Search PubMed⌕ Search

Biomedical subjects

S H Chu

Publications and source records attributed to S H Chu.

At least 163 records · Page 9Linked to original sources
PubMed1995

[Comparison of UW solution and UR (a modified Collins) solution for renal preservation in renal transplantation].

For the storage of human transplanted organs, the benefit of "UW solution" has been proven especially in keeping a longer preservation time for the liver and pancrease; however, the value for kidney preservation was still debated. A total of 293 cases of renal transplantation were performed over 12 years in our hospital and 206 cases were cadaveric transplants. The latter ones were further divided into 3 groups, according to the immunosuppressive medication and preservation solution used. In the CsA treated groups, the ATN rates significantly decreased in those preserved with the UW solution than with the UR solution. Although the UW solution did not improve the graft survival in our series, it did save the cost for postoperative hemodialysis and shorten the hospital stay which made it cost effective.

Adenosine↗
PubMed1995

Monitoring of two hearts in one chest.

A 32 year old patient with end-stage cardiomyopathy underwent heterotopic heart transplantation with a small donor heart. Monitoring of this unusual clinical setting of two hearts beating independently in one chest required special technique and scrutinous interpretation so one can differentiate donor heart from recipient heart immediately.

Adult↗
PubMed1995

Simultaneous Bentall's procedure and sternal turnover in a patient with Marfan syndrome.

A patient with Marfan syndrome with ascending aortic aneurysm, aortic regurgitation and pectus excavatum was treated with simultaneous Bentall's procedure and sternal turnover. Partial sternal necrosis and mediastinitis developed 12 days after surgery. After debridement of about one-third of turnovered sterno-costal complex (SC), successful salvage of the remaining two-thirds of SC and sterilization of the infected aortic Dacron graft were accomplished with pedicled omental flap. The 7 previously published cases of simultaneous Bentall's procedure and sternal turnover are reviewed.

Adult↗
PubMed1995

[The first successful case or Norwood operation for hypoplastic left heart syndrome in Taiwan].

UNLABELLED: Hypoplastic left heart syndrome is not infrequently seen in Taiwan, but all died previously. An 8 day-old-male baby suffering from hypoplastic left heart syndrome was transferred to our hospital after cardiopulmonary resuscitation. Oral prostaglandin E2 was used to maintain ductal patency and carbon dioxide was used through a respirator to control his pulmonary blood flow. He underwent Norwood operation at age 15 days under deep hypothermia and circulatory arrest. The postoperative course was smooth and occasional tachypnea was controlled by carbon dioxide inhalation through a mask. A follow up echocardiogram showed patent shunt and neoaortic pathway, good interatrial communication and mild tricuspid regurgitation. The baby survived and has fared well 2 years postoperatively. CONCLUSION: We recommend carbon dioxide manipulation before and after the Norwood operation for hypoplastic left heart syndrome with increased pulmonary blood flow uncontrollable by the respirator.

Carbon Dioxide↗
PubMed1995

Effects of prazosin on rat, guinea pig and human cardiac tissues.

In this study, the mechanical and electrophysiological effects of prazosin were examined in rat, guinea pig and human cardiac preparations. Prazosin (0.3 to 10 microM) inhibited the spontaneous beating rate of rat right atria and the twitch tension of driven left atria and right ventricular strips dose-dependently. Inward sodium current (INa) in isolated rat ventricular and guinea pig and human atrial cells was also inhibited by prazosin (1 to 10 microM) dose-dependently. Inhibition of INa in rat ventricular and guinea pig atrial cells by prazosin (1 to 10 microM) was not associated with the left shift of the voltage-dependent steady-state inactivation curves of INa. The time constant of recovery of INa from inactivation state was also unchanged. Compared with the inhibition of INa, the transient outward current (Ito), inwardly rectifying potassium current (IK1) and calcium inward current (ICa) in rat ventricular cells were unaffected by prazosin. The Ito in human atrial cells was also not affected by prazosin. It is concluded that prazosin inhibited INa by selective binding to open state of Na+ channels. The inhibition of INa is unrelated to the blockade of myocardial alpha 1-adrenoceptors but contribute to the negative inotropic effect of prazosin.

Animals↗
PubMed1995

Color Doppler ultrasound used for screening varicocele: the clinical significance as compared to physical examination.

