Biomedical subjects

T Y Lee

Publications and source records attributed to T Y Lee.

At least 19 recordsLinked to original sources

PubMed1995

Postoperative T-tube cholangiography: is routine antibiotic prophylaxis necessary? A prospective, controlled study.

OBJECTIVE: To determine the value of antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography. DESIGN: A prospective, controlled study. SETTING: A tertiary care center. STUDY PARTICIPANTS: The role of antibiotic prophylaxis during postoperative T-tube cholangiography was prospectively evaluated in 164 patients. INTERVENTION: Sixty-two patients were administered antibiotic prophylaxis treatment (1 g of cephalothin sodium was infused intravenously 30 minutes before the procedure and 500 mg of cephalexin was given orally every 6 hours for 3 days after the procedure). Seventy-one patients were in the control group and did not receive antibiotic therapy. MAIN OUTCOME MEASURES: Complications and adverse reactions following postoperative T-tube cholangiography were recorded and compared between the two groups. RESULTS: There was no significant difference between the groups in regard to age, sex, serum amylase level before T-tube cholangiography, white blood cell count, and liver function. The results of the bacteriologic culture specimens of the bile were also comparable between the groups. One patient who had received antibiotic therapy and one patient in the control group had fever (temperature, > 38 degrees C) and chills after the procedure. Two patients who had received antibiotic therapy and one patient in the control group had mild abdominal pain. These complications were treated conservatively without any event. No significant difference was found in the rates of complications and the success of postoperative T-tube cholangiography between the groups. CONCLUSION: Routine antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography is not necessary under selected conditions.

Bacterial Infections↗

PubMed1995

The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess.

OBJECTIVES: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non-gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. MAIN OUTCOME MEASURES: A chi 2 test for qualitative data and Student's test for quantitative data. RESULTS: Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6 +/- 10 days) (P < .005) and the incidence of septic shock was higher in the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P < .01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (> 5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non-gas-forming group (27.7% vs 14.4%) (P < .01). CONCLUSIONS: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.

Adult↗

PubMed1995

Ultrasonographic scanning of placental thickness and the prenatal diagnosis of homozygous alpha-thalassaemia 1 in the second trimester.

In order to evaluate the association between placental thickness (PT) and fetal homozygous alpha-thalassaemia 1 before the appearance of classic ultrasound findings of haemoglobin (Hb) Bart's hydrops fetalis, a total of 473 pregnancies were collected. The control group included 422 normal pregnancies with a gestational age from 14 to 23 weeks and the study group included 51 affected fetuses in the same gestational period. Fetal biparietal diameter (BPD) and PT were measured by high-resolution ultrasound. PT was evaluated against BPD. In the control group, the PT generally increased in parallel with the advancement of gestational age. All PT measurements in the study group were above the mean PT of their respective gestational week in the control group. Forty-six (90 per cent) of the pregnancies in the study group had PT larger than the mean plus two standard deviations of the control group. This study suggests that ultrasound measurement of PT may be a useful aid in the prenatal diagnosis of Hb Bart's hydrops fetalis before its classic findings become apparent in the late second trimester or third trimester.

Female↗

PubMed1995

Prenatal diagnosis by transabdominal chorionic villus sampling in the second and third trimesters.

From October 1989 through December 1993, 124 pregnant women (114 in the second trimester and 10 in the third trimester) underwent transabdominal chorionic villus sampling (CVS) for prenatal molecular or cytogenetic diagnosis. The mean gestational age was 18.2 weeks. Indications for CVS comprised single gene disease (72%), fetal anomalies detected by ultrasound (17%), advanced maternal age (6%), and previous siblings with chromosomal aberration (5%). Among the 89 fetuses at risk for single gene disease, 20 were diagnosed as affected by DNA analysis. Among the 35 fetuses at risk for chromosomal anomaly, 4 had trisomy, 3 had a 45,XO karyotype and 2 had a structural chromosomal abnormality. The miscarriage rate was 1.8% (2/114) and the spontaneous preterm birth rate was 2.4% (3/124). No maternal or other fetal complications occurred. This study suggested that second- and third trimester CVS is a safe and useful method for prenatal diagnosis.

Abnormalities, Multiple↗

PubMed1995

Primary gas-containing mediastinal abscess in a diabetic patient.

