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Biomedical subjects

L B Tan

Publications and source records attributed to L B Tan.

At least 91 records · Page 5Linked to original sources
PubMed1990

Surgical treatment of the ruptured bladder: 22 years reviewed.

During the 22-year interval from 1964 to 1985, 36 patients with bladder injuries were treated at the Kaohsiung Medical College Hospital. Thirty-two cases were male (89%) and 4 cases were female (11%), the sex ratio of patients was 8 to 1, respectively. The average patient age was 33 years and 75% were less than 40 years of age. Hematuria was present in all of the patients and it was microscopic in 25%. Traffic accidents accounted for 55% of the injuries; penetrating trauma was responsible in only 6% of the patients. Of the 36 bladder trauma cases, 11 (30.5%) had intraperitoneal injury, 24 (66.7%) had extraperitoneal injury and 1 (2.8%) had intraperitoneal and extraperitoneal injury. Of the 28 cases with pelvic fracture and bladder trauma in this study, 18 (60%) had extraperitoneal rupture, and 9 (30%) had intraperitoneal rupture. The position of intraperitoneal rupture was mostly at the posterior wall and dome, whereas that of the extraperitoneal rupture was partly located at the anterior wall and the bladder neck. Bladder rupture was treated by operative repair of the defect, bladder drainage by suprapubic cystostomy and/or urethral catheter and drainage of the perivesical space. The mortality rate with the ruptured bladder was 17%. Multiple injuries associated with the ruptured bladder and postoperative complications especially septic shock, were the main causes of mortality.

Adolescent↗
PubMed1990

[Treatment of Wilms' tumor in children].

During the last 13 years, the Kaohsiung Medical College Hospital has treated a total of nine patients with nephroblastoma (Wilms' tumor). Among them, six were male and three were female. The age of the patients ranged from 7 months to 11 years old with an average of 3.25 years. 88.9 percent of the patients complained of abdominal mass. However, the initial symptom was gross hematuria in 33.3% of the patients. Seven out of the nine patients underwent simple nephrectomy while the remaining two were treated with the more conservative open biopsy. All patients died within three years of initial treatment except two, who never came back for follow-up treatment and whom we were unable to trace to determine whether they had survived. Nevertheless, the combination of surgery and postoperative chemotherapy helped to prolong the life of patients with Wilms' tumors.

Adolescent↗
PubMed1990

[Primary tumor of the female urethra--a report of two cases].

From 1972 through 1986, 173 female patients with urinary tract tumors were treated at Kaohsiung Medical College Hospital. Only 2 (1.2%) had primary transitional cell carcinoma of the anterior urethra. These patients were treated with local excision of the tumor, one patient remained alive for more than three years while the other one was lost during the post-operative follow-up. Primary female urethral tumors are mostly malignant tumors. Prompt diagnosis and aggressive treatment is the only way to prolong the patients' survival time.

Aged↗
PubMed1989

Central haemodynamic changes during lower body positive pressure in patients with congestive cardiac failure.

Fifteen patients with moderately severe and severe chronic congestive heart failure were studied to determine the central haemodynamic results of short term increases in lower body positive pressure. Central haemodynamic variables were determined by Swan-Ganz thermodilution catheterisation and arterial cannulation. Graded increases in lower body positive pressure were applied to supine patients using Medical Anti-Shock Trousers (MAST). Increasing lower body positive pressure by 25 mm Hg and 55 mm Hg caused increases in mean right atrial pressure (6.0 to 13.2 to 17.9 mm Hg; p less than 0.001 and p less than 0.0001 respectively) and mean pulmonary artery pressure (26.8 to 35.5 to 41.3 mm Hg; p less than 0.05 and p less than 0.01 respectively). No significant changes were seen in left heart filling pressures or in pulmonary vascular resistance. Furthermore, there were no significant increases in indices of cardiac work (cardiac index, left ventricular stroke work index, right ventricular stroke work index or cardiac power output) despite the increased right heart filling pressures. These results show that in patients with longstanding severe congestive heart failure, short term increases in cardiac return may increase right heart pressures but do not appear to cause either beneficial or detrimental changes in left heart haemodynamic indices.

Coronary Disease↗
PubMed1989

Arterial vasodilator therapy in heart failure: haemodynamic response patterns predictive of changes in exercise capacity.

