventral abdominal approach in the llama. STUDY DESIGN: Prospective evaluation. ANIMAL POPULATION: Six healthy adult female llamas, aged 2 to 6 years. METHODS: Laparoscopic ovariectomy was performed with the llamas in a 30-degree Trendelenburg position. The mesovarium and proper ligament of the ovary were isolated, and two Hulka clips were placed in opposite directions across each mesovarium and proper ligament of the ovary. Ovaries were removed through either the instrument cannula or instrument portal. RESULTS: The ovaries, mesovarium, and proper ligaments of the ovaries were easily identified using laparoscopy by a ventral abdominal approach. The Hulka Clip Applicator was easy to use, and the Hulka Clips provided secure hemostasis of the vessels within the mesovarium. Mean duration of surgery was 35 minutes (range, 17 to 85 minutes). Two llamas were depressed after surgery but improved within 24 hours. No other complications occurred during an 18-month follow-up period. CONCLUSIONS: Laparoscopic ovariectomy in the llama was facilitated by the use of Hulka Clips placed across the mesovarium and proper ligament of the ovary. CLINICAL RELEVANCE: Laparoscopic ovariectomy in the llama can be accomplished easily with few complications.

Animals↗

PubMedDate not supplied

Stopping enteral feeding for arbitrary gastric residual volume may not be physiologically sound: results of a computer simulation model.

BACKGROUND: During tube feeding, it is a common practice to check gastric residual volume frequently for indications of pathologic impairment of gastric emptying. The volume threshold standards for holding feedings are applied nonselectively, disregarding slowing of gastric emptying by nutrient-triggered intestinogastric inhibitory feedback. We developed a computer simulation model considering this feedback to test the hypothesis that gastric residual volume increases with slower gastric emptying and faster formula delivery but reaches a plateau volume (equilibrium between input and output) at volumes commonly seen in the postprandial stomach. METHODS: A computer simulation model using Microsoft Excel 4.0 calculated the cumulative gastric residual volume over time when the input volume into the stomach is 125 mL/h (endogenous secretions)+ 0 to 125 mL/h (formula delivery rate) and the output volume out of the stomach is equal to gastric emptying rates that varied between 0% and 50%/h. The model simulated nasogastric feeding with nine different rates of gastric emptying and six different rates of formula delivery. Measurements consisted of the cumulative gastric residual volume at the end of each hour for a minimum of 48 hours. RESULTS: (1) Gastric residual volumes 1.5 to 6 times the commonly applied "stop feeding" threshold volume of 150 mL are encountered at gastric emptying rates of 20% to 50%/h; (2) gastric residual volume stabilizes to a plateau of 225 to 900 mL between 3 and 13 hours after start of formula delivery at these rates; and (3) at 0% gastric emptying, gastric residual volume does not reach a plateau. CONCLUSIONS: At gastric emptying rates expected with nutrient-triggered inhibitory feedback and at formula delivery rates common in nutrition support, gastric residual volume reaches a plateau rapidly and at volumes commonly encountered in normal postprandial stomachs. On the basis of the results of this model, the current practice of stopping enteral feeding when gastric residual volume exceeds an arbitrarily selected volume threshold may not be physiologically sound. Clinical studies are needed to verify this model.

Computer Simulation↗

PubMedDate not supplied

Advances in nutrition and gastroenterology: summary of the 1997 A.S.P.E.N. Research Workshop.

BACKGROUND: The 1997 A.S.P.E.N. Research Workshop was held at the annual meeting in San Francisco, on January 26, 1997. The workshop focused on advances in clinical and basic research involving the interface between nutrient and luminal gastroenterology. METHODS: Presentations on the genetic regulation of gastrointestinal development, the molecular biology of small intestinal adaptation, the effect of nutrition support on intestinal mucosal mass, the relationship between nutrition and gastrointestinal motility, nutrient absorption, and gastrointestinal tract substrate metabolism were made by the preeminent leaders in the field. RESULTS: The investigators presented an insightful analysis of each topic by reviewing data from their own laboratories and the published literature. CONCLUSIONS: This workshop underscored the important interactions between nutrition and luminal gastroenterology at the basic science, metabolic/physiologic, and clinical levels. The integration of presentations from the different disciplines provided a unique interaction of information and ideas to advance our understanding of nutrition and gastrointestinal tract.

Digestive System Physiological Phenomena↗

PubMedDate not supplied

Clinical analysis of a dysentery outbreak in Taichung.

