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Wu WC, Lin ZY, Chuang WL, Chang WY. Multiple inflammatory pseudotumors of the spleen: case report. ACTA ACUST UNITED AC 2003; 28:691-3. [PMID: 14628878 DOI: 10.1007/s00261-003-0013-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The imaging findings of multiple splenic inflammatory pseudotumors in a 45-year-old male are described. Peripheral ring enhancement on arterioportal phase and gradual enhancement from the periphery to the center on venous delay phase on contrast-enhanced dynamic magnetic resonance imaging were compatible with the pathologic findings. This result may aid in the preoperative diagnosis of these benign lesions.
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Ip D, Wu WC, Tsang WL. Early results of posterior-stabilised NexGen Legacy total knee arthroplasty. J Orthop Surg (Hong Kong) 2003; 11:38-42. [PMID: 12810970 DOI: 10.1177/230949900301100109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To retrospectively assess the early results of the NexGen Legacy posterior-stabilised total knee prosthesis, which is a newer version of the Insall-Burstein II posterior-stabilised implant. METHODS 48 consecutive elderly patients had 60 NexGen Legacy posterior-stabilised total knees. The mean follow-up duration was 21 months. Clinical evaluation was performed according to the Knee Society scores and a scoring system for patellofemoral articulation; radiographic assessment followed the guidelines of the Knee Society. Special emphasis was given to any patellofemoral complications, such as patellar clunk syndrome, patellar maltracking, and other disorders of the extensor mechanism. RESULTS Only one patient had mild patellofemoral anterior knee pain at the latest follow-up; 2 patients had patellofemoral crepitus but no pain. No patellar clunk or any other complication of the patellofemoral articulation, such as patellar fracture or subluxation was found. The mean preoperative and postoperative Knee Society scores were 60 and 85 respectively. The mean postoperative knee flexion was 115 degrees. CONCLUSION The overall early results from using the new implant were good, probably because of changes in design of the intercondylar box and its associated cam-and-post mechanism, and a more anatomic trochlea surface, so that the trochlea accommodates the natural patella.
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Ko PS, Chan WF, Siu TH, Khoo J, Wu WC, Lam JJ. Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population. J Arthroplasty 2003; 18:174-9. [PMID: 12629607 DOI: 10.1054/arth.2003.50040] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Scarcely any information has been published on deep vein thrombosis (DVT) in Chinese patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, generally, no prophylaxis is given to patients who do not have conventional high-risk factors because they are believed to be at "low risk." We performed a prospective study on 80 such "low risk" patients undergoing THA or TKA (58 TKA and 22 THA) without prophylaxis and performed duplex ultrasonography on both lower limbs 6 to 8 days after surgery. A total of 22 patients (27.5%) showed ultrasonographic evidence of DVT. Eighteen (31%) TKAs and 4 (18.1%) THAs were complicated by DVT. Three patients showed bilateral involvement, all of whom underwent TKA. Two patients had symptomatic pulmonary embolism. The sensitivity and positive predictive value of the clinical examination was 27.2% and 31.6%, respectively. This study showed that patients who are labeled "low risk" for DVT actually had a significant risk and suggests that the current practice of providing prophylaxis to only patients deemed at "high risk" should be revised.
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Liu HSY, Kho BCS, Chan JCW, Cheung FMF, Lau KY, Choi FPT, Wu WC, Yau TK. Venous thromboembolism in the Chinese population--experience in a regional hospital in Hong Kong. Hong Kong Med J 2002; 8:400-5. [PMID: 12459595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVE To estimate the incidence and determine the characteristic features of venous thromboembolism in the Hong Kong Chinese population. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. SUBJECTS AND METHODS Data were collected during a period of four years (1997-2000). Patients with duplex doppler ultrasonography or venography-documented venous thromboembolism and new episodes of deep vein thrombosis were identified from Department of Diagnostic Radiology records. Patients with high-probability ventilation-perfusion scans were identified from Department of Nuclear Medicine records and these scans were taken as evidence of pulmonary embolism. Patients with intermediate-probability ventilation-perfusion scans, with pulmonary embolism documented by either pulmonary angiography or spiral computed tomography scan, were also included in the study. Patients with autopsy-verified fatal pulmonary embolism were identified from Department of Pathology records. Patients with deep vein thrombosis at other sites were sought from patient discharge diagnostic coding data. Medical records were reviewed for patient characteristics and conditions associated with the development of venous thromboembolism. RESULTS Three hundred and seventy-six Chinese patients had venous thromboembolism during the study period. Of these, 352 had peripheral deep vein thrombosis, five had deep vein thrombosis at other sites (cerebral sinus and portal vein thrombosis), 40 had pulmonary embolism (26 had concomitant deep vein thrombosis), and six had fatal pulmonary embolism shown at autopsy. CONCLUSION The calculated annual incidence of venous thromboembolism in Hong Kong Chinese people was estimated at 16.6 events per 100,000 population, which is lower than incidence rates reported in Caucasians. The four conditions most commonly associated with venous thromboembolism were medical illness, malignancy, orthopaedic surgery, and intravenous drug use. Conditions associated with venous thromboembolism in patients younger than 45 years included intravenous drug use, thrombophilia, pregnancy, and the use of oral contraceptives.
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Yip HSF, Wu WC, Chang RYP, So TYC. Percutaneous cannulated screw fixation of acute scaphoid waist fracture. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2002; 27:42-6. [PMID: 11895344 DOI: 10.1054/jhsb.2001.0690] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This prospective study assessed the outcome of percutaneous cannulated screw fixation in 49 of 60 acute scaphoid fractures. The union rate was 100% (mean time for radiological union at 12 weeks). There were no early or mid-term complications and all achieved an excellent functional recovery.
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Ip D, Wu WC, Tsang WL. Comparison of two total knee prostheses on the incidence of patella clunk syndrome. INTERNATIONAL ORTHOPAEDICS 2002; 26:48-51. [PMID: 11954850 PMCID: PMC3620851 DOI: 10.1007/s00264-001-0316-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The patella clunk syndrome is not an uncommon complication, particularly after posterior-stabilized (PS) total knee arthroplasty. The present study was a consecutive unselected series comparing the incidence of the patella clunk syndrome amongst two comparable groups of elderly patients with knee arthritis implanted with the Insall-Burstein (IB II) total knee system and the newer NexGen Legacy total knee prosthesis. While 7.5% of patients in the PS IB II group developed patella clunk syndrome, none occurred in the NexGen group (P=0.05). We believe the difference is due mainly to a change in the design of the prosthesis, especially the more posterior intercondylar box and femoral cam of the NexGen femoral component.
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Wu WC, Wang Y, Kao LS, Tang FI, Chai CY. Nitric oxide reduces blood pressure in the nucleus tractus solitarius: a real time electrochemical study. Brain Res Bull 2002; 57:171-7. [PMID: 11849823 DOI: 10.1016/s0361-9230(01)00737-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Increasing evidence has demonstrated that nitric oxide (NO) is involved in central cardiovascular regulation. In this study, we directly measured extracellular NO levels, in real-time, in the nucleus tractus solitarius (NTS) of anesthetized cats using Nafion/Porphyrine/o-Phenylenediamine-coated NO sensors. We found that local application of L-arginine (L-Arg) induced NO overflow in NTS and hypotension. These responses were potentiated in the vagotomized animals. Pretreatment with NO synthase (NOS)/guanylate cyclase inhibitor methylene blue, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one or NO scavenger hemoglobin attenuated L-Arg-induced hypotension, suggesting that exogenous supplement of NO suppressed cardiac functions through the NOS/cyclic guanosine monophosphate mechanism. The role of endogenous NO was examined after local application of N(G)-nitro-L-arginine methyl ester (L-NAME). We found that L-NAME suppressed endogenous NO levels in NTS and elicited hypertension and tachycardia. Taken together, our data suggest that NO is tonically released in the NTS to inhibit blood pressure.