When the peripheral vascular resistance is abnormally high, the heart can be considered to be pumping inefficiently in that much of its effort is wasted in overcoming the extra high load. Patients with such conditions are liable to have reduced exercise capacity (ExC). It is unclear whether selective arterial vasodilation in these patients can improve ExC. In a double-blind crossover comparative study of the effects of felodipine versus placebo in 10 patients with heart failure in NYHA class III, all patients decreased systemic vascular resistance (SVR) and increased cardiac index (CI), not only at rest but also during exercise. Since heart rate (HR) did not change, the increase in CI was due to increased stroke volume (SV). This beneficial haemodynamic response did not, however, correlate with functional response to the drug. A mixed exercise response was obtained, with 3 patients showing an increase, 3 a decrease, and 4 no change in ExC with felodipine. Therefore, we investigated whether an alternative way of characterizing haemodynamic response would explain why individual patients responded differently to the same drug. We tested the hypothesis that vasodilator therapy would enhance ExC if it were able to alter the load facing the heart in such a way that the cardiac pump needed to impart less hydraulic power output to maintain the same degree of physical exercise. Patients who could perform with felodipine the same submaximal exercise for less cardiac effort than with placebo were the ones who could increase their ExC during the vasodilator therapy. The converse was also true. We conclude that exercise response to vasodilator therapy depended on whether the failing heart was rendered able to pump more efficiently by the drug.

Aged↗
PubMed1989

Assessing cardiac pumping capability by exercise testing and inotropic stimulation.

In heart failure both functional capacity and prognosis are primarily determined by the degree of pump dysfunction. Although data on haemodynamic function at rest may indicate impaired cardiac function, they do not assess the capacity of the heart to respond to stress. Maximal bicycle ergometry and incremental intravenous inotropic stimulation in 31 patients with moderately severe heart failure were evaluated as methods of stressing the heart to determine cardiac pumping capability, which is defined as the cardiac power obtained during maximal stimulation. There was good agreement between the cardiac pumping capabilities assessed by these two methods. Maximal cardiac power output was better than maximal cardiac output and left ventricular stroke work index in representing cardiac pumping capability, because it was less dependent on the type of stimulation used during evaluation. Inotropic challenge is at least as effective as exercise testing in assessing cardiac pumping capability in heart failure, and may be a better method in patients who find physical exercise difficult.

Adult↗
PubMed1989

Antigenic detection and prognosis of patients with transitional cell carcinoma of the urinary bladder.

We used the specific red cell adherence (SRCA) technique to detect the A, B, O cell surface antigen on 61 transitional cell carcinomas of the urinary bladder seen from 1979 to 1982 at the Urology Department of Kaohsiung Medical College Hospital. It was suggested in this study that the loss of surface antigen had good correlation with both the pathological grade and clinical stage of tumors. On the other hand, the patients deprived of the surface antigen were poorer in prognosis than those with positive surface antigens. Among the four groups of A, B, O and AB patients, patients with blood group O had higher mortality rates, and more susceptibility to loss of the surface antigen. This study also demonstrated that the activation of surface antigen will reduce as the age increased. Of 11 patients with recurrent stage A tumors in this study, 8 had positive surface antigen and 3 had negative surface antigen. In 8 cases of positive surface antigen, 1 (13%) subsequently developed an invasive tumor. In contrast, 2 (67%) among the 3 negative surface antigens developed invasive tumors and the statistics showed significant differences (p less than 0.05). Consequently, the SRCA technique may be valuable for predicting malignant potential in early stage cancer of the bladder.

ABO Blood-Group System↗
PubMed1989

Isoproterenol-induced myocardial fibrosis in relation to myocyte necrosis.

