Biomedical subjects

Heng-Shuen Chen

Publications and source records attributed to Heng-Shuen Chen.

4 recordsLinked to original sources

PubMed2006

The advancement of pure local anesthesia for penile surgeries: can an outpatient basis be sustainable?

Although topical anesthetic blockage for penile surgeries has been substantially reported in the medical literature, its methodology, reliability, and reproducibility have not been consistent. We report on several methods of topical blocks for local anesthesia in patients with indications for penile surgeries. From March 1993 to March 2003, a total of 1131 men, ages 19 to 87, underwent penile surgeries in which 165, 203, 708, 45, and 10 patients received penile implantation, modified Nesbit procedure, venous surgery, venous patches, and arterial revascularization respectively, under pure local anesthesia on an outpatient basis. They were categorized into the implant, Nesbit, venous, patch, and arterial groups respectively. Proximal dorsal nerve blockage, peripenile infiltration, and topical injection, although challenging, were sufficient local anesthesia for patients in the last 4 patient groups. A new method of crural blockade, however, was also required for optimal anesthesia of the cavernous nerve for implantation purposes. The anesthetic effects and postoperative results were satisfactory. Common immediate side effects included puncture of the corpus spongiosum or the deep dorsal vein as well as the innominate vessel, subcutaneous ecchymosis, transient palpitations, and acceptable low level of pain. There were no significant late complications. In the implant group, however, 6.1% of patients (10/165) had experienced pain over the perineum for 1 to 2 weeks postoperatively. Overall there were statistical differences in scoring between the 5 groups in which the implant group stood out when a visual analog scale of 100 mm was used. Topical nerve blockades proved to be reliable, simple, and safe, with minimal complications. They offer the advantages of less morbidity, reduced effects of anesthesia, protection of privacy, and a rapid return to preoperative daily activity.

Adolescent↗

PubMed2006

Long-term results of autologous venous grafts for penile morphological reconstruction.

In order to evaluate the long-term results of autologous venous grafts, we present an overview of patients who underwent a procedure utilizing a venous patch from the deep dorsal vein with or without combination of the cavernosal vein in treating penile deformity. From March 1995 to March 2005, a total of 85 consecutive patients with Peyronie disease or congenital penile deviation underwent venous grafting. Tunical corporotomy was covered using transplanted venous wall sutured microscopically to collagen bundles of the inner circular and outer longitudinal layer of the tunica albuginea. The vein was sutured with the serosal side outward, after it had been detubularized, properly constructed, and spliced together. In this cohort, 48 patients with Peyronie disease and 37 with congenital penile deviation were respectively categorized as belonging to the Peyronie and congenital groups. All patients were evaluated preoperatively and postoperatively with the International Index of Erectile Function (IIEF-5) scoring, angle measurement of erectile penis, satisfaction with the penile shape, and a cavernosogram which was further available for 15 patients. Histological confirmation in 5 cases was followed up for up to 10 years. The mean angle improvement was 44.8 +/- 3.6 degrees for the Peyronie group and 37.6 +/- 3.8 degrees for the congenital group. A satisfactory penile shape was achieved in 77 (90.6%) patients, although 8 men (9.4%) complained of mild deviation of the penis (<15 degrees). Erectile function was good in 81 patients, although 6 of them had to use oral sildenafil/tadalafil postoperatively. Overall, they had a mean preoperative IIEF-5 score of 19.7 +/- 2.8, which increased to a mean postoperative score of 21.6 +/- 2.2. The cavernosograms consistently disclosed a good penile shape. The histological confirmation showed that the donor vein retained its histological character despite the fact that perfect coalescence and lining up with the tunica albuginea were noted. The autologous vein appears to be an acceptable graft material, and the transplanted vein may have a modeling action rather than a scaffolding role in venous patch surgery on the penile tunica albuginea. Careful microsurgical manipulation is required to achieve a satisfactory, sustainable outcome.

Adult↗

PubMed2006

Insufficient response to venous stripping surgery: is the penile vein recurrent or residual?

There is currently controversy on whether the insufficient response to penile venous surgery done in an attempt to restore erectile function is due to recurrent or residual veins. In order to elucidate this issue, we report a study on those patients who failed to respond to the first venous surgery and subsequently underwent or declined a second operation. From July 1996 to July 2003, a total of 83 patients, aged 25 to 83, who were dissatisfied with their first venous surgery and were later diagnosed with a persistent veno-occlusive dysfunction via our dual cavernosography, were recruited into our study. Subsequently, 45 men underwent penile venous stripping surgery for a second time and were assigned to the surgery group, whereas the remaining 38 men were subject to follow-up and routine management and were assigned to the control group. All were evaluated with the abridged 5-item version of the international index of erectile function (IIEF-5) every 6 months for 1 to 5 years and cavernosogram, if necessary. In the surgery group their preoperative IIEF-5 score was 10.1 +/- 3.7, which increased to 17.1 +/- 3.2 (P < .001) after the first surgery and further increased to 20.7 +/- 3.1 (P < .001) after a second venous stripping of the cavernosal vein that was consistently demonstrated on the cavernosogram. Overall, 41 men (91.1%) reported a positive response to further venous surgery, with more satisfactory coitus, after the residual veins were stripped thoroughly, although eventually 4, 3, and 3 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. The follow-up period ranged from 12 months to 72 months, with an average of 37.0 +/- 11.5 months. In the control group, however, their corresponding IIEF-5 score changed from 17.4 +/- 2.9 to 16.9 +/- 3.2 (P > .05). Finally, 11, 7, and 8 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. Although there was no statistical significance between the 2 groups in the first postoperative IIEF-5 scores, there was a significant difference in their IIEF-5 after further venous surgery. In this study, we propose that the clinical relapse of erectile dysfunction is a result of "residual" veins rather than "recurrent" ones.

Adult↗

PubMed2004

A problem-based e-Learning prototype system for clinical medical education.

The purpose of this system is to establish virtual medical school (VMS) as the platform of e-learning center, which integrates collaborative and self-directed learning environment by virtual group, classroom and library, and automatically converts valuable clinical case from Hospital Information System (HIS) database into virtual patient by online authoring tools for problem-based e-learning. In this system, the VMS provides a problem-based e-learning environment, and utilizes HIS to capture and store valuable clinical cases. All medical students and residents now have the opportunity to learn from these typical cases online. The VMS at National Taiwan University has the potential to develop into a national medical education network for the meditation and provision of comprehensive medical resources. The system will use the international standard SCORM 1.2 to develop teaching material and assist with the HL7 v2.4, CDA v1.0 standards to connect Electronic Medical Record (EMR) systems in the hospital. It can provide resources sharing among medical centers by using high transportation ability of Grid Computing integrated with the broadband video platform, Access Grid, and personal multiple point videoconference platform, Multi-video, to popularize the application of e-learning in clinical medical education.

Clinical Medicine↗