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Peng YH, Shyur SD, Chang CL, Lai CL, Chu SH, Wu WC, Wu CY. Fish allergy in atopic children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2001; 34:301-4. [PMID: 11825013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The prevalence of fish allergy among 11 atopic children with elevated levels of specific immunoglobulin (Ig) E for cod was determined. None of the children had a history of fish allergy. All of the children had asthma and allergic rhinitis and 5 of them had also atopic dermatitis. The children underwent allergy skin tests (codfish, tuna, catfish, salmon, flounder, and bass), specific IgE tests (salmon, trout, tuna, eel, and mackerel), and food challenge tests. Skin tests in cod-specific IgE-positive children were positive for codfish in 4 children, tuna in 2, catfish in 2, salmon in 6, flounder in one, and bass in 2. Three children had elevated specific IgE for salmon, 5 for trout, 8 for tuna, 4 for eel, and 4 for mackerel. Oral fish challenge with 10 g of fish did not result in positive reaction in any of the children. In conclusion, a positive food challenge test provided the only definitive confirmation of fish allergy, whereas positive allergy skin tests or positive specific IgE tests were less reliable. Skin tests and in vitro specific IgE assays were not correlated with clinical symptoms of fish allergy, and the results of these 2 tests did not correlate with each other in this study.
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Bigoli F, Chen CT, Wu WC, Deplano P, Mercuri ML, Pellinghelli MA, Pilia L, Pintus G, Serpe A, Trogu EF. [Ni(R2pipdt)2](BF4)2 (R2pipdt = 1,4-disubstituted-piperazine-3,2-dithione) as useful precursors of mixed-ligand dithiolenes of interest for non-linear optics. Chem Commun (Camb) 2001:2246-7. [PMID: 12240133 DOI: 10.1039/b106064n] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A simple method to obtain in high yields mixed-ligand nickel-dithiolene complexes, which show strong negative solvatochromism and negative first molecular hyperpolarizability, and the use of Raman spectroscopy to establish the extent of electronic delocalisation in these complexes, are reported.
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Ip D, Wu WC, Wong SH. Rare complication of segmental breakage of plastic medullary tube in closed intramedullary nailing. Injury 2001; 32:730-1. [PMID: 11600123 DOI: 10.1016/s0020-1383(01)00083-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001; 345:1230-6. [PMID: 11680442 DOI: 10.1056/nejmoa010615] [Citation(s) in RCA: 590] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia may have adverse effects in patients with coronary artery disease. However, the benefit of blood transfusion in elderly patients with acute myocardial infarction and various degrees of anemia is uncertain. METHODS We conducted a retrospective study of data on 78,974 Medicare beneficiaries 65 years old or older who were hospitalized with acute myocardial infarction. Patients were categorized according to the hematocrit on admission (5.0 to 24.0 percent, 24.1 to 27.0 percent, 27.1 to 30.0 percent, 30.1 to 33.0 percent, 33.1 to 36.0 percent, 36.1 to 39.0 percent, or 39.1 to 48.0 percent), and data were evaluated to determine whether there was an association between the use of transfusion and 30-day mortality. RESULTS Patients with lower hematocrit values on admission had higher 30-day mortality rates. Blood transfusion was associated with a reduction in 30-day mortality among patients whose hematocrit on admission fell into the categories ranging from 5.0 to 24.0 percent (adjusted odds ratio, 0.22; 95 percent confidence interval, 0.11 to 0.45) to 30.1 to 33.0 percent (adjusted odds ratio, 0.69; 95 percent confidence interval, 0.53 to 0.89). It was not associated with a reduction in 30-day mortality among those whose hematocrit values fell in the higher ranges. In one of seven subgroup analyses (among patients who survived at least two days), transfusion was not associated with a reduction in mortality for patients with hematocrit values of 30.1 percent or higher. CONCLUSIONS Blood transfusion is associated with a lower short-term mortality rate among elderly patients with acute myocardial infarction if the hematocrit on admission is 30.0 percent or lower and may be effective in patients with a hematocrit as high as 33.0 percent on admission.
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Tung IC, Wu WC, Kao YH, Chang YC, Chung CH, Hu DN. The effect of combined 5-fluorouracil and dexamethasone on cultured human retinal pigment epithelial cells. Kaohsiung J Med Sci 2001; 17:524-9. [PMID: 11831116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
This study was designed to investigate the inhibitory effect of 5-fluorouracil (5-FU) and dexamethasone (DEX) on the proliferation of human retinal pigment epithelial (RPE) cells in vitro. The human RPE cells (R-50 cell line) were cultured and exposed to various concentrations of combined 5-FU (0, 250, 500, 1000, 2000 ng/ml) and DEX (0, 1, 10, 100, 200 micrograms/ml). The cells were incubated for 96 hr and the medium was changed every 48 hr to replenish the drug action. Cell viability was assessed using cell counting and trypan blue exclusion method. Tetrazolium salt, which can be metabolized by mitochondrial dehydrogenase to form a formazan dye, was used to assay cell proliferation. Treatment with 5-FU alone inhibited cell proliferation in a dose-dependent manner. The concentration of 5-FU that inhibited growth by 50% (IC50) was found to be 704.12 ng/ml. There was a bimodal effect of DEX on RPE cells--stimulation at low concentrations (1, 10 micrograms/ml) and inhibition at high concentrations (100, 200 micrograms/ml). When the two drugs were combined, there was additive inhibition in the concentration of 200 micrograms/ml of DEX. These results indicate that a combination of 5-FU and DEX is no more effective in the inhibition of human RPE cells, except in combination with high concentrations of DEX (> or = 200 micrograms/ml).
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Wu WC, Wang Y, Su CK, Chai CY. The nNOS/cGMP signal transducing system is involved in the cardiovascular responses induced by activation of NMDA receptors in the rostral ventrolateral medulla of cats. Neurosci Lett 2001; 310:121-4. [PMID: 11585582 DOI: 10.1016/s0304-3940(01)02100-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Nitric oxide (NO) is synthesized from L-arginine by NO synthase (NOS). NO stimulates the soluble form of guanylyl cyclase (sGC) and induces accumulation of cyclic guanosine monophosphate (cGMP). The purpose of this study was to examine whether the cardiovascular responses induced by N-methyl-D-aspartate (NMDA) in the rostral ventrolateral medulla (RVLM) depend on the actions of NOS and sGC. In anesthetized cats, the extracellular NO level was measured by in vivo voltammetry using a nafion/porphyrine/o-phenylenediamine-coated carbon-fiber electrode. Microinjection of NMDA into the RVLM produced hypertension and bradycardia associated with NO formation. These NMDA-induced responses were attenuated by prior injections of 7-nitroindazole, a neuronal NO synthase (nNOS) inhibitor, and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, a sGC inhibitor. These findings suggest that NO is involved in the NMDA-induced cardiovascular responses in the RVLM.
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Lai CC, Wu WC, Chen SL, Xiao X, Tsai TC, Huan SJ, Chen TL, Tsai RJ, Tsao YP. Suppression of choroidal neovascularization by adeno-associated virus vector expressing angiostatin. Invest Ophthalmol Vis Sci 2001; 42:2401-7. [PMID: 11527956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
PURPOSE To test the efficacy of a recombinant adeno-associated virus (rAAV) vector that expresses mouse angiostatin in suppressing experimental choroidal neovascularization (CNV) in a rat model. METHODS An rAAV vector, rAAV-angiostatin, was constructed to deliver the mouse angiostatin gene. rAAV-angiostatin and a control virus, rAAV-lacZ, were delivered in vivo by subretinal injection in Brown Norway rats, and the delivery was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). For a CNV suppression experiment, CNV was generated by fundus krypton laser photocoagulation 7 days after the viral vector injection and was evaluated by fluorescein angiography (FA) and histology. Apoptosis in retina was analyzed using the TUNEL assay. Inflammation in the retina was investigated by immunohistochemistry, using antibodies that recognize lymphocytes. RESULTS rAAV-angiostatin injection led to sustained expression of the angiostatin gene in chorioretinal tissue for up to150 days. FA analysis revealed significant reduction of the average sizes of CNV lesions in rAAV-angiostatin-injected eyes when compared with rAAV-lacZ-injected eyes at both 14 (P = 0.019) and 150 (P = 0.010) days after injection. Moreover, histologic analysis of CNV lesions also revealed significantly smaller lesions in rAAV-angiostatin-injected eyes (P = 0.004). As for adverse effects, rAAV-angiostatin injection did not cause inflammation or apoptosis of cells in retina and choroid. CONCLUSIONS This is the first report that subretinal injection of rAAV-angiostatin can significantly reduce the sizes of CNV lesions. This and the absence of apoptosis and inflammation in chorioretinal tissue indicate the feasibility of a gene therapy approach for treatment of CNV disease.