A case of primary gas-containing mediastinal abscess is reported. Mediastinal widening was seen on the chest radiograph of a diabetic patient who presented with nonspecific symptoms of shortness of breath and abdominal pain of 3 days' duration. The diagnosis of primary gas-containing mediastinal abscess was established by the characteristic findings of computed tomography and exclusion of all the etiological possibilities. The patient was treated by closed chest tube drainage and antibiotic therapy with an uneventful outcome. Primary gas-containing mediastinal abscess should be included in the differential diagnosis when treating a diabetic patient with mediastinal widening.

Abscess↗

PubMed1995

"Spoke wheel" sign of small intestinal volvulus.

Radiographic diagnosis of small intestinal volvulus and gangrenous change produced by an adhesive band is presented. A soft-tissue mass with radiating mucosal folds simulating a "spoke wheel" was found in the right mid-abdomen. Expansion of the mass was documented on a follow-up radiograph 3 hours later. A "spoke wheel" sign is reported as an early indication of small intestinal volvulus.

Adult↗

PubMed1995

Ductal dilatation and stenting make routine hepatectomy unnecessary for left hepatolithiasis with intrahepatic biliary stricture.

BACKGROUND: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture. METHODS: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledochoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered. RESULTS: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months. CONCLUSIONS: Postoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.

Adult↗

PubMed1995

Diverse spermatogenic defects in humans caused by Y chromosome deletions encompassing a novel RNA-binding protein gene.

We have detected deletions of portions of the Y chromosome long arm in 12 of 89 men with azoospermia (no sperm in semen). No Y deletions were detected in their male relatives or in 90 other fertile males. The 12 deletions overlap, defining a region likely to contain one or more genes required for spermatogenesis (the Azoospermia Factor, AZF). Deletion of the AZF region is associated with highly variable testicular defects, ranging from complete absence of germ cells to spermatogenic arrest with occasional production of condensed spermatids. We find no evidence of YRRM genes, recently proposed as AZF candidates, in the AZF region. The region contains a single-copy gene, DAZ (Deleted in AZoospermia), which is transcribed in the adult testis and appears to encode an RNA binding protein. The possibility that DAZ is AZF should now be explored.

Amino Acid Sequence↗

PubMed1995

Participation of noradrenergic neurotransmission in the enhancement of baroreceptor reflex response by substance P at the nucleus tractus solitarii of the rat: a reverse microdialysis study.

We applied reverse microdialysis and HPLC analysis to evaluate the participation of noradrenergic neurotransmission in modulation of the baroreceptor reflex response by substance P at the nucleus tractus solitarii in Sprague-Dawley rats anesthetized with pentobarbital sodium (50 mg/kg, i.p., with 20 mg/kg/h.i.v. supplement). Continuous infusion of substance P (600 microM) at 1 microliter/min into the nucleus tractus solitarii through a stereotaxically positioned microdialysis probe (active exchange length, 180-200 microns; diameter, 220 microns) for 1 h elicited an enhancement of the baroreceptor reflex response. This facilitatory effect correlated positively, during the 60-min infusion period, with the time course of increase in the extracellular concentration of substance P and noradrenaline in the nucleus tractus solitarii. Experimentally elevating the concentration of noradrenaline at this medullary nucleus also augmented the baroreceptor reflex sensitivity. On the other hand, depletion of the noradrenergic fibers and nerve terminals at the nucleus tractus solitarii with DSP4 diminished the enhancement of baroreceptor reflex response and the corresponding elevation in extracellular concentration of noradrenaline by substance P. Microinfusion of noradrenaline into the nucleus tractus solitarii in DSP4-treated animals, however, potentiated the baroreceptor reflex response. These results suggested that the enhancement of baroreceptor reflex response by substance P may involve an increase in the concentration of noradrenaline at the nucleus tractus solitarii via a presynaptic mechanism.

Animals↗

PubMed1995

Gonadotropin releasing hormone (GnRH) agonist induces down-regulation of the CD3+CD25+ lymphocyte subpopulation in peripheral blood.