The Acuson 128 XP color Doppler ultrasound (CDUS) unit has been applied to cases of infertility in the Chang Gung Memorial Hospital infertility clinic since November 1992. Seventy-four infertile males (group I) and 82 fertile cases (group II) with clinical obvious varicocele (detected by physical examination) were enrolled in this retrospective analysis. Subclinical varicocele (27%) may account for large group of the infertile men. It occurs almost bilaterally and can only be detected by CDUS. On the contrary, 26.8% of the cases with clinical obvious varicocele can be objectively ruled out by CDUS. Color Doppler ultrasound proved to be an easy, effective, convenient and noninvasive instrument for determining subclinical varicocele. It also helped to avoid unnecessary varicocelectomy in cases as judged by physical examination alone.

Humans↗
PubMed1994

Separation of ischiopagus tripus conjoined twins.

The authors report on their second experience of a successful separation of ischiopagus tripus conjoined twins. Particular emphasis is placed on the painful decision of sacrificing the only available leg to cover the infected wound after an unexpected complication in twin A. The twins' preoperative evaluation, separation surgery, and subsequent 16-month course are described.

Humans↗
PubMed1994

A new dosing regimen for esmolol to treat supraventricular tachyarrhythmia in Chinese patients.

OBJECTIVES: The purpose of this study was to find a safe dosing regimen for esmolol infusion to rapidly control supraventricular tachyarrhythmia after cardiac surgery in Chinese patients. BACKGROUND: Tachycardia increases cardiac work but reduces myocardial perfusion. Thus, in the critical period immediately after cardiac surgery, tachycardia itself warrants urgent intervention. Esmolol, an ultrashort-acting beta-adrenergic blocking agent, has been reported in western published reports to have good results and few side effects in the treatment of supraventricular tachyarrhythmia. However, its clinical application in Chinese patients has not yet been reported. METHODS: When supraventricular tachyarrhythmia with a rapid ventricular response (> 110/min) was found early after cardiac surgery, esmolol infusion with a different dosing regimen was used to control the tachyarrhythmia. RESULTS: With the dosing regimen recommended in western published reports (repeated loading infusion with stepwise increment), acute hypotension with systolic pressure < 80 mm Hg occurred in all six patients after 1 min of loading infusion of esmolol (500 micrograms/kg body weight per min). To avoid the aforementioned complications, a new dosing regimen was constructed. The initial infusion rate of esmolol was set at 150 or 100 micrograms/kg per min, depending on the patient's age and blood pressure. When the desired heart rate was achieved, the initial infusion rate was reduced to the maintenance infusion rate to maintain the therapeutic effect [Maintenance infusion rate = Initial infusion rate x (1 - e-0.077t), where t is the time period in minutes required by the initial infusion of esmolol to achieve the therapeutic effect]. With this new dosing regimen, tachycardia in most patients (9 of 11) could be controlled within 10 min, and no one experienced the side effect of hypotension. The maintenance infusion rate of esmolol needed to control supraventricular tachyarrhythmia in our patients was only 73 +/- 42 micrograms/kg per min (mean +/- SD), much less than that noted in western reports. CONCLUSIONS: The dosing regimen for esmolol infusion recommended in western studies is not suitable for Chinese patients. In this report we propose a new dosing regimen for esmolol infusion that is both safe and rapid in the treatment of supraventricular tachyarrhythmia in Chinese patients.

Adrenergic beta-Antagonists↗
PubMed1994

Haematological variations in pigs during experimental left ventricular assistance with a pulsatile impeller pump.

Left ventricular assistance with a pulsatile impeller pump was performed on 5 pigs. The pump delivered the blood from the left atrium to the aorta. The by-pass flow was adjusted to 40% of the total flow. All of the haematological variations were measured every hour. The results demonstrated that the pulsatile impeller pump caused less erythrocyte but more platelet damage than the nonpulsatile impeller pump in some experiments by dogs. The free haemoglobin was unchanged but lactate dehydrogenase increased remarkably in 6 h. Compared with the same experiments of the pulsatile impeller pump in goats and roller pump in pigs, it seems that the pig erythrocytes have more endurance to shear stress than that of dogs and goats, and pig platelets are more sensitive to mechanical force than those of other animals. The chronic experiment of pulsatile impeller pump is now in the planning stage for further investigations.

Animals↗
PubMed1994

Optic internal urethrotomy under transrectal ultrasonographic guide and suprapubic fiberoscopic aid.