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Shahi CN, Rathore SS, Wang Y, Thakur R, Wu WC, Lewis JM, Petrillo MK, Radford MJ, Krumholz HM. Quality of care among elderly patients hospitalized with unstable angina. Am Heart J 2001; 142:263-70. [PMID: 11479465 DOI: 10.1067/mhj.2001.116477] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Guidelines for the management of unstable angina have been published by the United States Agency for Health Care Policy and Research (currently known as the Agency for Healthcare Research and Quality); however, little information is available about the quality of unstable angina care, particularly among elderly patients. METHODS We examined 1196 elderly Medicare-insured patients hospitalized with unstable angina (ruled out for acute myocardial infarction) at Connecticut hospitals between August and November 1995 to evaluate quality of care provided during hospitalization. Patients without therapeutic contraindications were evaluated for the use of 5 Agency for Health Care Policy and Research guideline-recommended measures: electrocardiographic examination within 20 minutes of admission, use of aspirin on admission, intravenous heparin on admission, achievement of therapeutic anticoagulation among patients provided heparin, and prescription of aspirin on discharge. RESULTS Less than half (49.6%) of patients underwent electrocardiographic examination within 20 minutes of admission. After excluding patients with contraindications, aspirin was provided to 80.1% of patients and intravenous heparin to 59.2% of indicated patients, of whom only 43.3% achieved therapeutic anticoagulation. Aspirin was prescribed to 82.3% of eligible patients at discharge. Performance on the 5 quality measures varied widely among hospitals. CONCLUSIONS Agency for Health Care Policy and Research guideline-recommended risk stratification and therapeutic interventions are underused in elderly patients hospitalized with unstable angina, with quality of care varying widely among hospitals.
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Wu WC, Chang SM, Chen JY, Chang CW. Management of postvitrectomy diabetic vitreous hemorrhage with tissue plasminogen activator (t-PA) and volume homeostatic fluid-fluid exchanger. J Ocul Pharmacol Ther 2001; 17:363-71. [PMID: 11572467 DOI: 10.1089/108076801753162771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The incidence of recurrent vitreous hemorrhage of proliferative diabetic retinopathy following posterior vitrectomy ranges from 29% to 75% in reported series. Fluid-gas exchange and vitreous cavity lavage are the popular methods of treating this kind of recurrent hemorrhage. The fluid-gas exchange cannot offer clear vision immediately after the procedure. To improve the function of the classic vitreous cavity lavage, we designed a volume homeostatic fluid-fluid exchanger - Chen's I/A device. Tissue plasminogen activator (t-PA) is a protease that preferentially converts fibrin-bound plasminogen to the active proteolytic enzyme, plasmin. It has been clinically and experimentally proven effective in lysis of postvitrectomy blood clot and fibrin formation. When the blood clot is formed in the vitreous cavity, intravitreal injection of t-PA can convert plasminogen to plasmin and remove the clot. From July 1999 to January 2000, ten eyes of postvitrectomy diabetic vitreous hemorrhage (PDVH) were collected. In each case, 4 days after intravitreal injection (IVI) of t-PA (30 microg), vitreous cavity lavage was performed with Chen's I/A device. Of these cases, 8 eyes (80%) experienced an immediate clearing of the vitreous cavity. Early complications included anterior hyaloid fibrovascular proliferation (2 eyes) and postoperative intraocular pressure elevation (3 eyes). On the basis of the results of this study, our conclusion is that volume homeostatic vitreous cavity lavage, combined with intravitreal injection of t-PA, is an excellent method for treatment of postvitrectomy diabetic vitreous hemorrhage but, in cases of PDVH with iris rubeosis, the advantage of this procedure is uncertain.
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Wu WC. History of hand surgery in Hong Kong. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2001; 6:v-viii. [PMID: 11681315 DOI: 10.1142/s0218810401000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of hand surgery in Hong Kong can be largely divided into three phases: the early years, the 1960s and 70s, and the present. In the immediate post-World War II years, incidence of infectious diseases was high; there were many patients with tuberculosis, poliomyelitis, leprosy and osteomyelitis. In the 1960s and 70s, the light industry revolution brought along many patients with serious hand injuries caused by machines. Dr Yen-Shui Tsao was the first local surgeon trained in hand surgery. Prof. SP Chow and Prof. PC Leung were the two pioneers who developed this subspecialty and microsurgery during that period. At present, with the change in economic environment, the disease pattern has also changed. Despite our heavy clinical involvement, we have been very active in academic researches. The Hong Kong Society for Surgery of Hand was formed in 1986. For the past 15 years, the society organized Workshops and Annual Congresses attended by overseas speakers, including surgeons from China. It also provided scholarships for Fellows of the Asia-Pacific countries. In addition, the society provided the participants with the chance to exchange ideas and forge friendships. Hong Kong has thus been and will continue to be the meeting point of the East and the West.
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Wu WC, Tam MF, Peng HJ, Tsai LC, Chi CW, Chang ZN. Isolation and partial characterization of a 46-kd allergen of Bermuda grass pollen. J Biomed Sci 2001; 8:342-8. [PMID: 11455197 DOI: 10.1007/bf02258376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Cyn d Bd46K, a 46-kD component of Bermuda grass (Cynodon dactylon) pollen, had been identified as an allergenic constituent. In the present study two-dimensional (2D) gel electrophoresis illustrated the presence of five acidic isoforms in Cyn d Bd46K, and this molecule was purified by monoclonal antibody (MAb) affinity chromatography for further characterization. Using a digoxigenin-labeled lectin-binding assay, the elucidating protein was disclosed to be a glycoprotein with terminal mannose. The involvement of a carbohydrate moiety in the allergenicity and antigenicity of the elucidated molecule was demonstrated with sodium-periodate-treated Cyn d Bd46K, which reduced binding to its specific MAb and human IgE. We were unable to identify the N-terminal amino acid sequences of Cyn d Bd46K, but some internal amino acid sequences were disclosed by microsequencing some fragments cleaved by Achromobacter protease I and fractionated by reversed-phase column chromatography. The amino acid sequences of 4 identified Cyn d Bd46K internal peptide fragments were found to be 25-71% identical with that of cytochrome c oxidase III from corn grass pollen. The present study provided important information for future experiments on the molecular cloning of the elucidated allergen.
