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Biomedical subjects

K M Chu

Publications and source records attributed to K M Chu.

83 records · Page 5Linked to original sources
PubMed1990

[Drug interaction between digoxin and bisacodyl].

Digoxin is one of the inotropic agents commonly used to improve cardiac performance in patients with congestive heart failure and to control ventricular response in atrial fibrillation and other supraventricular tachycardias. Bisacodyl (dulcolax), a stimulant laxative, is also commonly prescribed to prevent straining at stool or constipation in these patients. Therapeutic monitoring of digoxin is helpful in the evaluation of clinical response and intoxication of digoxin. For the convenience of serum level measurement, digoxin is usually administered at night before sleep to allow ample time for tissue distribution and then blood sampling the next morning. Concomitant use of these drugs may increase the likelihood of drug interaction. Eleven healthy volunteers, aged 22-26, were studied within 35 days accordingly in four phases. The serum digoxin concentration (SDC) in phase 2 (digoxin and bisacodyl together) showed a significant decrease as compared with phase 1 (digoxin alone) (0.58 +/- 0.03 vs. 0.66 +/- 0.03 ng/ml, M +/- SE, p less than 0.05). The percentage of SDC changes was down to -11.7 +/- 5.4%. Phase 4 (digoxin taken 2 hours before bisacodyl) showed an increase in SDC in comparison with phase 3 (digoxin alone) but was not statistically significant (0.65 +/- 0.03 vs. 0.62 +/- 0.03 ng/ml, M +/- SE, p greater than 0.05). The average frequency of diarrhea was 3.5 times in the first day of phase 2 and 2.7 times in the first day of phase 4. We conclude that in volunteers bisacodyl interacts with digoxin resulting in reduction of the SDC. Interference of the absorption is the most likely mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Local vasodilator effect of platelet activating factor in the gastric, mesenteric and femoral arteries of the dog.

Platelet activating factor (PAF) has been postulated to have vascular effects that contribute to gastrointestinal ulceration and necrosis produced during endotoxin shock. To evaluate the regional arterial effects of PAF and its interaction with cyclooxygenase metabolites of arachidonic acid, we infused increasing doses of PAF (calculated to achieve an initial plasma concentration of 2 X 10(-9), 10(-8), 5 X 10(-8) M) into the gastric, mesenteric and femoral arteries in the presence or absence of indomethacin (5 mg/kg) in anesthetized dogs. During a 5-min infusion of PAF, regional resistances in the gastric, mesenteric and femoral arterial circulations decreased transiently and dose dependently in the initial phase (minute 1 and 2) by 71, 65 and 64%, respectively. In the late phase (minute 3-5), the arterial resistance returned gradually toward base line in the gastric and mesenteric circulations but remained reduced in the femoral arterial circulation. In the vehicle-treated group, the effect of PAF was reproducible. In the indomethacin-treated group, the initial vasodilator response to PAF was not altered in any of the arterial circulations, but in the late phase, the return of arterial resistance toward base line in the gastric and mesenteric circulations was attenuated by indomethacin (P less than .05). In contrast, in the femoral circulation, indomethacin enhanced the return of the arterial resistance (P less than .05) toward base line.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Adenosine in hemorrhagic shock: possible role in attenuating sympathetic activation.

Changes in plasma purine nucleoside level, autonomic activity and hemodynamic reactions were studied in pentobarbital anesthetized rabbits during hemorrhagic shock. Shock was elicited by bleeding the animals to a mean blood pressure of 40 mmHg and maintained until 60% of the maximum bleeding volume in the reservoir had been taken up spontaneously. The remaining shed blood was reinfused thereafter. Norepinephrine (NE), epinephrine (E), adenosine (AD) and uric acid were measured by HPLC with electrochemical detection, fluorometry or UV absorbance. The results showed hemorrhagic shock caused a significant rise in plasma NE, E, AD, and uric acid levels, but the magnitudes and time profiles were different among them. Plasma NE and E increased during the shock compensatory period then declined in the decompensation period whereas adenosine and its metabolite uric acid were elevated persistently during both periods. It is concluded that a balance between autonomic activity and tissue metabolism is important in the maintenance of hemodynamics during shock.

Adenosine↗
PubMed1985

Clinical results of pars plana vitrectomy in posterior-segment disorders.

From June 1981 to August 1983, a total of 142 eyes with posterior-segment disorders were treated with a pars plana vitrectomy technique using the Ocutome II system. The patients were 45 years old on average, with an average follow-up of six months. Simple vitrectomy was performed in 108 eyes, and additional retinal reattachment surgery was performed in the remaining 34 eyes. The lens was removed in 56 eyes and untouched in 65 eyes; the remaining 21 eyes were either aphakic or pseudophakic. All of the cases were divided into six main groups: two diabetic groups, two nondiabetic groups, a penetrating trauma group, and an endophthalmitis group. The two diabetic groups included 16 eyes with vitreous opacity, six of them complicated by retinal detachment. The two nondiabetic groups included a total of 91 eyes, with 31 of them complicated by retinal detachment. The group with penetrating trauma included 24 eyes, seven of which had been injured by intraocular foreign bodies. The endophthalmitis group included 11 eyes, of which six were the result of penetrating trauma and five the result of cataract operation. In this series, vision was maintained or improved in 78.9% of cases and improved in 51.4%. Eyes with vitreous opacities in conjunction with retinal detachment were complicated by proliferative vitreoretinopathy of moderate or severe degree. The reattachment rate was 50.0% in the diabetic group and 51.6% in the nondiabetic group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Anterior approach for difficult major right hepatectomy.

