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Biomedical subjects

T D Wang

Publications and source records attributed to T D Wang.

At least 19 recordsLinked to original sources
PubMed2001

Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population.

In this study, we assessed the efficacy of various lipid and lipoprotein measurements at baseline for predicting the risk for coronary heart disease (CHD) and determined the associated risk of CHD in subgroups stratified by different lipid and lipoprotein screening strategies to evaluate the adequacy of current total and low-density lipoprotein (LDL) cholesterol-based approaches in lipid management. We analyzed data from the Chin-Shan Community Cardiovascular Cohort study, a Chinese population-based prospective cohort study that began in 1990. During an 8-year follow-up period, 213 of 3,159 participants (6.7%) without CHD (aged > or =35 years) developed CHD. The total cholesterol/high-density lipoprotein (HDL) cholesterol ratio was the most powerful lipoprotein predictor of future CHD (hazard ratio 1.21 for a 1.0 increment in ratio; p <0.001). Subjects with "high-risk" LDL cholesterol levels (>160 mg/dl) and low total cholesterol/HDL cholesterol ratios (< or =5) had an incidence of CHD similar to those with low levels of both LDL cholesterol (< or =130 mg/dl) and total cholesterol/HDL cholesterol ratios (4.9% vs 4.6%). In contrast, subjects with "low-risk" LDL cholesterol levels (< or =130 mg/dl) and high total cholesterol/HDL cholesterol ratios (>5) had a 2.5-fold higher incidence of CHD than those with similar LDL cholesterol levels but low total cholesterol/HDL cholesterol ratios (p <0.001). Compared with using an LDL cholesterol level of 130 mg/dl as the cut-off point, using a total cholesterol/HDL cholesterol ratio of 5 was associated with superior specificity (73% vs 59%, p <0.001) and accuracy (72% vs 58%, p <0.001), and similar sensitivity (50% vs 53%). Our data indicate that current guidelines for lipid management may misclassify subjects with high levels of HDL and LDL cholesterol as well as those with low levels of HDL and LDL cholesterol. Using the ratio of total to HDL cholesterol as the initial screening tool can obviate this discrepancy.

Adult↗
PubMed2001

Gemfibrozil treatment potentiates oxidative resistance of high-density lipoprotein in hypertriglyceridemic patients.

BACKGROUND: Studies suggest that both oxidized low and high density lipoprotein (LDL and HDL) play a role in the pathogenesis of atherosclerosis. Gemfibrozil is widely used and is reported to increase cholesterol of LDL and HDL in hypertriglyceridemic patients. The aim of this study was to investigate the effect of gemfibrozil treatment on the oxidative status of lipoprotein particles in Fredrickson phenotype IV hypertriglyceridemic patients. METHODS: Twenty-two patients, aged 38-64 years, with fasting plasma triglyceride concentrations between 2.90 and 8.97 mmol L(-1), were recruited and were given gemfibrozil 300 mg three times daily for 12 weeks. Venous blood samples were collected before gemfibrozil treatment, after 4, 8, or 12 weeks of treatment, and 4 weeks after termination of treatment, and used to analyse the plasma lipid profile, isolate lipoproteins, and analyse the chemical composition and in vitro oxidation of lipoprotein particles. RESULTS: Gemfibrozil treatment resulted in a decrease in plasma total triglyceride levels and the triglyceride content of all lipoproteins. Plasma total cholesterol levels were decreased as a result of a decrease in very low density lipoprotein (VLDL) cholesterol levels. A slight increase in LDL cholesterol levels was observed, whereas the thiobarbituric acid-reactive substances (TBARS) of LDL were decreased and the lag and peak time of LDL to oxidation were unchanged and maximal diene production was decreased. Plasma HDL cholesterol levels, the surface-to-core ratio of HDL particles, and the resistance of HDL to oxidation were increased. CONCLUSION: The decreased TBARS and diene production of LDL, increased HDL cholesterol levels, and increased resistance of HDL to oxidation may, in part, explain why gemfibrozil treatment was found to be generally beneficial in terms of protection against coronary heart disease.

Administration, Oral↗
PubMed2001

Increased levels of tissue plasminogen activator antigen and factor VIII activity in nonvalvular atrial fibrillation: relation to predictors of thromboembolism.

