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Pang WW, Kuo CL, Huang HS, Wong E, Tang JC, Huang MH. Epidural catheter placement in the rabbit--a novel approach. ACTA ANAESTHESIOLOGICA SINICA 1999; 37:79-82. [PMID: 10410407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Using a pediatric epidural set and through caudal approach, we studied a relatively non-invasive technique for epidural percutaneous cannulation in rabbit for chronic laboratory investigations. METHODS Ten rabbits weighing over 3 kg were chosen and anesthetized with intravenous pentothal. A #19 pediatric Touhy needle and 23-gauge catheter were used for cannulation. Via the caudal approach, the epidural space could be located either by a "give" or with a technique of loss of resistance. Under fluoroscopy the catheter was tested with the injection of contrast medium for the confirmation of the proper position. The catheter was then tunneled under the skin and secured. The rabbits were kept in standard care for 4 weeks and then sacrificed by intraperitoneal pentothal overdose. A pathologist blinded to the study carefully examined the whole spine by laminectomy from cervical to coccyx and the findings were recorded. RESULTS With the injection of contrast medium, the final position of the catheter was validated by fluoroscopy in all rabbits. Two rabbits sustained immediate complications from the contrast medium and/or technique, of which one died shortly after the contrast medium injection and the other had weakness of the hind legs for a week. At sacrifice, all the catheters were found in good position. Two had hematoma associated with signs of trauma. One developed subcutaneous abscess. One had stitch infection of skin. CONCLUSIONS Percutaneous cannulation of epidural catheter is possible in the rabbit. Complications could be ameliorated by prudent approach in a skillful hand. It can be a reasonable model for the study of centrally administered medicines and their neurotoxicity.
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Huang MH, Yang RC, Ding HJ, Chai CY. Ultrasound effect on level of stress proteins and arthritic histology in experimental arthritis. Arch Phys Med Rehabil 1999; 80:551-6. [PMID: 10326920 DOI: 10.1016/s0003-9993(99)90198-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of ultrasound on the levels of stress protein in experimental arthritis and their relation to the therapeutic effects on arthritic cartilage repair. METHODS Thirty-six rats with similar degree of early arthritis were divided at random into two groups. In group s, 18 rats received sonication; in group c, 18 control rats received sham sonication. The severity of induced arthritis was evaluated from bone scan with technetium-99m. The presence and changes of stress protein were identified from immunostain of SP72 antibody from frozen sections of arthritic cartilage and from electrophoresis of proteins extracted from chondrocytes of arthritic cartilage. The severity index, density of immunostained chondrocytes, and histopathologic changes at various periods were also studied in each group. RESULTS The density of stress protein was increased markedly in treated rats after sonication and it was closely related to the repair of arthritic cartilage. Once the pathohistology of arthritic cartilage improved, stress protein declined significantly in the follow-up period. CONCLUSION Therapeutic ultrasound can enhance stress protein production in arthritic chondrocytes. The extragenic production of stress protein was well correlated with the therapeutic effect of ultrasound to preserve chondrocytes and bring about the repair of arthritic cartilage.
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Lin JH, Wei SH, Liu CK, Huang MH, Lin YT. The influence of rehabilitation therapy on the prognosis for stroke patients--a preliminary study. Kaohsiung J Med Sci 1999; 15:280-91. [PMID: 10375871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The purpose of this prospective study was to investigate the influence of rehabilitation therapy on the prognosis for stroke patients. Sociodemographic and clinical factors were collected in a sample of 147 stroke patients (81 men and 66 women) admitted to the inpatient rehabilitation department at our university hospital over 10 days between January 1, 1997 and December 31, 1997. Functional Independence Measure (FIM) scores at discharge and gains during rehabilitation period were used as the prognosis index. Statistical techniques with univariate and multiple regression analyses indicated that significant predictors of discharge FIM scores include age, previous attacks twice or over, medical comorbidities, sensory and orientation impairments, and dementia. In addition, previous stroke attacks twice or over and sensory impairment were significant predictors of FIM gains during rehabilitation period. We concluded that: 1) age is a critical factor to determine the rehabilitation outcome, but may not be an important factor to predict the ability for the improvement through rehabilitation therapy; 2) the delay of rehabilitation therapy may not affect the potential for further improvement; 3) patients with low initial functional level may have poor final outcome, they may still have good rehabilitation potential to improve the functional level; 4) complications of stroke may affect the rehabilitation outcome and should be prevented; and 5) patients with impaired mental status should not routinely be excluded from rehabilitation programs.