PROBLEM: To test whether GnRH agonist could alter in vivo human immune cells and whether the alteration is related to the success of pregnancy in an in vitro fertilization-embryo transfer (IVF-ET) program. METHODS: Thirty-six infertile patients were enrolled under the long protocol of GnRH agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells, and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry. RESULTS: B cells, NK cells, CD8+ T cells, and CD71+ T lymphocyte subpopulations were not changed throughout the whole course of treatment. CD4+ T cell and CD25+ T cell subpopulations were significantly down-regulated when the GnRH agonist was used for approximately 2 wk. CD3+CD69+, CD3+CD25+, and CD3+DR+ lymphocyte subpopulations were increased at 7 days (during implantation) and at 14 days after embryo transfer in pregnant patients, but not in patients who failed to get pregnant. CONCLUSIONS: The GnRH agonist had a transiently immunosuppressive effect on CD4+ and CD25+ T cells, but CD69+, CD25+, and HLA-DR+ T cells were activated during and after successful implantation.

Adult↗

PubMed1995

In vivo CD3+CD25+ lymphocyte subpopulation is down-regulated without increased serum-soluble interleukin-2 receptor (sIL-2R) by gonadotropin releasing hormone agonist (GnRH-a).

PROBLEM: To test further whether the suppression of the CD3+CD25+ lymphocyte subpopulation by gonadotropin-releasing hormone agonist (GnRH-a) is related to the change in levels of cytokines and soluble interleukin-2 receptor (sIL-2R). METHOD: Twenty-seven infertile patients were enrolled under the long protocol of GnRH-a agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry. Serum levels of cytokines and sIL-2R were measured. RESULTS: The B cells, NK cells, T cells, CD4+, CD8+ T cells, CD3+DR+, and CD3+CD71+ lymphocyte subpopulations were not changed after the use of GnRH-a. The CD25+ T cell subpopulation was significantly down-regulated, but the CD69+ T cell subpopulation was increased when the GnRH-a was used for approximately 2 wk. The serum levels of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma), and sIL-2R were not changed. CONCLUSION: The GnRH-a had a transiently suppressive effect on CD25+ T cells, but a stimulatory effect on CD69+ T cells. However, the serum level of cytokines or sIL-2R did not change. These immunological modulations seems to be the result of interaction between GnRH-a and estrogen.

Antigens, CD↗

PubMed1995

The effect of intrathecal bupivacaine with combined fentanyl in cesarean section.

BACKGROUND: The use of neuraxial opioids has gained popularity over the last few years; they may augment the analgesia produced by the local anesthetic through direct binding with the specific spinal receptors. Morphine, a lipophobic opioid, may not be optimal as an intrathecal drug for intraoperative analgesia because of its slow onset. The lipophilic opioid, fentanyl for instance, if administered intrathecally, its onset is fast and many of its merits by virtue of its lipophilic property may be seen intraoperatively. METHODS: Seventy five healthy pregnant women who sustained cesarean section under spinal anesthesia were assessed in a randomized fashion. The spinal anesthetic used was 0.5% hyperbaric bupivacaine. Patients were divided into 5 groups, 15 in each group. Fentanyl 0 (Group I), 7.5 (Group II), 10 (Group III), 12.5 (Group IV) and 15 (Group V) micrograms was respectively added to normal saline to make a total volume of 0.3 ml, which was then added to bupivacaine and administered to patients in a randomized fashion. The effect of analgesia, vital signs and side effects were observed every 5 min during operation and every 30 min after operation. RESULTS: It was disclosed that all patients in group V and IV had excellent analgesia intraoperatively, while only 33.3% patients in the control group had an analgesia which was qualified as excellent. Complete analgesia (time from injection to first report of pain) also lasted longer in group IV (201.3 +/- 16.4 min, mean +/- SEM) and group V (210.3 +/- 18.6 min) compared with group I (118.9 +/- 10.4 min). The duration of effective analgesia (time from injection to first parental opioid) was increased with the dose of intrathecal fentanyl above 12.5 micrograms (293 +/- 22.4 min). Both complete analgesia and effective analgesia were not significantly different between group IV and group V. Pruritus was the most common side effect. The incidence of shivering decreased significantly in group IV & V as compared with control group. CONCLUSIONS: The combination of bupivacaine with a dose of fentanyl as low as 7.5 micrograms did not produce actual clinical effects. As the dose of fentanyl was increased to 12.5 micrograms or 15 micrograms the quality of surgical analgesia was better and the postoperative analgesia lasted longer. It seemed that the clinical effect might reach its ceiling at the dose of 12.5 micrograms. Pruritus was the most common side effect, but it was mild.

Adult↗

PubMed1995

Magnesium sulfate has negligible effect on middle cerebral artery blood flow velocity in response to endotracheal intubation.

