Search PubMed⌕ Search

Biomedical subjects

M C Lee

Publications and source records attributed to M C Lee.

At least 253 records · Page 14Linked to original sources
PubMed1991

Intrapericardial pheochromocytoma.

In a 34-year-old man with hypertension and increased urinary catecholamine excretion for 12 years, an m-[131I]iodobenzylguanidine scan and chest computed tomography located an intrapericardial pheochromocytoma in the left atrium. The tumor was excised through a left thoracotomy with cardiopulmonary bypass and circulatory arrest. At 34-month follow-up, blood pressure and urine catecholamine levels were normal. In the 15 cases of intrapericardial pheochromocytoma treated by resection reported in the literature, all 11 survivors were symptom-free except 1 who had residual left atrial tumor and multiple skeletal metastatic lesions. Computed tomography directed by the m-[131I]iodobenzylguanidine scan can be used for detailed location of the tumor. Appropriate surgical approach and use of cardiopulmonary bypass are critical in the resection of these highly vascular tumors.

Adult↗
PubMed1991

Traumatic asphyxia.

During a 5-year period, we treated 14 cases of traumatic asphyxia. There were 12 male and 2 female patients ranging in age from 2 to 32 years. Most suffered crushing injuries at work or were run over by motor vehicles. Mild to severe cervicofacial cyanosis and petechiae developed in all patients. A fear response was reported by 12 of the patients. Subconjunctival hemorrhage was also found in 12 patients. Nine patients had tachypnea and 7 complained of dyspnea. Most of the patients suffered some associated injuries including 8 head injuries, 7 pulmonary contusions, and 6 cases of blunt abdominal trauma. Less-associated injuries were rib fractures, brachial and radial nerve injuries, hemothorax, and pneumothorax. The hospital stay ranged from 4 to 28 days (mean, 14 days) and follow-up from 10 to 60 months (mean, 32 months). Treatment for traumatic asphyxia included measurement of arterial blood gases, oxygen supplementation, and intubation with mechanical ventilation. The patients' recovery conditions were relative to the severity of injury and the associated injuries.

Adolescent↗
PubMed1991

Immunoglobulin G subclass values in healthy black and white children.

To determine whether IgG subclass concentrations differed between healthy black and white children, we measured IgG1, IgG2, IgG3, and IgG4 immunoglobulins by enzyme-linked immunosorbent assay in sera from 246 black children aged 6 to 42 months. We then compared these values with the normal values established for 664 white children aged 6 to 60 months. The IgG1, IgG2, and IgG4 subclass concentrations of the black children were lower than those for white children; many of the values were below the 95% confidence limits established for white children: 46 (19%) of 246 IgG2 values and 19 (8%) of 246 IgG4 values for black children were below the normal limits. We compared the geometric mean values for black and white children, as determined for each 6-month age grouping between 6 and 42 months of age; 367 of the 664 white children were less than 42 months of age and were included in this analysis. The geometric mean values for IgG1, IgG2, and IgG4 levels were consistently lower for black children than for white children. The differences were significant for IgG1 subclass values of those children older than 24 months and for IgG2 and IgG4 values of those children older than 18 months. No consistent differences were noted for IgG3 subclass values. We conclude that young black children have lower IgG1, IgG2, and IgG4 serum concentrations than are found in white children. If normal IgG values for white children are used, healthy black children may be erroneously classified as IgG subclass deficient. The mechanism and biologic relevance of these population differences need to be evaluated.

Black People↗
PubMed1991

Modulation of the stretch reflex during volitional sinusoidal tracking in Parkinson's disease.

Sinusoidal visually-guided wrist tracking, in normal and parkinsonian subjects, was perturbed by torque transients every 90 degrees throughout the movement. Long-latency stretch reflex and volitional EMG amplitude modulations were assessed as functions of the tracking phase. Reflex modulation during tracking, both in wrist flexor and extensor muscles, was found to differ significantly between parkinsonian and normal subjects. In the parkinsonian group, the abnormality consisted of an increased reflex activity during tracking phases in which the muscle was lengthening. At these phases the reflex generated torque is opposite in direction to the volitionally generated torque and the tracking movement. No differences in the unperturbed volitional EMG modulation were observed between groups for this error constrained tracking paradigm. Significant correlations were found between ratings of bradykinesia and the amount of abnormal reflex modulation in the wrist flexor. These data suggest that a component of bradykinesia results from a defective coordination of supraspinal reflex and volitional control systems.

Aged↗
PubMed1991

Demonstrating the characteristics of family practice through the family medicine clinic located at a college hospital.

