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Biomedical subjects

W J Su

Publications and source records attributed to W J Su.

At least 19 recordsLinked to original sources
PubMed1998

Nonspecific and immune-specific up-regulation of cytokines in rabbit dermal tuberculous (BCG) lesions.

To our knowledge, this is the first sequential study of cytokines in tissue sections of developing and healing tuberculous (BCG) lesions. In situ hybridization, immunohistochemical, and RT-PCR techniques were used. Cytokine mRNAs showed a biphasic pattern. The percentage of mononuclear cells (MN) containing IL-1beta, TNF-alpha, MCP-1, and IL-8 mRNAs was highest in 1- to 3-day lesions, apparently because of the nonspecific inflammatory response caused by the tubercle bacilli in the BCG vaccine. At 5 days, this percentage was significantly reduced. With IFN-gamma, the peak and trough were delayed by 2 days. By 9 days, the percentage of MN containing the mRNAs of all five cytokines had again increased and the rabbits had become tuberculin-positive. In general, MCP-1 and TNF-alpha proteins and the vascular adhesion molecules, ICAM, VCAM, and perhaps ELAM, peaked at about 3 days. Many mononuclear cells surrounding the central areas of solid and liquefied caseous necrosis contained chemokine IL-8 mRNA. IL-8 is known to attract PMN, and PMN were present nearby. In contrast, MN containing chemokine MCP-1 mRNA were present more peripherally in areas rich in macrophages and lymphocytes. The early nonspecific cytokine response seems to be an adjuvant effect of the mycobacteria in BCG vaccine in that it causes a rapid entry of macrophages, lymphocytes, granulocytes, and probably dendritic cells into local sites of antigen deposition. This effect should be considered in developing improved vaccines for the prevention of tuberculosis, because BCG vaccines producing a strong early cytokine response should be more immunogenic than BCG vaccines with similar antigens producing a weak response.

Animals↗
PubMed1998

Surgical closure of atrial septal defect. Minimally invasive cardiac surgery or median sternotomy?

BACKGROUND: Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. METHODS: We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. RESULTS: The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 +/- 12) and 14 to 158 min (27 +/- 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. CONCLUSION: Our results suggest that MICS is a good option for surgical closure of ASD.

Adolescent↗
PubMed1998

Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach.

BACKGROUND: Minimally invasive cardiac surgical techniques recently have been applied in the management of a variety of intracardiac lesions. METHODS: Fourteen patients (6 boys and 8 girls; age, 8.9 +/- 5.5 years; body weight, 29.0 +/- 13.5 kg) were operated on using minimally invasive cardiac surgical techniques for the closure of a ventricular septal defect (subarterial in 11 patients and perimembranous in 3 patients). The operations were performed through a left anterior minithoracotomy and were guided by video-assisted endoscopic techniques under femorofemoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. The right ventricular outflow tract was entered after pericardiotomy was performed. RESULTS: Closure of the defect (directly in 4 patients and by patch in 10 patients) was performed successfully in all patients. A right ventricular outflow tract obstruction and ruptured sinus of Valsalva aneurysm also were repaired in 1 patient each. The duration of cardiopulmonary bypass was 41 +/- 10 minutes (range, 28 to 100 minutes) and the total operative time was 2.2 +/- 0.8 hours (range, 1.3 to 3.5 hours). All the patients recovered rapidly from their operation and had an uneventful postoperative course. Follow-up (mean, 6.2 months; range, 6 to 9 months) was complete in all patients. There were no late deaths. Transthoracic echocardiographic examination showed no residual shunt and no aortic regurgitation in all patients. CONCLUSIONS: Our experience demonstrates that minimally invasive cardiac surgical techniques are technically feasible and an alternative option for the repair of a ventricular septal defect.

Cardiac Surgical Procedures↗
PubMed1998

One-stage sternal stenting with homograft bone after cardiac operation in pediatric patients.

Low cardiac output after open heart operations in neonates and infants carries a high mortality. Delayed sternal closure may be life-saving but may prolong hospital stay and increase costs. To circumvent these issues, we shaped homograft bone and interposed it between the sternal edges to allow primary wound closure in 2 pediatric patients. Midterm results are satisfactory.

Bone Transplantation↗
PubMed1998

PCR diagnosis on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in chronic dialysis patients of cervico-mediastinal tuberculous lymphadenitis.

