Biomedical subjects

S T Ho

Publications and source records attributed to S T Ho.

At least 91 records · Page 5Linked to original sources

PubMed1997

The lost endotracheal tube--a rare complication of accidental esophageal intubation.

Endotracheal intubation is a discreet skill for the management of compromised airway. Various complications associated with this procedure have been described. Here, we would like to present a pediatric patient suffering from cerebellar atrophy, who was intubated in a local clinic due to seizure with cyanosis and loss of consciousness. Unfortunately, due to inadvertent esophageal intubation and bad management, the patient swallowed the endotracheal tube together with two detached loose teeth. This irrational and iatrogenic medical misconduct as exemplified in this accident calls forth the need of educating and disciplining the nonanesthetic physicians for acute management of airway, particularly of those who would likely come across difficult airway problems.

Child, Preschool↗

PubMed1997

The preemptive effect of pre-incisional bupivacaine infiltration on postoperative analgesia following lower abdominal surgery under epidural anesthesia.

BACKGROUND: In attempts to reduce central sensitization after tissue injury, the concept of preemptive analgesia has evolved. The aim of the present study was to evaluate the preemptive effect of pre-incisional infiltration of the surgical area with bupivacaine on pain following lower abdominal surgery under epidural anesthesia. METHODS: Sixty female patients scheduled for lower abdominal surgery under epidural anesthesia with bupivacaine were randomly divided into two Groups (n = 30, each). Five minutes before surgical incision, patients in Group 1 received subcutaneous infiltration of the proposed surgical area with 30 ml of 0.125% bupivacaine (with 1/200,000 epinephrine), while those in Group 2 received 30 ml of isotonic saline (with 1/200,000 epinephrine) infiltration. Postoperatively, pain was assessed for 48 h by a visual analogue scale of pain at rest, during cough and by cumulative morphine doses (self-administered by patient-controlled analgesia). RESULTS: The pain score at rest was significantly lower in Group 1 than in Group 2 from the 6th h to the 24th h postoperatively. The cough-associated pain score was lower in Group 1 than in Group 2 from the 6th h to the 28th h postoperatively. Furthermore, Group 1 consumed less morphine than did Group 2 from the 6th h to the 24th h postoperatively. CONCLUSIONS: The results indicate that pre-incisional infiltration of surgical area with bupivacaine markedly decreases the intensity of pain following lower abdominal surgery under epidural anesthesia.

Abdomen↗

PubMed1997

Brachial plexus injury during surgery--report of two cases.

Brachial plexus is the most commonly injured peripheral nerve by malposition during operation. We present two cases of transient brachial palsy after surgery under general anesthesia. Symptoms of the first case persisted about 60 min. Electromyography (EMG) and nerve conduction velocity (NCV) revealed no abnormal finding three days later. In the second case, axonal neuropathy was found at left axillary and suprascapular nerves by EMG and NCV three weeks later. Symptoms persisted for three months and had complete remission after conservative treatment.

Adenocarcinoma↗

PubMed1997

Effect of preoperative transdermal ketoprofen on post-hysterectomy pain.

BACKGROUND: In an attempt to reduce central sensitization after tissue injury, the concept of "pre-emptive analgesia" was evolved. The aim of the present study was to evaluate the analgesic effect of pre-incisional transdermal ketoprofen on post-hysterectomy pain. METHODS: Sixty patients scheduled for elective trans-abdominal total hysterectomy were divided into three groups. The day before surgery, patients in Group 1 received transdermal ketoprofen 30 mg over the proposed surgical area twice; patients in Group 2 received a placebo patch under a similar design; patients in Group 3 received transdermal ketoprofen 30 mg over right thigh twice. Operations were performed under general anesthesia. Postoperatively, patients received patient-controlled analgesia with morphine for pain relief, and pain was assessed by visual analogue pain scale (VAS). Hemodynamic parameters, respiratory rate, sedation scale, morphine consumption and associated side effects were also recorded. RESULTS: There was no significant difference among groups with respect to VAS, sedation scale, blood pressure, respiratory rate or morphine consumption within 24 hours postoperatively. The mean time for first morphine demand was significantly delayed in Group 1 patients (p < 0.05). The incidence of nausea and vomiting among the three groups showed no significant difference. CONCLUSIONS: It seems that pre-incisional transdermal ketoprofen (30 mg, twice the day before surgery) has only a limited pre-emptive effect on post-hysterectomy pain as indicated by delayed first morphine request. Further, it had no effect on postoperative VAS, morphine consumption or incidence of nausea and vomiting.