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Shen HD, Lin WL, Tam MF, Wang SR, Tzean SS, Huang MH, Han SH. Characterization of allergens from Penicillium oxalicum and P. notatum by immunoblotting and N-terminal amino acid sequence analysis. Clin Exp Allergy 1999; 29:642-51. [PMID: 10231324 DOI: 10.1046/j.1365-2222.1999.00509.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Penicillium species are important causative agents of extrinsic bronchial asthma. However, little is known about the allergens of these ubiquitous fungal species. Objective The object was to analyse the composition, the allergenic cross-reactivity and the N-terminal sequences of allergens from two prevalent airborne Penicillium species, P. oxalicum and P. notatum. METHODS The allergenic composition and the immunoglobulin (Ig)E cross-reactivity were analysed by immunoblot and immunoblot inhibition, respectively, using sera from asthmatic patients. The N-terminal amino acid sequences of major allergens were determined by Edman degradation. Allergens identified were also characterized by immunoblotting using monoclonal antibody (MoAb) PCM39 against the alkaline serine proteinase major allergen of P. citrinum. RESULTS Among the 70 asthmatic sera tested, 18 (26%) and 17 (24%) had IgE immunoblot reactivity towards components of P. oxalicum and P. notatum, respectively. Major allergens (> 80% frequency of IgE-binding) from both species are the 34 and 30 kDa proteins of P. oxalicum and the 34 and 32 kDa proteins of P. notatum. IgE cross-reactivity among these major allergens and the 33 kDa major allergen of P. citrinum can be detected by immunoblot inhibition studies. The N-terminal amino acid sequences of the 34 kDa allergen of P. oxalicum and of the 32 and the 28 kDa allergens of P. notatum share homology with sequences of the vacuolar serine proteinase from Aspergillus fumigatus. The N-terminal amino acid sequence of the 34 kDa allergen of P. notatum shows sequence homology with that of alkaline serine proteinase from P. citrinum. Results obtained from immunoblotting showed that MoAb PCM39 reacted with the 34, 30 and 16 kDa IgE-binding components of P. oxalicum, and with the 34, 32 and 28 kDa IgE-binding components of P. notatum. CONCLUSIONS Results obtained suggest that the 34 kDa major allergen of P. oxalicum may be a vacuolar serine proteinase. The 34 and the 32 kDa major allergens of P. notatum may be the alkaline and the vacuolar serine proteinases of P. notatum, respectively. The 30 and 16 kDa IgE-binding components of P. oxalicum and the 28 kDa IgE-binding component of P. notatum may be breakdown products of the 34 and the 32 kDa major vacuolar serine proteinase allergens of P. oxalicum and P. notatum, respectively.
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Pang WW, Huang PY, Chang DP, Huang MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine. Reg Anesth Pain Med 1999; 24:246-9. [PMID: 10338176 DOI: 10.1016/s1098-7339(99)90136-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Tramadol and metoclopramide have a local anesthetic effect similar to lidocaine following intradermal injection. When metoclopramide was retained in the venous system for 1 minute, it was found to be as effective as lidocaine in reducing propofol injection pain. Using this metoclopramide model, the effects of tramadol in reducing pain on propofol injection was investigated. METHODS One hundred five patients were randomly allocated to receive 50 mg tramadol (group T), 60 mg lidocaine (group L), or normal saline (group NS) as pretreatment to reduce pain on propofol injection. Following venous occlusion with a tourniquet (70 mm Hg), one of the drugs was intravenously administered. Venous retention of the drug was maintained for 1 minute. Immediately after the tourniquet release, intravenous injection of 100 mg propofol (10 mL) at a rate of 0.5 mL/s followed. Pain assessment was made after each injection. RESULTS Transient minor injection pain and local skin reactions were significantly greater with tramadol than with lidocaine (P < .05). Both tramadol and lidocaine significantly reduced the incidence and intensity of propofol injection pain when compared with normal saline (P < .05). CONCLUSIONS Using -minute retention in veins, both tramadol and lidocaine significantly reduced propofol injection pain. A local anesthetic activity is postulated.
