Biomedical subjects

M J Hsieh

Publications and source records attributed to M J Hsieh.

At least 37 records · Page 2Linked to original sources

PubMed1998

Serodiagnosis of tuberculosis by enzyme-linked immunosorbent assay for anti-A60 and anti-A38.

BACKGROUND: For early diagnosis of tuberculosis (TB), especially in the patients without adequate sputum specimens for examination, we found a simple, rapid and inexpensive method among many current available diagnostic tools, the enzyme-linked immunosorbent assay (ELISA). To investigate the diagnostic effectiveness of this method, we applied ELISA for detection of antigen 60 IgG and IgM as well as antigen 38 IgG antibodies at Chang Gung Memorial Hospital from April 1995 through June 1996. MATERIALS AND METHODS: Sixty-seven patients were enrolled and divided into 3 groups, Group A (n = 24), patients with positive sputum acid-fast stain; Group B (n = 18), patients with lung cancer and negative sputum acid-fast stain; and Group C (n = 25), patients with chest roentgenogram (CXR) which were suggestive of TB but with negative acid-fast stain results or no sputum for examination. RESULTS: For the A60 IgG antibody, we found a sensitivity rate of 91.7% for Group A and Group B, and 85.7% for Group C as well as an overall sensitivity of 89.5% but with lower specificity. For the A60 IgM antibody, a lower sensitivity (37.5%, 14.3%, 28.9%, respectively) was found but with higher specificity. For the A38 IgG antibody, we found a lower sensitivity (40%, 11.1%, 31%, respectively) but with higher specificity (100%, 71.4%, 90%, respectively). CONCLUSION: With a high sensitivity but low specificity for diagnosis of TB, A60 IgG ELISA could be used as a rapid, simple screening test for patients with results suggestive of TB, especially in those who had no sputum or had negative sputum acid-fast stain results. Otherwise, A60 IgM or A38 IgG ELISA, with a high specificity, could be used as a reliable test in the diagnosis of pulmonary TB when the result is positive. In summary, although ELISA is a simple, rapid, inexpensive method, it is helpful but limited in the diagnosis of pulmonary TB.

Antibodies, Bacterial↗

PubMed1997

Continuous antegrade warm blood cardioplegia attenuates augmented coronary endothelium-dependent contraction after cardiac global ischemia and reperfusion.

BACKGROUND: Experiments were designed to evaluate the effect of warm blood cardioplegia on endothelium-dependent contraction of the coronary endothelium after cardiac global ischemia and reperfusion. METHOD: Dogs (n = 12 in each group) were exposed to extracorporeal circulation with the body temperature at 37 degrees C (group 1) or 28 degrees C (groups 2 and 3). The ascending aorta was crossclamped for 120 minutes while continuous infusion of warm blood cardioplegec solution (group 1) or intermittent infusion of cold (4 degrees C) crystalloid cardioplegic solution (group 2) was performed via the coronary arteries through the aortic root. Cardioplegic solution was not used in group 3 animals. The heart was then allowed to function for 60 minutes of reperfusion. Reperfused (groups 1, 2, and 3) and control (group 4) coronary arteries were then harvested for study. RESULTS: Perfusate hypoxia caused endothelium-dependent contraction in the arteries of all four groups that could be attenuated by NG-monomethyl-L-arginine (L-NMMA) or L-NMMA plus D-arginine, but not by L-NMMA plus L-arginine or endothelin receptor A and B antagonist PD 145065. The endothelium-dependent contraction results in groups 2 and 3 (75% +/- 4% and 80% +/- 5%, respectively) were significantly greater than those in groups 1 and 4 (15% +/- 3% and 18% +/- 5%, respectively). Scanning electron microscope studies showed that platelet adhesion and aggregation, areas of microthrombi, disruption of endothelial cells, and separation of the intercellular junction could be found in coronary segments from groups 2 and 3, but not in vessels from groups 1 and 4. CONCLUSION: These experiments suggest that global ischemia and reperfusion enhances hypoxia-mediated endothelium-dependent contraction of the coronary endothelium and damages the ultrastructure. These kinds of changes can be prevented by continuous antegrade infusion of warm blood cardioplegic solution during global ischemia.