During its development, family practice in Taiwan has been housed at the university/college hospitals, and different settings have served as the main bases for service and teaching. To demonstrate the progress made in the family medicine clinic at the Chung Shan Medical College Hospital and to evaluate the appropriateness of this kind of family practice setting, our patient population of 616 was investigated. There were 5177 patient encounters during the period from September 1987 to August 1989. Of 616 patients, 52.3% were male, the average age was 38.5 years, 85.1% lived in Taichung, where the hospital is located, and 60.1% were insured. A total of 117 families, containing 310 members, made up 50.3% of the patient population. Most patients (64.0%) visited us after introductions by their relatives or friends. There was an average of 4.2 visits per patient per year, and only 6.3% of patients were lost to follow-up after their first visits. The three leading causes for visits to the Family Medicine Clinic were general medical examination (14.5%), acute upper respiratory tract infection (13.6%), and peptic ulcer diseases (8.0%): these comprised 36.1% of all patients' problems. The average referral rate among the 5177 patient encounters was 2.9%. Patient education about treatment of disease, immunization against hepatitis B, and screening for liver cirrhosis/hepatoma in hepatitis B antigen carriers were the most common preventative encounters in our clinic. In conclusion, university/college hospitals are certainly not the best site for service and teaching of family practice, since they are not based on ambulatory care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Absent or faint renal uptake on bone scan. Etiology and significance in metastatic bone disease.

A review of 14,296 unselected bone scans identified 889 scans showing absent or faint renal uptake. The majority of cases were associated with renal insufficiency (816/889; 91.8%), while widespread metastatic bone disease was the most common cause in a group of patients without renal disease (53/889; 6.0%). Of the 140 patients with prostate cancer, 108 (77.1%) had evidence of bone metastasis, 19 of whom (17.6%) revealed absent or faint renal uptake, demonstrating that poor renal uptake is more frequently associated with prostate cancer than with any other malignancy. Of note was that 162 out of 328 (49.4%) patients with stomach cancer at varying stages showed evidence of bone metastasis, and 14 of them (8.6%) showed poor renal images on bone scan. Interestingly, ankylosing spondylitis and rheumatoid arthritis were occasional causes of lack of renal activity (4 and 3 cases, respectively). A case of adult-form osteopetrosis, showing strikingly increased uptake mainly in the long bones with markedly diminished renal uptake, was also included in this study. Of the 53 bone scans with metastatic disease showing poor renal uptake, 44 (83.0%) revealed evidence of diffuse or multiple metastases in both spine and ribs, while 49 (92.5%) showed malignant involvement in three or more regions and 35 (66.0%) in four or more regions, suggesting widespread bone involvement in most cases.

Adult↗
PubMed1991

Bone scintigraphy in acute renal failure with severe loin pain and patchy renal vasoconstriction.

To evaluate the patterns of renal images and the diagnostic value as a screening test of the whole-body bone and renal scintigraphy with technetium-99m-methylene diphosphonate (99mTc-MDP) or -pyrophosphate (99mTc-PYP), we performed bone scintigraphy in 6 patients with acute renal failure (ARF) with severe loin pain and patchy renal vasoconstriction on postcontrast renal computed tomography (CT). All 6 patients were young and previously healthy but experienced severe loin pain after track events. Five took analgesics. Postcontrast renal CT showed patchy low-density areas or diffuse enhancement immediately after radiocontrast injection and then patchy wedge-shaped enhancement 24 or 48 h later, which subsequently disappeared 72 h later. On the whole-body bone scintigrams with 99mTc-MDP or 99mTc-PYP before obtaining renal CT, there was no increased uptake of isotope in the soft tissue, and multiple patchy increased accumulations of the isotope in the kidney were observed in 5 patients. In 2 patients, renal scintigraphies with technetium-99m-dimercaptosuccinate showed photon-deficient areas in the same areas of patchy isotope accumulation in the whole-body bone scintigraphies. Whole-body image and renal scintigraphy with bone-seeking agents may be useful as a screening test and in the search for the theoretical evidence of ARF with severe loin pain and patchy renal vasoconstriction.

Acute Kidney Injury↗
PubMed1991

Job and life satisfaction among rural public health nurses in Taiwan.

This study sought to examine job and life satisfaction among rural public health nurses in Taiwan. All 339 public health nurses working in 31 aboriginal townships and on three offshore Islands were surveyed through a malled questionnaire to them. The survey results showed that the public health nurses were moderately satisfied with jobs and lives in general. Areas of greatest job satisfaction included relationships with community residents and with coworkers. Areas of least job satisfaction included salary and benefits, health resources available to them, and their abilities to remain knowledgeable. It is suggested that public health administrators and government legislators take immediate and effective actions to increase the economic incentives and to provide more on the job training programs for rural public health nurses.