In September 1993, we collected 207 patients due to dysentery, who visited the Department of Pediatrics at China Medical College Hospital. In our report, 67.6% of these patients were amebic dysentery, 19.3% were combined infection with amebic and Shigella sonnei dysentery, and 13.1% were Shigella sonnei dysentery. Therefore, amebic dysentery was the predominant cause during this outbreak. The clinical features of this outbreak were, in descending order, watery stool, fever, abdominal pain, mucinous stool and bloody stool. No concurrent liver abscess was discerned. Because there had not been such a clustering of dysentery in Taichung for so many years, we thought that travel to endemic areas might have been the underlying predisposing cause. Most of the school water supplying system was ground water, which might have been contaminated by a few patients returning from endemic areas. We thought that fecal-oral route by contaminated water might have been the primary transmission route.

Adolescent↗

PubMedDate not supplied

Influence of perinatal factors on limit of viability in extremely low birth weight infants.

This retrospective study investigated the influence of perinatal factors on the limit of viability in extremely low birth weight (ELBW) infants. From January 1997 to May 1998, all infants weighing less than 1000 gm admitted to NICU of China Medical College Hospital were enrolled in this study. Still-born infants and infants with congenital anomaly were excluded. The end outcome was survival of the infants (defined as alive at discharge). Eighty-four infants were included in this study. Their mean gestational age (GA) was 25.8 +/- 1.76 weeks, mean birth weight (BW) was 772 +/- 114 gm, and overall survival rate was 48.8%. The smallest intact survival was a female infant of GA 23 weeks and BW 530 gm. Early neonatal mortality rate (< 7 days) was 26.2% (23/84). The cut off levels, below which mortality significantly increased, were GA < 24 weeks and BW < 700 gm (odds ratio, 6.11, confidence interval, 2.01 to 18.63 for GA; odds ratio, 2.65, confidence interval, 1.09 to 6.39 for BW). The two most significant factors which independently affected neonatal survival were GA < 24 weeks and early neonatal dexamethasone treatment for the prevention of chronic lung disease (odds ratio, 9.24, confidence interval, 2.53 to 33.76 for GA; odds ratio, 35.83, confidence interval, 7.03 to 183 for dexamethasone treatment). We conclude that in order to further reduce neonatal mortality, efforts should be made in the areas of prenatal care and women's health to prevent extreme prematurity and low birth weight infants. In the case of an impending delivery of an ELBW infant, an active plan of management for all gestations > or = 24 weeks seems appropriate. Finally, unless it is proven to be safe, early neonatal dexamethasone treatment for prevention of chronic lung disease should not be routinely used in ELBW infants.

Anti-Inflammatory Agents↗

PubMedDate not supplied

Risk factors of pulmonary hemorrhage in very-low-birth-weight infants: a two-year retrospective study.

Pulmonary hemorrhage is a serious complications in very-low-birth-weight (VLBW) infants with respiratory distress syndrome (RDS). We undertook a 2-year retrospective study to investigate the predisposing factors and the incidence of pulmonary hemorrhage in VLBW infants. From January 1997 through December 1998, twenty infants were diagnosed with massive pulmonary hemorrhage (MPH) according to the following criteria: active bleeding from the endotracheal tube, acute drop in hematocrit (> or = 10%), and the development of multilobar infiltration on chest radiograph. The mean gestational age was 26.9 +/- 2.5 weeks, the mean birth weight was 909 +/- 290 g. Twenty historic controls with similar gestational age and birth weight were retrospectively identified during the study period. The incidence of MPH in VLBW infants was 5.9%(20/340). A lack of prenatal corticosteroid administration, surfactant replacement therapy for RDS, and a patent ductus arteriosus (PDA) with cardiovascular dysfunction requiring dopamine support were the significantly predisposing factors of MPH in the acute stage (< or = 7th day of life). To avoid MPH and decrease mortality and morbidity in the acute stage, prenatal corticosteroid administration, evaluation of the necessity of surfactant therapy, and early recognition and aggressive treatment of hemodynamically significant PDA were necessary.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Neurocutaneous melanosis with epilepsy: report of one case.

Neurocutaneous melanosis is a rare congenital syndrome characterized by the association of large or multiple congenital melanocytic nevi and benign or malignant melanotic tumors in the central nervous system. Patients with neurocutaneous melanosis usually have neurological symptoms early in life that progress rapidly due to the development of increased intracranial pressure or malignant melanoma. We report a 2-month-old female infant with multiple congenital melanocytic nevi and frequent seizure attacks. Magnetic resonance imaging of the brain demonstrated several regions compatible with melanotic deposits. During follow-up for one year, she had normal development and was seizure-free under the treatment of phenobarbital and valproic acid. We suggest that infants with large or multiple congenital melanocytic nevi should receive regular clinical check-up and brain imaging to exclude the possibility of central nervous system lesions.