Animals↗

PubMed1997

Thoracoscopic loop ligation of parenchymal blebs and bullae: is it effective and safe?

Surgeons who have gained experience and confidence with video-assisted thoracic surgery are now routinely applying the minimally invasive approach to treat patients with spontaneous pneumothorax. Although the endoscopic stapling device may be a preferred method for resection of parenchymal blebs or bullae, the stapling device is not inexpensive. In an effort to contain costs since we started performing the video-assisted thoracoscopic procedure in chest surgical diseases, we have used a self-made endoscopic loop as an alternative method. It has assisted us in performing bulla ablation in a cost-effective manner. Over a 4-year period (1992 to 1996), we assessed the efficacy of ligating parenchymal blebs and bullae with a self-made endoscopic loop by video-assisted techniques. A total of 263 ligations were performed in 250 patients. Surgical indications included recurrence (n = 146), bilaterality of the disease (n = 13), hemopneumothorax (n = 7), radiologically demonstrated large bulla (n = 9), persistent air leak (n = 52), and nonexpansion of the lung (n = 23). There were no operative deaths. Early postoperative complications included a dislodged endoscopic loop necessitating reexploration in one patient and postoperative minor wound infections in 13. The average postoperative hospitalization was 4.5 days. Two hundred seventeen patients (86.8% of all patients) were followed up for a median of 28 months (1 to 46 months) after the operation. There have been no recurrences to date. Our results showed that thoracoscopic loop ligation is safe and effective in managing blebs and parenchymal bullae, with a lower cost, fewer complications, and a lower recurrence rate than provided by standard surgical techniques. On the basis of our results, we advocate the use of the self-made endoscopic loop for ligation of parenchymal blebs and bulla in patients with spontaneous pneumothorax to achieve a truly cost-effective and minimally invasive thoracoscopic procedure.

Adolescent↗

PubMed1997

MR imaging of thoracic neurilemmomas.

Magnetic resonance (MR) imaging features of 15 thoracic neurilemmomas were analyzed. Morphologically, five tumor patterns could be identified on MR imaging including: inhomogeneous masses (n = 8), thick-walled multiloculated masses (n = 2), thick-walled central cystic masses (n = 2), homogeneous cystic masses (n = 2) and a target pattern mass (n = 1). The signal characterization of thoracic neurilemmomas was variable, usually brighter on T2-weighted images, hyper- to hypo-intense on T1-weighted images and always enhancing. Histopathologically, the inhomogeneous masses were characterized by irregular distribution of hypercellular Antoni A and hypocellular Antoni B tissues with variable degrees of cystic, hemorrhagic, myxoid and hyaline degenerative changes. Enlargement of the cystic areas led to the development of thick-walled multiloculated masses while confluence of these cystic areas produced a central cystic pattern. Extensive myxoid or hyaline degeneration yielded homogeneous cystic tumors. Peripheral fibrinous changes and central Antoni B stroma contributed to a target pattern. Appreciation of the protean MR manifestations and understanding of the underlying histopathological changes of thoracic neurilemmomas are helpful in the diagnosis of this tumor.

Adult↗

PubMed1997

Reconstruction of a large thoracoabdominal wall defect with a flow-through forearm flap and a latissimus dorsi-groin flap.

We report a case of a 45-year-old man with a recurrent, large, invasive dermatofibrosarcoma protuberans over the left lower chest and abdomen. Wide surgical excision of the tumor created a major thoracoabdominal wall defect. Wound coverage was achieved by using a flow-through forearm flap and an inferiorly based latissimus dorsi-groin flap. Follow-up at 1 year revealed no local recurrence or herniation.

Abdominal Muscles↗

PubMed1997

Respiratory drive and pulmonary mechanics during haemodialysis with ultrafiltration in ventilated patients.