INTRODUCTION: Given that nonvalvular atrial fibrillation (AF)-associated stroke can be either cardioembolic or atherothrombotic, we investigated the relationships between nonvalvular AF and hemostatic factors reflecting intrinsic thrombogenic and atherogenic potentials (tissue plasminogen activator [t-PA] antigen, plasminogen activator inhibitor-1, and factor VIII activity). We also evaluated the clinical applicability of these hemostatic factors by examining whether AF subjects with established clinical or echocardiographic predictors of thromboembolism had higher levels of these factors. METHODS AND RESULTS: Of the 3,212 participants of a Chinese population-based study, 53 subjects (1.7%) with AF were identified. Among the hemostatic factors measured, t-PA antigen (median 12.8 vs 8.1 ng/mL; P < 0.01) and factor VIII activity (median 155% vs 133%; P < 0.05) were significantly higher in AF subjects after adjustment for age and sex. In multivariate analysis, features independently associated with t-PA antigen levels were AF, sex, body mass index, systolic blood pressure, total cholesterol, triglycerides, and left ventricular systolic dysfunction. Features independently associated with factor VIII activity levels included AF, age, and total cholesterol. Levels of both t-PA antigen and factor VIII activity were primarily elevated in AF subjects with predictors of thromboembolism (age > 75 years, hypertension, diabetes, and left ventricular systolic dysfunction), whereas in AF subjects with no thromboembolic predictors, plasma levels of hemostatic factors examined were similar to those without AF. CONCLUSION: We demonstrated that nonvalvular AF was independently associated with increased peripheral levels of t-PA antigen and factor VIII activity. Levels of both hemostatic factors were primarily elevated in AF subjects with predictors of thromboembolism. Whether these hemostatic factors are independently predictive of future thromboembolic events in AF patients requires further investigation.

Adult↗
PubMed2001

Local flaps in scar revision.

Local and regional skin flaps provide the foundation for reconstructive surgery of the face. When planned and executed properly, local skin flaps provide rapid reconstruction using donor tissue with excellent color and texture match, and a reliable, adequate blood supply. The majority of local skin flaps are utilized for reconstruction after superficial cancer extirpation, however, unfavorable scars from previous trauma, burns, or reconstruction efforts provide the motivated patient and surgeon another opportunity to restore form and function. This article reviews techniques commonly used to reconstruct the face and provides several cases where these techniques were successfully employed.

Cicatrix↗
PubMed2000

Dilemma in managing spontaneous pneumoperitoneum: a case report.

Pneumoperitoneum is often associated with an underlying severe life-threatening emergency. This emergency is always treated successfully by a surgical approach. When a patient situated in hopeless situation but is found with spontaneous pneumoperitoneum, it creates a dilemma. We deal with such a rare situation which occurred in a 58-year-old woman with recurrent cervical carcinoma. The patient received a radical hysterectomy, pelvic lymph node dissection and bilateral salpingo-oophorectomy 10 years ago. Recurrent retroperitoneal lymphadenopathy and inguinal lymphadenopathy were suspected by computed tomography and proven by excision biopsy of inguinal lymph node. She received a complete course of concurrent chemoradiation therapy; however, clinically persistent disease was suspected although it was very difficult to prove. Unfortunately, the case was complicated by severe radiation fibrosis over the whole abdominal wall, poor appetite and urinary tract infection. She was treated with supportive care treatment. Nevertheless, the patient was attacked by spontaneous pneumoperitoneum during hospitalization and died later and autopsy of the patient showed military carcinomatosis of the abdominal cavity and lower abdominal wall without any evidence of internal hollow organ perforation and intraabdominal infection. The cause of death might be related to her carcinomatosis with severe chacexia. Because pneumoperitoneum is always considered as a surgical emergency, we reviewed the possible causes of non-surgical pneumoperitoneum to avoid an unnecessary surgical approach.

Female↗
PubMed2000

[Laryngeal function preservation in comprehensive therapy of carcinoma of pyriform sinus].