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Vennes JA, Ament M, Boyce HW, Cotton PB, Jensen DM, Ravich WJ, Sugawa C, Wu WC, Sanowski RA, Ament M. Principles of training in gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Standards of Training Committees. 1989-1990. Gastrointest Endosc 2001; 38:743-6. [PMID: 1473697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Cheung F, Ma L, Ng WK, Wu WC. Spindle cell sarcoma with neuroepithelial [correction of neuroectodermal] differentiation. Histopathology 2001; 38:278-80. [PMID: 11260312 DOI: 10.1046/j.1365-2559.2001.01068-2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chung CP, Hsu SY, Wu WC. Cataract formation after pars plana vitrectomy. Kaohsiung J Med Sci 2001; 17:84-9. [PMID: 11416962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
To investigate the duration and pattern of cataract formation after pars plana vitrectomy, thirty-three eyes from 33 patients with complete data from March 1995 to January 2000 were collected in this study. The time and pattern of cataract formation was analyzed according to Lens Opacities Classification System III (LOCS III). The correlation between the mean cataract progression and follow-up time was determined by simple regression and correlation analysis. Diabetes mellitus and hypertension were the main causes of patients with vitreoretinopathy who underwent pars plana vitrectomy procedure. Twenty-one patients (63.6%) had diabetes mellitus and 11 patients (33.3%) had hypertension. Four eyes (13.8%) received intravitreal gas injection after pars plana vitrectomy. The correlation between cataract progression and follow-up time was clinically significant (p < 0.05). Thirty-one patients (94%) were nuclear cataract, the mean time of cataract formation being 9.1 months; 15 patients (46.9%) were cortical cataract, the mean time of formation being 8 months; and 24 patients (72.7%) were posterior subcapsular cataract, the mean time of formation being 13.3 months. Cataract formation after pars plana vitrectomy is not infrequent. Nuclear cataract is the most common type in this study. Vitreous microenvironmental changes, post-vitrectomy uveitis, intravitreal gas, and patient age may be the key points of cataract formation after surgery. The mechanism of longer-term effect of pars plana vitrectomy on lens status is still unknown and merits further study.
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Wang CY, Wu WC, Huang CS. A second deciduous molar impacted in right maxillary sinus: a long-term follow-up. CHANG GUNG MEDICAL JOURNAL 2000; 23:788-93. [PMID: 11416901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Primary tooth impaction is quite rare during the development of primary dentition. Various factors contribute to the impaction of a deciduous tooth, including malposition and malformation of the tooth bud, dentomaxillofacial disharmony, tumors, and cysts. This case was a 6-year-old female with complete left cleft lip/palate. A maxillary right second deciduous molar impacting at a high level approximate to the maxillary sinus was noted on the initial visit. To prevent surgical trauma to the surrounding tissue and succedaneous teeth, regular follow-up with radiographic examination was taken every 2 years. After a 7-year long-term follow-up, the impacted second primary molar in the right maxillary sinus had almost completely been resorbed with only about 10% of the original structure left. To the present, the resorption of the impacted deciduous molar seemed to have continued with no major pathological changes. Periodic radiographic examination is strongly advised until the total resorption process is completed.
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Wu WC, Kao YH, Hu DN. Relationship between outcome of proliferative vitreoretinopathy and results of tissue culture of excised preretinal membranes. Kaohsiung J Med Sci 2000; 16:614-9. [PMID: 11392101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
The purpose of this study was to explore the relationship between clinical post-surgery outcome of proliferative vitreoretinopathy (PVR) and the laboratory results of tissue culture, the specimens of which were excised of pre- or subretinal membranes from PVR patients. Surgically excised membranes from 25 PVR patients were microdissected into small pieces and plated into culture dishes with F12 medium supplemented with 30% fetal bovine serum. After primary culture became confluent, cells were passaged in subculture with F12 medium (10% fetal bovine serum). PVR patients were followed-up after surgery for an average of 21 months. The clinical outcome was compared, according to the growth pattern of the cells derived from the explanted membranes. In 25 PVR patients, 16 cases showed cell migration in the membrane, and cells grew rapidly to confluence in the primary culture in 7 cases. All active growing cells were identified as retinal pigment epithelial (RPE) cells by immunocytochemistry. In 7 cases with active cell growth, all had recurrent retinal detachment. In 18 cases without active cell growth, only 4 cases had the same outcomes. Statistical study showed that the difference between these two groups was significant (P < 0.01). These results indicate that the growth capacity of cultured RPE derived from excised membranes of PVR patients strongly influenced the prognosis for surgery.
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Wu WC, Ho JD, Ho CL, Chen TL, Chen SN. Perfluorodecalin condensation on posterior surface of lens capsule and corneal endothelium during vitrectomy. CHANG GUNG MEDICAL JOURNAL 2000; 23:768-75. [PMID: 11416898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND High-density vitreous substitutes, including perfluorodecalin, are widely used in current vitreoretinal surgery. We report 4 cases of perfluorodecalin condensation on the posterior capsule of the lens or corneal endothelium during vitrectomy. To the best of our knowledge, no such phenomenon has ever been reported. METHODS This study consisted of 4 patients with retinal detachment and large retinal tears. All patients were men. All of the patients underwent pars plana vitrectomy, perfluorodecalin injection, endolaser retinopexy and air-fluid exchange. Two patients received additional surgery for scleral buckling. RESULTS Perfluorodecalin condensation was observed on the posterior surface of the lens capsule in one phakic patient and on the endothelium in three aphakic patients during vitrectomy. The condensation obscured the image of the fundus and made air-fluid exchange difficult. The condensation could be dissipated by first removing the perfluorodecalin as completely as possible, and then by lowering the intraocular pressure below the vapor pressure of perfluorodecalin. CONCLUSIONS Perfluorodecalin condensation may occur when perfluorodecalin is not properly used. To avoid forming condensation, high-density vitreous substitutes should never be injected into eyes that are completely air-filled, prolonged air-fluid exchanges should be avoided, and the intraocular pressure should always be kept at a higher level during air-fluid exchange.
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Su CY, Chen MT, Wu WS, Wu WC. Concentration of vascular endothelial growth factor in the subretinal fluid of retinal detachment. J Ocul Pharmacol Ther 2000; 16:463-9. [PMID: 11110038 DOI: 10.1089/jop.2000.16.463] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to investigate the release of vascular endothelial growth factor (VEGF) within the subretinal fluid in eyes with retinal detachment. Subretinal fluid was collected from patients with retinal detachment undergoing surgery for scleral buckling. Serum samples were also collected. The concentration of VEGF in the subretinal fluid and serum was investigated by enzyme-linked immunospecific assay. The average concentration of VEGF in serum samples was 168 +/- 153 pg/ml (mean +/- standard deviation). It was lower than the VEGF concentration in the subretinal fluid (485 +/- 570 pg/ml) in the same 18 patients with retinal detachment (p < 0.05). The average concentration of VEGF was 355 +/- 373 pg/ml in 31 samples of the subretinal fluid collected from simple rhegmatogenous retinal detachment. It was lower than the average concentration of 901 +/- 385 pg/ml in 8 samples of the subretinal fluid from retinal detachment with proliferative vitreoretinopathy (p < 0.05). The results suggest that the relative retinal ischemia in detached retina increases the release of VEGF into the subretinal space. Also, the concentration of VEGF within the subretinal fluid in proliferative vitreoretinopathy was higher than in simple rhegmatogenous retinal detachment.
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Sadaniantz A, Wu WC. Survival of renal transplant patients after first myocardial infarction: a look to the past and promises for the future. Am J Kidney Dis 2000; 36:211-3. [PMID: 10873895 DOI: 10.1053/ajkd.2000.9200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wu WC, Yang CY, Chai CY. Nitric oxide mediates depressor responses by activation of N-methyl-D-aspartate receptors in the nucleus tractus solitarius of cat. CHINESE J PHYSIOL 2000; 43:75-80. [PMID: 10994697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Nitric oxide (NO) is involved in cardiovascular regulation and sympathetic nerve activity of the central nervous system (CNS). The nucleus tractus solitarius (NTS) is important to cardiovascular regulation. However, the physiological role of NO in cardiovascular regulation effecting through the NTS remains unclear. The purpose of this study is to investigate the effect of NO measured by in vivo voltammetry on the cardiovascular responses in NTS induced by N-methyl-D-aspartate (NMDA) in anesthetized cats. Extracellular NO concentration was monitored through a Nafion- and porphyrin-coated carbon fiber electrode, which has previously been demonstrated sensitive and selective to NO responses. Microinjection of NMDA into NTS elicited a dose-dependent decrease in cardiovascular responses associated with NO release. Following the dose-response curve, a dose of 3 nmol of NMDA was selected. Microinjection of NMDA into NTS produced depressor responses and NO release. These responses in NTS to NMDA were attenuated by pretreatment with a competitive antagonist, 2-amino-5-phosphonopentanoat (AP-5, 1 nmol), and methylene blue (MB, 1 nmol), an inhibitor of guanylate cyclase. These results suggest that NO is formed from NMDA activation in NTS and that NO diffuses out of neurons into the nearby target neurons to produce depressor response and NO release through cyclic guanosine monophosphate (cGMP) formation. In conclusion, NO mediates depressor response consequent to activation of NMDA receptors in neurons of NTS.