Adult↗
PubMed1991

Assessment of regional cerebral blood flow (rCBF) in ischemic stroke using Tc-99m HMPAO SPECT--comparison with CT and MR findings.

To assess the regional cerebral blood flow (rCBF) in ischemic stroke, we analyzed the findings of single photon emission computed tomography (SPECT) using technetium-99m hexamethyl propyleneamine oxime (Tc-99m HMPAO). The SPECT images revealed abnormal areas of decreased perfusion in 29 out of 31 subjects (93.5%), which represented a higher detection rate than those for CT and MR (89.5%, respectively). Also, the areas of decreased perfusion were frequently larger than the lesions on CT and MR. Areas of decreased perfusion remote from the CT/MR lesions were found in 10 patients, including 8 with crossed cerebellar diaschisis (CCD). Thus, studies of rCBF by Tc-99m HMPAO SPECT can be useful in the assessment of ischemic stroke.

Adolescent↗
PubMed1991

Job and life satisfaction among remote physicians in Taiwan.

To determine the nature and current level of job and life satisfaction among remote physicians in Taiwan, 115 physicians practicing in 31 aboriginal townships and on 3 offshore islands were interviewed through a mail survey. Out of 95 respondents, 93% were male. The average age was 46.0 years, and 82% of the physicians practiced only primary care. About half of the respondents had not received any residency training prior to their beginning practice. Physicians aboriginal areas and on offshore islands appear to be moderately satisfied with their jobs and with their lives in general. In aggregate, the areas of greatest job satisfaction included their contacts with other physicians and their relationships with other health care workers. Areas of least satisfaction included physicians' salary/income and their opportunities for promotion in the future. Most respondents felt that the greatest causes of work stress were the realities of medical practice and the time pressures. Areas of least stress included clinical competence/interpersonal relations and anxieties about the future. In aggregate, the areas of lowest life satisfaction included the physicians' incomes and the lack of leisure activities. It is suggested that a family practice residency training course prior to practice and access to continuing medical education programs are urgently needed for remote physicians in Taiwan. On the other hand, economic incentives seem to be the best strategy to increase the job and life satisfaction of these physicians.

Adult↗
PubMed1991

[Effects of family medicine education on medical students' attitudes].

Undergraduate education is considered to be one of the main contributory factors for the development of family medicine through increasing the number of medical graduates opting for a career in family practice. To evaluate the effects of family medicine education on student's attitudes, 140 fifth year medical students were asked in 1989 to fill in a questionnaire both before and after their curricula. The average age of the 123 students who completed the questionnaire on both occasions was 24.9 years; 106 were males; 17 were tuition free and 26 took additional family medicine clerkships. On aggregate, the students' disposition toward family medicine before their curricula appeared to be uncertain. Mean scores on the attitude scale did not significantly differ between socioeconomic subgroups before the curricula. After the curricula, students' attitudes were significantly altered, especially toward the future development of family medicine in Taiwan. However, their disposition toward family practice as a career changed the least. The degree of alteration in students' attitude toward family medicine before and after the curricula was related to the intensity of the course and to their socioeconomic backgrounds.

Adult↗
PubMed1990

Jejunal leiomyosarcoma detected by Tc-99m sulfur colloid gastrointestinal bleeding scan.

Jejunal leiomyosarcoma was initially detected in a patient by a gastrointestinal bleeding scan with Tc-99m sulfur colloid (SC). The scan showed increased blood flow and delayed persistent accumulation of radiotracer in the tumor. The Tc-99m SC gastrointestinal bleeding scan provided useful information to help determine the differential diagnosis of gastrointestinal tumor with bleeding.

Female↗
PubMed1990

Negative correlation between the change in bone mineral density and serum osteocalcin in patients with hyperthyroidism.

To assess the changes in bone mineral density and osteoblastic activity in patients with hyperthyroidism and to investigate the relationship between those changes, we measured bone mineral density and serum osteocalcin in 109 patients with Graves' disease, comprising 75 untreated patients and 34 patients under treatment, and 200 normal controls. The degree of change in bone mineral density was quantified with Z transformation, in which we used means and SDs of bone mineral densities obtained in the process of age- and sex-matched 1:1 pairing developed by ourselves. Bone mineral density was low in female patients with hyperthyroidism in the spine, femur neck, trochanter, and Ward's triangle, but was not low in male patients. Serum osteocalcin was elevated in patients with untreated Graves' disease and correlated negatively with the Z values of bone mineral densities of the spine, femur neck, and trochanter. In conclusion, indices of osteoblastic activity were elevated in patients with hyperthyroidism, probably secondary to a thyroid hormone-induced increase in bone resorption which resulted in reduced bone mineral density. Quantification of the change in bone mineral density by using the parameters derived in the process of age- and sex-matched pairing seems to be an efficient method for statistical analyses.

