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Biomedical subjects

J Lang

Publications and source records attributed to J Lang.

At least 73 records · Page 4Linked to original sources
PubMed2001

[Complications in laparoscopic gynecologic surgery: analysis of 34 cases].

OBJECTIVE: To investigate retrospectively the complication rate of gynecological laparoscopies at Peking union medical college (PUMC) hospital over 6-year period. METHODS: 1,769 laparoscopic surgeries were carried out from Jan. 1994 through Oct. 1999. The procedures included 1,421 adnexal surgeries, 52 myomectomies and 296 laparoscopic assisted vaginal hysterectomy (LAVH). Complication was defined as an event that had modified the usual course of the procedure or of the postoperative period. RESULTS: Complications occurred in 34 cases, the overall complication rate was 1.9%. Unintended laparotomies occurred in 6 cases (0.3%). Complication rate was 0.9%, 1.9% and 6.8% in adnexal surgeries, myomectomies and LAVH respectively. 12 (35.3%) complications related to puncture and pneumoperitoneum, including five severe emphysema, 7 injuries to epigastric blood vessels of abdominal wall and omental blood vessel, this figure represented 35.3% of all complications of this series. 5 (14.7%) intraoperative, complications occurred during the laparoscopic surgery (3 severe bleedings, 1 bladder injury and 1 skin burn of leg related to the electrode plate), laparotomy was required in 4 of these cases. 17 (50.0%) complications occurred during postoperative stage: 2 intraperitoneal hemorrhages needing re-laparotomy, 2 bowel complications, 4 nerve paresis and 9 febrile morbidities. CONCLUSIONS: In our experience, operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complications seems related to advanced procedures such as LAVH.

Female↗
PubMed2001

[Effect of a risk of malignancy index in preoperative diagnosis of ovarian cancer].

OBJECTIVE: To evaluate the ability of a risk of malignancy index (RMI), based on a serum CA125 level, ultrasound findings and menopausal status, to discriminate a benign from a malignant pelvic mass. METHODS: One hundred and forty women with a pelvic mass, 30 years or older, admitted between January 1998 and June 1999, were studied. The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status separately and combined into the RMI, to diagnose ovarian cancer. RESULTS: RMI was more accurate than any individual criterion in diagnosing cancer. Using a RMI cut-off level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, specificity of 84.4%, and positive predictive value of 82.1%. CONCLUSIONS: RMI is able to correctly discriminate between malignant and benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

Adult↗
PubMed2001

[The malignant potential of ovarian atypical endometriosis].

OBJECTIVE: To investigate the malignant potential of ovarian atypical endometriosis and ovarian endometrioid adenocarcinoma. METHODS: 12 cases of ovarian endometroid adenocarcinoma with associated endometriosis were reviewed retrospectively. Microsatellite markers were used to detect the loss of heterozygosity on chromosome 10q23 in ovarian carcinoma and their coexisting endometriosis. RESULTS: Among the 12 cases, benign eosinophilic metaplasia was observed in 8 cases, 5 of which (41.7%) with atypia. In these 5 cases, a spectrum of benign-atypical endometriosis with a transition to endometrioid adenocarcinoma was identified, and common genetic lesions were also detected in 2 of the 5 atypical endometriosis and their coexisting carcinomas. CONCLUSION: Histological observations as well as the molecular genetic evidence indicate that ovarian atypical endometriosis may possess a precancerous potential or play a role in the pathogenesis of certain malignant ovarian cancers.

Adenocarcinoma↗
PubMed2001

[A clinical evaluation on reconstruction in extended partial laryngectomy for transglottic cancer].

OBJECTIVE: Transglottic cancer has been a definite indication for total laryngectomy in decades, compromising function of the larynx. The purpose of this study is to present a new radical surgery of extended partial laryngectomy and reconstruction to restore the essential function of larynx. METHODS: Forty-one cases of transglottic cancer were treated by extended vertical laryngectomy (26/41), extended frontolateral laryngectomy (5/41) and subtotal laryngectomy (10/41); the defects of larynx were reconstructed by rotary door myocutaneous flap in twenty-seven cases, by sternohyoideus flap in seven cases, by osteomuscular flap in five cases and by sternocleidomastoid flap in two cases. RESULTS: The 3 and 5 year survival rates were 85.7% (30/35) and 74.1% (20/27) respectively, those for stage III were 84.6% (22/26) and 76.2% (16/21), for stage IV were 3/4 and 1/2 respectively. All cases resumed acceptable voice, 92.7% (38/41) and enjoyed satisfactory phonation. The over-all decannulation rate was 87.8% (36/41), those with rotary door myocutaneous flap was 96.3% (26/27), with sternohyoideus flap was 5/7, with osteomuscular flap was 4/5 and with sternocleidomastoid flap was 1/2. All patients had normal swallow function. CONCLUSION: Extended partial laryngectomy is a kind of radical operation in selected cases of transglottic cancer. The method of reconstruction with rotary door myocutaneous flap can improve curative effect and the essential functions of the larynx.