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Wu WC, Chan WF. Defatting of skin flaps using arthroscopic instruments--an effective alternative. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2000; 25:300-3. [PMID: 10961560 DOI: 10.1054/jhsb.2000.0390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Defatting is often required when skin flaps are transferred to the hand. We present three patients with skin flaps which were defatted using an arthroscopic shaver and a standard suction device. There were no complications and all three patients were satisfied with their outcomes. This method provided an effective treatment for our patients and did not require the purchase of specialised equipment.
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Huang SC, Wu SC, Wu WC, Hong HL. Microbial keratitis--a late complication of penetrating keratoplasty. Trans R Soc Trop Med Hyg 2000; 94:315-7. [PMID: 10975009 DOI: 10.1016/s0035-9203(00)90338-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A retrospective review of 323 penetrating keratoplasties performed in Taiwan between January 1993 and December 1997 revealed that late microbial keratitis developed in 39 eyes of 36 patients (12.1%). All patients were operated on by the same surgeon, and all were followed for at least 1 year. The mean interval between the corneal transplantation and the onset of graft infection was 8.6 +/- 8.8 months (range 3 weeks-47 months). Predisposing risk factors for keratitis included chronic blepharitis with poor lid hygiene (43.6%), suture-related problems (38.5%), dry eyes (28.2%), epithelial defects (25.6%), and use of contact lenses (5.1%). Infectious keratitis was diagnosed within 6 months after keratoplasty in 59% of cases. Positive cultures were obtained in 100% of the ulcers; Pseudomonas aeruginosa and Staphylococcus aureus were the most common pathogens. In the final visual outcome assessment, 30.8% of cases had clear grafts, 20.5% had graft failures, and 10.3% had corneal perforations.
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Liao GF, Zhong H, Jiang GH, Mu XF, Wu WC. [Measurement and evaluation of visual index in VDT operators under Multi-user system]. HANG TIAN YI XUE YU YI XUE GONG CHENG = SPACE MEDICINE & MEDICAL ENGINEERING 2000; 13:61-4. [PMID: 12214615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To evaluate the visual function of the visual display terminal (VDT) operators under the Multi-user system. METHOD Subjective symptoms of the VDT operators under the Multi-user system were measured before and after work in the field study. Visual indices were measured at 8:15, 9:15, 10:15, 11:15, or 12:15 a.m. RESULT No discomfort symptom was observed during the working time, and Longitudino-Kinetic visual acuity, and Critical flicker frequency didn't decrease. Refraction showed no significant decrease as compared with that at 8:15 except that of right eye measured at 12:15. CONCLUSION The Visual function of the VDT operators remained good in the Multi-user's system.
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Wu WC, Wu SC, Lin SM. Surgical outcome of combined phacoemulsification and trabeculectomy. CHANGGENG YI XUE ZA ZHI 1999; 22:572-8. [PMID: 10695203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND A retrospective study was undertaken to evaluate the results of phacoemulsification, intraocular lens implantation, and trabeculectomy in patients with cataracts coexisting with glaucoma. METHODS This study consisted of 20 eyes from 19 patients. Fifteen eyes had chronic angle-closure glaucoma and 5 eyes had primary open-angle glaucoma. All cases were followed for a minimum of 6 months (range, 6 to 16 months). The mean preoperative intraocular pressure (IOP) was 17.3 +/- 4.5 mmHg. The mean preoperative visual acuity was 0.05 +/- 0.19. The mean number of preoperative antiglaucoma medications per patient was 2.3. RESULTS Postoperatively, all patients except for one no longer required antiglaucoma medication. The mean IOP was 10.7 +/- 3.7 mmHg one month postoperatively and 13.7 +/- 4.3 mmHg at the final follow-up visit. Vision improved in 80% of the patients and remained unchanged in 20%. The failure to achieve improvement was due to advanced optic atrophy. The mean level of surgically induced astigmatism at the final visit was 0.98 +/- 0.91 diopters as calculated by vector analysis. Various extents of fibrin exudate was found in 10 eyes (50%). The most serious postoperative complication, occurring in one eye (5%), was temporary hypotony with moderate choroidal effusion, which later resolved spontaneously. CONCLUSION Combined phacoemulsification and trabeculectomy is an effective and safe approach for obtaining good visual rehabilitation and glaucoma control.
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Wu WC, Kuo SL, Chen JY. Management of severe proliferative vitreo-retinopathy with perfluorocarbon liquids and silicone oil. Kaohsiung J Med Sci 1999; 15:611-6. [PMID: 10603709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
12 patients of retinal detachment with advanced proliferative vitreoretinopathy were managed with intraoperative perfluoro-N-octane and postoperative silicone oil injection from March 1994 to June 1996 in Kaohsiung Medical University Hospital. The combined intraoprative procedures included posterior vitrectomy (12 eyes), membrane peeling (12 eyes), lower peripheral iridectomy (8 eyes), endo-photocoagulation (8 eyes), retinotomy (8 eyes), and retinal fixation with tack (1 eye). After a minimum of 10 months of follow up, the retina was successfully reattached in 10 (84%) of the 12 eyes, 5 of these eyes had stable tractional detachments on the anterior part of the scleral buckle. Seven patients (58.3%) regained vision of 5/200 or better. The rate of improvement by listing best corrected visual acuity after operation was 75%. We think that the ability to readily remove additional pre-retinal fibrous tissue after the retina was flattened with perfluorocarbon liquids allowed the surgeon to perform a further complete membrane dissection. It can therefore improve the success rate of surgery and hence decrease the rate of complications that was previously thought to be caused by sillicone oil.
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Huang SC, Wu WC, Tsai RJ. Recurrent herpetic keratitis induced by laser iridectomy: case report. CHANGGENG YI XUE ZA ZHI 1999; 22:515-9. [PMID: 10584428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The mechanism for herpetic keratitis reactivation remains unclear. When observed clinically, the reactivation may be associated with a variety of endogenous and exogenous stimuli, such as strong sunlight, fever, menstruation, and psychiatric disturbances. In experimental studies, most methods of inducing recurrence have involved some degree of corneal trauma, inflammation, neuronal stimulation, or damage to the nerves that innervate the cornea. Although corneal damage after laser iridectomy (LI) is well documented, recurrent herpetic keratitis induced by LI has never been reported. Here we present an unusual case of recurrent herpetic keratitis induced by LI. The location of the bullous keratopathy was strongly correlated to the site of laser iridectomy. Clinical findings as well as the dramatic response to antiviral treatment supported the diagnosis. Although the energy for laser iridectomy is relatively safe for most circumstances, the possibility of inducing herpetic keratitis cannot be ignored. Therefore it is important for clinicians to beware of this potential complication.
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Wu WC, Lin JC. The experience to use a modified en bloc excision technique in vitrectomy for diabetic traction retinal detachment. Kaohsiung J Med Sci 1999; 15:461-7. [PMID: 10518362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Modified en bloc excision is a technique in which all posterior hyaloid is excised except the portions essential for membrane dissection. Then, bimanual dissection techniques allow excision of retained fibrovascular membrane "en bloc" with hyaloid. In a consecutive series of 16 eyes with diabetic traction retinal detachment treated with this technique, visual acuity of 5/200 or better was obtained in 11 (69%) of the cases, and complete macula reattachment was noted in 14 (87%) of 16 eyes. The final visual acuity was improved in 12 (75%) cases. While this surgical technique allows a higher rate of anatomic success and less postoperative morbidity, visual results remain limited by irreversible alteration in retinal function.