OBJECTIVE: To investigate the sufficiency of comprehensive therapy in the preservation of laryngeal function of carcinoma of pyriform sinus. METHOD: Since 1986, 33 cases of pyriform sinus carcinoma were treated, the clinical stages were as follows: stage I 2 cases, stage II 9 cases, stage III 12, stage IV 10. The induced chemotherapy agents were cisplatin, methotrexate and pingyangmycin. Surgical treatment include local dissection of tumor, partial hypopharynx and partial larynx dissection. All patients were received postoperative radiotherapy. RESULT: Chemotherapy partial response rate was 42.4%, 3 years survive rate was 54.8%, 5 years survive rate was 38.7%. CONCLUSION: The cisplatin centered combined induced chemotherapy was effective in the treatment of pyriform sinus, the laryngeal function preservation surgical treatment of pyriform sinus carcinoma in T1 T2 and selective T3 patients is practicable. Postoperative radiotherapy can improve the local control rate.

Adult↗
PubMed2000

[The clinical features of laryngeal malignant lymphoma with 5 cases reported].

OBJECTIVE: To improve the diagnosis and treatment of laryngeal malignant lymphoma. METHOD: Clinical features of 5 cases were reported and recent literatures were reviewed. RESULT: 2 cases presented with large ulcerated lesions and their laryngeal structure were destroyed, their prognosis were poor. Another 3 cases were local primary lesions, they were generally associated with a relatively short history of hoarseness and dysphagia and exhibited grey-white neoplasms with preferential involvement in the supraglottic parts of larynx, but non-ulcerated lesions, they were treated with operation and radiotherapy or chemotherapy or combinations. The prognosis were very well after 2 to 6 years follow up. CONCLUSION: It is important for the local primary lesion to be diagnosed correctly for the treatment and prognosis.

Adult↗
PubMed1999

In vivo identification of colonic dysplasia using fluorescence endoscopic imaging.

BACKGROUND: Previous in vitro studies showed that autofluorescence images of colonic mucosa collected endoscopically can be used to detect dysplasia with high sensitivity. This method is extended to the collection of fluorescence images of adenomatous polyps in vivo. METHODS: Fluorescence images were collected during colonoscopy in 30 patients. A total of 12 adenomatous and 6 hyperplastic polyps were identified. A fiberoptic excitation probe, located in the instrument channel of the colonoscope, delivered 300 mW of near-ultraviolet light at lambdaex = 351 and 364 nm. Mucosal fluorescence in the spectral bandwidth between 400 and 700 nm was imaged, processed, and displayed with various likelihoods of associated dysplasia. RESULTS: Adenomatous polyps exhibited decreased fluorescence intensity compared with adjacent mucosa with normal appearance. With the fluorescence threshold set to 80% of the average intensity of normal mucosa, a sensitivity of 83% for dysplasia identification was achieved. All hyperplastic polyps were correctly identified as being non-dysplastic. Optimal identification of dysplastic regions was obtained with the colonoscope oriented at a near-normal angle of incidence to the polyps. At higher angles of incidence, artifacts caused by illumination shadows were introduced. CONCLUSIONS: The dysplasia associated with adenomatous polyps can be identified in vivo by fluorescence imaging with high sensitivity, thus demonstrating the potential to guide endoscopic procurement of biopsy specimens.

Adenomatous Polyps↗
PubMed1999

The effects of dyslipidemia on left ventricular systolic function in patients with stable angina pectoris.

Large-scale clinical trials have shown that long-term treatment with lipid-lowering therapy results in a significant reduction in the occurrence of heart failure among patients with coronary artery disease without previous evidence of congestive heart failure, suggesting dyslipidemia may have an adverse effect on left ventricular performance. To examine whether dyslipidemia has a detrimental effect on left ventricular systolic function and whether this effect is dependent on the corresponding severity of coronary atherosclerosis, 114 consecutive patients with stable angina and a positive exercise thallium-201 myocardial perfusion single-photon emission computed tomography were studied. All patients underwent measurement of serum lipid profiles, right-sided heart catheterization, left ventriculography, and selective coronary arteriography. Mean serum levels of total cholesterol and triglycerides were 4.5 and 1.4 mmol/l, respectively. In univariate analysis, a significant positive correlation between serum high-density lipoprotein (HDL) cholesterol and left ventricular ejection fraction (LVEF) (r = 0.49, P<0.0001) was found. Patients in the lower tertile of serum HDL cholesterol had a significantly lower mean LVEF than those in the upper tertile (55.9+/-15.2 vs. 72.8+/-6.8%, P<0.0001). Stepwise multiple linear regression analysis revealed that LVEF significantly correlated with HDL cholesterol (P<0.0001), the Gensini score (P = 0.008), and diabetes mellitus (P = 0.08) (r = 0.55, P<0.0001). In subgroup analysis of patients with angiographically normal coronary arteries, serum HDL cholesterol was still significantly associated with LVEF. The present study demonstrated an independent association between low HDL cholesterol and subclinical left ventricular systolic dysfunction in Chinese patients with stable angina whose serum levels of total cholesterol and triglycerides were relatively low. Moreover, this correlation remained significant even in patients with normal coronary angiograms, suggesting HDL cholesterol might influence left ventricular systolic performance through extra-atherosclerotic mechanisms.