The improvements of respiratory drive and pulmonary mechanics which follow haemodialysis with ultrafiltration in mechanically ventilated renal failure patients seem predictable but have not been studied before. In this study, 14 renal failure patients with stable haemodynamics mechanically ventilated with pressure support ventilation (PSV) were enrolled. Respiratory drive (represented as P0.1), pulmonary mechanics, breathing pattern, arterial blood gas and haemodynamics were measured according to the time schedule: pre-dialysis (Time 0), and at 60, 120, 180, 240 minutes thereafter. Following the removal of excess lung water during haemodialysis, auto-PEEP and patient's work of breathing (WOBp) decreased gradually. P0.1 lessened progressively along with the improvement in pulmonary mechanics. The changes in auto-PEEP and WOBp correlated closely to the pre- and post-dialysis decline of P0.1 (delta P0.1). There was a negative, moderately significant correlation between the amount of fluid ultrafiltrated during dialysis (delta UF) and the delta P0.1 (R = -0.54). The breathing pattern remained stable during dialysis. No hypoventilation or hypoxaemia occurred despite the development of metabolic alkalosis induced by bicarbonate dialysate. We have shown that respiratory drive decreases gradually during bicarbonate haemodialysis. The improvements of pulmonary mechanics, rather than the rapid alkalization of body fluids, responds to the decrease of P0.1 in renal failure patients ventilated with PSV.

Aged↗

PubMed1997

An alternative technique in the management of bullous emphysema. Thoracoscopic endoloop ligation of bullae.

STUDY OBJECTIVES: With the improvements in video-assisted thoracoscopic surgery, more older patients and patients with respiratory impairments are undergoing bulla ablation using new and costly technology. We evaluated the cost-effective technique of thoracoscopic endoloop ligation of bullae in patients with bullous emphysema. PATIENTS: From March 1992 through January 1996, 79 advanced age (mean age, 64 years) and oxygen dependency patients underwent thoracoscopic procedure using endoloop ligation for treatment of bullous emphysema. Clinical data were collected from chart review. Only patients with radiographically confirmed diagnosis of bullous emphysema were included in this evaluation. Thoracoscopic endoloop ligation of bulla was carried out under general anesthesia with double-lumen endotracheal tube and single-lung ventilation. RESULTS: Sixty-five patients (82%) exhibited subjective improvement in their symptom status at 3-month follow-up (from grade 2 or 3 to grade 1 or 2) according to the Modified Medical Research Council dyspnea scale. The mean duration of chest drainage was 6 days (range, 4 to 16 days). Average hospital stay was 9.5 days (range, 5 to 26 days). There was no postoperative death. A comparison of preoperative and postoperative functional evaluation was available in only 16 patients who showed an increase in FEV1 (from 0.85 to 1.02 L) and a decline in residual volume after operation. Complications include persistent airleak over 10 days in seven patients (8.9%), wound infection in three patients, and localized empyema in two patients. There was no recurrence after a mean follow-up of 21 months. CONCLUSION: These encouraging results have shown that thoracoscopic endoloop ligation of bulla has proved to be a safe, reliable, and cost-effective technique for bullous emphysema. With careful preoperative evaluation and meticulous postoperative care, many patients could be rehabilitated by endoloop litigation of the bullae.

Cost-Benefit Analysis↗

PubMed1997

Transaortic patch angioplasty for left main coronary artery occlusion.

Isolated total occlusion of the left main coronary artery is rare, and may be conventionally treated by standard bypass surgery. We describe a 54-year-old woman with isolated left main coronary artery disease presenting as unstable angina of 1 week's duration. She was treated with transaortic autologous pericardial patch angioplasty. Postoperative coronary angiography showed a widely patent left main coronary artery. She was angina-free 5 months postoperatively. In selected patients, this technique offers a valuable alternative to coronary artery bypass with the advantage of restoring more physiologic perfusion to the coronary tree.

Angioplasty↗

PubMed1997

Home-made endoloops for bullous lung disease: a case report.