BACKGROUND: Pretreatment of magnesium sulfate (MgSO4) attenuates pressor response associated with endotracheal intubation. Vasodilating effect of MgSO4 may increase cerebral blood flow, which upsets the known benefit to cardiovascular hemodynamic. In the present study, we evaluated the effect of MgSO4 on the changes of cerebral blood flow in response to endotracheal intubation. METHODS: Twenty four ASA class I or II patients who randomly received either normal saline 5 ml or MgSO4 (60 mg/kg, i.v.) 3 min before induction of anesthesia were included in the study. Mean blood flow velocity (VMCA) of the middle cerebral artery was obtained using a transcranial Doppler sonography (TCD) before and after endotracheal intubation. Anesthesia was induced with fentanyl (4 micrograms/kg) and thiopental (5 mg/kg) and endotracheal intubation was facilitated with succinylcholine (1.5 mg/kg). RESULTS: Before endotracheal intubation, MgSO4 caused a transient decrease in VMCA (98 +/- 6% vs. 76 +/- 3% of baseline) and increase in heart rate (132% vs. 114% of baseline) compared to saline group. However, VMCA and heart rate did not show significant difference in both groups after tracheal intubation. Also, systolic and diastolic blood pressure did not differ during the study. CONCLUSIONS: Our results suggest that MgSO4 appeared to have negligible effects on cerebral blood flow and hemodynamics in response to tracheal intubation. Its attenuating effect on pressor response induced by endotracheal intubation might be over emphasized.

Adult↗

PubMed1995

Effect of assisted hatching by partial zona pellucida dissection on mouse embryos in vitro.

The zonae pellucida of mouse embryos were dissected to examine the effect of partial zona dissection (PZD) at the four-cell stage on embryonic development and the hatching process in vitro. Micropipettes were used to create a gap of one-sixth the zona circumference, to avoid damage to the blastomere. A total of 484 embryos at the four-cell stage (defined as day 2 embryos) were randomly divided into two groups, the PZD group (n = 238) and the control group (n = 246). Embryos of both groups were cultured in vitro under identical conditions and examined on the following day. The hatching rates were as follows: day 3, 11/238 (4.6%) in the PZD group and 0/246 (0%) in the control group; day 4, 105/238 (44.1%) in the PZD group and 54/246 (22.0%) in the control group; day 5, 71/238 (29.8%) in the PZD group and 36/245 (14.5%) in the control group. On day 4 the rates of complete hatching were 7/238 (2.9%) in the PZD group and 2/246 (0.8%) in the control group. On day 6 they were 88/238 (37.0%) in the PZD group and 66/246 (26.8%) in the control group. A significantly higher percentage of PZD embryos than controls initiated and completed hatching in similar culture conditions. The present study indicates that the creation of an opening in the zona pellucida is not harmful to embryonic development and may facilitate hatching. Whether the enhanced hatching ability of embryos in vitro caused by PZD can improve the implantation rate requires further study.

Animals↗

PubMed1995

Evaluation of the hemostatic clot formation of newborns by Sonoclot coagulation analyzer.

BACKGROUND: Sonoclot Analyzer has been widely used for more than five years in The United States to evaluate the platelet function and coagulation in adult. No clinical trial with the Analyzer has been reported in the field of pediatrics. The present study was aimed to evaluate the efficacy of the Sonoclot Analyzer for urgent determination of platelet function and coagulation in newborns. METHODS: Venous blood samples were drawn from the umbilical vein in 70 healthy newborns, and from the median cubital vein in 70 healthy adult volunteers, between 24 to 40 years of age, for control. DP2951 Sonoclot II Surgical Analyzer with graphic printer was used to evaluate the hemostatic clot formation. RESULTS: Results demonstrated that Sono ACT (activated coagulation time), peak time and retraction time increased by 36%, 66% and 70% respectively in newborns, while clot rate decreased by 69% in comparison with that of these adults. CONCLUSIONS: The results of using the Sonoclot Analyzer in this study confirmed other previous investigation that platelet function and coagulation are altered in newborns when compared with that of adults. The Sonoclot Analyzer is a simple device, easy to perform; It requires only small amounts of blood sampled (0.4 ml), and provides a rapid coagulation function for newborns.

Adult↗

PubMed1995

Magnetic resonance imaging of siderotic hepatic adenoma.

