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Biomedical subjects

J Wong

Publications and source records attributed to J Wong.

At least 469 records · Page 26Linked to original sources

Endothelin-1 does not mediate acute hypoxic pulmonary vasoconstriction in the intact newborn lamb.

The mechanisms by which acute alveolar hypoxia induces pulmonary vasoconstriction remain unclear. Previous studies suggest that hypoxia-induced vasoconstriction is endothelium-dependent and is associated with the release of endothelin-1 (ET-1), a potent vasoactive paracrine hormone produced by vascular endothelial cells. The vasoconstrictive effects of ET-1 are likely to be mediated by ETA receptors located on vascular smooth-muscle cells. BQ-123 is a selective ETA receptor antagonist. To determine the role of ET-1 and ETA receptors on resting tone and hypoxic pulmonary vasoconstriction, we studied the effects of ET-1 and BQ-123 at rest and during hypoxia-induced pulmonary vasoconstriction in 12 intact newborn lambs (< 1 week old). At rest, the intrapulmonary infusion of BQ-123 did not change resting pulmonary arterial pressure but completely blocked the rapid increase in pulmonary artery pressure produced by high doses of ET-1 (2,000 ng/kg) (23.0 +/- 10.8% versus -12.6 +/- 27.5%; p < 0.05). During mechanical ventilation there was no difference in the increase in mean pulmonary arterial pressure and pulmonary vascular resistance induced by alveolar hypoxia before and after BQ-123 (34.0 +/- 8.9% versus 30.5 +/- 10.9% and 25.3 +/- 11.6% versus 35.2 +/- 22.4%). This study suggests that the pulmonary vasoconstrictive effects of ET-1 are mediated by ETA receptors and that ET-1 does not mediate acute hypoxic pulmonary vasoconstriction in intact newborn lambs.

Acute Disease↗

Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia: a report of 135 procedures.

BACKGROUND: Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti-arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition. AIMS: To present our early experience of RF catheter ablation for PSVT. METHODS: One hundred and thirty-five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio-ventricular junctional (nodal) re-entrant tachycardia (AVJRT). Twenty-five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radiofrequency pulses delivered was ten for a mean duration of 25 seconds. Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left-sided in 29 patients, postero-septal in 21, midseptal in five, Mahaim connection in two, antero-septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation. RESULTS: Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow-up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT.

Adult↗

Distribution and molecular analysis of Lyme disease spirochetes, Borrelia burgdorferi, isolated from ticks throughout California.

Previous studies describing the occurrence and molecular characteristics of Lyme disease spirochetes, Borrelia burgdorferi, from California have been restricted primarily to isolates obtained from the north coastal region of this large and ecologically diverse state. Our objective was to look for and examine B. burdorferi organisms isolated from Ixodes pacificus ticks collected from numerous regions spanning most parts of California where this tick is found. Thirty-one isolates of B. burgdorferi were examined from individual or pooled I. pacificus ticks collected from 25 counties throughout the state. One isolate was obtained from ticks collected at Wawona Campground in Yosemite National Park, documenting the occurrence of the Lyme disease spirochete in an area of intensive human recreational use. One isolate from an Ixodes neotomae tick from an additional county was also examined. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, immunoblot analysis, agarose gel electrophoresis, Southern blot analysis, and the polymerase chain reaction were used to examine the molecular and genetic determinants of these uncloned, low-passage-number isolates. All of the isolates were identified as B. burgdorferi by their protein profiles and reactivities with monoclonal and polyclonal antibodies, and all the isolates were typed by the polymerase chain reaction as North American-type spirochetes (B. burgdorferi sensu stricto). Although products of the ospAB locus were identified in protein analyses in all of the isolates, several isolates contained deleted forms of this locus that would result in the expression of chimeric OspA-OspB proteins. The analysis of OspC demonstrated that this protein was widely conserved among the isolates but was also quite variable in its molecular mass and the amount of it that was expressed.

Animals↗

Endothelin-1 produces pulmonary vasodilation in the intact newborn lamb.