Aged↗
PubMed1999

Unilateral cleft rhinoplasty: a review.

Correction of the unilateral cleft lip nasal deformity can be a formidable surgical challenge. Multiple techniques have been developed over the last 75 years addressing the deformity. This article is a review of those surgical techniques. The most successful techniques and the reasons behind their effectiveness are described and analyzed.

Age Factors↗
PubMed1999

Skeletal implants in aesthetic facial surgery.

The features of the nose, mentum, and malar complex define a person's profile and give the essence of character to the visage. Whether profile deficiencies are due to congenital, traumatic, or aging factors, facial plastic surgeons are able to meet patients' and their own exacting demands more thoroughly with skeletal implants. Although the search for the perfect implant continues, today's armamentarium of implant materials is vast and, with appropriate selection and attention to technique, facial skeletal implants can be successful in creating change impossible to obtain with soft tissue techniques alone. This article reviews both the biomaterials used in mandibular and malar complex implants and the techniques.

Biocompatible Materials↗
PubMed1999

The Internet and the World Wide Web.

The Internet offers easy, unrestricted access to an incredible volume of information. Once cumbersome methods of information retrieval and communication, the Internet and World Wide Web are now vital tools in medical practice. This article discusses current Internet technology and provides the basics necessary to incorporate this useful medium into your practice.

Face↗
PubMed1999

Malignant mixed mesodermal tumor presenting as metastatic lymph node adenosquamous cell carcinoma: a case report.

A solitary inguinal lymph node metastasis from a poorly differentiated adenosquamous cell carcinoma of unknown origin in a 52-year-old female is described. The patient was reported to have had a 2-cm palpable mass in the left inguinal area for three years. She had made regular annual clinic visits for Pap smears since the age of 45 years. Her last visit was eight months prior to a complaint of progressive abdominal distention and dull pain of three months' duration. Physical examination showed a huge pelvic mass, and ultrasound and magnetic resonance imaging of the abdomen showed a 12-cm complex solid mass on the left ovary. The patient underwent a complete excisional biopsy of the left inguinal lymph node. Frozen section pathology revealed a poorly differentiated adenosquamous cell carcinoma. Exploratory laparotomy immediately followed pathologic confirmation of malignancy of the left inguinal lymph node. Complete surgical staging including abdominal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, retroperitoneal lymph node sampling and excisional biopsy was performed for all suspicious lesions. Stage IIIC malignant mixed mesodermal tumor (MMMT) was diagnosed due to positive left inguinal lymph node metastasis. However, the retroperitoneal lymph node and intra-abdominal cavity did not show spread of the tumors, except those confined to the left ovary with adhesion to the cul-de-sac, and sole lymph node metastasis in a left inguinal lymph node. Although we could not prove that the left inguinal lymph node metastasis had been present for the three years that it was palpable without histologic confirmation, we believe that any enlarged inguinal lymph node might be the first hint of underlying malignancy in the pelvic area, lower extremities or perineal area. In cases of a poorly differentiated carcinoma of inguinal lymph nodes of unknown origin, the abdomen should be carefully evaluated.

Carcinoma, Adenosquamous↗
PubMed1998

Increased ventricular repolarization inhomogeneity during postural changes in patients with syndrome X.