Administration, Cutaneous↗

PubMed1997

The analgesic effect of PCA buprenorphine in Taiwan's gynecologic patients.

BACKGROUND: The aim of this study was to evaluate the analgesic effect of PCA buprenorphine (intravenous) on postoperative pain in gynecologic patients of Taiwan and the potency ratio of buprenorphine versus morphine, a commonly used potent analgesic. METHODS: Fifty women undergoing abdominal total hysterectomy under spinal anesthesia were enrolled into the investigation. Patients were randomly divided into 2 groups (n = 25 each). Group 1 received intravenous buprenorphine using PCA device for the management of postoperative pain, whereas Group 2 received PCA morphine for the same purpose. During the first 48 hours postoperatively, we collected the following data: demand and delivery of analgesics, pain scores, vital signs, nausea, vomiting and pruritus. RESULTS: Despite different treatments, we found that pain scores on day 1 and day 2 postoperatively were low and were not significantly different between groups. Also, times of demand for delivery of PCA medication were not significantly different between groups. The cumulative consumption of buprenorphine and morphine within 48 h were 1.5 +/- 0.6 mg and 36 +/- 7 mg, respectively. The potency ratio between buprenorphine and morphine was 24:1. Both treatments showed only minor side effects. CONCLUSIONS: We found that PCA buprenorphine (intravenous) could be effective in the treatment of postoperative pain in the gynecologic patients in Taiwan and the potency ratio of buprenorphine versus morphine appeared to be 24:1.

Analgesia, Patient-Controlled↗

PubMed1997

Patient barriers to cancer pain management: from the viewpoint of the cancer patients receiving analgesics in a teaching hospital of Taiwan.

BACKGROUND: The purpose of this study was to investigate the barriers to receiving analgesics for cancer pain in Taiwanese patients. METHODS: The sample consisted of 128 hospitalized patients. All of the subjects were receiving analgesics. Three questionnaires entitled "Barriers Questionnaire-Taiwan Form (BQT)", "Brief Pain Inventory Short Form", and "Pain Management Index (PMI)" were used in this study. Data were analyzed using Student's t-test and Pearson correlation. RESULTS: The results showed that most of BQT subscales including disease progression, time interval, tolerance, injection, addiction, fatalism and side effects were approaching toward the moderate or high end of the scale. 42.1% (n = 54) of the patients had negative PMI scores indicating that they were using less than adequate analgesics for pain. There was a significant difference between those who had adequate medication and those who did not, in terms of disease progression score and the total BQT score. CONCLUSIONS: Overall the result revealed that pain management in these cancer patients was inadequate. Misconceptions on the part of patients still exist. Educational intervention could be an effective means for overcoming such barriers in Taiwanese patients who received analgesics for cancer pain.

Adolescent↗

PubMed1996

Determination of nalbuphine by high-performance liquid chromatography with ultraviolet detection: application to human and rabbit pharmacokinetic studies.

A rapid, sensitive, precise and accurate high-performance liquid chromatographic assay with ultraviolet detection was developed for the determination of nalbuphine in human, rabbit, pig and dog plasma. It is comprised of only a one-step extraction procedure with hexane-isoamyl alcohol at pH 9.25 and reversed-phase chromatography on a micro Porasil column. The recoveries of nalbuphine and ethylmorphine (internal standard) were greater than 86%. Calibration graphs were linear over the concentration range 0.75-150 ng/ml with a coefficient of variation, both within-day and between-day, of less than 10% at any level. The limit of quantitation was 0.75 ng/ml of plasma based on a signal-to-noise ratio of 3. Seven other clinically used analgesics were investigated to check for potential interferences and their analytical conditions. The specificity of this assay was checked with a metabolite of nalbuphine (noroxymorphine). Nalbuphine in plasma did not decompose significantly at -20 degrees C for six weeks. Pharmacokinetic application in three surgical patients and four rabbits revealed that nalbuphine followed a linear three-compartment model with two distribution phases. The two distribution and one elimination half-lives and the plasma clearance of nalbuphine were 0.9, 5.8 and 157 min and 370 ml/min in human, and 3.5, 28 and 117 min and 21 166 ml/min in rabbits.

