Biomedical subjects

Shih-Chieh Chueh

Publications and source records attributed to Shih-Chieh Chueh.

24 records · Page 2Linked to original sources

PubMed2002

Dopaminergic modulation of aldosterone secretions on changes of sodium intake in aldosterone-producing adenoma.

BACKGROUND: Impairment of renal dopamine excretion on high-salt diet (HS) may account for increased blood pressure (BP) in hypertensive subjects. Whether such impairment of dopaminergic activity exists in the adrenal gland is unknown. The purpose of this study was to differentiate degrees of dopaminergic inhibition of aldosterone secretion in patients with aldosterone-producing adenoma (APA). METHODS: A total of 15 patients with unilateral APA were fed a low-salt diet (LS) for 1 week, followed by another week on HS. At the end of each diet period, 24-h ambulatory BP recording, daily urine catecholamine measurement, and a metoclopramide test were performed. RESULTS: A high-salt diet increased both daytime and nighttime BP (P < .001), and urine dopamine excretion (P < .01). Intravenous injection of 10-mg metoclopramide increased plasma aldosterone concentrations (PAC) on both diets. The areas-under-the-curve for PAC between LS and HS were not different, but the area-under-the-curve for PAC increment was greater on HS (P < .05). Six patients with increment areas on HS greater than those on LS by 50% were termed "suppressible," and the remainders as "nonsuppressible." On HS, the so-called suppressible subjects had greater urine dopamine and less urine norepinephrine excretions (P < .05). The nonsuppressible subjects had greater percentage increase of nighttime BP by HS than the suppressible (for systolic BP, 13.1% v 4.5%, P < .01; for mean BP, 12.0% v 5.1%, P < .01, respectively), but no difference in daytime BP. CONCLUSIONS: Two subtypes of APA were defined according to their responses to metoclopramide during salt manipulation. On HS, the nonsuppressible subjects, with less dopaminergic inhibition of aldosterone secretion, had less urinary DA excretion and greater BP elevation. The renal and adrenal dopaminergic activities are regulated in a parallel fashion.

Adrenal Cortex Neoplasms↗

PubMed2002

Hand assisted laparoscopic bilateral nephroureterectomy in 1 session without repositioning patients is facilitated by alternating inflation cuffs.

PURPOSE: Transitional cell carcinoma is common and often multifocal in patients with uremia. We report a novel approach of simultaneous laparoscopic bilateral nephroureterectomy without the need to reposition patients. MATERIALS AND METHODS: Seven patients with uremia and organ confined transitional cell carcinoma of the upper urinary tract underwent simultaneous laparoscopic bilateral nephroureterectomy. Inflatable cuffs of an air tourniquet device were placed beneath each side of the back. Alternatively inflating the cuffs and rotating the operation table facilitated position changes during surgery. The incision for the hand assisted device during laparoscopy was also used for resecting the distal ureters in an open manner. Data were compared with those on 7 patients treated with simultaneous open bilateral nephroureterectomy. RESULTS: All laparoscopic bilateral nephroureterectomies were accomplished successfully without complications except for heart failure and atlectasis in a patient with a history of myocardial ischemia. Mean blood loss (218 versus 457 ml.), parenteral narcotic requirement (25 versus 60 mg. morphine equivalent), solid food oral intake (39 versus 83 hours), postoperative hospital stay (9 versus 14 days) and convalescence to normal nonstrenuous activity (3.5 versus 5.4 weeks) were superior in the laparoscopic bilateral nephroureterectomy group. Mean operative time was about 5 hours in each group. CONCLUSION: Our data show that laparoscopic bilateral nephroureterectomy facilitated by inflatable cuffs can be performed at 1 stage with a clear operative field and no repositioning problems.

Adult↗

PubMed2002

Technical considerations in hand-assisted laparoscopic live donor nephrectomy: initial Taiwan experience from National Taiwan University Hospital.

This report describes the initial experience of laparoscopic live donor nephrectomy (lap-LDN) in Taiwan and discusses the technical considerations and modifications of our technique. From September to November 2000, three (one right and two left) lap-LDNs were performed at our institute. The right kidney was retrieved in one donor because of an early branching of the left renal artery. The details of our technique are described for both left and right LDN. The perioperative parameters were compared to those of the 10 immediately preceding cases of LDNs using the traditional open approach. All lap-LDNs and open LDNs were successful, and all 13 recipients had smooth recovery of renal function. The donors recuperated better in the lap-LDN group with resumption of oral intake on postoperative day (POD) 1 and discharge on POD 5 (vs POD 3.4 and 8.5, respectively, in the open group). The mean blood loss was lower and narcotic use was less in the lap-LDN group (75 vs 164 mL, 25 vs 47 mg morphine sulfate equivalent, respectively). The extraction wound was much shorter in the lap-LDN group (6.5-8 vs 23 cm). The warm ischemia time was slightly but not significantly shorter in the open group (4 vs 2.75 min), and the average operative time was shorter in the open group. The results of our initial experience suggest that for surgeons with laparoscopic surgery experience, lap-LDN is a feasible procedure that decreases donor discomfort, while improving the quality of graft kidneys and the safety of the donor.

