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Biomedical subjects

S H Chu

Publications and source records attributed to S H Chu.

At least 73 records · Page 4Linked to original sources
PubMed1999

Cardiorespiratory response of heart transplantation recipients to exercise in the early postoperative period.

In this study, we evaluated the cardiorespiratory function of orthotopic heart transplantation (OHT) recipients during exercise. Seventeen male OHT recipients, ranging in age from 22 to 60 years, participated in this study 47 +/- 21 days after surgery. The control group consisted of 17 sedentary healthy men. Breath-by-breath measurement of cardiorespiratory function was obtained during the incremental exercise of leg cycling. At peak exercise, the oxygen (O2) uptake (16.5 +/- 3.3 vs 33.9 +/- 8.2 mL.kg-1.min-1), work rate (82 +/- 19 vs 169 +/- 42 watts), heart rate (HR), O2 pulse, and blood lactate level of the OHT recipients were significantly lower than the respective values of the control group. At the ventilatory threshold, the OHT group also showed a significantly lower O2 uptake (10.7 +/- 1.6 vs 18.3 +/- 5.1 mL.kg-1.min-1), work rate (39 +/- 12 vs 89 +/- 33 watts), HR, O2 pulse, ventilatory equivalent for O2, and ventilatory equivalent for carbon dioxide. The OHT recipients showed a high resting HR (97 +/- 7 beats/min) and a low peak HR (123 +/- 14 beats/min) during exercise, and their HR continued to increase for 1 to 3 minutes after cessation of exercise. Our data revealed a low level of cardiorespiratory endurance in OHT recipients during the early postoperative stage. A multidisciplinary cardiac rehabilitation program should be considered to enhance physical functional capacity and quality of life, and promote return to work.

Adult↗
PubMed1999

Prognostic factors and strategy of treatment in Fournier's gangrene: a 12-year retrospective study.

BACKGROUND: Fournier's gangrene (FG) is a fulminant and fatal infection of the genitalia. However, the clinical course is unpredictable. This study retrospectively analyzed the possible prognostic factors of FG. METHODS: Data obtained from 57 patients treated for FG from January 1985 through December 1996 were retrospectively analyzed. Possible prognostic factors including age, diagnostic delay, hospital stay, underlying diseases, clinical symptoms, origins, extents, bacteriologic findings, diverting colostomy and mortality rate were all considered in the analysis. RESULTS: Patients with extensive or localized FG had mortality rates of 31.3% and 16.0%, respectively (p = 0.227). The mortality rates of patients with FG of anorectal, urogenital and non-specific origin were 30.3%, 0% and 40.0%, respectively (p = 0.712). The mortality rates of patients with FG of anorectal origin who received primary or secondary diverting colostomy were 16.7% and 40.0%, respectively. However, the mortality rate of patients with FG of anorectal origin who did not undergo diversion was 29.4%. The mortality rate of patients with FG presenting with septic shock at emergency was 53.8% as compared with 0% in those without septic shock (p < 0.001). CONCLUSION: Fournier's gangrene is a rapidly progressive and life threatening infection of the genitalia. Age, underlying diseases, origin, extent and fecal diversion can not be regarded as prognostic factors of FG. Early primary diverting colostomy may reduce the mortality rate in those with severe infection of anorectal origin. Presence of septic shock in those with FG is the most important and the only factor related to death.

Adult↗
PubMed1999

Application of the holmium yttrium-aluminum-garnet laser for complicated impacted ureteral stones: a preliminary report.