BACKGROUND: Bacteriologic studies often provide negative results in tuberculous infection, and do not favour early diagnosis. Polymerase chain reaction (PCR) is known to diagnose tuberculosis quickly. With this in mind, we used PCR to detect mycobacterial DNA on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in two dialysis patients with cervico-mediastinal lymphadenopathy. METHODS: Sections of neck lymph nodes were cut at two different levels. At each level, two semi-adjacent sections with a thickness of 5 microm each were cut using standard microtomes with disposable blades. The first section mounted on a glass slide was stained by Ziehl-Neelsen, and the second section was examined by PCR based on a 123 bp fragment of IS6110 that is specific for the Mycobacterium tuberculosis complex. RESULTS: The histology of lymph nodes disclosed inflammatory necrotizing granulomas, but acid-fast stain for M. tuberculosis was negative in the two patients. DNA of M. tuberculosis was detected in lymph node samples from each patient by PCR on the IS6110 element and by dot-blot hybridization. CONCLUSIONS: PCR assay is a potentially useful approach for early and rapid diagnosis of tuberculous lymphadenitis in chronic dialysis patients, since mycobacterial staining and culture often provide negative results.

Adult↗
PubMed1998

The changing pattern of intestinal tuberculosis: 30 years' experience.

SETTING: Although the incidence of tuberculosis had been decreasing for many years, it has recently risen. OBJECTIVES: To investigate the changes in the pattern and distribution of intestinal tuberculosis and to alert surgeons to the importance of maintaining a high index of suspicion for this disease entity. DESIGN: Retrospective analysis of 134 patients with intestinal tuberculosis discharged from the Veterans General Hospital in Taipei from 1965 to 1995. All records, bacteriological examinations and pathological specimens were reviewed and extracted onto a standard questionnaire. RESULTS: A decline in the case numbers of intestinal tuberculosis was noted after 1975. However, there seems to be a slight rise in case numbers since 1990. The average age of those patients after 1990 (64.8 years) is higher than those before 1990 (44.4 years). None of our patients had clinical signs of human immunodeficiency virus (HIV) infection. Most patients (81.3%, 109/134) had not received a definite diagnosis until surgery. Active pulmonary tuberculosis was found in 37 patients (29.1%). CONCLUSION: The possible reasons for the rise in cases of intestinal tuberculosis in our patients may be linked to an increased life expectancy, the reappearance of some formerly 'silent' tuberculosis cases, and relapse in patients having received incomplete antituberculosis chemotherapy. Its insidious and non-specific clinical presentation makes the diagnosis of intestinal tuberculosis difficult. An increased index of suspicion and greater familiarity with the disease may shorten the time of diagnosis and may also prevent some unnecessary operations.

Adolescent↗
PubMed1998

Transcatheter closure of atrial septal defect guided by on-line transesophageal echocardiography.

Transcatheter occlusion of secundum atrial septal defect has been tried since 1976. Some investigators have incorporated on-line transesophageal echocardiography so as to better monitor the procedure. Most, however, have used endotracheal intubation and general anesthesia. The aim of this study was to evaluate the feasibility of adjunct guidance using on-line transesophageal echocardiography without intubation and general anesthesia in adolescent or adult patients undergoing transcatheter occlusion of secundum atrial septal defects. Ten consecutive cases (age 15-68 years) of secundum atrial septal defects with a pulmonary to systemic flow ratio of > 1.5 and a balloon-stretched diameter of < or = 25 mm were enrolled in the study. The Sideris' buttoned devices were used. The procedure was guided by on-line transesophageal echocardiography and fluoroscopy. Endotracheal intubation and general anesthesia were not employed. The diameters of the atrial septal defects ranged from 6 to 19 mm as determined by transesophageal echocardiography, from 7 to 20 mm as determined by atrial angiography and from 11 to 25 mm as determined by balloon sizing. The Sideris' buttoned devices were successfully deployed in all the patients. On-line transesophageal echocardiography greatly facilitated balloon sizing, device development and immediate assessment. One device unbuttoned 24 hours after the procedure and was retrieved smoothly. The remaining 9 patients were followed-up for 12 months. Two patients had no shunt, 3 had a trivial (average diameter by transesophageal echocardiography = 1-3 mm) and 4 had a small (average diameter = 4-6 mm) residual shunt at the latest follow-up. The cardiothoracic ratios decreased from 0.52 +/- 0.06 to 0.48 +/- 0.06 (p = 0.0131). There was no mortality, stroke or device fracture during the follow-up period. Thus, transcatheter occlusion of secundum atrial septal defect under adjunct guidance using on-line transesophageal echocardiography without endotracheal intubation and general anesthesia is promising for selected patients.