Treatment of rats with the beta-adrenergic agonist isoproterenol results in cardiac hypertrophy, myocyte necrosis, and interstitial cell fibrosis. Our objectives in this study have been to examine whether hypertrophy and fibrosis occur in a compensatory and reparative response to myocyte loss or whether either process may be occurring independently of myocyte loss and thus be a reactive response to adrenergic hormone stimulation. We have examined this question by evaluating each of these responses in rats treated with different doses and forms of isoproterenol administration. Myocyte necrosis was evaluated using in vivo labeling with monoclonal antimyosin for identification of myocytes with permeable sarcolemma, which was indicative of irreversible injury. Myocardial fibrosis was evaluated by morphometric point counting of Gomori-stained tissue sections and by assessment of the stimulation of fibroblast proliferation by determination of increased levels of DNA synthesis. Stimulation of fibroblast DNA synthesis was determined from DNA specific radioactivities and radioautography after pulse labeling with [3H]thymidine. The evidence provided by this study suggests that the degree and timing of myocardial hypertrophy does not follow the course of myocyte loss and, thus, appears to be either a response to altered cardiac loading or a reactive response to beta-adrenergic hormone stimulation rather than a compensation for myocyte loss. Myocardial fibrosis, on the other hand, appears to be more closely related to myocyte necrosis with respect to collagen accumulation in the same areas of the heart, its dose-response relation to the amount of isoproterenol administered, and the timing of increased DNA synthesis, or fibroblast proliferation, after myocyte loss.

Animals↗
PubMed1989

[Surgical treatment of ureteropelvic junction stricture].

Forty-five patients with hydronephrosis due to pelviureteric junction stricture were operated on at Kaohsiung Medical College Hospital between 1971 and 1986. In unilateral cases, the left kidney was affected more frequently than the right (24 to 13), while 8 (18%) had bilateral ureteropelvic stricture. Of the 45 cases, 24 cases (53%) underwent Anderson-Hynes pyeloplasty, 5 cases underwent Y-V plasty, 5 cases underwent ureterolysis and 11 cases underwent simple nephrectomy due to severe hydronephrosis. Except for the 11 nephrectomy cases, 11 of the remaining 34 cases had ureteral catheter placement and 9 cases had double-J ureteral catheter placement, postoperatively; another 14 cases received no ureteral stent for draining urine. The results were very encouraging with clinical improvement in 64% of the patients, and improvement in the pelviocaliceal system and early appearance of contrast medium in the ureter in 47% of the patients. The results of pyeloplasty with and without a nephrostomy or ureteral stent were compared. Patients with a nephrostomy or ureteral stent tended to have an increased incidence of urinary tract infections and longer hospital stays. In general, the results of treatment were poorer for patients with a nephrostomy or ureteral stent, than for patients without.

Adolescent↗
PubMed1989

[Urethral injuries: analysis of 24 cases].

Cases analysis of 24 operations for the anterior urethral injuries is presented. 7 patients were treated one-stage transperineal end-to-end anastomosis and 17 underwent an immediate urethral realignment over a fenestrated catheter. Hospital stays were generally short and the rate of complication was low as well as the number of blood transfusions needed in both groups. The operating time however was longer in patients in the anastomosis group. Postoperatively, urethral strictures occurred in 71% of the patients who underwent one-stage transperineal end-to-end anastomosis and in 65% of those treated by realignment over a fenestrated catheter. The high incidence of postoperative stricture formation caused both techniques indicated neither procedure as a valuable modality for the primary and early treatment of anterior urethral injuries. According to the authors the suprapubic cystostomy and delayed urethroplasty offer a better choice of therapy.

Adolescent↗
PubMed1989

[Clinical experience of treatment of urethral stricture].

The records of 53 patients treated for urethral stricture at Kaohsiung Medical College Hospital over a 8-year period were reviewed. Young men those affected and trauma appeared to have been the most frequent etiological cause. Of the 53 patients 12 were treated by filiform dilatation , 33 were treated by metal sound dilatation , and 8 underwent a pull-through technique. Good results were noted in 29 cases (54.7%), fair in 10 (18.9%) and poor results in 14 (26.4%). When the results were analyzed according to the method of treatment, poor results were most common among those who had underwent the pull-through technique and the metal sound dilatation as compared to filiform dilation group.

Adolescent↗
PubMed1989

[Diagnosis and treatment of adult polycystic kidney disease].