Optic internal urethrotomy is the initial treatment of choice for most urethral strictures because of the relatively low morbidity and ease of accomplishment. However, the procedure is difficult and frustrating if a severe stricture or complete disruption of the urethra is encountered. Transrectal ultrasonography of the urethra offers good anatomical visualization, and defines the exact length and extent of bulbous and posterior urethral strictures, which could ensure a more accurate and aggressive incision of the stricture. Eleven patients (8 with posttraumatic and 3 with iatrogenic strictures) with complete obliteration of the bulbous and posterior urethra were successfully treated by optic internal urethrotomy with the aid of transrectal ultrasonography and a suprapubic fiberscope. After 1 year of followup, 5 of the 8 posttraumatic urethral strictures required further management, while the remaining patients had satisfactory results. Although the recurrence rate is high in the posttraumatic patients, transrectal ultrasound and the suprapubic fiberoscope afford a reliable and satisfactory aid during optic internal urethrotomy.

Adolescent↗
PubMed1994

Deoxyribonucleic acid flow cytometric study in pheochromocytomas and its correlation with clinical parameters.

OBJECTIVES: To study deoxyribonucleic acid flow cytometry (DNA-FC) in pheochromocytomas and its correlation with clinical parameters. METHODS: Fifty cases of pheochromocytomas of a total of 58 cases were studied for DNA-FC from archival paraffin-embedded tissue blocks and were correlated with clinical parameters (ie, size of tumor, benign or malignant pathologic type, vanillymandelic acid [VMA] level in 24 hour urine, age, sex, duration of symptoms, symptom scores). RESULTS: A total of 19 cases were diploid while 31 cases (62%) showed DNA aneuploidy with 21 cases tetraploid. Four cases were malignant. All of them were tetraploid. However, among the 46 benign cases, 10 were aneuploid and 17 were tetraploid. All 19 cases with DNA diploidy were benign. The DNA-FC did not correlate with other clinical parameters in our study. CONCLUSIONS: We confirmed a high incidence of DNA aneuploidy in pheochromocytomas. All malignant pheochromocytomas were tetraploid and all cases with DNA diploidy were benign. Long-term follow-up of all cases, especially those with DNA aneuploidy (including tetraploidy), is mandatory.

Adrenal Gland Neoplasms↗
PubMed1994

Traumatic asphyxia.

Four patients showing classic physical stigmata of traumatic asphyxia were studied. Cervicofacial cyanosis and edema, subconjunctival hemorrhage, and multiple ecchymotic hemorrhage of the face, neck, and upper part of the chest were documented. Admission Glasgow coma scale scores ranged from 8 to 15. All but one had no associated injury. Skin discoloration resolved within 3 weeks. Complete resolution of subconjunctival hemorrhage occurred 1 month later. In our series, sore throat, hoarseness, dizziness, numbness, and headaches were common. Profound lower leg pitting edema, hemoptysis, hemotympanum, and transient visual loss were noted. Chest radiographic findings were normal in all patients. Microscopic hematuria was noted in one patient. Diagnosis is made from the history and characteristic appearance of the patient. Treatment is directed to the associated injury. Oxygen supplement with head elevation to 30 degrees is the mainstay of treatment. If the patient survives the initial insult, the prognosis is excellent.

Adolescent↗
PubMed1994

Comparison of conventional and simultaneous compression-ventilation cardiopulmonary resuscitation in piglets.

To determine the mechanism of cardiac output and hemodynamic changes during cardiopulmonary resuscitation (CPR), we performed 60 min of CPR using a mechanical resuscitator ("Thumper", MII, USA) in 20 piglets (13.7 +/- 1.2 kg) following cardiac arrest induced by intravenous injection of KCl. Conventional CPR (C-CPR), i.e., 60 external chest compressions (60 psi force, 3 cm deep, and 50% duration) and 12 ventilations (following every 5th compression, with peak airway pressure of 30 cmH2O) per minute, was performed in 10 piglets; and simultaneous compression and ventilation CPR (SCV-CPR), i.e., 60 external chest compressions of the same magnitude, simultaneously with 60 ventilations (with peak airway pressure of 60 cmH2O) per minute, was performed in the 10 other piglets. Cardiac output in C-CPR and SCV-CPR was maintained near 70% or more of baseline throughout the CPR. Systemic vascular resistance dropped to below 50% of baseline. Systolic, mean and diastolic arterial pressures were maintained above 70, 40, and around 20 mmHg, respectively, during the first 30 min of CPR. Central venous pressure rose after arrest and subsequent CPR to above 25 mmHg, and remained high in SCV-CPR, but declined thereafter in C-CPR. Aortic diastolic minus right atrial diastolic pressure was around 15 mmHg early in CPR and dropped to almost zero thereafter. Serial arterial blood gas analyses showed a significant deterioration after 20 min of SCV-CPR. All but one piglet in the SCV-CPR group died after 60 min of CPR. Postmortem examination revealed that pulmonary barotrauma was more extensive and severe in SCV-CPR than in C-CPR.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Difference in efficacy of the Cell Saver in coronary bypass grafting surgery and cardiac valvular reoperations.