Adolescent↗
PubMed1990

Localization of In-111 antimyosin Fab and 99mTc-pyrophosphate in reperfusion myocardial infarction model.

The myocardial uptake of In-111 antimyosin Fab and Tc-99m pyrophosphate was studied in dogs undergoing coronary artery occlusion for 90 minutes followed by reperfusion. The regional myocardial blood flow was determined by injecting Sc-46 labeled microsphere and was related to the relative concentrations of In-111 antimyosin and Tc-99m pyrophosphate. There was an inverse linear correlation between In-111 antimyosin Fab localization and the regional blood flow in both the subendocardial (r = 0.81) and subepicardial myocardium (r = -0.80). The greatest uptake of antimyosin was observed in areas of severe blood flow reduction (0-10% of normal). On the other hand, there was no correlation between the Tc-99m pyrophosphate uptake and the degree of blood flow reduction. Maximal subendocardial localization of Tc-99m degree of blood flow reduction. Maximal subendocardial localization of Tc-99m pyrophosphate was observed in areas where the blood flow was reduced to 31-50% of the normal. In the case of the subepicardium, the greatest uptake was localized to areas of 0 to 10% of the normal flow. In addition, there was significant myocardial uptake in regions where the blood flow was minimally reduced (greater than 81%). This study suggests that In-111 antimyosin Fab is a specific and quantitative tool in the evaluation of myocardial necrosis.

Animals↗
PubMed1990

Changes in the properties of the thyrotropin receptor antibody in patients with Graves' disease after radioiodine treatment.

We investigated the effect of a single dose of 131I upon thyrotropin receptor antibodies (TRAb) in 21 patients with Graves' disease. The thyrotropin receptor antibodies were assessed by parallel measurements of thyrotropin binding inhibitor immunoglobulin (TBII), thyroid stimulating antibody (TSAb) and thyroid stimulation blocking antibody (TSBAb) in serum by radoreceptor assay, stimulation of adenlate cyclase and inhibition of TSH-stimulated adenylate cyclase activation in FRTL-5 cells, respectively. Prior to radioiodine treatment, TBII was detected in all 21 patients and TSAb in 19 patients. After radioiodine treatment, TBII activities did not change during the 12-months observation period, but in eight patients TSAb activities gradually decreased and were undetectable at the end of the 12-month observation period. Persistence of TSAb was not associated with the clinical outcome. Eight patients developed hypothyroidism within one year after radioiodine treatment. Three of the hypothyroid patients developed TSBAb, and the appearance of TSBAb coincided with the development of hypothyroidism. These results suggest that TSBAb might develop after radioiodine treatment in a minority of patients with Graves' disease and that the appearance of TSBAb, in addition to radiation-induced thyroid destruction, might be involved in the development of hypothyroidism following radioiodine treatment.

Adolescent↗
PubMed1990

Pulmonary mucormycosis: the first case with preoperative diagnosis and successful surgical treatment in Taiwan.

Pulmonarycosis is a rare disease, which refers to an infection by fungi belonging to the order Mucorales. This organism usually invades the skin, nose mouth, paranasal sinus, gastrointestinal tract, lung, brain, eyes and so forth. It usually occurs in patients with diabetes mellitus, hematological malignancy or other immunocompromised states. Until recently, this disease was rarely diagnosed before death. We report a case of pulmonary mucormycosis in a woman with poorly controlled diabetes mellitus. This is the first case in Taiwan of pulmonary mucormycosis diagnosed preoperatively and treated successfully by lobectomy only. Persistent pulmonary lesions resistant to antibiotic treatment in high risk patients should arouse the suspicion of mucormycosis. Prompt bronchoscopic examination, open lung biopsy and transthoracic pulmonary aspiration cytology and biopsy should be done. Surgical resection of localized lesions remains the treatment of choice.

Aged↗
PubMed1989

[Chondrosarcoma of the rib--a case report].

Chondrosarcoma is second in frequency only to osteogenic sarcoma as a malignant tumor of bone, and constitutes 17 to 22% of all bone tumors. However, chondrosarcoma is the most common malignant tumor of the sternum or rib. The natural history of chest wall chondrosarcoma is one of slow growth and local recurrence. Wide excision is the main treatment, but usually plastic surgery is needed for chest wall reconstruction. A 29-year-old male patient visited to local clinic due to URI symptoms (eg: cough, rhinorrhea). Routine chest X-ray examination showed a huge tumor within L't chest cavity and chondrosarcoma was proved via tissue biopsy. P't underwent surgery for total removal of the tumor and corresponding rib (3rd rib) and the chest wall defect was repaired with bovine pericardium. So far, after follow-up and treatment for 4 months, there is no evidence of recurrence.

Adult↗