Epilepsy↗

PubMedDate not supplied

Septo-optic dysplasia: report of a case.

A female infant presented with poor feeding, hypotonia, prolonged jaundice, seizure and wandering nystagmus. A case of septo-optic dysplasia was proved by demonstrating the absence of septum pellucidum, small optic discs and hypothalamic-pituitary dysfunction at the age of three months. It is stressed that a diagnosis of septo-optic dysplasia must be entertained in infants who present with prolonged jaundice and hypoglycemia, particularly when rotatory nystagmus is associated.

Female↗

PubMedDate not supplied

[Degenerative changes in neutrophils as an indicator of neonatal sepsis].

Detection of the degenerative changes of neutrophils (D.C.N.) including vacuolization and toxic granulation in peripheral blood smear can be of value in identifying neonates with infection. A prospective study of 264 neonates who required septic work-ups in the first month of life was conducted. Thirty neonates were proved to have sepsis subsequently. The accuracy of the degree of the D.C.N. to predict neonatal sepsis was assessed. Vacuolization and/or toxic granulation in neutrophils varied from 0% to over 50%/100 neutrophils scanned. The higher the degree of D.C.N. the greater was the like-hood of sepsis. The positive predictive accuracy and specificity increased with the degree of D.C.N. from 24.7% to 100% and 70% to 100% respectively, but the sensitivity decreased accordingly. When D.C.N. was less than 10% the chance of sepsis was less than 5%. Most of newborns dying of proven sepsis had higher percentage of D.C.N.. These findings suggest that degree of D.C.N. may be associated with the outcome of the patients. This simple test can be performed easily in all hospital; it does not require special laboratory facilities and provide a valuable adjunct in early detection of severity and outcome of the neonates with sepsis.

Cytoplasmic Granules↗

PubMedDate not supplied

Primary Sjögren's syndrome and primary biliary cirrhosis: differences and similarities in the autoantibody profile.

Sera from 61 patients with primary biliary cirrhosis (PBC) and 23 patients with primary Sjögren's syndrome (pSS) were tested for the presence of autoantibodies to 15 different antigens (PDH, RNP, SS-A, SS-B, Sm, Scl-70, H2AH2B, Jo-1, collagen-type I, GBM, GM <--> 1, Sulf, GD1b, MPO, PR3). Patients with pSS had significantly (p < 0.01) higher frequencies of antibodies to SS-A, SS-B and RNP (78%, 52%, 22% vs 29%, 20%, 5%, respectively) when compared to patients with PBC. On the other hand, patients with PBC had significantly (p < 0.01) higher frequencies of antibodies to PDH, Sm, Jo-1, collagen and MPO (80%, 34%, 26%, 52%, 67% vs 13%, 9%, 13%, 13%, 9%, respectively) as compared with patients with pSS. For all the other autoantibodies, no significant differences were found between PBS and pSS patients. These data on the similarities in autoimmunity between two diseases with different clinical presentations shed more light on the mosaic of autoimmunity.

Adult↗

PubMedDate not supplied

Intestinal volvulus caused by a persistent omphalomesenteric band: report of one case.

Persistent omphalomesenteric band is a rare cause of volvulus or intestinal obstruction. A 7-month-old male infant was brought to this Emergency Room after having shown poor appetite for three days, frequent bilious vomiting, and fever for half a day. Physical examination revealed the infant was dehydrated and had slight abdominal distension as well as hypoactive bowel sounds with a tender, ill-defined mass over right lower quadrant. Radiography and sonography were consistent with distal small bowel obstruction. Emergent laparotomy was done and a fibrous band found extending from the anti-mesenteric border of the ileum to the posterior wall of the umbilicus. Small bowel volvulus had occurred around the band and dilated small bowel was noted. An understanding of the embryologic development of these structures and their normal disappearance may assist pediatricians and surgeons to make the correct diagnosis and select the right pathoanatomic approach in surgery.

Humans↗

PubMedDate not supplied

A giant retroperitoneal ganglioneuroma with intraspinal involvement: report of one case.

A 9-year-old girl was discovered to have had a huge retroperitoneal mass causing moderate hydronephrosis and anterior displacement of the right kidney and which was found on a renal ultrasonographic examination. A series of examinations including (1)IVP, (2) abdominal computed tomography, (3) MRI and(4) incisional biopsy revealed a giant dumb-bell shaped retroperitoneal ganglioneuroma with intraspinal involvement. Secondary scoliosis was also noticed. We successfully resected the huge ganglioneuroma of the right retroperitoneum in a two stage procedure: her postoperative course was uneventful.

Child↗