Adolescent↗
PubMed1997

Large bowel tuberculosis and possible influencing factors for surgical prognosis: 30 years' experience.

The incidence of tuberculosis is rising in the United States. Similarly, the incidence of pulmonary tuberculosis in Taiwan is increasing, but that of large bowel tuberculosis in this region has not been reported. The purpose of this study was to investigate the changing disease pattern and to determine some possible surgical prognostic factors for large bowel tuberculosis. Seventy cases of large bowel tuberculosis treated at our institute during the period 1965-1995 were reviewed and analyzed. A steady decline in the case number of large bowel tuberculosis were noted from 1975, but there seems to be a slight increase in cases since 1990. The average age of these patients was 65.1 years, and none had human immunodeficiency virus infection. The ileocecum is the most common region of involvement. Of these 70 patients, 59 had not been definitively diagnosed until surgery. Active pulmonary tuberculosis was found in 18 patients (25.7%). The incidence of postoperative pulmonary complications was higher in patients with active pulmonary tuberculosis or disseminating large bowel tuberculosis. Postoperative abdominal complications, including intestinal obstruction, abdominal cutaneous fistula, and wound infection, were seen in 13 patients, none of whom had active pulmonary tuberculosis. Although the incidence of tuberculosis has been reduced for years, it is now rising. Physicians should bear in mind the possibility of large bowel tuberculosis in patients with intestinal obstruction without specific origin. Postoperative respiratory care is important for patients with pulmonary tuberculosis, with either active or disseminating lesions.

Adolescent↗
PubMed1997

Pulmonary vascular obstructive disease and hemoptysis in a child with tetralogy of Fallot and patent ductus arteriosus.

Tetralogy of Fallot (TOF) and patent ductus arteriosus complicated by pulmonary vascular obstructive disease (PVOD) and hemoptysis in a 5-year-old girl are described. The echocardiogram was typical of TOF, as well as ductus arteriosus and right aortic arch. Cardiac catheterization revealed a pulmonary vascular resistance of 44 hybrid resistance units, and the pulmonary-to-systemic resistance ratio was 1.4. Diagnosis of PVOD was made by cardiac catheterization. Angiography revealed a bronchial artery arising from the left subclavian artery. PVOD itself, rupture of a bronchial artery or both, were considered the contributory causes of hemoptysis in this patient.

Child, Preschool↗
PubMed1997

Unusual manifestations in children with Kawasaki disease.

Between January 1983 and December 1992, the medical records of 187 patients (116 boys and 71 girls) with Kawasaki disease (KD) who were admitted to the hospital in the acute phase were retrospectively reviewed. Of these, 175 patients (93.6%) were under 4 years of age. Among the six principal symptoms of KD, the incidence of cervical lymphadenopathy (41.2%) was relatively low. Additionally, we found some unusual features including intussusception in a 4-month-old female, transient thrombocytopenia in seven children (3.7%) and isolated azotemia in five. KD is a systemic disease of unknown etiology. The diverse associated features make KD puzzling and difficult to diagnose. In caring for children with KD, physicians should be alert to the principal symptoms as well as the unusual associated manifestations.

Child↗
PubMed1997

Drug resistance of Mycobacterium tuberculosis isolated from patients at a medical center in Taiwan.

