Biomedical subjects

M J Shieh

Publications and source records attributed to M J Shieh.

7 recordsLinked to original sources

PubMed1991

Aggressive colonoscopic approaches to lower intestinal bleeding.

The most obvious advantage of colonoscopy is to establish the diagnosis at any level of the colon by direct observation of the mucosal surface and identification of any active bleeding and or responsible lesions. It also enables therapeutic intervention. In a period of 18 years from 1973 to 1990, 230 emergency colonoscopic examinations were performed in 205 cases for evaluation of acute and severe bleeding from the lower intestinal tract. There were 108 men and 97 women. They appeared quite serious and needed constant medical supervision including shock treatment and blood transfusion. The ages of the patients varied from 5 months to 90 years old. There were 24 children in this series. Colonoscopy was performed within 48 hours after onset of anal bleeding. All examinations were done without fluoroscopy. It was necessary to reach the cecum in 66% of cases to determine the responsible lesions. Bleeding was identified in all except 11 cases (94.7%). Bleeding and the responsible lesions were both visualized in 147 cases (71.7%). The source of bleeding was located proximal to the ileocecal valve in 37 cases (18%). Much blood was found in the bowel which interfered observation in 14 cases. No bleeding nor lesions could be identified in 8 cases (3.9%). Most common causes of bleeding in adults were cancer, inflammatory lesions, ischemic colitis and vascular ectasia, while the most common cause of bleeding in children was juvenile polyp.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

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↗

PubMed1990

Determination of erythrocyte glutathione peroxidase activity and its reference range in Chinese adults.

A method to assess selenium status of the body by measuring glutathione peroxidase activity in erythrocytes was studied. Reaction was measured by continuous monitoring of the decrease of NADPH at 340 nm. The erythrocyte glutathione peroxidase activity was determined at 37 degrees C, pH 7.5 by using one of the substrates, t-butyl hydroperoxide, to initiate the reaction, and using glutathione reductase as the coupling enzyme. The Km of the enzyme for glutathione and t-butyl hydroperoxide were determined to be 1.8 mM and 238 microM, respectively. The enzyme was stable at -20 degrees C or -70 degrees C for at least 5 months, and for at least 2 months when stored at 4 degrees C. The within-run and between-run coefficients of variation for this method were 3.3-4.9% and 3.0-7.1%, respectively. The test was linear up to 100 U/g hemoglobin, and had a sensitivity of 0.002 delta A/min at 3 U/L. The reference range of erythrocyte glutathione peroxidase in Chinese adults was estimated to be 28.6-87.8 U/g hemoglobin (n = 84), without a significant difference in the results between males and females.

Adult↗

PubMed1989

Transatrial membranotomy for Budd-Chiari syndrome.

In a 7-year period, transatrial membranotomy was performed in 11 patients with membranous obstruction of the inferior vena cava. There were 5 men and 6 women, ranging in age from 23 to 53 years. Clinical symptoms included jaundice in 4 patients, hepatomegaly in 4, leg edema or varicose veins in 10, and venous collaterals over the abdominal and chest wall in all 11 patients. Transatrial membranotomy was performed through a median sternotomy in all patients. When inferior vena cava venography revealed that the obstruction was accompanied by long segmental thrombosis, additional dilation was performed with a Hegar dilator. There was no surgical mortality. Early operative complications included pulmonary embolism in 2 patients and bleeding requiring reoperation in 1. In a mean follow-up period of 30.6 months (range, 2 to 88 months), 9 patients had no symptoms, transient pericardial constriction developed in 1 patient and resolved 1 month later, and restenosis of the inferior vena cava developed in another patient 1 year after the first operation. This latter patient received a second transatrial membranotomy followed by percutaneous balloon angioplasty of the inferior vena cava, with a satisfactory result at 8 months follow-up. We conclude that transatrial membranotomy is an effective and safe procedure for patients with membranous obstruction of the inferior vena cava.

Adult↗

PubMed1989

Surgical management of congenital coronary artery fistula.

Over a period of 6 years, 8 patients underwent surgical treatment at our hospital for congenital coronary artery fistula (CAF). The ages of the patients ranged from 4 months to 50 years (mean 22.7 years). Continuous heart murmurs could be heard in all patients, except one. The diagnosis was made by retrograde aortography and/or selective coronary arteriography. Only one patients had associated cardiac disease. All the drainage sites of the CAF were on the right side of the heart (right atrium, right ventricle, pulmonary artery). Two patients had both right and left CAFs. Symptoms due to "coronary steal" by a coronary artery fistula were demonstrated by a nuclear medicine study in one of our patients. Four patients were operated on with the aid of cardiopulmonary bypass. The other 4 patients were treated with suture ligation directly. There was no surgical mortality or morbidity, and the longterm results have been good. Since surgical correction is safe and effective, it would appear desirable for all patients with CAF be operated on. However, surgical intervention is controversial in asymptomatic patients.

Adult↗

PubMed1989

Acute mitral regurgitation secondary to blunt chest trauma: report of a case.

A 24-year-old male patient who sustained blunt trauma to the chest resulting in a flail chest, myocardial contusion and injury to mitral valve is reported. An emergency surgical correction of the mitral lesion was performed. A high index of suspicion, prompt diagnosis and aggressive intervention of such injuries can lead to successful repair of such a potentially fatal cardiac trauma.

Acute Disease↗