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Verne GN, Hahn AB, Pineau BC, Hoffman BJ, Wojciechowski BW, Wu WC. Association of HLA-DR and -DQ alleles with idiopathic achalasia. Gastroenterology 1999; 117:26-31. [PMID: 10381906 DOI: 10.1016/s0016-5085(99)70546-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Idiopathic achalasia is a motility disorder of the esophagus characterized by incomplete relaxation of the lower esophageal sphincter and a loss of normal peristaltic activity in the body of the esophagus. The loss of inhibitory neurons in the distal esophagus, as well as abnormalities in the vagus nerve, dorsal motor nucleus of the vagus nerve, and autonomic nervous system, have been described in achalasia. Although the underlying cause of idiopathic achalasia is unknown, the diffuse neuronal effects found suggest a possible viral or neurodegenerative mechanism. By use of serological methods, a significant association between the HLA-DQ1 phenotype and idiopathic achalasia has been found, suggesting a possible immunogenetic mechanism. To further define immunogenetics in the pathogenesis of idiopathic achalasia, we performed tissue typing in patients with achalasia to determine their specific HLA phenotypes. METHODS We prospectively studied 32 patients (23 white and 9 black) with idiopathic achalasia. Peripheral blood was collected, and HLA-DR and -DQ typing by polymerase chain reaction with sequence-specific primers was performed. Results were compared with those from 268 racially matched local controls. RESULTS Idiopathic achalasia and the broad HLA-DQ1 allele were not significantly associated in either population, although a trend was found in white subjects (odds ratio [OR], 2.16; chi2 = 5.36, P corrected [Pc] = 0.0824). Further subtyping in white subjects revealed a significant association between idiopathic achalasia and the DQB1*0602 allele (OR, 3.10; chi2 = 7.32, Pc = 0.0408). A strong trend was also found with the DRB1*15 allele (OR, 2.83; chi2 = 8.11, Pc = 0.0572). In the black population, there was no association between idiopathic achalasia and DQB1*0602 or DRB1*15, but a trend was found with DRB1*12 (OR, 6. 19; chi2 = 5.19, P = 0.0227 uncorrected, Pc = 0.295). CONCLUSIONS Idiopathic achalasia is associated with HLA alleles in a race-specific manner. These results support an immunogenetic mechanism in the pathogenesis of idiopathic achalasia.
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Chen ZC, Fan KF, Wu WC, Chen HC. Fusion of the lumbar spine with a free vascularized fibular bone graft: case report. CHANGGENG YI XUE ZA ZHI 1998; 21:463-8. [PMID: 10074735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Spinal fusion with either non-vascularized or vascularized bone grafts has been well documented for inflammatory, degenerative, post-oncological and post-traumatic reconstruction Vascularized bone graft has been proven to have more rapid healing and better clinical results. A few reports have indicated that free vascularized fibular bone grafts have been used for reconstruction of the cervical and thoracic spine with good clinical results. We report a case of a third lumbar vertebra burst fracture successfully treated with a free vascularized fibula graft after failure of an initial conventional bone graft. The neurological symptoms improved significantly. The strong and straight bone quality makes the vascularized fibula an ideal choice for reconstruction of the spine. Vascularized fibula bone graft is an option in cases with failed nonvascularized bone grafts, in cases where an iliac bone is not suitable for reconstruction, or in cases where a poor recipient bed makes having well-vascularized bone necessary. This report describes our surgical approach and demonstrates the versatility of the free fibular osteoseptocutaneous flap for reconstruction of any portion of the spine.
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Wu WC, Chai CY. Spike responses of sympathetic vertebral nerve activities during stimulation of the pressor dorsomedial and rostral ventrolateral medulla differ in cats. CHINESE J PHYSIOL 1998; 41:45-52. [PMID: 9629481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this study, we developed a differential integrator unit containing a window discriminator (WPI-121) and three integrators (sample/hold, Gould) to characterize the difference in spikes involved in sympathetic vertebral nerve activity (VNA) and integrated VNA (Int. VNA) during stimulation of the dorsomedial (DM) and rostral ventrolateral (RVLM) medullar. The upper level (UL) in the window discriminator was set at a value, 80% of the VNA amplitude above the zero. The low level (LL) was set at a value 10% above the zero. The number of VNA spikes above the UL in the window discriminator was defined as Fa, while the number of VNA spikes within the UL and LL as Fw. In 26 cats anesthetized with urethane and alpha-chloralose, results showed that electrical stimulation and microinjections of glutamate (Glu, 0.25 M, 50 nl) or glycine (Gly, 1.0 M, 50 nl) at the same point in DM or RVLM increased both systemic arterial pressure (SAP) and Int. VNA. However, the increase of Int.VNA on DM stimulation was contributed by increases of both Fa and Fw, while on RVLM stimulation the increase of Int.VNA was mainly contributed by the increase of Fa, against a decrease of Fw. As compared to Glu, stimulation of DM by Gly produced more increase in Fw, while stimulation of RVLM by Gly produced more decrease in Fw. During RVLM stimulation the VNA was usually transferred to a huge synchronized oscillation. These findings suggest that although stimulations of the sympathetic-pressor neurons in DM and RVLM produce similar increases in SAP and VNA, the nature of these neurons is different.
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Lam CK, Wu WC, Ip FK. An unorthodox solution to an intra-operative complication of hip fracture fixation. Injury 1998; 29:248-9. [PMID: 9709431 DOI: 10.1016/s0020-1383(97)00216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
STUDY DESIGN This case report describes a middle-aged woman with concomitant tuberculosis and pyogenic infection of the cervical spine. OBJECTIVE To describe an unusual case of concomitant tuberculosis and pyogenic infection of the cervical spine. SUMMARY OF BACKGROUND DATA Neither tuberculosis nor pyogenic spondylitis of the cervical spine is a common disorder. This case report describes a concomitant infection of C3-C4 in an otherwise healthy patient. To the authors' knowledge, such a case has never been reported. METHODS This 52-year-old woman had spontaneous neck pain and myelopathy. Radiologic examination revealed the presence of an epidural abscess with destruction of C3-C4 vertebral bodies. RESULTS Anterior decompression and fusion were performed, followed by therapy with antituberculosis drugs and antibiotics. The patient completely recovered. A follow-up radiograph revealed that solid fusion had been achieved. CONCLUSION A case of concomitant tuberculosis and pyogenic infection of the cervical spine is presented. The possibility of this differential diagnosis should be considered, especially in areas of endemic tuberculosis. Examination of biopsy samples for histologic and bacteriologic findings is important to confirm this diagnosis. Radical debridement and combination therapy are strongly recommended to treat patients with this combination of infections.