BACKGROUND: Minimally invasive surgery is a current trend in all kinds of surgical fields. Endoscopic stone manipulation with electrohydraulic lithotripsy (EHL) is the preferred method for treating lower ureteral stones or calculi which cannot be resolved with extracorporeal shock wave lithotripsy (SWL). We evaluated the efficiency and safety of holmium yttrium-aluminum-garnet (YAG) laser for treatment of large impacted ureteral stones. METHODS: In a clinical trial period including April and May 1998, 13 patients with ureteral stones underwent holmium YAG lasertripsy. Six patients had large impacted ureteral stones (1.3 to 3.8 cm). We conducted lasertripsy with a 6.5-Fr. rigid tapered ureteroscope and a 550-nm SlimLine laser fiber under the guidance of a 3-Fr. ureteral catheter. The irrigation pump was set at 300 mmHg to increase the surgeon's visual clearance and to help keep the operative field ston-free. RESULTS: The postoperative stone-free rate was 100%. There were no intraoperative complications, even in the treatment for a 3.8-cm steinstrasse in the upper ureter. All preoperative hydronephrosis improved. In general, the operative time, not including anesthesia, was less than 30 minutes. There was no intraoperative or postoperative flank pain or fever when the procedure was combined with pressure irrigation for visual clearance and keeping the area stone-free. CONCLUSION: Holmium YAG lasertripsy is an excellent treatment modality, especially for a large impacted ureteral stone or steinstrasse. The treatment is efficient and safe. Furthermore, there is no learning curve necessary for an experienced endo-urologist. It helps the urologist to carry out a minimally invasive lithotripsy instead of an open surgery for large impacted ureteral stones.

Adult↗
PubMed1999

Partial nephrectomy for incidental primary renal neuroendocrine carcinoma: case report.

Here we present an 83-year-old woman who was referred to our hospital and had had left flank pain and oligouria for 3 days. Plain abdominal film and ultrasonography revealed left ureteropelvic junction stone with obstructive uropathy. The serum level of creatinine fell to 3.1 mg/dl from 7.6 mg/dl after ureteral catheter drainage was given 5 days after admission. Then a left pyelolithotomy was performed and a tumor of 2 x 1 x 1 cm over the lower pole of the left kidney was found incidentally. Partial nephrectomy was performed in consideration of her age and poor renal function although the biopsy result showed it to be carcinoma. The final pathological report and immunohistochemical study results proved that it was neuroendocrine carcinoma. To our knowledge, this is the first case of primary renal neuroendocrine carcinoma to be treated using conservative surgery. The clinical course was acceptable, since she had been found to be free of disease during regular follow-up of 2.5 years with the creatinine level of about 2.5 mg/dl.

Aged↗
PubMed1999

Postoperative short-term sedation with propofol in cardiac surgery.

We conducted a randomized double-blind study to assess the safety and effectiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery. Sixty hemodynamically stable adult patients who underwent cardiac surgery were randomly assigned to receive propofol postoperatively or no postoperative sedation. The propofol group (n = 30) received propofol infusion (1 mg.kg-1.hr-1) immediately after they awoke postoperatively. The infusion rates were adjusted to maintain a sedation level (Ramsay score) of 3. Nurses assessed the effectiveness of the sedation according to Ramsay scores; the patients also subjectively evaluated sedation. Postoperative pulmonary oxygenation dysfunction (PaO2/FiO2 < 300 mm Hg) was noted in 10 patients receiving propofol and in eight patients in the control group. The dysfunction was greatly improved after overnight ventilator support, and this improvement was not affected by propofol sedation. The propofol group received an average of 13.6 +/- 5.3 hours of propofol infusion, at an average infusion rate of 0.96 +/- 0.16 mg.kg-1.hr-1. Patients receiving propofol remained well sedated (Ramsay score > or = 2) during 99.3% of the study period, while the control patients remained anxious or agitated (Ramsay score, 1) during 12% of the study period. Patients receiving propofol were successfully extubated 9 +/- 4 minutes after cessation of propofol infusion, without complications. The turnover of intensive care unit beds was not delayed by propofol sedation. Subjective evaluations (scored on an analog scale: 0 = nil, 10 = extreme) revealed that patients receiving propofol felt less pain than those in the control group (2.3 +/- 2.7 vs 4.7 +/- 3.1, p < 0.05), had better sleep quality (7.8 +/- 2.9 vs 5.1 +/- 2.9, p < 0.05), and were more satisfied with the care they received (8.3 +/- 2.2 vs 5.8 +/- 3.9, p < 0.05). These findings suggest that propofol infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay score of 3 may be ideal. Postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or agitation.

Cardiac Surgical Procedures↗
PubMed1999

Heart transplantation with marginal recipients and donors.