In selected patients with huge right hepatic tumors that had infiltrated the surrounding structures, injudicious mobilization of the liver before transection, as in the conventional manner, may result in excessive bleeding, prolonged ischemia from rotation of the hepatoduodenal ligament, and spillage of cancer cells into the systemic circulation. Alternatively, the "anterior" approach, which involves initial completion of the parenchymal transection before the right hepatic lobe is mobilized, can be adopted for these patients with difficult right hepatic tumors. After hilar control of the inflow vessels, liver parenchyma was transected using an ultrasonic dissector until the anterior surface of the inferior vena cava is exposed. The right hepatic lobe is then mobilized laterally by securing all venous tributaries, including the right hepatic vein. The prospective data of 25 patients who had major right hepatectomy using the "anterior" approach were compared with data from 34 patients who had their operation performed in the conventional manner. Despite the facts that larger tumors (p < 0.004), more extrahepatic structures (p < 0.05), and the caudate lobes (p < 0.03) were resected, the amount of perioperative blood transfusion, fluid replacement, and outcome between the two groups of patients were comparable. There were three hospital deaths, among which one could be attributed to an intraoperative catastrophe during hepatectomy using the conventional approach. The "anterior" approach is a safe, effective option for selected patients undergoing complicated major right hepatectomy.

Adult↗
PubMedDate not supplied

Intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma is an uncommon neoplasm of liver compared with hepatocellular carcinoma. Hepatic resection seems to provide the only chance for therapeutic success. The records of 77 patients with intrahepatic cholangiocarcinoma treated over a 28-year period were studied to determine demographics, clinical features, laboratory findings, diagnostic tests, operative management, and results of therapy. Survival was analyzed according to three treatment groups: conservative management, palliative operation, and hepatic resection. Conservative management was used for 15 patients, and hepatic resections were performed in 39 patients. The remaining 23 patients had laparotomy alone (10 patients), bile duct intubation (4 patients), hepatic artery ligation (3 patients), bilienteric bypass (3 patients), gastrojejunostomy (1 patient), insertion of a hepatic artery port for regional chemotherapy (1 patient), or open drainage of an abscess (1 patient). The median survival after conservative management, palliative operation, and hepatic resection were 1.8, 2.9, and, 12.2 months, respectively. After hepatic resection, patients without lymphatic permeation (p < 0.02) or hilar nodal metastases (p < 0.0003) survived significantly longer. We concluded that hepatic resection is indicated for intrahepatic cholangiocarcinoma when it is deemed resectable.

Bile Duct Neoplasms↗
PubMedDate not supplied

One-week once-daily triple therapy for Helicobacter pylori--a pilot study.

BACKGROUND/AIMS: Proton-pump inhibitor-based triple therapy given over one to two weeks is currently one of the recommended regimens for eradication of Helicobacter pylori. Most of these regimens require twice daily intake of medication. The present study explored the possibility of using a one-week once-daily triple therapy in the eradication of H. pylori. METHODOLOGY: Thirty-two consecutive patients with acid-peptic disease associated with H. pylori infection (duodenal ulcer 18 patients; gastric ulcer 8 patients; duodenitis 1 patient; gastritis 5 patients) were prospectively recruited. They were given a 1-week course of lansoprazole 30 mg, clarithromycin modified-release 500 mg, and metronidazole 800 mg, all taken once daily. RESULTS: The age of these 32 patients ranged from 17-89 years with a mean of 57.5 years. Side effects occurred in 5 patients (15.6%; 95% CI: 5.3-32.8%). All patients finished the treatment and underwent a second endoscopy. Positive endoscopic finding was found in one patient (3.1%; 95% CI: 0.07-16.2%). On intent-to-treat and per protocol analysis, the eradication rate was 87.5% (95% CI: 71.0-96.5%). CONCLUSIONS: A one-week once-daily course of lansoprazole, clarithromycin modified release and metronidazole is a safe, well-tolerated, easy to comply with, and efficacious treatment for H. pylori infection. In view of the small sample size, further studies should be performed to validate its effectiveness.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation.

Choking is a common emergency problem. The Heimlich maneuver is unquestionably effective in relieving airway obstruction. Serious and life-threatening complications may arise, however, if the maneuver is applied incorrectly. Two cases of gastric rupture after Heimlich maneuver are reported. Lay public, paramedics and the medical professionals should be educated with the correct technique of Heimlich maneuver and its potential complications. All patients receiving Heimlich maneuver should be examined by an experienced physician.

Aged↗
PubMedDate not supplied

Malignancy associated with hepatolithiasis.

BACKGROUND/AIMS: Malignancy is known to be associated with hepatolithiasis. The present report summarizes the results of our management of patients with cholangiocarcinoma associated with hepatolithiasis. MATERIALS AND METHODS: Twenty patients with cholangiocarcinoma and associated hepatolithiasis were analyzed retrospectively. There were 12 males and 8 females, with a mean age of 59.3 years. The clinical records of these patients were reviewed to determine demographic characteristics, clinical features, laboratory findings, diagnostic tests, operative management and results of therapy. RESULTS: One patient was moribund on presentation and was treated conservatively. Fourteen patients underwent hepatic resection. Three of them had palliative resection. Hepatic resection was less likely to be performed in patients having right lobe disease (50%) as compared to patients having left lobe disease (90%) (p = NS). The overall operative morbidity and mortality rates after hepatic resection were 36% and 7%, respectively. Non-resective operations were performed in five patients. The overall operative morbidity and mortality rates after non-resective operations were 20% and 0%, respectively. After curative hepatic resection (11 patients), the 1- and 2-year survival rates were 81% and 51%, respectively. CONCLUSIONS: A suspicion of malignancy is necessary in managing patients with hepatolithiasis. Hepatic resection is the treatment of choice for cholangiocarcinoma when it is resectable.

Adenocarcinoma↗