Humans↗

PubMed2002

Potential pool of non-heart-beating kidney donors in Taiwan: chart review in a regional hospital.

The annual number of renal transplantations performed in Taiwan is strictly limited by the availability of donor organs. One way to expand the donor pool is the use of non-heart-beating (NHB) donors. This study evaluated the potential number of NHB kidney-donors in Taiwan using a retrospective death chart review from a regional hospital in patients who died between January 1 and December 31, 1999. Exclusion criteria were extremities of age, systemic infection, malignancies other than primary brain tumor, uncontrolled diabetes mellitus, hypertension, kidney disease, or deaths with incomplete records. Detailed biomedical data of potential donors were collected. Of the 840 in-hospital deaths, 258 were in patients aged 3 to 65 years. Among these patients, 52 (6%) did not meet any exclusion criteria and were classified as potential kidney donors. Of these 52 patients, eight (1%) were classified as very suitable donors, defined as no diabetes mellitus, no hypertension, good renal function (serum creatinine < 1.3 mg/dL), age less than 50 years, and death in the intensive care unit or emergency service. Twenty-five of the remaining 44 sub-optimal potential donors who did not meet the criteria of very suitable were classified as having high potential to be donors by a combined scoring system (sum score = 5-6). The results suggest that there is a considerable number of potential NHB kidney-donors in Taiwan. Programs to advocate use of NHB kidney donors and education of the public and transplant professionals might significantly increase the number of kidneys available for transplantation in Taiwan.

Adolescent↗

PubMedDate not supplied

Cardiac glycosides induce resistance to tubulin-dependent anticancer drugs in androgen-independent human prostate cancer.

Due to high prevalence and mortality and the lack of effective therapies, prostate cancer is one of the most crucial health problems in men. Drug resistance aggravates the situation, not only in human prostate cancer but also in other cancers. In this study, we report for the first time that cardiac glycosides (e.g. ouabain and digitoxin) induced resistance of human prostate cancer cells (PC-3) in vitro to tubulin-binding anticancer drugs, such as paclitaxel, colchicine, vincristine and vinblastine. Cardiac glycosides exhibited amazing ability to reverse the G2/M arrest of the cell cycle and cell apoptosis induced by tubulin-binding agents. However, neither ionomycin (a Ca(2+) ionophore) nor veratridine (a Na(+) ionophore) mimicked the preventive action of cardiac glycosides, indicating that elevation of the intracellular Ca(2+) concentration and Na(+) accumulation were not involved in the cardiac glycoside action. Furthermore, cardiac glycosides showed little influence on the effects induced by actinomycin D, anisomycin and doxorubicin, suggesting selectivity for microtubule-targeted anticancer drugs. Using in situ immunofluorescent detection of mitotic spindles, our data showed that cardiac glycosides diminished paclitaxel-induced accumulation of microtubule spindles; however, in a non-cell assay system, cardiac glycosides had little influence on colchicine- and paclitaxel-induced microtubule dynamics. Using an isotope-labeled assay method, we found that ouabain modestly but significantly inhibited the transport of [(14)C]paclitaxel from the cytosol into the nucleus. It is suggested that cardiac glycosides inhibit the G2/M arrest induced by tubulin-binding anticancer drugs via an indirect blockade on microtubule function. The decline in transport of these drugs into the nucleus may partly explain the action of cardiac glycosides.

Androgens↗

PubMedDate not supplied

Clipless needlescopic bilateral varix ligation.

We report a novel technique of clipless needlescopic bilateral varix ligation and compare its results with the conventional laparoscopic approach. The positions of ports and surgical procedures were similar to those of the conventional 3-port laparoscopic technique, but all 5- and 10-mm trocars were replaced by 2-mm trocars. The internal spermatic veins proximal to the internal inguinal ring were isolated and coagulated for an adequate segment with a 2-mm bipolar electrocautery apparatus and then transected. The perioperative parameters of 25 patients operated on in this manner were compared with a historical cohort of 25 patients operated on using the conventional laparoscopic approach. Both groups of patients had uneventful surgery with no complications. The mean amount of analgesics used (1.25 vs 3.68 mg of morphine sulfate equivalent, P=.03), the maximal and mean postoperative pain scores (3.5 vs 5.6 and 2.5 vs 4.0, respectively, both P <.05), the postoperative hospital stay (0.5 vs 1.1 days, P=.03), and convalescence to normal activity (0.56 +/- 0.3 vs 1.64 +/- 0.4 weeks, P=.01) were all significantly decreased in the needlescopic group. We conclude that needlescopic bilateral varix ligation not only is feasible and safe but also provides the same therapeutic efficacy of a conventional laparoscopic approach; most importantly, it causes less pain and yields faster convalescence and excellent cosmetic results.

Adult↗