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Abstract
Recently, Hendrick, Hendrick, and Dicke presented two short forms of the Love Attitudes Scale, the first using 24 items with 4 items for each subscale and the second using 18 items with 3 items for each subscale. Their data indicated that the two short versions have even stronger psychometric properties than the original scale. This study reports an 18-item short form of the scale developed independently in Taiwan using 460 graduate and undergraduate students in the fall semester of 1997. The results demonstrated a remarkable cross-cultural similarity in the development and response to the short form of the scale and its applicability to a broader cultural setting.
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Pang WW, Ho ST, Huang MH. Selective lumbar spinal nerve block, a review. ACTA ANAESTHESIOLOGICA SINICA 1999; 37:21-6. [PMID: 10407523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Selective spinal nerve block is a useful tool in today's multidisciplinary approach to the diagnosis and treatment of low back pain. The indications, sources of spinal pain, block technique, result interpretation, complications and clinical applications relevant to the subject are discussed. The value of a spinal nerve block relies on an understanding of the pain elements in the back, nerve innervations and careful patient selection. If the technique is performed properly and the results are interpreted cautiously, selective spinal nerve block may prove helpful, especially for patients from whom diagnostic information is inadequate. In some cases, therapeutic effect including that from surgical intervention can be achieved selectively at the symptomatic root. However, controversy remains and therefore well designed clinical studies are needed to provide more information about the validity of this diagnostic and therapeutic modality.
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Huang MH, Knight PR, Izzo JL. Ca2+-induced Ca2+ release involved in positive inotropic effect mediated by CGRP in ventricular myocytes. THE AMERICAN JOURNAL OF PHYSIOLOGY 1999; 276:R259-64. [PMID: 9887204 DOI: 10.1152/ajpregu.1999.276.1.r259] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To investigate the effects and mechanisms of calcitonin gene-related peptide (CGRP) on ventricular contractility, ventricular myocytes isolated from adult rat and mouse hearts were exposed to CGRP. Myocyte contractility was assessed by a video edge motion detector, and the intracellular [Ca2+] transients were measured by a spectroflurophotometer in fura 2-loaded myocytes. CGRP exerted a potent concentration-dependent (10 pM-10 nM, EC50 = 44.1 pM) positive inotropism on rat ventricular myocytes. CGRP (1 nM) increased cell shortening during contraction by 140 +/- 40% above baselines and increased maximum velocity of contraction and relaxation by 98 and 106%, respectively. CGRP failed to produce any response in the presence of the CGRP1 receptor antagonist. CGRP induced similar inotropic response in mouse ventricular myocytes. CGRP increased the amplitude of [Ca2+] transients of ventricular myocytes by 120 +/- 25% above baseline and shortened the time of half-maximum myoplasmic Ca2+ clearance by 30 +/- 5%. Increase in intracellular Ca2+ mobilization by CGRP was dependent on Ca2+ influx through the activation of the L-type Ca2+ channel, because nifedipine blocked the CGRP-induced increase in [Ca2+] transients. Furthermore, CGRP failed to increase [Ca2+] transients after the inhibition of protein kinase A in ventricular myocytes. These data indicate that stimulation of mammalian ventricular myocardial CGRP1 receptors enhances [Ca2+] transients through the activation of protein kinase A, which in turn activates voltage-dependent L-type Ca2+ channels. These events lead to Ca2+-induced intracellular Ca2+ release and enhanced myocyte contraction and facilitated relaxation.