Analgesics↗

PubMed1996

Blood lead levels in Taiwanese adults: distribution and influencing factors.

Five-thousand nine-hundred thirteen Taiwanese adults were selected by multistage sampling methods to investigate environmental lead exposure in Taiwan. The blood specimens were distributed to six laboratories for blood lead levels (BLL) measurement. The mean BLL of the 5913 Taiwanese adults was 8.28 +/- 5.39 microg/dl, with a maximum level of 57.6 microg/dl. The median was 7.0 microg/dl and 90th percentile was 15.0 microg/dl. BLLs were associated with gender, ethnic group, education level, smoking, alcohol consumption, herbal drug consumption, milk consumption, sources of drinking water, level of urbanization, and occupational lead exposure. These results showed that BLLs in Taiwanese adults were stable during the 2-year study. Most of the influencing factors were consistent with other studies, while local risk factors, such as Chinese herbal drug consumption are important ways of preventing the general population from overexposure to lead.

Adolescent↗

PubMed1996

Effects of NMDA receptor antagonists on inhibition of morphine tolerance in rats: binding at mu-opioid receptors.

Past studies have shown antagonists of excitatory amino acid receptors, both N-methyl-D-aspartate (NMDA) and non-NMDA, to produce an antinociceptive effect in vitro and in vivo. Additionally, NMDA receptor antagonists have been demonstrated to prevent morphine tolerance. We had found that one NMDA receptor antagonist, ketamine, potentiates morphine's analgesic effect in post-operative patients. Our latest experiment was performed to examine the modulatory effect of competitive and non-competitive NMDA receptor antagonists on morphine antinociception and tolerance. A PE10 catheter was intrathecally (i.t.) implanted in male Sprague-Dawley rats for drug administration. The antinociceptive effect of morphine, D-(-)-2-amino-5-phosphonovaleric acid (D-AP5) and (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d] cyclohepten-5,10-imine maleate (MK-801) was measured using the hot-water tail immersion test. Neither competitive nor non-competitive NMDA receptor antagonists had an antinociceptive effect by themselves, but they did potentiate the antinociceptive effect of morphine. Both D-AP5 (AD50 = 0.18 micrograms) and MK-801 (AD50 = 0.57 micrograms) shifted the antinociceptive dose-response curve of morphine (AD50 = 4.2 micrograms) to the left. Both D-AP5 (4 micrograms/h) and MK-801 (10 micrograms/h) when co-administered with i.t. morphine infusions (10 micrograms/h) also inhibited the development of tolerance. In [3H][D-Ala2,N-Me-Phe4,Gly5-ol]enkephalin ([3H]DAMGO) binding assays, MK-801 (Bmax = 32.90 +/- 3.33 fmol/mg) treatment prevented the down-regulation of mu-opioid receptor high-affinity sites induced by continuous morphine infusions alone (Bmax = 13.97 +/- 1.47 fmol/mg). D-AP5 (Bmax = 20.78 +/- 3.36 fmol/mg) did not prevent the reduction of mu-opioid receptor high-affinity sites. However, high-affinity sites in rats treated with D-AP5 and morphine displayed a higher affinity (KD = 0.45 +/- 0.09 nM) than those of control animals (KD = 0.95 +/- 0.08 nM). Results of this study indicate that competitive as well as non-competitive NMDA receptor antagonists enhance morphine's antinociceptive effect, and prevent the development of morphine tolerance. Thus, in our opinion, there opens a new frontier in clinical pain management, especially for those patients who require long-term opioid treatment for pain relief.

