Biomedical subjects
Publications and source records attributed to M H Hwang.
Immediate pacemaker malfunction following defibrillation or cardioversion has been reported. In this paper we report one patient whose pacemaker appeared to be functioning normally after D. C. countershock but malfunctioned 13 days later manifested by changing from an R-wave inhibited to an R-wave synchronous mode.
Repeat angiography was performed at 63 +/- 9 months in 26 medically treated patients and at 66 +/- 10 months in 32 surgically treated patients with chronic angina. The native coronary arteries were divided into three major trunk vessels and 15 angiographic segments. Progression of disease was defined as the appearance of new (greater than 50%) obstruction or significant worsening of existing lesions in a segment or vessel. The incidence of progression was similar in medical and surgical patients, comparing individual segments (69 of 312 [22%] and 91 of [23%], respectively) or vessels (49 of 78 [63%] and 60 of 96 [63%], respectively). In both medical and surgical patients, segments initially free of disease showed a 14% incidence of developing new lesions, compared with the 37% progression in segments initially diseased (p less than 0.001). In the surgical patients, progression occurred in 48 of 219 (22%) nongrafted and 43 of 177 (24%) grafted segments (NS). When analyzed by major trunk vessel, progression occurred in 40 of 57 grafted arteries (70%) and 20 of 39 nongrafted arteries (51%) (NS). The incidence of new total occlusions was similar in medical and surgical patients (6% and 8%, respectively); new total occlusions occurred predominantly in diseases segments (15% and 22%, respectively). In patients with stable angina pectoris who have medical or surgical treatment assigned by randomization, progression of coronary disease at 5 years is not influenced by which mode of therapy was received. Vessels initially free of disease are at relatively low risk for development of disease within 5 years. In surgical patients, grafted and nongrafted vessels show similar rates of progression.
We prefer a nonaggressive approach to the treatment of high risk patients with intrahepatic stones. We perform extensive choledochotomy, remove all accessible intrahepatic stones, use bouginage of all stenotic segments and maintain patency with a T-tube stent. Postoperatively, we extract the remaining intrahepatic stones mainly with the choledochofiberscope and various types of forceps. The combined use of the Burhenne catheter and Dormia basket and the different types of curved forceps, scoops and Bakes' dilator has improved the success rate of removal. Thirty patients have thus far been treated in this manner with encouraging results.
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BACKGROUND AND OBJECTIVES: Meperidine is frequently used in general anesthesia and perioperative analgesia. In addition to its opioid action, meperidine possesses some local anesthetic properties. A preliminary study using the tourniquet venous retention technique found meperidine to be more effective in reducing propofol injection pain than fentanyl or morphine, both of which were slightly better than placebo. This study was undertaken to evaluate whether this peripheral analgesic effect of meperidine is affected by naloxone. METHODS: In a randomized, double-blind manner, after venous occlusion with a tourniquet, meperidine 40 mg was given intravenously to patients in group A (n = 31), meperidine 40 mg followed by naloxone 0.04 mg to group B (n = 32), meperidine 40 mg followed by naloxone 0.2 mg to group C (n = 30), and normal saline placebo to group D (n = 30). The venous retention of drug(s) was maintained for 1 minute, followed by tourniquet release and intravenous administration of propofol 100 mg. Pain assessment was made immediately after the propofol injection. RESULTS: All three groups given meperidine had significantly less propofol injection pain (P < .01 ) than the group given saline placebo, and there was no difference among groups A, B, and C. CONCLUSION: The peripheral analgesic effect of meperidine in reducing propofol injection pain is not mediated by its opioid activity.
Corticosteroid-induced acute psychoses in three Chinese patients receiving prednisolone 15-75 mg/d are described. The cases are compared with other cases of corticosteroid mental disturbances in the literature. It is concluded that the mental disturbance usually occurs within the first ten days of treatment, and presents most often in women, as either an acute manic or depressive episode accompanied by delusion and/or hallucinations. An exponential increase in the risk of the mental disturbance occurs as the corticosteroid dose increases.