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Liu HC, Huang BS, Hsu WH, Huang CJ, Hou SH, Huang MH. Surgery for achalasia: long-term results in operated achalasic patients. Ann Thorac Cardiovasc Surg 1998; 4:312-20. [PMID: 9914458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Achalasia is a functional disorder of the alimentary tract due to decreased or absent peristalsis of the esophageal body and obstructive outlet of the esophagus. Surgical treatment, eg. esophagomyotomy of the lower esophageal sphincter (LES), was one choice for resolving the problem and its effect was affirmative from reviews of many internationally authorized articles. However, few reports have ever questioned the long-term effects of it. From January 1968 to May 1996, 159 esophageal achalasic patients, 90 males and 69 females, were admitted due to dysphagia or food regurgitation. One hundred and forty-five patients had received 158 operations related to this benign motor disorder. The majority of patients received either modified Heller esophagomyotomy (M) or M plus modified Belsy Mark IV antireflux procedure (M+W) for primary treatment of their esophageal disorder, while conditional selection with addition of esophageal resection as advanced procedures for failure of primary surgery. We retrospectively studied these patients, collected their preoperative and postoperative clinical results, analyzed the causes of recurrent symptoms, compared the long-term results in different surgical procedures and searched for the pathogenesis of their failure. The results disclosed that the overall success rate for both methods was 73.1% with 85.7% for patients receiving M+W (56) and 64.9% of M (77) only. Through long-term follow-up, we had an improvement rate of 97.4% at an early stage and 53.3% for M at a late stage and 98.4% and 55.6% for M+W, respectively. The postoperative natural course of achalasic patients could be seen and progressive deterioration of the operated patients with time was noted. Several factors might contribute to the causes of unsuccessful surgery. We summarized them as incomplete myotomy, fused or healed myotomy, gastroesophageal reflux (GER), mucosal hernia and co-combined antireflux procedure by hypercalibrated or floppy wrapping. Esophagomyotomy or myotomy plus antireflux procedure for the esophagus could be concluded to rather effective in the long-term but palliative treatments for achalasia chronic deterioration of the results could be found for both of them. Defective myotomy and GER may be the major causes for their failure. The choice of types of surgery between M and M+W was not the cause of the unsuccessful results whereas the operative strategy and procedures would have a certain significance on the long-term effect.
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Fahn HJ, Wang LS, Kao SH, Chang SC, Huang MH, Wei YH. Smoking-associated mitochondrial DNA mutations and lipid peroxidation in human lung tissues. Am J Respir Cell Mol Biol 1998; 19:901-9. [PMID: 9843924 DOI: 10.1165/ajrcmb.19.6.3130] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To investigate the effect of cigarette smoking on mitochondrial DNA (mtDNA) mutation and lipid peroxidation in lung tissues, 152 samples from lung resections were collected. A novel deletion of 4,839 bp of mtDNA was found in 80 (52.6%) of the 152 lung samples. The breakpoints of the 4,839-bp mtDNA deletion were flanked by a nine-nucleotide direct repeat (5'-CATACACAA-3'). The frequency of occurrence and the proportion of the 4,839-bp mtDNA deletion in the lung increased significantly with the smoking index in terms of pack-years (P < 0.05). The incidence and proportion of the 4,839-bp mtDNA deletion in the lung tissues of current smokers were significantly higher than in those of nonsmokers (P < 0.05). In addition, we found that the content of lipid peroxides in the lung tissues of the smokers was significantly higher than in that of nonsmokers, and increased with the smoking index. The average malondialdehyde level in the lung tissues was 12.81 +/- 4.99 micromol/g for subjects with a smoking index of more than 50 pack-yr, and was 5.39 +/- 0.48 micromol/g for nonsmokers (P < 0.05). Multiple regression analysis showed that the smoking index, tissue lipid-peroxide content, and FEV1/FVC ratio were correlated with the proportion of the 4,839-bp mtDNA deletion in the lung. These results suggest that cigarette smoke plays an important role in the increase in mtDNA mutation and lipid peroxidation in the lung tissues of smokers.