2-Amino-5-phosphonovalerate↗

PubMed1996

Three-year survey of blood lead levels in 8828 Taiwanese adults.

The purpose of this study was to investigate environmental lead exposure in the general Taiwanese population. A total of 8828 Taiwanese adults selected by a multistage sampling method were investigated. Characteristics of the participants were ascertained by questionnaire and 10 ml venous blood was drawn by public health nurses. The blood specimens were distributed to six laboratories for blood lead level (BLL) measurement. A quality control program was applied during the analysis of the BLLs in order to improve precision and accuracy. The arithmetic mean BLL of the 8828 Taiwanese adults was 7.70 +/- 5.23 micrograms/dl, with a maximal level of 69.1 micrograms/dl. The median was 6.5 micrograms/dl and the 90th percentile was 14.0 micrograms/dl. After logarithmic transformation, the geometric mean was 1.84 +/- 0.67 microgram/dl. This study also found that elevated BLLs were associated with certain personal characteristics, i.e., gender, ethnic group, and education level; life-style factors, such as smoking, alcohol consumption, Chinese herbal drug consumption, milk consumption, and sources of drinking water; residential location, i.e., level of urbanization; and occupational history of lead exposure. However, age, floor level of residence, distance from house to road, and betel nut consumption were not associated with elevated BLLs. These results showed that BLLs in the Taiwanese population were not higher than those in developed and developing countries. Most of the influencing factors were also found in other studies; however, local factors such as ethnic group, Chinese herbal drug consumption, and sources of drinking water are important considerations in Taiwan when examining ways to prevent overexposure to lead in the general population.

Adult↗

PubMed1996

Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain.

PURPOSE: Ketamine has been administered epidurally and intrathecally for operative and post-operative pain control. Animal studies showed potentiation of analgesia induced by ketamine and morphine. We hypothesized that intrathecal ketamine would potentiate the effects of intrathecal morphine in the treatment of cancer pain. METHODS: A double blind, cross over study was designed to evaluate the effect of ketamine on spinal morphine analgesia in terminal cancer pain patients. A two-phase protocol was used; phase M, intrathecal morphine alone twice daily; phase M + K, co-administration of ketamine (1.0 mg) with morphine intrathecally twice daily. The dose of morphine was titrated upwards until acceptable pain relief was achieved, defined by numeric rating scales (0-10) < or = 3, and the rescue dose of morphine was less than 5 mg after each intrathecal administration for two days. The dose of intrathecal morphine was defined as the effective dose. RESULTS: The effective dose of intrathecal morphine in phase M of 0.38 +/- 0.04 mg.day-1 was higher than that in phase M + K (0.17 +/- 0.02 mg.day-1) (P < 0.05). The average pain scales were 7.95 +/- 0.25 before intrathecal drug administration. Pain scales were decreased to 2.2 +/- 0.17 (P < 0.05) in phase M and 1.95 +/- 0.20 (P < 0.05) in phase M + K after the effective dose of morphine had been reached. No serious side effects were observed in this study. CONCLUSION: The present study demonstrates that ketamine enhances the analgesic effect of morphine, thus reducing the dose of intrathecal morphine.

Adult↗

PubMed1996

Development of a rapid DNA screening procedure for the Factor V Leiden mutation.

Aim-To develop a rapid, simple and highly specific DNA screening procedure based on the amplification refractory mutation system (ARMS) to detect the Leiden mutation in whole blood.Methods-ARMS PCR amplification primers with additional mismatches at either -2 or -3, which greatly improves specificity, were constructed to detect the normal Factor V gene and the Leiden mutation in whole blood samples from patients with abnormal clotting results.Results-Construction of ARMS primers with either an additional mismatch at -2 or -3 at the 3' end of the primer could be used to detect the Leiden mutation in 0.5 mu1 whole blood in under three hours. Primers destabilised at position -3 could be used at a lower annealing temperature, which gave greater sensitivity and are now routinely used. A control set of primers was included in the same reaction to act as a positive control.Conclusions-This rapid and specific assay for the factor V Leiden mutation is a useful addition to the investigation of patients with or at risk from thrombovascular disease.