The vascular endothelium mediates, in part, pulmonary vascular tone. Because endothelin-1 (ET-1), a paracrine hormone produced by vascular endothelial cells, has vasoactive properties, we investigated the hemodynamic effects of intrapulmonary injections of ET-1 in eight intact newborn lambs at rest and during pulmonary hypertension. At rest, ET-1 (50-1,000 ng/kg) did not change pulmonary arterial pressure. During pulmonary hypertension induced by the infusion of U46619 (a thromboxane A2 mimic), ET-1 (50-1,000 ng/kg) produced a selective dose-dependent decrease in pulmonary arterial pressure (5.8 +/- 3.9 to 32.9 +/- 6.9%; P < 0.05). Similarly, during pulmonary hypertension induced by alveolar hypoxia, ET-1 (50-500 ng/kg) produced a selective dose-dependent decrease in pulmonary arterial pressure (7.2 +/- 3.6 to 26.1 +/- 3.3%; P < 0.05). The decrease in pulmonary arterial pressure produced by ET-1 (250 ng/kg) was attenuated by N omega-nitro-L-arginine (an inhibitor of endothelium-derived nitric oxide synthesis, 23.7 +/- 3.4 vs. 12.5 +/- 4.7%; P < 0.05) and by glibenclamide (an ATP-gated potassium-channel blocker, 25.2 +/- 5.0 vs. 9.6 +/- 5.3%; P < 0.05) but not by meclofenamic acid (an inhibitor of prostaglandin synthesis). ET-1 is a pulmonary vasodilator during pulmonary hypertension in the intact newborn lamb. The vasodilating properties are mediated, in part, by release of endothelium-derived nitric oxide, and by activation of ATP-gated potassium channels.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

Role of V1 receptors in the action of vasopressin on the baroreflex control of heart rate.

Arginine vasopressin (AVP) elicits a larger decrease in heart rate for a given increase in arterial pressure than do other vasoconstrictors, but there is disagreement as to whether this results from an increase in baroreflex gain or a resetting of the baroreflex to a lower blood pressure. It is also unclear which type of vasopressin receptor mediates the action of vasopressin on the baroreflex. In the present study, the effects of vasopressin, selective vasopressin V1 and V2 receptor agonists, oxytocin, and a vasopressin V1 receptor antagonist on the baroreflex control of heart rate were investigated in conscious, chronically prepared rabbits. Baroreflex curves were generated with intravenous infusions of phenylephrine and nitroprusside and analyzed using a four-parameter logistic model. Intravenous infusion of vasopressin at 5 ng.kg-1.min-1 increased mean arterial pressure by 9 mmHg and decreased heart rate by 31 beats/min. The arterial pressure at the midrange of the baroreflex curve (BP50) decreased from 75.9 +/- 4.8 to 57.6 +/- 1.7 mmHg (P < 0.01), indicating a shift of the baroreflex curve to a lower pressure, but the gain did not change significantly. The actions of vasopressin on blood pressure, heart rate, and BP50 were completely blocked by pretreatment with d(CH2)5[Tyr(Me)2]AVP, a selective V1 receptor antagonist. Infusion of [Phe2,Ile3,Orn8]AVP, a selective V1 receptor agonist, produced cardiovascular effects similar to those of vasopressin and decreased the BP50 of the baroreflex from 73.0 +/- 2.2 to 63.8 +/- 2.2 mmHg (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Role of AT1 receptors in the resetting of the baroreflex control of heart rate by angiotensin II in the rabbit.