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Wang LS, Wu LH, Chang CJ, Li WY, Fahn HJ, Huang MH, Chiu JH. Flow-cytometric DNA content analysis of oesophageal carcinoma. Comparison between tumour and sequential non-tumour mucosae. SCAND CARDIOVASC J 1998; 32:205-12. [PMID: 9802138 DOI: 10.1080/14017439850139988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The DNA content in oesophageal carcinoma and in sequential non-tumour mucosa was evaluated in 35 patients with oesophageal carcinoma, to explore the hypotheses that DNA distribution pattern and S-phase fraction can reflect malignant potential and that DNA aneuploidy can provide an early-warning signal of developing cancer. DNA flow cytometry was performed on 129 specimens from the tumours and on 119 specimens from non-tumour mucosa. Control specimens from gastric fundus had normal diploid DNA content and low S-phase fraction. Aneuploidy was found in 94.3% of the carcinoma specimens and intratumoral heterogeneity in 54.3%. Of the non-tumour specimens, 43.7% showed aneuploidy and none multiple aneuploidy. Pattern III distribution was present in 8.6% of the tumour specimens but not in non-tumour mucosa, where the incidence of aneuploidy rose with closeness to the tumour (p < 0.001). S-phase fraction was smaller in non-tumour than in tumour specimens (p < 0.0001). The study indicated that histologically tumour-free oesophageal mucosa may have a high malignant potential in patients with oesophageal carcinoma. The relative instability of such mucosa, with aneuploid cells and low S-phase fraction, may facilitate transition to abnormally proliferating cells in response to environmental signals. Cigarette smoking and alcohol may increase the risk of multicentric cancer development.
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Pang WW, Mok MS, Chang DP, Huang MH. Local anesthetic effect of tramadol, metoclopramide, and lidocaine following intradermal injection. Reg Anesth Pain Med 1998; 23:580-3. [PMID: 9840854 DOI: 10.1016/s1098-7339(98)90085-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES We observed clinically that tramadol and metoclopramide appear to have local anesthetic action. Tramadol is a central-acting analgesic. Metoclopramide is a commonly used antiemetic. The local anesthetic effect of tramadol in reducing propofol injection pain has never been mentioned, although it was speculated with metoclopramide. METHODS We conducted a double-blind, placebo-controlled study by injecting tramadol or metoclopramide intradermally in 10 healthy volunteers (5 men, 5 women; age 25-56 years). Each subject received 0.5 mL of four solutions in random order on the volar side of the forearm. These solutions were 25 mg tramadol, 5 mg metoclopramide, 5 mg lidocaine, and 0.5 mL normal saline. Pain on injections and the degree of local anesthesia (tested by pinprick, light touch, and cold) at each site was reported on a 0-3 scale at designed time intervals. RESULTS Like 1% lidocaine, tramadol and metoclopramide demonstrated loss of sensation for pinprick, light touch, and cold for 15 minutes after intradermal injection (P < .01 ). CONCLUSIONS Intradermal tramadol or metoclopramide can produce local anesthetic effect.
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Hsieh CC, Chow KC, Fahn HJ, Tsai CM, Li WY, Huang MH, Wang LS. Prognostic significance of HER-2/neu overexpression in stage I adenocarcinoma of lung. Ann Thorac Surg 1998; 66:1159-63; discussion 1163-4. [PMID: 9800799 DOI: 10.1016/s0003-4975(98)00792-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Even with early diagnosis and adequate resection, the 5-year survival rate for stage I lung cancer patients is around 60% to 70%. Overexpression of HER-2/neu protein is associated with poor prognosis in lung cancers. In this study, we evaluated the expression of HER-2/neu in cancer cells of lung and assessed their clinicopathologic and prognostic significance. METHODS From 1986 to 1995, clinical data on 42 consecutive patients who underwent complete surgical resection for stage I lung adenocarcinoma were collected. Expression of HER-2/neu in paraffin-embedded tumor samples was determined by immunohistochemistry and scored with a semiquantitative method. RESULTS Twenty-one of 42 patients were positive for HER-2/neu overexpression in tumor. Compared with patients with low HER-2/neu expression, patients with HER-2/neu overexpression had a significantly higher incidence of early tumor recurrence (p = 0.014). Survival was also significantly better in patients without HER-2/neu overexpression than in those with HER-2/neu overexpression (p = 0.0047). By univariate analysis, HER-2/neu overexpression and poor cell differentiation are two important factors correlated with poor prognosis. CONCLUSIONS Expression of HER-2/neu oncoprotein in stage I lung adenocarcinoma can predict the tumor's aggressiveness. Early tumor recurrence was frequently detected in patients with HER-2/neu overexpression. We recommend an individualized therapeutic strategy based on the level of HER-2/neu oncoprotein in the tumor cells.