A review of 20 polycystic kidney disease patients in admitted to Kaohsiung Medical College Hospital is herein reported. In this series 60% of the patients were in the fourth to sixth decades of life at the time of diagnosis. The average age was 50 years. The disease was generally more commonly found in the females than in male subjects. Flank pain and gross hematuria was the most common presenting symptom in these cases. In 70% of the patients hypertension were noted, besides 55% of patients have associated liver cysts and 9% of the patients have associated pancreatic cystic diseases. In a comparison of ultrasonography, CT scans, renal angiography, intravenous pyelography and retrograde pyelography in the evaluation of polycystic kidney disease, it was found that CT scans and ultrasonography had more than a 90 per cent diagnostic accuracy rate, while intravenous pyelography had only a 30 percent accuracy rate. Because of improved treatments such as antibiotic and hemodialysis techniques the five-year survival rate of patients, with polycystic kidney diseases, may be increased.

Adult↗
PubMed1988

Detrimental haemodynamic effects of cyclizine in heart failure.

The haemodynamic effects of intravenous cyclizine, an antiemetic that is widely given with opioids in left ventricular failure and myocardial infarction, were studied in 11 patients with severe heart failure. Cyclizine significantly increased systemic and pulmonary arterial pressures, and right and left ventricular filling pressures, and negated the venodilatory effects of diamorphine. The use of cyclizine in patients with heart failure should, therefore, be avoided.

Adult↗
PubMed1988

Which exercise test variables are of prognostic importance post-myocardial infarction?

The prognostic value of parameters noted on pre-discharge exercise testing was assessed in 300 survivors of acute myocardial infarction. Exercise testing was performed at a mean of 9 days post-infarction. Each patient's data were studied for the presence of ST-segment depression or elevation greater than or equal to 0.1 mV in any of the 12 leads recorded, angina pectoris, exertional hypotension and duration of exercise. The patients were followed for a mean of 12 months and the incidence of death, reinfarction, angina pectoris, heart failure and coronary revascularization procedures was noted. All variables studied, other than the presence of exercise-induced ST-segment elevation, were significantly associated with the occurrence of subsequent cardiac events (P less than 0.001). Exercise-induced ST-segment depression identified 80% of patients who developed complications and was significantly more sensitive than any of the other variables as a prognostic marker (P less than 0.05). The finding of angina pectoris, an abnormal blood pressure response or a limited exercise tolerance in association with exercise-induced ST-segment depression heightened the prognostic implications of this variable.

Angina Pectoris↗
PubMed1988

Reciprocal change, exercise-induced ST segment depression and coronary anatomy: are they related in the post-infarct patient?

1. The relationship of reciprocal change on the electrocardiogram, at the time of acute myocardial infarction, to exercise-induced ST segment depression and coronary anatomy was studied in 125 post-infarct patients. 2. Eighty-three patients had reciprocal changes, 90 had exercise-induced ST depression and 72 had both of these findings. 3. Patients with reciprocal changes had larger myocardial infarctions, as assessed by peak enzyme release and ejection fraction, than patients without this finding. 4. Multi-vessel disease was significantly more common among patients with reciprocal changes and those with exercise-induced ST depression compared with patients without these findings. 5. The exercise test was more sensitive and had a higher predictive accuracy than reciprocal change when electrocardiographic changes were compared with findings at coronary angiography. 6. With both tests the antero-lateral leads were significantly more sensitive, but less specific, than the inferior leads in classifying patients. 7. Thus while both tests yielded information with regard to coronary anatomy in post-infarct patients, the exercise test was a better predictor of coronary anatomy than reciprocal change. 8. Therefore, reliance should not be placed on the presence or absence of reciprocal change alone when assessing patients for further investigation after myocardial infarction.

Aspartate Aminotransferases↗
PubMed1988

Does beta adrenergic blockade influence the prognostic implications of post-myocardial infarction exercise testing?

The influence of beta blockade on the ability of ST depression, during pre-discharge exercise testing, to predict coronary anatomy and subsequent complications was studied in 300 consecutive post-infarct patients, 125 of whom underwent cardiac catheterisation. At the time of exercise 62 patients were taking a beta blocker. The exercise test had a higher sensitivity in predicting multivessel disease in patients who were not taking beta blockers than in patients who were (95% v 76%). beta Blockade did not, however, influence the ability of the test to identify patients at risk of subsequent cardiac events (sensitivity 84% and 85% respectively). These results suggest that it is not necessary to stop treatment with beta blockers before predischarge exercise testing of patients who have had an acute myocardial infarction.

Adrenergic beta-Antagonists↗