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Wu WC, Kuo JS, Wang Y, Chai CY. Glycine increases arterial pressure and augments NMDA-induced pressor responses in the dorsomedial and ventrolateral medulla of cats. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1997; 67:145-55. [PMID: 9479666 DOI: 10.1016/s0165-1838(97)00106-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The present study is designed to determine and characterize two neurobiological events. Firstly, we investigated whether increases of systemic arterial pressure (SAP) and sympathetic vertebral nerve activity (VNA) produced by microinjection of glycine (Gly) in the dorsomedial (DM) or rostral ventrolateral medulla (RVLM) are mediated by pressor neurons in DM or RVLM. Secondly, we assessed whether simultaneous microinjections of Gly and N-methyl-D-aspartate (NMDA) in DM or RVLM potentiate the NMDA-pressor effects. Changes in SAP and VNA were recorded in 33 cats under alpha-chloralose and urethane anesthesia. Microinjection of sodium glutamate (Glu, 0.25 M, 30 nl) or Gly (1.0 M, 30 nl) into the DM or RVLM increased SAP and VNA in similar magnitude. Latencies of changes in SAP and VNA induced by Gly, however, were longer (3 s) than those induced by Glu. Prior microinjection of the following antagonists blocked the Gly-induced pressor responses: 2-amino-5-phosphonopentanoate (AP-5, 25 mM, 30 nl), a specific NMDA receptor antagonist; or glutamate diethyl ester (GDEE, 0.5 M, 30 nl), a quisqualate receptor antagonist; or kynurenic acid (KYN, 10 mM, 30 nl), a broad spectrum competitive Glu antagonist. Prior treatment with strychnine (3 mM, 30 nl), a specific Gly antagonist, also blocked the Gly-induced pressor responses. Since Gly is believed to be an inhibitory neurotransmitter, these data suggest that Gly may produce pressor actions via an inhibition on specific inhibitory neurons synapsing with the pressor neurons. NMDA (0.1 M, 30 nl) and Gly (1.0 M, 30 nl) microinjected simultaneously in DM or RVLM produced a greater pressor action than NMDA alone. This potentiation was blocked by KYN, another known antagonist for such potentiation, but was only partially blocked by strychnine.
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Abstract
A lower leg open fracture with an accompanying extensive soft-tissue defect may require free flap transfer to resurface the wound. In open-leg fracture injuries the major arteries are frequently damaged during the injurious event. When the antegrade arterial blood flow is not available for arterial inflow to the free flap, end-to-side arterial anastomoses or a venous graft from a proximal healthy artery is an appropriate solution. Reversed arterial flow is another technique that may be used to provide arterial inflow to the free flap. We report 5 patients with open tibial fracture injuries that were successfully covered using latissimus dorsi muscle free flaps with reverse arterial inflow and either antegrade venous outflow (4 patients) or retrograde outflow (1 patient). This technique is indicated when (1) the defect is not located at the site adjacent to the residual antegrade artery, (2) a long vein graft might pass through severely scarred soft tissue, or (3) after failure in end-to-side anastomosis with accompanying insufficient antegrade proximal arterial flow but good distal arterial reflux.
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Chen JY, Wu WC, Chen MT, Wang HZ. Balanced fluid exchange by volume homeostatic fluid-fluid exchanger--a new solution to postvitrectomy vitreous hemorrhage. Kaohsiung J Med Sci 1997; 13:700-3. [PMID: 9425871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We introduce a new device and a new technique that facilitate the clearance of postvitrectomy vitreous hemorrhage. We have developed a volume homeostatic fluid-fluid exchanger--Chen's Infusion/Aspiration (Chen's I/A) device. Due to reciprocal synchronized hydraulic action, Chen's I/A provides simultaneous infusion and aspiration of fluid of equal amounts. Therefore, it can be used to perform vitreous cavity lavage through smaller caliber needles and at the same time maintain a constant intraocular pressure. This improved vitreous cavity lavage technique is named Balanced Fluid Exchange. Performing Balanced Fluid Exchange with Chen's I/A can reduce trauma to the eyeball and decrease complications resulting from unstable intraocular pressure. Thus, it increases both the intra-operative and post-operative clearance rates of postvitrectomy vitreous hemorrhage, and is a promising method for the management of postvitrectomy vitreous hemorrhage.
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Abstract
AIMS Osteoblastoma is a rare bone tumour and differentiation from osteosarcoma is occasionally a diagnostic problem. The difficulty is further compounded when such a lesion microscopically shows cytological or architectural atypia. METHODS AND RESULTS A case of pseudomalignant osteoblastoma occurring in the left iliac crest of a 34-year-old Chinese woman is presented. Radiographic findings were non-diagnostic, but favoured a benign yet locally aggressive lesion. Histologically the diagnosis was based on the findings of classical osteoblastoma areas harbouring pseudomalignant osteoblasts in the absence of mitoses, but there were co-existing atypical architectural features also. CONCLUSION The significance and pathogenesis of the 'permeative pattern' are discussed. Difficulties in differentiating borderline lesions are emphasized.
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Yang CY, Luk HN, Chen SY, Wu WC, Chai CY. Propofol inhibits medullary pressor mechanisms in cats. Can J Anaesth 1997; 44:775-81. [PMID: 9232310 DOI: 10.1007/bf03013394] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Propofol may cause hypotension and the mechanism is complex. The present study was designed to determine the direct actions of propofol in medulla of cats. METHODS Mean systematic arterial pressure (MSAP), heart rate (HR) and cardiac contractility (dp/dt) were compared before and after administration of propofol the femoral vein (2, 3, or 4 mg.kg-1), vertebral artery (1 mg.kg-1) or the lateral cerebral ventricle (0.5 mg.kg-1) in eight anaesthetized cats. To study the direct effect of propofol in medulla, pressor areas of the dorsomedial medulla (DM) and rostral ventrolateral medulla (RVLM), or the depressor area of the caudal ventrolateral medulla (CVLM) were first identified with electrical stimuli and then confirmed by pressure microinjection of glutamate (Glu, 0.25M, 30 nl) via a multibarrel-micropipette in 28 cats. One hour later, propofol (0.001%, 50 nl) was microinjected at the same site. Electrical stimulation and Glu were applied again to compare changes of SAP, HR and dp/dt with that of the control. RESULTS Propofol dose-dependently decreased SAP, HR and cardiac contractility. The percent increase of MSAP induced by Glu were reduced by propofol in DM (59 +/- 3% vs 13 +/- 2%, n = 11, P < 0.01) or in RVLM (56 +/- 4% vs 18 +/- 2%, n = 9, P < 0.01). In CVLM, propofol slightly but not significantly increased depressor responses elicited by Glu (-27 +/- 2% vs -33 +/- 3%, n = 5, P > 0.05). CONCLUSION Our results show that propofol principally inhibits the vasomotor mechanism in the dorsomedial and ventrolateral medulla to effect its hypotensive actions.
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Chai CY, Wu WC, Hwang JJ, Wang MR, Kuo JS. Attenuation of cardiovascular reactions of vocalized and non-vocalized defence areas of periaqueductal grey following lesions in dorsomedial or ventrolateral medulla of cats. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1997; 64:115-27. [PMID: 9203132 DOI: 10.1016/s0165-1838(97)00021-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the pretentorial periaqueductal grey (PAG), the region producing pressor responses, vocalization and other somatic and visceral signs (VPR) of the defence reaction and another region producing pressor responses (PR) were localized by electrical stimulation in adult cats, anesthetized with intraperitoneal chloralose (40 mg/kg) and urethane (400 mg/kg). The pressor responses included increases of systemic arterial pressure (SAP) and heart rate, increases of blood flow in the common carotid and femoral arteries and a decrease of blood flow in the superior mesenteric artery. The VPR was found in a relatively restricted region of the dorsolateral PAG, while PR was found scattered within the dorsal and ventral portions of the lateral PAG. The increase of SAP and the changes of blood flow in the sampled arteries were slightly greater during VPR than PR stimulation. Mild vocalization with a slight increase of SAP but marked increases of carotid and femoral blood flow (vasodilation) could be induced by microinjection of N-methyl D-aspartate (0.2 M, 200 nl) into the VPR and the blood flow increase, particularly that of the femoral artery, was greatly attenuated by atropine (1 mg/kg, i.v.). In order to ascertain the contribution of the medullary pressor areas to the VPR- and PR-induced responses, extensive lesions were made in the dorsomedial (DM) or vetrolateral medulla (VLM) by microinjections of kainic acid (KA, 0.024 M) in 27 of the 42 cats. The resting SAP and blood flow of the three arteries were reduced by lesioning of the VLM more than that of the DM. Responses of SAP and blood flow from activation of the PR and VPR, particularly the latter, were affected more after DM compared to VLM lesioning. These data suggest that, while the pretentorial PAG constitutes the 'defence area,' vocalization is confined exclusively to its dorsolateral region and that both the VLM and DM contribute to the cardiovascular components of defence reactions. The DM appears to have a greater contribution compared to the VLM.