Adult↗
PubMed2001

[Clinical evaluation on second stage reconstruction for laryngostenosis after partial laryngectomy for laryngeal cancer patients].

OBJECTIVE: To present a new method of decannulation for laryngostenosis patients after partial laryngectomy and extended partial laryngectomy, and restoration of the essential functions of larynx and normal neck appearance. METHODS: Nineteen cases of laryngostenosis after partial laryngectomy and extended partial laryngectomy were treated with second stage reconstruction. The patients had been treated by vertical laryngectomy (6/19) using extended vertical laryngectomy (11/19) and frontolateral laryngectomy (2/19). Among these patients, second stage reconstruction of larynx was performed by using rotary door myocutaneous flap (17/19). Stemohyoideus flap (1/19) and sternocleidomastoid flap (1/19). RESULTS: Three and five year-survival rates were 91.7% (11/12) and 3/5, respectively. Over-all decannulation rate was 84.2% (16/19), but 94.1% (16/17) in patients with rotary door myocutaneous flap and 0% (0/2) in both patients with sternohyoideus flap and sternocleidomastoid flap. There were 3 decannulation failures (15.8%). All patients resumed acceptable voice, 94.7% (18/19) enjoyed satisfactory phonation, but 5.3% (1/19) showed severe hoarseness. All except 2 patients returned normal swallow function. The latter 2 patients experienced mild abnormal swallow during eating fluid food in early stage of surgery, but had normal swallow function after 1-2 weeks. CONCLUSION: Functional laryngectomy is a radical operation in selected cases with advanced laryngeal cancer. The second stage reconstruction with bi-pedical rotary door myocutaneous flaps can help decannulation in patients who developed laryngostenosis after partial laryngectomy and extended partial laryngectomy, and restore the essential function of larynx and normal neck appearance.

Adult↗
PubMed2001

Laparoscopic myomectomy.

OBJECTIVE: To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. MATERIALS AND METHODS: A retrospective study was carried out in 74 patients with fibroids > 3 cm from March, 1995 until May, 2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids (20 cases), mainly pain or urine frequency; progressively increasing fibroid size (7 cases); coexistent adnexal pathology(26 cases) and infertility(21 cases). RESULTS: The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7%). The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3 approximately 8 cm (mean 4.8 cm). In 19 cases (25.6%), the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids > or = 4 cm than those with fibroids < 4 cm. The difference was statistically significant ( P < 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4%. The average postoperative follow-up period was 22 months (1 approximately 62 months). All the patients with symptoms showed remission of their complaints at 2-month follow-up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. CONCLUSIONS: Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.

Adult↗
PubMed2001

[Expression of vascular endothelial growth factor and thrombospondin-1 in the ectopic and eutopic endometrium of women with endometriosis].

OBJECTIVE: To detect the expression of vascular endothelial growth factor (VEGF) and thrombospondin (TSP)-1 mRNA in the ectopic and eutopic endometrium of patients with endometriosis. METHODS: Thirty-two specimens of ovarian endometrioma, 12 red peritoneal lesion, 8 uterosacral ligament nodule, and 30 matched eutopic endometrium were biopsied from 38 patients with endometriosis, another 25 specimens of endometrium were biopsied from women without endometriosis. Reverse transcript-polymerase chain reaction (RT-PCR) and Northern Blot analysis were utilized to examine VEGF mRNA and TSP-1 mRNA expression and their relative levels in the above endometrium. RESULTS: Among endometriotic lesions, red peritoneal lesion expressed higher level of VEGF and lower level of TSP-1, whereas ovarian endometrioma expressed lower level VEGF and higher level of TSP-1. Eutopic endometrium of women with endometriosis had higer level of VEGF expression and lower level of TSP-1 expression than women without endometriosis. CONCLUSIONS: The expression of VEGF and TSP-1 in endometriotic lesion appears to be associated with its neovalscualization extent. The imbalance in expression of VEGF and TSP-1 in endometrium might be related to the development of endometriosis and its biological behavior.