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Burstein FD, Cohen SR, Huang MH, Sims CA. Applications of endoscopic surgery in pediatric patients. Plast Reconstr Surg 1998; 102:1446-51. [PMID: 9773998 DOI: 10.1097/00006534-199810000-00018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the advent of endoscopic technology is expanding the fields of reconstructive and aesthetic surgery in adults, there have been few reports of the use of this technology in the pediatric population. Because of their minimally invasive nature, yet wide range of exposure, endoscopic techniques have much appeal for this age group. Here we present our experience with endoscopic pediatric plastic surgery. From February of 1995 to August of 1997, 104 patients underwent 139 procedures utilizing 5- and 10-mm endoscopes. There were 58 male and 46 female patients. The mean age at surgery was 5.6 years (range, 3 weeks to 19 years). The most common type of procedures performed were insertion of tissue expanders (n = 34), excision of benign head and neck masses (n = 27), torticollis release (n = 20), excision of vascular lesions (n = 13), and miscellaneous procedures, (n = 10). There were 26 complications in 139 procedures (19 percent). Seventeen (65 percent) were in the tissue expander group. The rest were scattered among the groups with other diagnoses. Although there did not appear to be a specific type of complication associated with endoscopy, 77 percent occurred in the first 2 months of our study. This suggests a relatively steep technical learning curve. These results demonstrate that endoscopic techniques are eminently applicable in the pediatric population, providing the benefits of small and remote incisional wounds, with complication rates that are comparable with those of conventional open surgical treatment.
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Liu CC, Hsu WH, Li WY, Huang MH. Treatment results of 17 patients with diffuse pleural mesothelioma. Ann Thorac Cardiovasc Surg 1998; 4:233-9. [PMID: 9828278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Treatment for diffuse pleural mesothelioma is very difficult. A retrospective study is established for analyzing the experiences in management of such a rare but fatal disease. From May 1960 to August 1996, 17 patients underwent treatment for pathologically confirmed malignant pleural mesothelioma at Veteran General Hospital-Taipei. The chart records were carefully reviewed and surgical specimens were reconfirmed by the pathologist. Single or combined treatment protocols with surgery, chemotherapy, and radiotherapy had been used according to the clinical situation. Pathological staging was recorded according to the Butchart staging system. Gender, smoking, asbestos exposure, histology, and survival were analyzed. There were 17 patients in total, including 15 males and 2 females with a mean age of 62 years. The most common symptoms were chest pain, cough, dyspnea and weight loss. For getting definite pathological diagnosis, the most sensitive procedures were video-assisted thoracic biopsy and open lung biopsy. In spite of trying multiple different treatment protocols, disease staging ( p = 0.0186) and the epithelial pathological type ( p = 0.0353) were the significant prognostic factors in our series. Prognosis of diffuse pleural mesothelioma is very poor. It was predominant in nen and no definite relationship with smoking or asbestos exposure was noted in our series, but it was relatively better in patients with early-stage and epithelial-type disease. Further efforts to improve the survival should be delivered on more aggressive cytoreductive surgery with early postoperative concurrent chemo-radiotherapy.