Various surgical techniques for bulla ablation have been used since the introduction of video-assisted thoracoscopic surgery. Endoscopic stapler resecting (Endo-GIA) is now the most common procedure for bulla ablation. Other endoscopic techniques include bulla suturing, clipping, laser ablation and electrocauterization. We present here a select report on using a "home-made" endoloop on a patient with bullous lung disease. No intraoperative morbidity was attributable to the procedure. The operating room time was 110 minutes, and ventilator support was given for 18 hours. The chest tube was removed on day 7 and the patient discharged on the ninth postoperative day uneventfully. The patient exhibited subjective improvement in his symptom preceptions during an one-month follow-up examination. A comparison of pre- and post operative functional evaluation showed increase in FEV1 (from 0.45 L to 1.02 L) during 3-month follow-up. From our experience, thoracoscopic home-made endoloop ligation is a safe and cost effective means of volume reduction surgery for bullous emphysema that interferes with optimum function of the adjacent lung parenchyma.

Aged↗

PubMed1997

Castleman's disease: a case report.

Castleman's disease is a rare, benign disorder most commonly located in the mediastinum as a solitary mass. It is a lymphoid tissue disorder characterized by lymphoid proliferation. In this paper we describe a case of asymptomatic interlobar fissure tumor, localized Castleman's disease, hyaline vascular type, in a 30-year-old female. The tumor arose from the interlobar fissure between the right middle and lower lobes. Laboratory data revealed hypochromic microcytic anemia, similar to that found in iron deficiency, and an elevated erythrocyte sedimentation rate. She underwent video-assisted thoracic surgery for excision of the tumor. Anemia disappeared two months after surgery. No recurrence of the lung tumor was seen 19 months following surgery and she remains well.

Adult↗

PubMed1996

Prolonged circulatory arrest in moderate hypothermia with retrograde cerebral perfusion. Is brain ischemic?

BACKGROUND: Circulatory arrest (CA), which provides a bloodless field and good visualization without the need of aortic cross-clamp, is commonly used to facilitate repair of aortic lesions. However, extended periods of CA may impair cerebral metabolism and cause ischemic injury. Studies were performed to evaluate the efficacy of retrograde cerebral perfusion (RCP) in protecting the brain from ischemic injury during a prolonged period of CA in moderate hypothermia. METHODS AND RESULTS: Twenty-three patients (18 men and 5 women) were operated on for aortic lesions (17 acute type A aortic dissection and 6 chronic type A aortic dissection with Marfan's syndrome). The aortic operations were performed with CA (58 to 104 minutes; mean +/- SD, 75 +/- 12 minutes) at a rectal temperature of 23.3 +/- 0.5 degrees C (21 degrees C to 25 degrees C). For RCP, cold (14 degrees C to 18 degrees C) oxygenated blood (300 mL/min) was pumped to the superior vena cava with internal jugular venous pressure of 15 +/- 5 mm Hg. The cardiopulmonary bypass time was 157 +/- 18 minutes. Cortical blood flow during RCP detected by subdural laser Doppler probe was 10 +/- 5% of baseline. Percent oxygen extraction and pyruvate and lactate levels (26 +/- 2% and 0.43 +/- 0.17 and 45 +/- 16 mg/dI) were insignificantly different from those before CA (28 +/- 3% and 0.71 +/- 0.08 and 62 +/- 20 mg/dL, P > .05). Creatine kinase-BB isoenzyme was undetectable. All but 1 patient survived the operation (95.5%) and woke up without neurological deficit. Follow-up (mean, 13 months) was complete in all survivors. There were no late deaths. Cerebral functional studies performed 3 months after discharge showed results insignificantly different from those of the normal control subjects. CONCLUSIONS: There is no evidence of ischemia of the brain during prolonged moderate hypothermic CA with the aid of RCP. Retrograde cerebral perfusion effectively extends the safe time of CA. Deep hypothermia during CA seems unnecessary.

Adult↗

PubMed1996

Identification of low molecular weight allergens of American cockroach and production of monoclonal antibodies.