Blotting, Northern↗
PubMed2000

Immunogenicity and effectiveness of post-exposure rabies prophylaxis with a new chromatographically purified Vero-cell rabies vaccine (CPRV): a two-stage randomised clinical trial in the Philippines.

Recent improvements in chromatographic purification procedures have made it possible to develop a new chromatographically purified rabies vaccine (CPRV) by further purifying the current rabies vaccine prepared from Vero-cell culture (PVRV) (Verorab; Pasteur Merieux Connaught). The immunogenicity and effectiveness of post-exposure rabies prophylaxis with this new vaccine were evaluated in a two-stage clinical trial conducted in the Philippines. In both study stages. post-exposure treatment consisted of five injections of vaccine [(D)ays 0, 3, 7, 14, 28], together with a dose of rabies immunoglobulin (RIG) of equine or human origin on D0. In stage 1, 231 subjects with low-risk rabies exposure (WHO category I or II), and who had a negative ERIG skin test, were treated with either CPRV (n = 114) or PVRV (n = 117). By D14, all subjects in each group had achieved rabies antibody titres over ten times that recommended by the WHO as indicating seroconversion (> or = 0.5 IU/ml). The kinetics of the immune response to vaccination were very similar in the two groups, and at D28, the immunogenicity of CPRV was equivalent to that of PVRV (one-sided equivalence test). Following these positive results, 132 subjects with severe rabies exposure were included in the second stage of this trial. All were scheduled to receive four vaccine doses with CPRV. After D14, only those 57 patients with confirmed rabies exposure (animal with positive FA test) and seven patients for whom rabies exposure could not be excluded (animal lost or not tested) completed the treatment and were followed for one year to assess survival. After 1 year, 62 patients treated for confirmed or possible severe rabies exposure had been examined and were still alive. Two patients contacted by letter and telephone confirmed good health 7 and 16 months after exposure. No severe local or systemic reactions were reported in either stage of the study, and no treatment-related serious adverse event occurred. This two-stage clinical trial attests to the safety and satisfactory immunogenicity of CPRV in post-exposure rabies treatment, and confirms the effectiveness of a new rabies vaccine in patients with severe confirmed exposure.

Adolescent↗
PubMed2000

B cell clonal elimination induced by membrane-bound self-antigen may require repeated antigen encounter or cell competition.

Transgenic mouse experiments indicate that autoreactive B cells are eliminated upon encounter with membrane self-antigen. In this study we tested how B cell tolerance to MHC class I antigens is affected by altering the frequency of antigen-carrying cells in mixed bone marrow (BM) chimeras. When antigen-bearing cells are present at low frequency, the reactive B cells and their antigens may coexist in the peripheral lymphoid organs, but under these conditions the B cells are functionally anergic and have a shortened lifespan. Such putative anergic cells are strongly deleted in the presence of additional, non-antigen-bearing, non-transgenic B cells. Since the antigen concentration on the surface of each antigen-bearing cell should be high, these results suggest that for efficient deletion of autoreactive B cells multiple antigen encounters may be required, particularly when cellular competition is weak. These results have implications for the therapeutic use of BM chimerism to induce B cell tolerance to grafts.

Animals↗
PubMed2000

B-cell-receptor-dependent positive and negative selection in immature B cells.

This review touches on only a small part of the complex biology of B cells, but serves to illustrate the point that the antigen receptor is the most important of many cell-surface receptors affecting cell-fate decisions. Receptor expression is necessary, but not sufficient, for cell survival. It is also essential that a B cell's antigen-receptor specificity be appropriate for its environment. The need to balance reactivity with self tolerance has resulted in an intricate feedback control (affected by both the recombinase and cell survival) that regulates independent selection events at the level of the receptor and the cell.

Animals↗
PubMed2000

Pneumoperitoneum secondary to endoscopic harvest of saphenous vein graft.