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Huang MH, Lee ST, Rajendran K. Clinical implications of the velopharyngeal blood supply: a fresh cadaveric study. Plast Reconstr Surg 1998; 102:655-67. [PMID: 9727428 DOI: 10.1097/00006534-199809030-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this investigation was to examine the blood supply of the normal velopharyngeal musculature and its clinical implications. Detailed dissections were performed on each side of five fresh human adult cadaveric head and neck specimens (n = 10) following carotid artery injection with liquid neoprene latex stained with green pigment. The vascular network of the soft palate was situated within its glandular layer. The velopharyngeal muscles were supplied by the following four branches of the external carotid artery: (1) ascending palatine branch of the facial artery, which supplied the palatoglossus, palatopharyngeus, musculus uvulae, and the intravelar part of the levator veli palatini; (2) ascending pharyngeal artery, which supplied the superior constrictor; (3) the previously undescribed recurrent pharyngeal artery, which supplied the extravelar part of the levator veli palatini; and (4) maxillary artery, which supplied the tensor veli palatini. All muscles except the musculus uvulae had at least a dual blood supply. Analysis of this vascular anatomy suggests that (1) the overall generous blood supply of the velum allows it to tolerate the dissection performed during intravelar veloplasty and the Furlow double opposing Z-plasty; (2) dissection around the hamulus, along the medial pterygoid plate, and in the space of Ernst should be performed carefully to avoid damage to the ascending palatine artery, ascending pharyngeal, and recurrent pharyngeal arteries; (3) vertical pharyngeal flaps are random pattern in nature; and (4) the posterior tonsilar pillar flaps of the sphincter pharyngoplasty are adequately supplied by the hamular branch of the ascending palatine artery.
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Fu YL, Fahn HJ, Shi HS, Wu YC, Huang MH, Wang LS. Management of descending necrotizing mediastinitis. ZHONGHUA YI XUE ZA ZHI = CHINESE MEDICAL JOURNAL; FREE CHINA ED 1998; 61:513-9. [PMID: 9798299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Descending necrotizing mediastinitis (DNM) is uncommon, and may be lethal if not treated adequately and promptly. Delayed diagnosis of the disease is sometimes encountered in clinical practice. METHODS Eight consecutive patients with acute DNM were identified between 1991 and 1995, including five men and three women. The mean age was 45.8 years (range, 22-71 years). The infectious sources consisted of six esophageal perforations, one cervical cutting injury and one tonsillitis. The clinical presentations were evaluated. Diagnostic procedures including chest radiograph, sonogram and computerized tomography scans of the chest and neck were examined. Diagnosis and treatment, including culture results from drained fluids and debrided tissues, and antibiotic and supportive therapies were reviewed. RESULTS Six patients who underwent aggressive surgical treatment recovered well. Two patients who received supportive treatment died of sepsis alone. The cultured bacteria included: Klebsiella oxytoca, Staphylococcus aureus, Trichosporum and other mixed oral cavity flora. CONCLUSIONS Early diagnosis and adequate antibiotic and support therapies are essential to achieve good patient outcomes in acute descending mediastinitis. Adequate drainage and debridement, appropriate antibiotic therapy, and sufficient nutritional and respiratory support are the main treatment elements.
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Pang WW, Mok MS, Chang DP, Yang TF, Lin CH, Huang MH. Intradermal injection of tramadol has local anesthetic effect: a comparison with lidocaine. ACTA ANAESTHESIOLOGICA SINICA 1998; 36:133-6. [PMID: 9874860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND We observed that intravenous retention of tramadol with a pneumatic tourniquet on the arm inflated to 70 mmHg for one minute could effectively reduce the subsequent propofol injection pain. Tramadol is a central-acting analgesic. The local analgesic effect of tramadol on reducing propofol injection pain is not well known. METHODS To explore this problem we conducted a double-blind study on intradermal injections of tramadol 25 mg, lidocaine 5 mg and normal saline (all in 0.5 ml volume) which were given to each of the 10 healthy volunteers on the forearm at random. Pain on injections and the degree of local analgesia to pinprick, light touch and cold at each injection site were scored on a 0-4 scale at designated intervals. RESULTS 5% tramadol, similar to 1% lidocaine, rendered loss of sensation to pin prick, light touch and cold for 30 min after intradermal injection as compared with normal saline (p < 0.01). CONCLUSIONS We concluded that intradermal injection of tramadol or lidocaine can produce local anesthetic effect.