The interlead variation in QT interval (QT dispersion) can be used to assess regional inhomogeneity of ventricular repolarization under a variety of conditions, including stress. Patients with syndrome X may have increased sympathetic activity that could change QT interval regionally and give rise to an increase in QT dispersion under exercise testing. To test the hypothesis, 26 consecutive patients with syndrome X (group 1) were studied. Two additional groups matched in terms of age, sex, and left ventricular mass index consisting of 26 nonconsecutive patients with coronary artery disease (group 2) and 20 normal subjects (group 3) were studied for comparison. Standing induced a significantly higher increase of heart rate in group 1 than in groups 2 and 3 (7.5+/-6.0 vs 4.0+/-6.3 and 1.1+/-3.6 beats/min; p = 0.05 and 0.003, respectively). There were significant differences in QT dispersion between groups 1 and 2 on upright standing (48+/-12 vs 34+/-14 ms, p = 0.0003), but not at baseline (33+/-14 vs 38+/-11 ms, p = NS) or at peak exercise (38+/-9 vs 38+/-9 ms, p = NS). Results did not change when QTc dispersion was substituted for QT dispersion. From a conditional multivariate logistic regression analysis, the only independent predictor of occurrence of syndrome X on upright standing was QTc dispersion (odds ratio = 1.255, p = 0.01). Electrocardiographic QTc dispersion provides important clinical information. Patients with syndrome X had a higher increase of heart rate and QTc dispersion in response to standing from the supine position compared with patients with coronary artery disease and normal subjects.

Adult↗
PubMed1998

Dyslipidemias have a detrimental effect on left ventricular systolic function in patients with a first acute myocardial infarction.

Several large-scale clinical trials have shown that lipid-lowering interventions are associated with reduced coronary events and mortality. However, whether dyslipidemias have a detrimental effect on the evolution of myocardial infarction (MI) is still unknown. To examine whether dyslipidemias can aggravate myocardial vulnerability following MI, 165 patients with a first MI were studied. All patients underwent measurements of serum lipid profiles 1 week and 3 months after MI, a radionuclide ventriculographic study, and a coronary angiographic study. The patients were divided into 3 groups according to their 3-month serum cholesterol levels (group 1, <200 mg/dl; group 2, 200 to 240 mg/dl; group 3, >240 mg/dl). Groups 1, 2, and 3 consisted of 66, 59, and 40 patients, respectively. Group 3 had a higher Gensini score than groups 1 and 2, although this was not statistically significant (p = 0.13). The postinfarct left ventricular ejection fraction (LVEF) was highest in group 1 (53 +/- 13%), at mid level in group 2 (43 +/- 14%), and lowest in group 3 (35 +/- 11%) (p < 0.0001). A significant negative correlation between 3-month low-density lipoprotein (LDL) cholesterol (r = -0.55, p < 0.0001) and the postinfarct LVEF was found. The product of peak creatine kinase (CK(MAX)) and time to CK(MAX) (p = 0.001), and patency of the infarct-related artery (p = 0.009), rather than variables of coronary atherosclerosis, were also independent predictors of the postinfarct LVEF. Increases in 1-week LDL cholesterol and decreases in 1-week high-density lipoprotein cholesterol were associated with a higher CK(MAX) and a lower patency rate of the infarct-related artery, respectively. This study revealed that dyslipidemias per se, especially LDL cholesterol, had a detrimental effect on the postinfarct LVEF; this effect might be independent of the atherogenic properties of dyslipidemias.

Aged↗
PubMed1997

Left isomerism in a middle-aged woman with early-onset atrial fibrillation.

An unusual case of left isomerism in a 52-year-old woman with early-onset atrial fibrillation was presented. Magnetic resonance imaging clearly delineated the morphology of both atrial appendages, the vascular anatomy and all other associated anomalies, obviating further invasive studies. The discovery of left isomerism at advanced age indicates that abnormal atrial situs itself is of less clinical importance, and despite the associated sinus node dysfunction may predispose the heart to atrial fibrillation.

Abnormalities, Multiple↗
PubMed1997

Myocardial stunning after cerebral infarction.

Myocardial stunning has not been described in patients with cerebrovascular accidents. We present a patient in whom inferior wall hypokinesis, ST-segment elevations and Q waves developed after acute right hemisphere ischemic stroke. Total recovery ensued within 5 days. Coronary vasospasm induced by stroke-related sympathetic surge might be the cause of this cardiac event.

Aged↗