Biomedical subjects
Publications and source records attributed to R H Fang.
Haemodynamic monitoring is important in severely burned patients and repeated catheterization of the arteries of these victims seems to be inevitable. We present a 46-year-old female with 54 per cent TBSA burns who suffered from bilateral femoral mycotic aneurysms due to repeated arterial punctures.
The influence of oestrogen on spermatogenesis was evaluated by comparing its effect on the testes of primary male transsexuals and those who had undergone hormone therapy for prostatic carcinoma. Eight primary transsexuals were studied. They had been diagnosed on clinical and psychiatric evidence and had been on oestrogen therapy for several years since puberty. Histological sections of testicular tissue obtained at reassignment surgery from 8 phenotypic male transsexuals (aged 24-32 years) with an XY chromosome complement were studied by light microscopy. The formalin-embedded specimens were analysed by flow cytometry for deoxyribonucleic acid (DNA) histograms. Both the histology and DNA histograms revealed a pattern of maturation arrest in 12 of 16 testes in which the diploid cell compartment occupied most of the spermatogenetic element, followed by tetraploid and monoploid cells. Two testes showed impaired spermatogenesis and 2 were normal. The DNA histograms and pathology were also evaluated in 20 testes after 3 to 8 years of hormone therapy in patients with advanced prostatic carcinoma (aged 60-78 years). No maturation arrest was found in these patients. Sixteen of them had a pattern of fibrosis and atrophy and 4 had impaired spermatogenesis. It was concluded that oestrogen influenced spermatogenesis and affected the maturation of spermatogonia mostly during puberty.
Free radicals may be involved in various human disease processes. Cutaneous edema and acute pulmonary damage of thermal injury mediated by oxygen free radicals can be monitored by studying the levels of lipid peroxidation in blood plasma. In this study, we investigated lipid peroxidation induced by human skin burns. The subjects included 14 healthy subjects and eight burn patients. Healthy subjects included nine males and five females, aged 50.5 +/- 19.1 years. The burn patients included seven males and one female, aged 46.9 +/- 19.1 years, who had burns over 45.6% +/- 14.0% of their total body surface area. Plasma lipoperoxides were measured by high performance liquid chromatographic separation of malondialdehyde-thiobarbituric acid adduct. The average plasma lipoperoxide concentration (measured as malondialdehyde) of the 14 healthy subjects was 0.72 +/- 0.18 mumol/L. This concentration increased significantly (p < 0.0013) in the eight burn patients to a 3.75 +/- 1.34 mumol/L (peak level). Plasma lipoperoxides increased in the first few hours postburn. Plasma lipid peroxide peak levels were found on the third day postburn in 75% of burn patients. Moreover, patients with inhalation injuries had higher plasma lipid peroxide levels (5.27 +/- 5.30 mumol/L) than those without inhalation injury (2.84 +/- 2.88 mumol/L). These results suggest that both oxygen free radicals and lipid peroxidation play a major role in the injuries caused by skin burns and related inhalation [corrected].
Sweat gland carcinoma is a rare malignancy of the skin appendage. Surgeons and pathologists have limited experience with such tumor. Various classifications and diagnostic identifications lead to easy confusion with other metastatic lesions. Eight cases of sweat gland carcinoma were collected from 1020 cases of primary skin malignancies seen at the Veterans General Hospital-Taipei over the past 20 years. After a careful review of the clinical history and histopathology files, as well as immunohistochemical stains of CEA and S-100 protein, only three cases were proved to be sweat gland carcinomas, accounting for less than 0.3% of the primary tumors of skin. All three cases were eccrine histology in type. Two cases were CEA positive, and one case was positive with S-100 protein stain. Five cases which were excluded were negative to CEA and S-100 protein analysis. Thus it is suggested that sweat gland carcinoma should receive more accurate differential diagnosis from other skin malignancies, particularly metastatic tumors. Immunohistochemical analysis could help differential diagnosis. Treatment modalities of sweat gland carcinoma base mainly upon adequate wide surgical excision.
Necrotizing fasciitis is a relatively rare soft tissue infection that is characterized by rapidly widespread necrosis of the fascia and subcutaneous tissue. Fifty-eight cases were reviewed over a 5.5-year period. The majority of wound cultures were polymicrobial and single culture rate was 18.6%. The facultative organisms were most frequently recovered. The most frequently discovered bacteria were E. coli, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus and group D enterococcus. The overall mortality rate was 48.3%. Early recognition, serial radical surgical debridement and strong and appropriate antibiotics were essential for survival.
Sex reassignment surgery has proved to be the best resolution for primary transsexuals. In 1980, Dr. Rubin stated that preservation of the glans to reconstruct the clitoris in male-to-female sex reassignment surgery gave good cosmetic and functional results. In his series, Rubin used the corpus spongiosum as the vascular pedicle of the neoclitoris, but urine leakage is a complication. From 1988 to the present, the dorsal portion of the glans penis with the dorsal neurovascular pedicle has been used here for clitoroplasty in nine male-to-female primary transsexuals. All neoclitorides survived well, with good preservation of light touch and sexual sensation. No urine leakage has occurred. Six patients who were followed reported sexual satisfaction.
Twenty-nine patients treated with the Chinese forearm flap from 1985 to 1989 were reviewed. This flap was used for soft tissue defect reconstruction in 19 cases, and phallus reconstruction in 10 patients. There were two cases of total flap failure and two cases of partial failure. Twenty cases used sensory flaps. Donor site complications included partial loss of the skin graft with tendon exposure in one patient (3.4%), limitation of range of movement of the wrist joint in one case (3.4%), and paresthesia over the radial site of the hand in 12 patients. On functional evaluation, 20 patients demonstrated no significant loss of strength in the donor extremity.