With improvements in surgical techniques and management of postoperative complications, heart transplantation can now be performed with donors and recipients who were previously considered unsuitable. In this study, we report the results of heart transplantation with marginal donors and recipients in our hospital. From June 1993 through June 1998, we performed 79 heart transplantations. Marginal recipients were defined as those with high pulmonary vascular resistance (> 6 Wood units), severe renal impairment (serum creatinine > 2 mg/dL and creatinine clearance < 50 mL/min), or severe hepatic dysfunction (ALT and AST > 100 IU/L or serum bilirubin > 2.5 mg/dL). Marginal donors were those with any of the following conditions: old age (> 40 years), size mismatch (donor/recipient body weight ratio < 0.8), history of chronic alcohol use, previous cardiopulmonary resuscitation and hypotension, hepatitis B or C virus positivity, coronary artery disease, high-dose dopamine (> 10 micrograms.kg-1.min-1), or prolonged allograft ischemic time (> 4 hours). Of the 79 transplantations performed, 45 (58%) involved marginal recipients or donors. The 30-day mortality rate was 5%, and the 1-year and 5-year survival rates were 87% and 83%, respectively. The survival rates did not differ significantly between cases involving marginal donors or recipients and those involving nonmarginal donors and recipients. There were 27 marginal recipients (34%), only one of whom died during surgery. Five of six recipients with severe renal impairment needed short-term hemodialysis after transplantation. Recipients with high pulmonary vascular resistance had a higher incidence of early acute rejection (5/10 vs 22/69). Thirty-three (42%) of the patients received transplants from marginal donors, four of whom died during surgery; two died of acute vascular rejection, one of allograft failure caused by prolonged ischemic time, and one of bleeding secondary to preoperative sepsis and coagulopathy. These results show that heart transplantation may be performed in marginal recipients and donors, with acceptable operative mortality.

Adolescent↗
PubMed1999

Heart transplantation in Asia.

BACKGROUND: The first clinical heart transplantation in Asia was performed by Wada in 1968. Due to cultural and religious problems, heart transplantation was rarely performed in Asia until 1987 and since then the number of heart transplantation has increased rapidly. This study was undertaken to investigate the results of heart transplantation in Asia. METHODS: Data was collected through the use of a questionnaire by mail. The questionnaire included information on the year when heart transplantation was started, the number of heart transplantations by year and country population, sex, age and diagnosis of recipients, causes of brain death of the donors, number of centers with an active heart transplantation programs, operative mortality and actuarial survival, brain death and organ transplant legislation. RESULTS: From July 17, 1987 to December 1996, 380 patients received heart transplantation in Asia. Up to 1996, Taiwan had performed 178 cases of heart transplantation. Thailand also started in 1987 and had 95 cases. South Korea started in 1992 and had 65 cases. Singapore and India each had 12 cases. Hong Kong 8 cases, China 7 cases, and the Philippines 3 cases, all started in the early 1990s. The recipient ages ranged from 1 to 70 years with a male to female ratio of 3 to 1. The one-month operative mortality rate ranged from 0 to 25% with an average of 7.4%. The one-year survival rate ranged from 0 to 84% with an average of 78.8%. The 5-year survival rate ranged from 30 to 74.1% with an average of 67. 5%. CONCLUSION: Heart transplantation was well-established in most Asian countries, and the number was increasing. The result and survival rate of heart transplantation in Asia were comparable with that of the world series.

Actuarial Analysis↗
PubMed1999

Enterovesical fistula: experiences with 41 cases in 12 years.

BACKGROUND: A retrospective analysis of enterovesical fistula treated at Chang Gung Memorial Hospital was conducted to determine the optimal diagnosis and management of this disease. METHODS: The records of 41 patients who presented from 1984 to 1996 and had a final diagnosis of enterovesical fistula were retrospectively reviewed. The etiology, symptoms on presentation, diagnostic tools, and modality of treatment were analyzed. RESULTS: The majority of these cases were associated with malignancy (38, 92.7%), and the others with diverticulitis (2, 4.9%) and iatrogenic causes (1, 2.4%). In those with malignancy, 15 patients (39.5%) were found to have tumor recurrence. The most frequent symptom in enterovesical fistula was fecaluria (58.5%), followed by abdominal pain (22%) and dysuria (14.6%). Diagnostic tools included the barium enema, cystography, and cystoscopy; these methods could identify the fistula in 63.2%, 60%, and 53.8% of the patients, respectively. Methods of management included diversion only (39%), one-stage fistula repair (36.6%), and watchful surveillance (24.4%). CONCLUSION: Enterovesical fistula should be considered if fecaluria, pneumaturia, or persistent non-specific urinary tract infection present as the initial complaint. A thorough surgery for a possible underlying malignancy is mandatory when confronted with enterovesical fistula, since the incidence of inflammatory bowel disease is low in this area. An abdominal computer tomography (CT) scan, barium enema, and cystogram can be useful diagnostic tools. Treatment of this entity should be individualized according to each patients clinical status.