Journal Article↗

PubMed1996

Cancer patients' knowledge of their diagnoses.

The most frequently discussed ethical issue on the subject of cancer is whether patients should be told their diagnosis. Cancer patients' knowledge of their diagnosis and the relationship between patient characteristics and that knowledge were evaluated in a cross-sectional study. From July 1992 to December 1993 at Tri-Service General Hospital, Taipei, a total of 964 patients with cytologically- or pathologically-proven cancer were studied. Of those studied, 359 patients (37.2%) knew their diagnosis. The proportion of patients who believed that they had a benign tumor was 25.1%; 12.6% believed they had nonneoplastic disease (inflammation or other chronic disease); 7.5% believed they had precancerous changes; and 17.6% knew nothing about their diagnosis. Multivariate analyses showed that patients with the following characteristics were inclined to know their diagnosis: younger age (20-59 yr), higher levels of education (> 9 yr) with relatives of a high socioeconomic status, cancer of a genital organ, cancer requiring disfiguring treatment (osteosarcoma, leukemia), cancer in obvious sites (head and neck), cancer of more than one type (multiple primary lesions), cancer of good prognosis (excluding lung, liver, gall bladder or pancreatic cancers), aggressive anticancer treatment and longer duration of pathologic proof (> 14 d). The results showed that concealing the diagnosis from cancer patients is still very common in Taiwan. Patient's sociodemographic background and disease-related factors were the most important patient characteristics related to their knowledge of the diagnosis.

Adolescent↗

PubMed1996

Paw pressure test in the rabbit: a new animal model for the study of pain.

BACKGROUND: In order to develop an animal model which is suitable for the pharmacokinetic (PK) and pharmacodynamic (PD) studies of analgesics in the field of pain assessment, we examined a new animal model, the paw pressure test (PPT), in rabbits for the study of pain. METHODS: The sensitivity of the model was tested with a broad range of drugs, including mu-opioid agonist (morphine), kappa-opioid agonist (nalbuphine), three non-opioid analgesics (acetaminophen, ketorprofen and indomethacin) and two non-analgesics (droperidol and diazepam). Furthermore, PK and PD studies of nalbuphine (chosen as an example of analgesics) were performed. RESULTS: The authors found that the PPT in rabbits recognized the antinociceptive activities of both opioid and non-opioid analgesics with no positive response to non-analgesics. AD50s determined by the PPT in rabbits for morphine and nalbuphine were 3.1 and 8.4 mg/kg, respectively. In the PK and PD studies, the plasma concentration time profiles of nalbuphine were well fitted to a linear two-compartment open model, and the correlation between pharmacokinetics and pharmacodynamics was significant (p < 0.05). CONCLUSIONS: These results suggest that the PPT in rabbits can be used extensively to explore the analgesic effects (PD) of a broad range of analgesics. Also, with this model, PK and PD studies of analgesics can be easily performed.

Analgesics, Non-Narcotic↗

PubMed1996

Interpleural bupivacaine for pain relief after transthoracic endoscopic sympathectomy for primary hyperhidrosis.

BACKGROUND: Interpleural local anesthetic has been reported to provide good postoperative pain relief in patients receiving thoracotomy or upper abdominal surgery. However, there were few reports regarding interpleural local anesthetic for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis. The aim of the present study was to evaluate the effect of interpleural bupivacaine for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis. METHODS: Sixty adult patients undergoing bilateral transthoracic endoscopic sympathectomy were randomly divided into two groups (n = 30, each group) for study. At the end of surgery, patients in group 1 were given bilaterally an injection of 0.5% interpleural bupivacaine (10 ml) through the surgical endoscope, whereas those in the group 2 who were not given any treatment at the juncture served as control. Postoperatively, intravenous morphine 2.5 mg was given luxuriously to the patients at their request at intervals of 30 min. The intensity of postoperative pain was assessed at rest and during cough with visual analogue scale (VAS, 0-10 points). RESULTS: It was showed that at rest the pain scores were less in group 1 than in group 2 within 4 h postoperatively. During cough, group 1 also had less VAS scores than group 2 within 5 h postoperatively. Furthermore, patients in group 1 consumed less intravenous morphine than those in group 2 within 6 h postoperatively. CONCLUSIONS: Interpleural bupivacaine significantly decreased the intensity of postoperative pain and morphine consumption in patients undergoing transthoracic endoscopic sympathectomy for palmar hyperhidrosis. We are looking forward to seeing that with the addition of epinephrine to the anesthetic solution and a considerable increase of dosage and/or volume of bupivacaine may provide a better and longer pain relief, about which further studies are needed.