BACKGROUND: The advent of bactericidal drugs has had a major impact on the treatment of pulmonary tuberculosis. However, the main reasons for continuing tuberculosis prevalence are the resistance of mycobacteria and patients' lack of endurance to undergo the long-term therapy. In Taiwan, the prevalence of tuberculosis among the population of over 20-year olds has fallen from about 5.15% in 1957, to 0.88% in 1982, but then increased to 1.29% in 1987. Although it continued decreasing to 0.65% in 1994, tuberculosis remains a potential public health problem. METHODS: To determine the temporal status of drug resistance pattern among the Mycobacterium tuberculosis (M. tuberculosis) isolated at Veterans General Hospital (VGH)-Taipei, analysis was undertaken of the drug susceptibility data reported by the central Mycobacterial Laboratory, using conventional indirect methods, between 1990 to 1992. RESULTS: The susceptibility pattern of 651 M. tuberculosis isolates obtained from patients admitted to VGH-Taipei during 1990 to 1992 were analyzed; 504/651 (77.4%) were sensitive to all drugs tested. Among veterans, 23.7% (95/401) had organisms resistant to one or more antituberculosis medications: 11.5% (46/401) to a single drug; 6.2% (25/401) to two drugs; 3.2% (13/401) to three drugs, and 2.7% (11/401) to four drugs. The overall resistance rates in isolates from 250 non-veterans (142 males and 108 females) were 22.5% (32/142) in male patients and 18.5% (20/108) in female patients. Among the 142 male patients, 6.3% were resistant to a single drug; 3.5% to two; 7.7% to three and 4.9% to four drugs. Among 108 female patients, 8.3% to a single drug; 1.9% to two drugs; 2.8% to three drugs, and 5.6% to four drugs. The proportion of drug-resistance was higher in the isolates from patients with a history of previous therapy (p < 0.05). Overall, of the 401 veterans with positive cultures, 4.0% had isolates resistant to only isoniazid (INH), 14.7% had isolates resistant to at least INH, and 7.5% had isolates resistant to both INH and rifampin (RIF). Of the 142 non-veteran males, 1.4% had isolates resistant to only INH, 16.9% had isolates resistant to at least INH, and 10.6% had isolates resistant to both INH and RIF. Of the 108 non-veteran females, 3.7% had isolates resistant to only INH, 12.0% had isolates resistant to at least INH, and 8.3% had isolates resistant to both INH and RIF. Among the 401 veterans, all the drug resistant isolates were found in patients older than 45 years, and of these, 66.3% (63/95) were over 65 years, whereas age was not a significant factor for predicting resistance rates among the non-veteran patients. CONCLUSIONS: There has been a marked increase in drug-resistant tuberculosis in old aged veterans. In contrast, age was not found to be a significant factor to predict resistance rates among the non-veterans. Previously treated patients are at increased risk for drug resistance. In view of these data, it is important to identify drug susceptibility patterns accurately from all tubercle bacilli isolated from patients as this has implications for control programs as well as for patient therapy. Surveillance of drug resistance is again being considered for patients admitted to this hospital, and all physicians are urged to remain alert to drug-resistance rates and patterns in the areas where they practice.

Adult↗
PubMed1996

Video-assisted cardiac surgery in closure of atrial septal defect.

BACKGROUND: Video-assisted endoscopy has been applied in the management of a variety of intrathoracic vascular lesions. Here we report its use in the correction of intracardiac congenital defects. METHODS: Eight patients (3 male and 5 female) underwent operation for closure of an atrial septal defect. The patients ranged in age from 2.0 to 60.9 years (mean, 19.2 +/- 19.0 years). The patients weighed 11 to 66 kg (mean, 41.3 +/- 23.5 kg). The ratio of pulmonary blood flow to systemic blood flow ranged from 2.0 to 6.0 (mean, 3.4 +/- 1.3). The mean pulmonary artery pressure was 19.7 +/- 4.0 mm Hg (range, 13 to 24 mm Hg). The operations were performed through a right anterior minithoracotomy and guided by video-assisted endoscopic techniques under femorofemoral or femoral-right atrial extracorporeal circulation. The aorta was not cross-clamped, and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature, 22.0 degrees +/- 2.0 degrees C). Transesophageal echocardiographic monitoring was maintained during the operations. The right atrium was entered after pericardiotomy. Primary closure of the defect was performed successfully in all patients. Conventional nondisposable instruments were used for dissection, grasping, suturing, and hemostasis. RESULTS: The durations of extracorporeal circulation and operation ranged from 47 to 126 minutes (mean, 80 +/- 31 minutes) and from 2.2 to 4.5 hours (mean, 3.1 +/- 0.8), respectively. All patients recovered from the operation rapidly with an uneventful postoperative course. CONCLUSIONS: Our experience demonstrates that video-assisted cardiac surgery is technically feasible and can be used with excellent results for the repair of congenital heart defects in general.

Adolescent↗
PubMed1995

Successful intravenous streptokinase treatment of a child with Kawasaki disease complicated by acute myocardial infarction.

A 9-year-old boy developed ischemic cardiac symptoms 1 year after he presented with Kawasaki disease. The myocardial infarction was confirmed by the typical changes of electrocardiograms, echocardiograms, cardiac enzymes, thallium myocardial scintigrams, and angiograms. With successful intravenous streptokinase therapy, he remained well during the following 4 months.

Child↗
PubMed1994

Serological evaluation for tuberculosis by antigen 60 IgG ELISA test.