We refined the mouse ear-heart transplant model developed by Fulmer and coworkers and tested cyclosporine as a sole immunosuppressive agent in this model. Three-week-old CBA mice were used as heart recipients, and unsexed newborn BALB/c mice were used as heart donors. The heart grafts were examined for visible pulsations at 10-fold to 20-fold magnification daily for the first 10 days and every other day thereafter. Graft electrocardiograms were also obtained on the same schedule. Preliminary studies had established that a dose of 15 mg/kg/day was the optimal cyclosporine dose in our model. This dose was administered subcutaneously to each of two treatment groups. Group 2 received this dose for the entire 30-day experimental period. Group 3 received this dose for the first 16 days of the experimental period. Group 1 consisted of allografts receiving no immunosuppression. Group 1 grafts showed evidence of initial successful engraftment by day 7; however, by day 13 none of the grafts remained viable. In group 2, 19 of 23 grafts remained viable for the entire experimental period. In group 3, all of the grafts remained viable until day 17 (after day 16 cyclosporine was discontinued) and rapidly lost evidence of viability thereafter. By day 21, none of the grafts in group 3 remained viable. Survival curves for the three groups as determined by electrocardiogram and visible pulsations were constructed, and the differences between the curves were significant (p = 0.001). The results of this study demonstrate the potential usefulness of the ear-heart transplantation model in screening immunosuppressive agents.(ABSTRACT TRUNCATED AT 250 WORDS)
There were few, but conflicting, reports dealing with the clinical significance of c-erbB-2 in biliary tract cancer. We evaluated the expression of c-erbB-2 in normal epithelium of bile ducts (n = 46), gallbladder cancer (n = 11), carcinoma of the ampulla of Vater (n = 18), and intrahepatic cholangiocarcinoma (CC) (n = 18). c-erbB-2 protein is present in 63% (29/46) of surface epithelium in large and septal bile ducts, but not in peripheral small ducts. Overexpression of the gene product was found in 27.8% (5/18) of intrahepatic CC, 27.8% (5/18) of carcinoma of the ampulla of Vater, and 63.6% (7/11) of gallbladder cancer. But, there was no c-erbB-2 overexpression in the hyperplasia or atypical hyperplastic bile duct epithelium (p = 0.002). In terms of prognostic implication, expression of c-erbB-2 did not correlate to the histopathological grade (p = 0.60) and tumor stage (p = 0.63). The results indicate that c-erbB-2 protein may play some roles in physiology of normal bile ducts. Overexpression of the gene product occurs in one forth to about two thirds of carcinoma of biliary tract, and may be used as phenotypic marker for neoplastic transformation. However, the gene product may not be important in the aggressive behavior of tumor.
BACKGROUND/AIMS: The aim of the present study was to determine the usefulness and sensitivity of percutaneous cholangiofiberscopic guided forceps biopsy in patients suspected of intrabile duct diseases. This study also emphasized the use of a video monitor system in which the field of view is magnified; thus, even a small lesion can easily be detected. Furthermore, coordination of both the operator and assistant is easier because both can observe the image together on the video monitor. METHODOLOGY: Percutaneous cholangio-fiberscopic forceps biopsy was performed in 27 patients (14 men, 13 women, aged 37-81 years with a mean age of 61 years). A mature T-tube tract was used as an access for cholangioscopy in 17 cases while the remaining 10 patients underwent percutaneous transhepatic biliary drainage and gradual tract dilatation from 7-French to 16-French. A flexible fiberoptic choledoscope was gently inserted into a mature tract and once an abnormal mucosal lesion was identified, a forceps biopsy was inserted into a working channel of the scope, and 3-5 specimens were taken for histological examination. RESULTS: A histological diagnosis was obtained in 24 cases of the 27 patients (sensitivity 89%) and included cholangiocarcinoma (n=8), papillomatosis (n=3), ampullary adenoma (n=1), ampullary adenocarcinoma (n=1), hepatoma with intrabile duct invasion (n=1), and chronic inflammation (n=10). Post-procedural bleeding was noted in 1 patient. CONCLUSIONS: Percutaneous cholangiofiberscopic-guided forceps biopsy is a safe and easy to perform procedure. It yielded a high sensitivity rate for definitive diagnosis of very small or early intrabile duct lesions; thus, a curative therapeutic modality can be appropriately applied. The use of a video monitor system, which magnified the field of view without distorting the quality of the image, plays a crucial role in this technique. Mucin substance is commonly seen in cholangiocarcinoma. The association between bile duct stones and neoplasm needs further evaluation.