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Lam CK, Leung WY, Wu WC, Lam J, Ip FK. Orthopaedic ice-skating injuries in a regional hospital in Hong Kong. Hong Kong Med J 1997; 3:131-134. [PMID: 11850561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Ice-skating is a popular sport in Hong Kong. Since the opening of our hospital, we have observed a special pattern of injury related to ice-skating. Individuals have had a wide range of injuries including fractures and deep tissue lacerations, many of which have needed operative intervention. Public awareness of the risks remains low. The pattern and mechanisms of injury, management modalities, and contributing factors to the injuries are discussed. Preventive measures and socioeconomic implications are also discussed.
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Sontag SJ, Robinson M, Roufail W, Hirschowitz BI, Sabesin SM, Wu WC, Behar J, Peterson WL, Kranz KR, Tarnawski A, Dayal Y, Berman R, Simon TJ. Daily omeprazole surpasses intermittent dosing in preventing relapse of oesophagitis: a US multi-centre double-blind study. Aliment Pharmacol Ther 1997; 11:373-80. [PMID: 9146778 DOI: 10.1046/j.1365-2036.1997.141317000.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Relapse of erosive oesophagitis occurs in almost all patients if treatment is stopped after initial healing. AIM To assess the potential of different therapeutic regimens of omeprazole to prevent relapse of erosive reflux oesophagitis after initial healing with omeprazole. PATIENTS AND METHODS Patients whose active erosive reflux oesophagitis (grade > or = 2) had healed (grade 0 or 1) after 4-8 weeks of open-label omeprazole 40 mg daily (phase I) were eligible to join a multi-centre, 6-month double-blind, placebo-controlled maintenance study (phase II), which included endoscopy, symptom assessments, serum gastrin measurements, and gastric fundic biopsies. During phase I, endoscopy was performed at weeks 0, 4, and 8. At the end of phase I, 429 of 472 patients (91%) were healed, and there were significant reductions in heartburn, dysphagia and acid regurgitation. Of the 429 patients who healed, 406 joined phase II and were randomized to one of three groups: 20 mg omeprazole daily (n = 138), 20 mg omeprazole for 3 consecutive days each week (n = 137), or placebo (n = 131). During phase II, endoscopy was performed at months 1, 3, and 6 or at symptomatic relapse. RESULTS The percentages of patients still in endoscopic remission at 6 months were 11% for placebo, 34% for omeprazole 3-days-a-week, and 70% for omeprazole daily. Both omeprazole regimens were superior to placebo in preventing recurrence of symptoms (P < 0.001); however, omeprazole 20 mg daily was superior to omeprazole 20 mg 3-days-a-week (P < 0.001). Compared to baseline, omeprazole therapy resulted in no significant differences among treatment groups in the distribution of gastric endocrine cells. CONCLUSIONS These results show that after healing of erosive oesophagitis with 4-8 weeks of omeprazole, relapse of oesophagitis and recurrence of reflux symptoms can be prevented in 70% of patients with a maintenance regimen of 20 mg daily, but that intermittent dosing comprising 3 consecutive days each week significantly compromises efficacy.
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Lan CT, Wu WC, Ling EA, Chai CY. Evidence of a direct projection from the cardiovascular-reactive dorsal medulla to the intermediolateral cell column of the spinal cord in cats as revealed by light and electron microscopy. Neuroscience 1997; 77:521-33. [PMID: 9472408 DOI: 10.1016/s0306-4522(96)00502-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To ascertain whether the dorsal medulla, a well-established vasopressor structure, would project directly to the sympathetic intermediolateral cell column of the spinal cord, we have carried out both anterograde and retrograde tracing studies in cats. For anterograde tracing, biotin-dextran was iontophoretically delivered into the cardiovascular-reactive dorsal medulla following its functional identification by electrical stimulation. The anterogradely transported biotin-dextran was then visualized using the avidin-biotin-horseradish peroxidase complex method. By light microscopy, dextran-labelled varicose axons were observed bilaterally in the intermediolateral nucleus extending from segments T1 to L3, but concentrated in segments T1-T5, notably at levels T2-T4. Electron microscopic examination revealed the localization of biotin-dextran reaction product in some small myelinated axons and axon terminals in the intermediolateral cell column. The majority of tracer-labelled axonal boutons contained spherical synaptic vesicles and made asymmetric synaptic contacts primarily with small dendrites. A few boutons contained polymorphic synaptic vesicles and tended to form symmetric axodendritic synapses. Spinally projecting neurons of the dorsal medulla were identified using the retrograde transport of horseradish peroxidase injected into the electrically cardiovascular-reactive intermediolateral nucleus. The labelled neurons were localized in the medullary dorsomedial reticular formation ventromedial to the nucleus of the solitary tract, approximately 0.5-5 mm rostral to the obex. The projection was bilateral, but was relatively denser in the rostral portion of the contralateral dorsal medulla. The present findings support the hypothesis that the dorsal medulla, through its direct pathway innervating the intermediolateral nucleus, may serve as a sympathetic premotor structure for regulation of arterial pressure.
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Chang CH, Tsai RK, Wu WC, Kuo SL, Yu HS. Use of dynamic capillaroscopy for studying cutaneous microcirculation in patients with diabetes mellitus. Microvasc Res 1997; 53:121-7. [PMID: 9143543 DOI: 10.1006/mvre.1996.2003] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To investigate the relationship between cutaneous microcirculation and retinopathy in diabetes mellitus, we studied by dynamic capillaroscopy 35 diabetes mellitus patients, including 10 patients without retinopathy, 10 patients with background retinopathy, and 15 patients with proliferative retinopathy. We found that (1) cutaneous and retinal microcirculation in diabetes mellitus in long-term diabetes mellitus, regressional rather than proliferational changes occurred in skin vasculature as compared to that in retina; (2) functional impairments of cutaneous microcirculation, that is, decreased resting capillary blood cell velocity, peak blood cell velocity, and prolonged time to peak capillary blood cell velocity by dynamic capillaroscopy, could be detected in diabetes mellitus patients without retinopathy; (3) the degree of tortouosity of capillaries, impairment in peak capillary blood cell velocity, and time to peak capillary blood cell velocity of cutaneous microcirculation were significantly correlated with the gravity of retinopathy in diabetes mellitus patients; (4) abnormal leakage of fluorescence in cutaneous microcirculation appeared in diabetes mellitus patients with or without abnormal fluorescein angiography in retina. In conclusion, dynamic capillaroscopy used in concert with ophthalmoscopy and fluorescein angiography can facilitate a comprehensive examination of vasculopathy in diabetes mellitus.
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Wu WC, Chang YP, So YC, Ip WY, Lam CK, Lam JJ. The combined use of flaps based on the subscapular vascular system for limb reconstruction. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:73-80. [PMID: 9135422 DOI: 10.1016/s0007-1226(97)91317-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The combined use of flaps based on the subscapular vascular system for limb reconstructions has been infrequently reported. Such combinations have mainly been used for mandibular and facial reconstructions. We have used these flaps as free flaps for lower limb reconstructions in 7 patients, in 6 cases after trauma and in one after infection. A latissimus dorsi muscle or musculocutaneous flap and serratus anterior muscle flap were used together in 4 cases, and a latissimus dorsi muscle flap and parascapular flap in 3 cases. All cases healed satisfactorily. The indications for the combined use of these flaps are to resurface two separate defects simultaneously or to resurface very large defects. The anatomy of the subscapular vascular system allows the combined use of two or more flaps. It has the advantage of requiring anastomosis of one vascular pedicle only. Such combined flaps are particularly suitable for resurfacing defects wider than their length in relation to the long axis of the limb.
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