BACKGROUND: Previous studies have identified two allergic fractions (Cr-PI and Cr-PII) from crude American cockroach extract, from which the 72- and 78-kilodalton (kD) components of Cr-PI have been identified as major allergens. OBJECTIVE: The objective of this study was to identify important allergens in Cr-PII and produce monoclonal antibodies. METHODS: Sera of cockroach-sensitive atopic patients were examined for IgE binding to Cr-PII proteins and monoclonal antibodies were generated by fusion between spleen cells of BALB/c mice immunized with Cr-PII and FO cells. RESULTS: Immunoblotting revealed that eight allergenic compounds in Cr-PII are able to bind specific IgE. Allergens of 18, 28, 32 and 45 kD bound 16.7% (2/12), 100% (12/12), 83.3% (11/12), and 100% (12/12) of the atopic sera tested, respectively. Cell fusion resulted in three stable subclones secreting monoclonal antibodies, and none of the monoclonal antibodies recognized any epitopes of German cockroach and Cr-PI of American cockroach. One monoclonal antibody reacted strongly with the 28- and 32-kD allergens of Cr-PII, and two monoclonal antibodies were able to bind the 18- and 12-kD components of Cr-PII with similar epitope specificities. All the epitopes defined by monoclonal antibodies are recognized by human IgE as demonstrated by a fluoroallergosorbent test (FAST) inhibition assay. Five commercial cockroach extracts were compared for Cr-PII levels by monoclonal antibody-base ELISA, and all extracts were found to contain detectable Cr-PII. CONCLUSION: The 28-, 32-, and 45-kD components of Cr-PII may be considered as additional important allergens of American cockroach and monoclonal antibodies can be used to identify and define American cockroach allergens.

Allergens↗

PubMed1996

Pulmonary actinomycosis appearing as a "ball-in-hole" on chest radiography and bronchoscopy.

A 40 year old diabetic man with pulmonary actinomycosis was admitted to hospital with recurrent haemoptysis. The chest radiograph showed an air meniscus in the left upper lobe, a rare presentation of pulmonary actinomycosis. Bronchoscopic examination revealed a mass in a cavity which has never been reported previously. He underwent lobectomy and the surgical specimen revealed sulphur granules, the typical pathological finding of actinomycosis, without evidence of fungal or mycobacterial infection.

Actinomycosis↗

PubMed1996

Creutzfeldt-Jakob disease: clinical analysis of eight cases.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) or spongiform encephalopathy in humans, is a rare, rapidly progressive and fatal disorder of the central nervous system. Since clinical diagnosis is challenging, this retrospective investigation was performed. METHODS: Eight cases who had been diagnosed as CJD from 1987 to 1995 were reviewed thoroughly, with a resulting clinical diagnosis of CJD. Two cases were proved by brain biopsy. RESULTS: Four males and four females were included; their ages were 53 to 81 years with a mean of 66 years. The mean illness duration of the six patients who died was six and a half months. Clinical findings were variable and included dementia, aphasia, ataxic gait, pyramidal, extrapyramidal, myoclonus and visual problems. CONCLUSIONS: For diagnosis of CJD, clinical suspicion is very important. Electroencephalogram (EEG) remains the most helpful laboratory diagnostic tool; serial recordings are necessary if the initial EEG finding is nonspecific. Single photon emission computed tomography (SPECT) may be helpful for premorten diagnosis of CJD, but sensitivity and specificity need further investigation. Brain biopsy seemed to be unnecessary if the clinical, EEG and SPECT findings are typical.

Aged↗

PubMed1995

Application of thoracoscopy for lung metastases.

Lung nodules in patients with a history of malignancy usually require tissue diagnosis that will provide prognostic information and dictate further therapy. Patients with a favorable tumor histologic condition and limited tumor burden were often considered for resection. This is usually accomplished by wedge resection through open thoracotomy when the lesions were peripheral. However, complications related to open thoracotomy often exclude poor-risk patients, especially those with impaired pulmonary function. Currently, technique of thoracoscopic resection is opening up new vistas and unimagined options for the thoracic surgeon in the management of pulmonary diseases. With the application of thoracoscopy and small incisions, it is now possible for the thoracic cavity and its contained organs to be thoroughly explored. Our recent experience with the thoracoscopic resection as a primary treatment for lung metastases is the focus of this report. Forty-seven patients with a history of malignancy and new lung metastases underwent this type of resection. Postoperatively, there is less pain, quick functional recovery, and excellent cosmetic healing. It is a safe and promising approach.

Female↗

PubMed1995

Thoracoscopic surgery as a routine procedure for spontaneous pneumothorax. Results from 82 patients.