This is a case report of a patient with hepatic adenoma who had a magnetic resonance imaging (MRI) appearance mimicking that of adenomatous hyperplasia. The adenoma was hyperintense on T1-weighted image (T1WI) and hypointense on T2-weighted image (T2WI). Pathologically, iron deposition in hepatocytes and Kupffer cells was proved by Prussian blue stain that caused hypointensity on T2WI. Iron deposition in hepatic adenomatous hyperplasia has been documented in the past, but there are no reports of siderotic adenoma in the literature. We suggest that siderotic hepatic adenoma be included in the differential diagnosis when MRI appearance is hyperintense on T1WI and hypointense on T2WI.

Adenoma, Liver Cell↗

PubMed1995

Hepatobiliary imaging of functional and morphological changes following hepatic arterial embolization in hepatocellular carcinoma.

UNLABELLED: Hepatic arterial embolization (HAE) is the treatment of choice for inoperable hepatocellular carcinoma. There are functional changes following HAE in the tumor and in the adjoining normal liver and biliary structures. We sought to determine if a 99mTc-HIDA hepatobiliary scan could evaluate the morphological and functional changes of the liver and biliary systems in patients with hepatocellular carcinoma undergoing HAE. METHODS: Patients with hepatoma were evaluated by 99mTc-HIDA hepatobiliary scans before and after HAE. RESULTS: Ten patients with histologically proven hepatomas had 44 99mTc-HIDA scans over a 319-mo period. Liver uptake was good in all patients, none developed hepatic failure. Liver tumors were detected in five of the eight studies done before the first HAE. The HIDA scan failed to locate the tumor throughout the whole study period in only one patient. Two patients showed evidence of tumor uptake of the HIDA agent. In one of these two patients the hot uptake disappeared after the HAE but reappeared after tumor recurrence. Gallbladder filling time and contractility worsened in all eight patients the day after embolization. On the HIDA scans, the gallbladder was not visualized in three of four patients who survived longer than 40 mo after HAE. Bile stasis in the left intrahepatic duct was found in six of the eight patients who survived longer than 8 mo after HAE. CONCLUSIONS: Biliary complications were common in patients who received HAE, and HIDA scans may be useful for evaluating the biliary system and hot uptake in hepatocellular carcinoma in candidates for HAE.

Adult↗

PubMed1995

Evaluation of stress response to surgery under general anesthesia combined with spinal analgesia.

BACKGROUND: Each type of anesthesia has varying influence on the amount of catecholamine secretion during surgery. Epidural or spinal anesthesia can markedly suppress the increase of many of the stress hormones. Our purpose of this study is to evaluate metabolism change during surgery under anesthesia and to see whether general anesthesia combined with intraspinal anesthetic and narcotic is a better way to suppress such stress response. METHODS: Seventeen patients in fit physical condition (ASA class I) with normal biochemical screening scheduled for radical gastrectomy were studied. All patients were premedicated with diazepam and glycopyrrolate and an indwelling catheter was inserted into a radial artery under local anesthesia for monitoring blood pressure and obtaining blood samples for glucose and hormonal assays. A CVP line was set up via the right internal jugular vein for the administration of fluid (free of sugar). In the study group, a 32-G intraspinal catheter was placed via lumbar interspaces. Spinal blockade up to T4 by titrating 0.25% marcaine. Then anesthesia in both groups was induced with thiopental 5 mg/kg, followed by succinylcholine 1.5 mg/kg for intubation. Anesthesia was maintained with isoflurane, N2O, O2 and pancuronium. Blood samples for measurement cortisol, catecholamine and sugar were taken after induction and 30 min after surgical incision. Thirty min after skin incision all patients were subjected to glucose tolerance test, accomplished by giving 50% dextrose at 0.33 g/kg in 3 min. Arterial blood samples were then obtained at 1, 3, 5, 7, 10, 20, 30, 45 and 60 min intervals for plasma glucose determination. RESULTS: No difference was evident in cortisol values, baseline, before and after surgical incision (p > 0.05) either intragroup or inter-group. Catecholamine and glucose were significantly higher in control group after surgical incision (p < 0.05, intra-gr and inter-gr). Following a glucose load the decay of plasma glucose was similar in both groups but glycemic level was higher in the control group. CONCLUSIONS: Better control of stress response by general anesthesia combined with subarachnoid block was disclosed in this study.

Aged↗