BACKGROUND: Tuberculosis remains a significant global health problem, especially among developing countries. It unfortunately results in high morbidity and mortality rates. This disease is also prevalent to a large extent in Taiwan. The traditional tuberculous tests, including the acid-fast smear and culture, have a limited activity in regard to extrapulmonary or smear-negative tuberculosis. A new testing is necessary to improve diagnosis of this disease. METHODS: An enzyme-linked immunosorbent assay (ELISA) test for detection of serum IgG antibodies, based on Antigen 60, was applied to 146 subjects including 68 non-tuberculous cases and 78 tuberculous cases. A titer of less than 200 serounits was considered negative, and one of 200 or more serounits was thought positive. RESULTS: In the healthy group, which included 5 newborns, 5 children and 20 healthy adults, 6.1% (2/30) showed positive results. Of the 15 hospital attendants, 60% (9/15) also displayed positive results. Nine of 17 cases (52.9%) with non-tuberculous pulmonary diseases had positive results. Among 6 cases with other diseases, the results were all negative. The false positive rate in non-tuberculous group was 29.4% (20/68). In 10 cases with inactive pulmonary tuberculosis, 30% (3/10) showed positive results. In 50 with active pulmonary tuberculosis, 88% (44/50) generated positive results. Effectual results were obtained in 66.7% (8/12) of the cases with extrapulmonary tuberculosis. Including 6 cases with mixed pulmonary and extrapulmonary tuberculosis, 83.3% (5/6) proved positive results. The positive rate in active tuberculous group was 83.8% (57/68). CONCLUSIONS: The ELISA test, for detection of IgG antibody with Antigen 60, is helpful in improving the diagnosis of tuberculosis, especially in extrapulmonary tuberculosis.

Adult↗
PubMed1993

Chest roentgenographic guidelines in the selection of patients for fiberoptic bronchoscopy.

We conducted this study to define the value of fiberoptic bronchoscopy (FOB) in the evaluation of chest radiographic abnormalities and to provide guidelines for fiberoptic bronchoscopy on the basis of chest radiographic appearances. Fiberoptic bronchoscopy without fluoroscopy was carried out in 530 patients, 455 male and 75 female, aged 19 to 85 years, during a 1-year period at Chest Department, Veterans General Hospital, Taipei. Of 530 patients, 19 (3.6 percent) had normal chest radiographs, and the remaining 511 (96.4 percent) patients had abnormal chest radiographs. Overall diagnostic yield of FOB was 55.4 percent in patients with abnormal chest radiographs and 52.6 percent in patients with normal chest radiographs. On the basis of radiographic findings, patients with lobar collapse (87.0 percent), hilar abnormalities (81.8 percent), pericardial effusions (66.7 percent), mass lesions (> 4 cm) (65.7 percent), and pleural effusions (64.9 percent) were most frequent to obtain a positive diagnosis via bronchoscopy (p < 0.001). Of 530 patients; mass lesion was the most frequent abnormality on bronchoscopy and had the highest incidence of providing a positive diagnosis (36.2 percent) (p < 0.001). A predilection of mass lesion on bronchoscopy was seen for chest radiographic features of lobar collapse (64.8 percent) and mass (> 4 cm) (47.0 percent) (p < 0.001). Of 19 patients with normal chest radiographs, a correct diagnosis was made in 4 (21.1 percent) with bronchoscopic findings of mass lesions, 3 (15.8 percent) with endobronchial abnormalities, and 3 (15.8 percent) patients with abnormal bronchial mucosa. Indeed, the decision to perform bronchoscopy should be guided by many factors other than chest radiograph. In this study, however, emphasis has been placed on the incidence of positive diagnosis via bronchoscopy on the basis of chest radiographic patterns. In this respect, we believe that in patient with lobar collapse, hilar abnormality, pericardial effusion, mass lesion (> 4 cm), and pleural effusion on the chest radiograph bronchoscopy should be considered.

Adult↗
PubMed1993

Extralobar pulmonary sequestration presenting as an anterior mediastinal tumor in an adult.

Extralobar pulmonary sequestration (EPS) is a rather uncommon congenital anomaly. Most patients are diagnosed in their early life or during the first decade because of the early appearance of symptoms, including feeding difficulty, cyanosis, and dyspnea, or because of symptoms arising from the associated congenital abnormalities. Extralobar pulmonary sequestration is more often found between the lower lobe and the diaphragm and is usually associated with other congenital abnormalities, but the case reported herein differs in these respects. In this report, an incidental finding of EPS is described in a 30-year-old Chinese man, where EPS presents as an anterior mediastinal mass roentgenographically. The mass was attached to the right suprahilar region by a fibrovascular pedicle which contained a small elastic artery, veins, and nerve bundles.

Adult↗