The efficacy of the Cell Saver in reducing transfusion requirements in patients who underwent either coronary artery bypass grafting (CABG) or reoperation for valvular replacement (Redo) were prospectively studied in 112 patients. In 41 patients, the Cell Saver was used from the beginning of the surgery (group 1), and in the other patients, no blood conservation techniques were undertaken (group 2). Perioperative hematological profile, postoperative chest tube drainage and transfusion requirements were examined in all patients. More red cells could be retrieved from the Redo patients than from the CABG patients (p < 0.05) during operation. The use of the Cell Saver in CABG patients reduced the total amount of blood transfusion required (p < 0.001). However, in the Redo patients, the use of the Cell Saver did not reduce the transfusion requirements during hospitalization. Furthermore, the amount of platelet concentrates transfused in the group 1 Redo patients was greater than the group 2 Redo patients. The use of the Cell Saver did not increase the postoperative chest tube drainage in either the CABG or the Redo patients. We conclude that the Cell Saver is useful in CABG patients, as far as the reduction of transfusion requirements is concerned; however, its efficacy in reducing transfusion requirements for Redo patients is questionable.

Blood Transfusion, Autologous↗
PubMed1994

Change of blood pressure and urine flow rate during cardiopulmonary bypass and its relation to postoperative renal function.

The relationship between the perfusion flow, the mean arterial pressure (MAP) and the urine flow rate during cardiopulmonary bypass (CPB) and the effect of oliguria developed during CPB on the postoperative renal dysfunction were studied prospectively in 69 open heart surgery patients. The MAP, the perfusion flow and the urine flow rate were monitored every five minutes during the first 45 minutes after the commencement of CPB and after the removal of the aortic cross clamp (AX). The serum creatinine (Cr), creatinine clearance (CCr) and blood urea nitrogen were measured before operation, as well as on the first, second and third postoperative days. The dosage of catecholamines and diuretics used and the duration of intubation and hospitalization in the intensive care unit were also recorded. The urine flow rate correlated with MAP much better than the perfusion flow during CPB (r = 0.4768, p < 0.0001). The urine flow rate and MAP decreased significantly after the initiation of CPB and after the release of the AX; however, oliguria developed only during the first 30 minutes of CPB. There were no differences in postoperative Cr, postoperative CCr, doses of catecholamines or diuretics, and the duration of intubation between patients with or without development of oliguria during CPB. Parameters measured during CPB could not predict CCr during the first three postoperative days. We conclude that it is MAP rather than perfusion flow which correlates with the urine flow rate during CPB. Periods of oliguria during CPB did not correlate with or help in the prediction of the development of postoperative renal dysfunction.

Blood Pressure↗
PubMed1994

Clinical experience of posterior urethral valves.

Nine patients with posterior urethral valves were seen at Chang Gung Memorial Hospital from 1985 to 1992. The age at presentation ranged from five days old to 28 years old. The presenting symptoms and signs included abdominal distension, urinary tract infection, respiratory distress, urinary ascites, and weak stream. Patients were examined by voiding cystourethrography and ultrasonography. Surgical management of these patients included primary valve ablation (three cases), cutaneous vesicostomy plus delayed valve ablation (five cases) and primary valve ablation with delayed ureteral reimplantation (one case). For small infants with posterior urethral valves (five cases), temporary vesicostomy and delayed valve ablation offers excellent results in preventing iatrogenic urethral stricture. However, for older children and young adults, the recommended treatment is primary valve ablation. For seven patients with nadir serum creatinine < 1.0 mg/dL, the renal function remained within the normal range, yet during follow-up, one case had renal insufficiency. Vesicoureteral reflux was found in five cases. Spontaneous resolution was noted in two cases after valve ablation, and three cases were controlled with prophylactic antibiotics. The experience of our series suggests that primary valve ablation may be traumatic to the neonatal urethra and temporary diversion would allow greater renal recovery during the neonatal period. With newer delicate instruments, valve ablation may be performed earlier and as a one-stage operation in the future.

Adolescent↗