Angiotensin II (Ang II) resets the baroreflex control of heart rate to a higher blood pressure. This action is apparently mediated via Ang II receptors in the area postrema, but it is not known if these are of the AT1 or AT2 subtype. In the present study the effects of losartan, a selective AT1 receptor antagonist, and PD 123319, a selective AT2 antagonist, on the cardiac baroreflex response to Ang II were investigated in conscious rabbits with chronically implanted arterial and venous catheters. Baroreflex curves were generated with intravenous infusions of phenylephrine and nitroprusside (2.6-25 micrograms/kg per min) and analyzed using a four-parameter logistic model to yield their upper and lower plateaus, arterial pressure at the midpoint of the heart rate range (BP50), and slope coefficient. From these four parameters, the gain and range of the baroreflex were calculated. Background intravenous infusion of Ang II at 10 ng/kg per min increased mean arterial pressure by 17 mmHg but did not change heart rate. Ang II shifted the baroreflex curve to the right as indicated by an increase in BP50 from 70.9 +/- 2.0 to 89.3 +/- 2.7 mmHg (P < 0.05), but did not change baroreflex gain significantly. Ang II did not alter the upper plateau of the baroreflex, but decreased the lower plateau from 119.4 +/- 10.3 to 73.6 +/- 11.5 beats per minute (bpm) (P < 0.05), extending the heart rate range by 52.5 bpm. Pretreatment with losartan completely abolished the pressor and cardiac baroreflex responses to Ang II. In contrast, PD 123319 had no effect on these responses. Administration of losartan alone to block endogenous Ang II shifted the baroreflex curve to the left as indicated by a decrease in BP50 from 71.2 +/- 2.7 to 64.7 +/- 2.5 mmHg (P < 0.05). These results demonstrate that the resetting of the baroreflex control of heart rate by Ang II is mediated by AT1 receptors, and that basal levels of endogenous Ang II exert a tonic action on the cardiac baroreflex to increase the setpoint around which the baroreflex regulates heart rate.

Angiotensin II↗

Hyperoxia and alkalosis produce pulmonary vasodilation independent of endothelium-derived nitric oxide in newborn lambs.

Supplemental oxygen and alkalosis are the most effective treatments used to lower pulmonary arterial pressure in children with pulmonary hypertensive disorders. However, their mechanisms of action are unknown. Endothelium-derived nitric oxide (EDNO) is an important mediator of pulmonary vascular tone and produces potent pulmonary vasodilation during pulmonary hypertension. In vitro evidence suggests that EDNO may mediate the vasodilating effects of oxygen. To investigate whether EDNO synthesis mediates the pulmonary vasodilation produced by hyperoxia [normocarbic ventilation with 100% oxygen, arterial oxygen tension > 450 torr (60 kPa)] or alkalosis (hyperventilation with 21% oxygen, pH > 7.55) in vivo, eight intact newborn lambs were studied during similar degrees of pulmonary hypertension induced either by the infusion of U46619 (a thromboxane A2 mimic) or N omega-nitro-L-arginine (an inhibitor of EDNO synthesis). The lambs were sedated, paralyzed, and mechanically ventilated. Meclofenamic acid was infused to inhibit prostaglandin synthesis. During pulmonary hypertension induced by U46619, pulmonary arterial pressure and pulmonary vascular resistance were significantly decreased by acetylcholine (an EDNO-dependent vasodilator) (23.1 +/- 3.4% and 43.3 +/- 14.5%, respectively), hyperoxia (26.8 +/- 7.8% and 32.9 +/- 10.6%), and alkalosis (32.1 +/- 10.3% and 36.1 +/- 17.0%) (p < 0.05). During pulmonary hypertension induced by N omega-nitro-L-arginine, the decreases in pulmonary arterial pressure and pulmonary vascular resistance produced by acetylcholine (9.6 +/- 6.4% and 23.9 +/- 14.1%, respectively) were significantly attenuated (p < 0.05), but the decreases produced by hyperoxia or alkalosis were unchanged. Therefore, hyperoxia and alkalosis can produce pulmonary vasodilation independent of EDNO synthesis in the intact newborn lamb.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

Fracture of the scaphoid associated with volar displacement of a lower radial epiphyseal fracture. Case report.

A 13-year-old boy fell off his bicycle and landed on his outstretched left hand, sustaining a Salter-Harris type II fracture of the lower radial epiphysis with volar displacement, and an undisplaced fracture across the waist of the left scaphoid. After manipulation, and immobilisation for six weeks, he made a complete recovery and has no residual deformity. We hypothesise that the fracture was caused by the weight of the body being taken by the relatively stiff and immobile hand, and could find no report of a similar case.

Accidental Falls↗

EEG monitoring during angiographic balloon test carotid occlusion: experience in sixteen cases.