A total of 82 consecutive patients with recurrent or persistent spontaneous pneumothorax were considered for thoracoscopic blebectomy or bullectomy and pleurodesis. The median age was 47 years, and 70% were men. All the patients were successfully treated using a video-assisted thoracoscopic technique. There were no deaths attributable to the procedure. Complications occurred in 6 patients (7.3%). Three patients (4%) with diffuse bullous lung disease had prolonged intubation (9, 11, and 12 days, respectively). Persistent air leaks lasting from 10 to 14 days occurred in 2 patients (3%). One patient had an endoloop slip from the lung parenchyma after a forceful sneeze 2 days after the operation. Air leak subsided after the second operation using a conventional suturing technique. Blebs or bullae were present in 69 patients (83%). These were ablated by endoscopic stapling (37 patients) and through thoracoscopic ligation using an endoloop technique (32 patients). In this group of patients, the median postoperative hospital stay was 5 days. Thirteen patients with air leaks and diffuse bullous lung disease received only talc insufflation thoracoscopically. All of them showed good lung expansion after the operation. There are no recurrences, with a mean follow-up of 22 months. These results suggest that thoracoscopic ablation of blebs or bullae and pleurodesis may be applicable to patients with spontaneous pneumothorax who require surgical intervention.

Adolescent↗

PubMed1995

Thoracoscopic-assisted lobectomy. Preliminary experience and results.

A preliminary report is made on the use of videothoracoscopy to achieve pulmonary lobectomy in 16 patients, including 12 with centrally located pulmonary metastases and 4 with benign lesions (3 bronchiectases and 1 endobronchial hamartoma). Videothoracoscopy was performed on eight right-lower lobes, one middle lobe, two right-upper lobes, four left-lower lobes, and one left-upper lobe with a thoracoscope and conventional thoracic instruments. All patients received standard pulmonary lobe resection with lymph node clearance similar to that achieved with open thoracotomy. The mean operative time was 3 h (range, 2.5 to 4 h). Average blood loss was 100 mL and mean length of hospital stay was 6 days (range, 4 to 8 days). A combination of videothoracoscopy with use of conventional instruments resulted in similar performance but less chest wall interruption than in conventional pulmonary lobectomy. Videothoracoscopy showed safer and faster lung resection, which subsequently minimized the perioperative morbidity. Pain intensity was lessened, functional recovery was quicker, and hospital stays were shorter in the patients we reviewed.

Adult↗

PubMed1994

Enhancement of endothelium-dependent contraction of the canine coronary artery by UW solution.

University of Wisconsin (UW) solution has been used almost routinely in the preservation of the hepatic, pancreatic, renal, and cardiac allografts. However, its effect on vascular endothelium is unknown. Experiments were designed to evaluate its effect on canine coronary endothelium. Canine coronary arteries (n = 8 in each group) were preserved in cold (4 degrees C) UW solution (group 1) and physiological solution (group 2) for 6 hr immediately after harvesting. Segments of preserved and control (group 3) coronary arteries with or without endothelium were then suspended in organ chambers to measure isometric force. Perfusate hypoxia (pO2 30 +/- 5 mmHg) caused endothelium-dependent contraction in the arteries of all 3 groups. However, vascular segments with endothelium of group 1 exhibited hypoxic contractions (107 +/- 26% of the initial tension contracted by prostaglandin F2 alpha 2 x 10(-6) mol/L, P < 0.05) that were significantly greater than those of the group 2 and group 3 segments with endothelium (25 +/- 5% and 20 +/- 4%). The hypoxic contraction in arteries of group 1 could be attenuated by NG-monomethyl-L-arginine (L-NMMA), the blocker of endothelial cell synthesis of the nitric oxide from L-arginine. The action of L-NMMA could be reversed by L-arginine but not D-arginine. Endothelium-dependent relaxation of coronary endothelium to acetylcholine and adenosine diphosphate and endothelium-independent relaxation and contraction of coronary smooth muscle were not altered by the UW solution. After preservation with the UW solution, endothelium-dependent contraction of the canine coronary arteries, occurs by L-arginine-dependent pathway, is enhanced. This augmentation by the UW solution would favor vasospasm after transplantation.

Acetylcholine↗