Adult↗

PubMed1996

Spinal actions of nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the signs and symptoms of inflammation. They originated from man's early use of willow bark in the treatment of rheumatism. Although these drugs have been developed because of their effects on arthritis, their substantial analgesic and antipyretic actions have led to their widespread application. The NSAIDs are classified on the basis of their chemical structure under the category of acidic and nonacidic agents. The anti-inflammatory, analgesic and antipyretic effects of NSAIDs are attributable to their suppression of prostaglandin synthesis activity through cyclooxygenase inhibition. Regarding the analgesic effects of NSAIDs, initially, the peripheral mechanism was proposed. It has been assumed that the effects result from inhibition of the synthesis of prostaglandins in the peripheral inflamed tissue because prostaglandin may sensitize the peripheral nociceptors to the effects of other mediators released from the inflamed tissue. However, the central mechanism, acting within supraspinal or spinal level, was also suggested recently. Their exact sites and modes of action within the spinal cord are poorly defined, and even controversial. There are two main hypotheses to elucidate this issue. One is that the spinal analgesic actions are associated with prostaglandins synthesis, because of the excitatory effect of prostaglandins in the spinal cord and the other is dissociated from prostaglandins synthesis, and their effect may be related to their ability to affect the spinal nociceptive, processing cellularly or intracellularly. However, both mechanisms are probably linked. In conclusion, although the real mechanisms of the spinal analgesic actions of NSAIDs remain unclear, further basic and clinical studies should be made. In this way, we may hopefully provide more opportunities for effective pain management.

Analgesia↗

PubMed1996

Epidural coadministration of ketamine, morphine and bupivacaine attenuates post-herpetic neuralgia--a case report.

The N-methyl-D-aspartate (NMDA) receptor system plays an important role in nociceptive signal modulation in the central nerve system. There is considerable evidence that NMDA receptor antagonists can abolish hypersensitivity of nociceptors in animal models. In this case report, we described a patient who suffered post-herpetic neuralgia with severe pain, allodynia, and hyperesthesia over right side T2 to T8 dermatomes. Treatment with conventional doses of non-steroid anti-inflammatory drug (NSAID), antidepressant, anticonvulsant and benzodiazepine failed to provide satisfactory pain relief. With the patient's consent, we administered subanalgesic doses of ketamine (10 mg), morphine (1 mg), and 6 ml bupivacaine (0.1%) through the thoracic epidural route. After the treatment, hyperalgesia and allodynia improved dramatically, and the receptive field also reduced. After four weeks' treatment, satisfactory pain relief was achieved with conventional analgesics treatment. The combination of relatively low doses of morphine, ketamine and bupivacaine epidurally provides effective pain relief in this case. The result strongly suggests a synergy from this combination that warrants a formal study of the dose-response relationship involved in this treatment and the mechanism by which this effect is achieved. This regimen provides a promising treatment for the neuropathic pain with limited side effects.

Adult↗

PubMed1996

Erratic passage and anchorage of a right subclavian catheter caused by preoccupancy of an indwelling right jugular venous catheter--a case report.

We report a case of central venous catheter (CVC) malposition. Through subclavian approach the CVC tip was intended to anchor in the superior cava, but it turned out to be in the right internal jugular vein as revealed by chest X-ray. The cause of malposition was perhaps the preoccupancy of the jugular venous CVC which interferred with a normal advancement. Although the malposition of the catheter might not produce any immediate problem, later complication might occur. Thus, removal of a problematic catheter and recatheterization was indicated.

Aged↗