Ipsilateral hemispheric ischaemia related to permanent or temporary arterial occlusion at the time of operation is a potential risk of surgery upon some aneurysms or tumours which involve the internal carotid artery. Presurgical evaluation of the risks of temporary or permanent internal carotid artery occlusion may help predict patients in these circumstances at risk of stroke. Balloon test occlusion studies involve the elective preoperative occlusion of the internal carotid artery by a deflatable balloon inserted into the cerebral circulation under angiographic control. We have performed 16 balloon test occlusion studies; 2 subjects developed clinical and electroencephalographic changes when the carotid artery was temporarily occluded, and these changes reverted to normal when the balloon was deflated. The results of the test occlusion studies helped in planning the surgical management of all the subjects involved.

Adolescent↗

New directions in cardiovascular mapping and therapy.

Cardiovascular mapping has allowed us to fully understand the mechanisms of some of the cardiac arrhythmias and enabled us to devise new therapeutic options for them. Endocardial mapping by electrophysiological studies using three to four endocardial catheters introduced via the vein or artery to the heart allows us to directly map the electrical activity of the heart during sinus rhythm and during abnormal tachyarrhythmias. The simultaneous recording of electrical activity from the surface electrocardiogram, right ventricular apex, His bundle, high right atrium, coronary sinus, with or without a roving mapping catheter, enables us to precisely map the electrical activation sequence in the heart. This technique has been especially useful for mapping supraventricular tachycardias and the precise mapping of the accessory pathway or slow pathway potentials have now allowed us to selectively ablate them using radiofrequency energy delivered via the tip of the endocardial catheter. Intraoperative direct cardiac mapping has allowed us to reconfirm the findings of endocardial catheter mapping immediately prior to surgery. The intraoperative mapping is more precise and allows direct visualisation of the abnormal site for the surgeon to operate. Computerised mapping using multichannel recordings has facilitated mapping of the abnormal site for patients with haemodynamically unstable or nonsustained ventricular tachycardia, and thus allows the surgeon to perform surgical resection or cryoablation of the abnormal site. Cardiovascular mapping has thus enabled us not only to understand the mechanisms of cardiac arrhythmias but allows us to provide curative therapy for patients who are at risk from sudden arrhythmic death or otherwise need life long drug therapy.

Adult↗

Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study.

METHODS: A prospective, randomized controlled study of radiotherapy after resection of esophageal carcinoma was carried out in 130 patients. Patients were stratified according to whether the resection was curative or palliative and were then randomized to receive postoperative radiotherapy or no additional treatment. Sixty patients underwent curative resection; 30 each were randomized into the radiotherapy group (CR + R) and the control group (CR). Seventy patients underwent palliative resection; 35 each were randomized into the radiotherapy group (PR + R) and the control group (PR). RESULTS: No complications occurred while the patients were undergoing radiotherapy treatment. On follow-up, complications in the intrathoracic stomach occurred in 24 patients (37%) who underwent radiotherapy compared with four patients (6%) in the control group (p < 0.0001). Seventeen of these 24 patients in the radiotherapy group had gastric ulceration and there were five deaths as a result of bleeding. Local recurrence developed significantly less frequently in the PR + R group compared with the PR group (seven patients [20%] vs 16 patients [46%]; p = 0.04); no difference was observed between CR + R and CR groups (10% and 13%, respectively). Intrathoracic recurrence occurred in fewer patients in the radiotherapy groups (CR + R and PR + R) compared with the control groups (CR and PR) (four patients vs 15 patients; p = 0.01). In patients with residual tumor in the mediastinum after resection, two (7%) of 29 patients who underwent radiotherapy died of tracheobronchial obstruction, compared with nine (33%) of 27 patients in the control groups (p = 0.03). No difference in local recurrence was observed for extrathoracic or anastomotic recurrence. Distant metastasis developed in 12 patients (40%) in the CR + R group, nine patients (30%) in the CR group (p = 0.59), 24 patients (69%) in the PR + R group, and 18 patients (51%) in the PR group (p = 0.22). The time of onset of metastasis was 5.1 months for the PR + R group, which was shorter than the 8.5 months for the PR group (p = 0.05). The time of onset of metastasis was similar for the CR + R and CR groups (9.9 months and 11.0 months, respectively; p = 0.76). The overall median survival of patients after postoperative radiotherapy (CR + R and PR + R) was 8.7 months, which was shorter than the 15.2 months for the control groups (CR and PR) (p = 0.02). CONCLUSIONS: The shorter survival of patients who underwent postoperative radiotherapy was the result of irradiation-related death and the early appearance of metastatic diseases. The role of postoperative radiotherapy is therefore limited to a specific group of patients with residual tumor in the mediastinum after operation, for whom radiotherapy can significantly reduce the incidence of local recurrence obstructing the tracheobronchial tree.