An Abbe flap with lateral vermilion extension (Fleur-de-lis flap) was used in four cases of secondary deformity of lip and palate with tightness and thinness of upper lip following primary cleft lip and palate surgery. The Abbe island flap was converted into fleur-de-lis flap with extensive mucosal wings to improve the fullness of the upper lip. The results were considered to be superior to those obtained by using an Abbe flap only. The balance between the lips was also improved. The technique is recommended in patients of secondary deformity of cleft lip with severe shortage and thinness of the lip vermilion.
We reviewed 39 cases of squamous cell carcinoma of lip from 53 consecutive patients with carcinoma of the lip. The retrospective review includes age, location, risk factors, TNM classification, histologic differentiation, treatment methods, recurrent disease, site of recurrence, and follow-up status. Results reveal prognosis is related to original tumor size, local recurrence, and presence of cervical metastasis. Aggressive surgical treatment is recommended for identifiable poor prognostic lesions and includes surgical excision, prophylactic suprahyoid neck dissection, and possible radical neck dissection.
A randomized, prospective, double-blind study designed to compare the effectiveness of the use of cloxacillin with the result of nontreatment in patients undergoing surgical intervention of axillary hyperhidrosis was conducted from August 1987 to October 1987 at the Veterans General Hospital, Taipei, Taiwan. Forty-two patients were enrolled in this study. Fifty wounds (25 patients) were control subjects, and 34 wounds (17 patients) received cloxacillin. The positive bacterial culture rates of the tissues and draining from patients in the treatment group compared with the control group was statistically significantly lower (p less than 0.01). No significant differences presented in relation to age, sex, complication rate, fever index, and length of hospital stay. Prophylactic antibiotic is of no value in elective surgical intervention of axillary hyperhidrosis.
Voluntary control of the bowel movements is a social necessity. Lack of control relegates one to psychological debility and the possible need for a permanent colostomy. Anorectal angle plays an important role in fecal continence. In the normal individual, this angle lies in the range of 60 to 105 degrees. Perineal colostomy, once proposed for patients who had received abdominoperineal resection (APR), has been abandoned because of frank incontinence. This study used a canine model. The anorectal angle, external sphincter, internal sphincter, and the puborectalis were all destroyed after APR. The colon was pulled through the perineal defect. Enteropexy, gracilis muscle transfer, and perineal colostomy were performed to restore the anorectal angle. Barium enema was performed preoperatively and postoperatively. The anorectal angle was reconstructed within normal ranges after abdominoperineal resection of the rectum and anus.
The effectiveness of a modified glucose-insulin-potassium (GIK) formula, which was derived from the results of a previous study (the maximal glucose disposal rate of 400 mg/M2/min required an insulin infusion rate at 1,200 mU/M2/min and KCl supplement rate at 0.08 mEq/M2/min), was evaluated in the treatment of extensive acute burn injury (EABI) in dogs. Under anesthesia initially with intravenous sodium pentobarbital 35 mg/kg followed by a maintenance dose of 5 mg/kg/hr, a third-degree burn of about 50% of the total body surface was created by acetylene torch over the ventral wall of the chest and abdomen. Cardiovascular parameters including heart rate, mean arterial blood pressure, pulmonary wedge pressure, cardiac index, and cardiac contractility (dP/dt of left ventricular pressure), as well as blood chemical data of pH value and K+ concentration were monitored. The present GIK therapy in EABI dogs effectively prevented a decrease in cardiac function, markedly enhanced cardiac function, steadily prolonged cardiac enhancement, and safely avoided hypoglycemic attack.
In order to reconstruct soft tissue defects, plastic and reconstructive surgeons have developed various means that range from the simplest skin grafts to the most complex transfer of microvascular free flaps, but there are no other more than tissue expansion can achieve good results in both aesthetic and functional aspects. From Oct. 1986 to Oct. 1988, tissue expansion was used in seven male and six female patients aged from 11 to 40 years, with a mean of 25. They were divided into 3 groups according to the location of defects: head and neck, 6 cases; trunk, 2 cases; and extremity, 5 cases. Seven cases had successful results and 6 cases failed: one due to infection, one due to leakage of bag and another 4 due to expander extrusion. We know that tissue expansion is a relatively new technique. It expands the healthy tissue immediately adjacent to the defects and provides tissue with near perfect color match, texture, sensation and hair distribution for reconstruction. Although high risk of failure was noted (6 in 13 cases), it still deserves trying for its reasonable aesthetic and functional results.
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Interleukin (i.l.)-8 levels in serial serum samples of 10 burned patients were analysed. The total body surface areas (TBSAs) of the burn injury ranged 30 to 85 per cent. Of these ten patients, five recovered and the other five, who were septic, died. On admission at about 5-13 h postburn, one of the five survivors and two of the non-survivors had serum IL-8 levels higher than 18.1 pg/ml, which is the detection limit of the IL-8 assay kit. The serum IL-8 values of six healthy laboratory personnel included in the present study were all less than 18.1 pg/ml. Afterwards, an initial peak serum IL-8 response was detected within 2-4.5 days postburn. Significant differences in the peak serum IL-8 levels were not found between patients with TBSAs of greater or less than 50 per cent and patients who survived or expired from burn injury. In the survivors, serum IL-8 remained low, whereas IL-8 increased markedly, starting at about one week postburn in four of the five non-survivors with confirmed sepsis. Significant differences in the maximum serum IL-8 levels were detected between patients who recovered vs. those who died from the thermal injury. In conclusion, the results showed that there was an increase in serum IL-8 postburn. Serum IL-8 was significantly higher in the septic patients, who all died. This cytokine may play a significant role in the pathophysiology of sepsis in burned patients.