Adult↗
PubMed1999

Renal autotransplantation for ureter stricture and renovascular disorders.

BACKGROUND: Renal autotransplantation is an established therapy in cases of renal vascular lesions, tumors of the kidney and ureter, complex ureteral lesions, and kidney trauma. It has been a significant technical innovation, aiding the urologist in his great effort to preserve renal function by conserving renal tissue. We report our experience with autotransplantation in 4 patients. The indications, techniques, and results of renal autotransplantation in relation to our own experience are discussed. METHODS: The patients included 3 women and one man. The average age of the patients was 35 years old, with a range from 20 to 54 years. One patient had Takayasu's arteritis, the second had Nutcracker syndrome with flank pain and hematuria, the third a complicated long ureter stricture, and the fourth patient a renal artery saccular aneurysm. RESULTS: The average operation time was 7 hours (4.5 to 8.5 hours), and the cold ischemia time was about 88 minutes (45 to 150 minutes). Three of the autografts resumed normal renal perfusion, and in the fourth patient the renal autograft was lost due to vascular thrombosis. CONCLUSION: Renal autotransplantation is a feasible method for the surgical treatment of renal and ureteral lesions. To avoid postoperative ureteral sloughing and subsequent urinary fistulas, the ureter can be left intact to preserve the ureter blood supply. However, in the case of a complicated vascular reconstruction procedure, it appears to be appropriate to divide the ureter and have the kidney completely free, thus avoiding back-flow perfusion from the intrinsic and intercommunicating blood supply in the ureteral wall, which may result in vascular thrombosis and subsequent autograft failure.

Adult↗
PubMed1998

Postpartum myocardial infarction rescued with an intraaortic balloon pump and extracorporeal membrane oxygenator.

A 37-year-old woman had postpartum myocardial infarction complicated with cardiogenic shock. The infarction was attributed to diffuse coronary artery spasm caused by methylergonovine, which had been used to treat the postpartum haemorrhage due to placenta increta. The haemodynamics could not be maintained with catecholamine infusion and intraaortic balloon counterpulsation. At last, an extracorporeal membrane oxygenator was used to save her life, and the patient was successfully weaned from the machine 100 h later; she made an uneventful recovery thereafter.

Adult↗
PubMed1998

Electrophysiological mechanisms for the antiarrhythmic activities of naloxone on cardiac tissues.

It has been reported that naloxone, an opioid antagonist, has antiarrhythmic activity in vivo. In Langendorff perfused rat hearts, we found that ischemia-reperfusion-induced ventricular tachyarrhythmia reverted to normal sinus rhythm after the treatment with naloxone (3 approximately 10 microM). The method of voltage and current clamp were used to study the underlying mechanism of its antiarrhythmic activity on isolated cardiac myocytes. In isolated rat ventricular and in guinea-pig and human atrial myocytes, naloxone prolonged the action potential duration reversibly. In rat ventricular myocytes, naloxone (1 approximately 30 microM) inhibited sodium current (I(Na)), transient outward potassium current (I(to)), and calcium current (I(Ca)). On the contrary, the addition of naloxone significantly increased inward rectifier potassium current (I(K1)). For the effect on I(Na), naloxone did not shift the inactivation curve of I(Na) but retarded the I(Na) recovery rate from inactivation state. Naloxone suppressed I(to) with a significant left-shift of the inactivation curve, however, the time course of I(to) recovery from inactivation was not affected. In guinea pig atrial myocytes, naloxone (10 microM) decreased the delayed rectifier K+ current (IK). These results show that naloxone exert various extent of inhibition on I(Na), I(to), IK and I(Ca). The prolongation of cardiac action potential is related to the inhibition of I(to) and IK. The antiarrhythmic activity of naloxone is more closely related to the inhibition of Na+ and K+ currents rather than the blockade of myocardial opioid receptors.

Action Potentials↗