Adenocarcinoma↗

Endoscopic biliary drainage for severe acute cholangitis.

BACKGROUND: Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment. METHODS: During a 43-month period, 82 patients with severe acute cholangitis due to choledocholithiasis were randomly assigned to undergo surgical decompression of the biliary tract (41 patients) or endoscopic biliary drainage (41 patients), followed by definitive treatment. Hospital mortality was analyzed with respect to the use of endoscopic biliary drainage and other clinical and laboratory findings. Prognostic determinants were studied by linear discriminant analysis. RESULTS: Complications related to biliary tract decompression and subsequent definitive treatment developed in 14 patients treated with endoscopic biliary drainage and 27 treated with surgery (34 vs. 66 percent, P greater than 0.05). The time required for normalization of temperature and stabilization of blood pressure was similar in the two groups, but more patients in the surgery group required ventilatory support. The hospital mortality rate was significantly lower for the patients who underwent endoscopy (4 deaths) than for those treated surgically (13 deaths) (10 vs. 32 percent, P less than 0.03). The presence of concomitant medical problems, a low platelet count, a high serum urea nitrogen concentration, and a low serum albumin concentration before biliary decompression were the other independent determinants of mortality in both groups. CONCLUSIONS: Endoscopic biliary drainage is a safe and effective measure for the initial control of severe acute cholangitis due to choledocholithiasis and to reduce the mortality associated with the condition.

Acute Disease↗

Pickled vegetables in the aetiology of oesophageal cancer in Hong Kong Chinese.

Oesophageal cancer is common in Chinese populations, but individual-based epidemiological studies have provided little explanation. A case control study with 400 cases and 1598 controls (800 hospital and 798 general practice) was conducted among Hong Kong Chinese. In multivariate analyses, statistically significant effects on risk were detected for several potentially preventable exposures with high attributable risks (ARs). These included preference for consuming drinks or soups at high temperature (AR = 14%), infrequent consumption of green leafy vegetables (AR = 15%) and citrus fruits (AR = 26%), ingestion of pickled vegetables (AR = 29%), tobacco smoking (AR = 44%), and alcohol drinking (AR = 48%). On the assumption of multiplicative risk, the combined AR due to these exposures was 89%. This is the first case control study to show an association between pickled vegetable consumption and oesophageal cancer risk. The finding considerably strengthens the evidence for carcinogenicity of N-nitroso compounds in man and helps to explain the very high risk among Chinese.

Aged↗

Infected femoral pseudoaneurysm in intravenous drug abusers.

The result of surgical treatment of 21 infected femoral pseudoaneurysms in 19 intravenous drug addicts was evaluated. Eight pseudoaneurysms involved only the common or superficial femoral artery and 13 involved the femoral bifurcation. Excision and ligation was performed as the sole procedure in 19 instances, and revascularization by bypass through the obturator route was carried out in two. The mean follow-up was 12.3 months. One patient required an above-knee amputation. The resultant ischaemia was greater after triple vessel ligation (mean ankle:brachial pressure index (ABPI) 0.41) than single vessel ligation (mean ABPI 0.58). Postoperative bleeding occurred in one patient. Intermittent claudication was present in 14 patients after excision and ligation. Claudication was universal and more severe after triple than after single vessel ligation. There was no subsequent limb loss. Excision and ligation is safe and is the treatment of choice for infected femoral pseudoaneurysm in drug addicts.

Adult↗