Endoscopic harvest of saphenous vein graft for coronary artery bypass grafting decreases leg wound complications compared with traditional longitudinal incision. A case of pneumoperitoneum secondary to endoscopic harvest of saphenous vein using insufflation of carbon dioxide is reported. Hypercarbia, increased peak airway pressure, but no significant changes of hemodynamics, or myocardial ischemia were noted. The management of this rare complication is described.

Angina Pectoris↗
PubMed2000

Nonradiative and radiative deactivation of singlet molecular oxygen (O2(a1deltag)) in micellar media and microemulsions.

The effects of microheterogeneous media (micelles and microemulsions) on the lifetime and, to our knowledge for the first time, on the emission of singlet molecular oxygen (O2 (a1Ag), denoted as 1O2) were investigated. Micellar media and various types of microemulsions based on anionic (sodiumdodecyl sulfate), cationic (cetyltrimethylammonium chloride) or nonionic (Triton X-100) surfactants were formulated for this purpose. The nonradiative and radiative deactivation rate constants (k(d) and k(e), respectively) were determined in selected microheterogeneous media and in the pure solvents used for their formulation, by combining steady-state and time-resolved 1O2, luminescence detection techniques. We have shown that a simple additive model, as used in homogeneous mixtures of solvents, was inadequate for predicting values of k(d) and k(e) in organized media. In contrast, both 1O2 lifetimes (taudelta = 1/k(d)) and k(e) in the microheterogeneous systems investigated could be predicted with good precision from the composition of the media and the taudelta and k(e) values in the pure solvents, using a two-pseudophase kinetic model for the 1O2 distribution. Such a model takes into account the average times spent by 1O2 in the aqueous and lipophilic pseudo-phases of the organized media, the corresponding equilibrium constant (Keq) depending on the nature of the system.

Cetrimonium↗
PubMed2000

Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery.

OBJECTIVE: To evaluate hemodynamic and clinical responses to induction of anesthesia and intubation at 3 different values of the electroencephalogram bispectral index (BIS). DESIGN: Prospective randomized trial. SETTING: University-affiliated hospital. PARTICIPANTS: Forty-five patients undergoing elective coronary artery bypass graft surgery. INTERVENTIONS: Patients were assigned to 3 groups (n = 15 for each group). Anesthesia was induced with midazolam, sufentanil, and pancuronium. In each group, sufentanil was titrated to a BIS value of 60, 50, or 40 before intubation. Mean arterial blood pressure, heart rate, incidence of coughing, tearing, and need for fluid replacement or injections of norepinephrine were recorded before intubation as well as immediately and 1 and 2 minutes after intubation. MEASUREMENTS AND MAIN RESULTS: Thirteen patients intubated at a BIS value of 60 coughed and 14 experienced tearing after intubation, whereas no patient of the other groups showed signs of arousal. Mean arterial blood pressure remained stable in the BIS 60 and 50 groups, whereas in the BIS 40 group it decreased significantly to lower values before and after intubation. Patients in the BIS 40 group needed significantly more fluid replacement and injections of norepinephrine compared with the other groups. No significant changes in heart rate were detected. CONCLUSIONS: Electroencephalogram BIS predicts hemodynamic and arousal reaction resulting from induction of anesthesia and endotracheal intubation. BIS value should be kept at 50 before intubation to ensure safe hemodynamic conditions during induction of anesthesia in cardiac surgical patients.

Anesthesia, Inhalation↗
PubMed2000

Spontaneous lumbar intervertebral disc protrusion in cats: literature review and case presentations.

Reports on intervertebral disc disease in cats are rare in the veterinary literature. It has been postulated that intervertebral disc protrusion is a frequent finding during necropsy in cats, without having any clinical relevance (King and Smith 1958, King & Smith 1960a, King & Smith 1960b). However, a total of six cases with disc protrusions and clinically significant neurological deficits have been reported over the past decade. (Heavner 1971, Seim & Nafe 1981, Gilmore 1983, Littlewood et al 1984, Sparkes & Skerry 1990, Bagley et al 1995). As in dogs, there are also two types of intervertebral disc disease in cats: Hansen's type I (extrusion), and type II (herniation). Cervical spinal cord involvement was more commonly recognised in cats than the lumbar or the thoraco lumbar area. Cats over 15 years were mainly affected (King & Smith 1958, King & Smith 1960a, King & Smith 1960b). We describe two cats with lumbar intervertebral disc protrusions. Emphasis is placed on differential diagnoses, treatment and follow-up.

Animals↗