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Pang WW, Chang DP, Lin CH, Huang MH. Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter. Can J Anaesth 1998; 45:785-8. [PMID: 9793669 DOI: 10.1007/bf03012150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Negative pressure pulmonary oedema (NPPE) is a well-recognized but rare complication secondary to upper airway obstruction such as laryngeal spasm during emergence from general anaesthesia. Cauterization of the second and third thoracic sympathetic ganglia is a treatment for hyperhidrosis of the hands. We report a case of NPPE induced by direct suctioning of the endotracheal tube adapter during thoracic sympathetic ganglionectomy without recognized upper airway obstruction. CLINICAL FEATURES A 19-yr-old otherwise healthy, non-smoking man was scheduled for elective bilateral chest endoscopic ablation of the second and third thoracic sympathetic ganglion for hyperhidrosis of the hands under general anaesthesia. To view and cauterize the ganglion with the endoscope, the surgeon requested cessation of positive pressure ventilation. As the surgeon could not satisfactorily visualize the target ganglia, he requested brief application of wall suction via the ETT tube adapter. A pressure of -100 mmHg was generated which lasted for three to four seconds. The goal was to reduce further the lung volume by increasing the pneumothorax produced by the endoscope. The patient developed negative pressure pulmonary oedema without upper airway obstruction. CONCLUSION This case demonstrated that intrathoracic negative pressure generated by direct ETT adapter suctioning may produce pulmonary oedema similar to that induced by laryngeal spasm during the emergence of general anaesthesia.
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Yeow VK, Huang MH. Endoscopically assisted suction evacuation in the surgical treatment of subcutaneous hematomas. Plast Reconstr Surg 1998; 101:2016-7. [PMID: 9623869 DOI: 10.1097/00006534-199806000-00063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Huang MH, Mouradian WE, Cohen SR, Gruss JS. The differential diagnosis of abnormal head shapes: separating craniosynostosis from positional deformities and normal variants. Cleft Palate Craniofac J 1998; 35:204-11. [PMID: 9603553 DOI: 10.1597/1545-1569_1998_035_0204_tddoah_2.3.co_2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The correct differential diagnosis of an abnormal head shape in an infant or a child is vital to the management of this common condition. Establishing the presence of craniosynostosis, which warrants surgical correction, versus non-synostotic causes of head deformity, which do not, is not always straightforward. This paper deals with three groups of abnormal head shape that may cause diagnostic confusion: the spectrum of metopic synostosis; the dolichocephaly of prematurity versus sagittal synostosis; and the differential diagnosis of plagiocephaly. Special emphasis has been placed on the problem of posterior plagiocephaly, in the light of recent evidence demonstrating that lambdoid synostosis has been overdiagnosed. Metopic synostosis presents as a wide spectrum of severity. Although only severe forms of the disorder are corrected surgically, all cases should be monitored for evidence of developmental problems. The dolichocephalic head shape of preterm infants is non-synostotic in origin and is managed nonsurgically. The scaphocephalic head shape resulting from sagittal synostosis requires surgical intervention for correction. Posterior plagiocephaly may be due to unilambdoid synostosis or positional molding, which have very different clinical and imaging features. True lambdoid synostosis is rare. Most cases of posterior plagiocephaly are due to positional molding, which can usually be managed nonsurgically. Regardless of the suture(s) involved, all children with confirmed craniosynostosis should be monitored for increased intracranial pressure and developmental problems.
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Yu CL, Huang MH, Kung YY, Tsai CY, Tsai YY, Tsai ST, Huang DF, Sun KH, Han SH, Yu HS. Interleukin-13 increases prostaglandin E2 (PGE2) production by normal human polymorphonuclear neutrophils by enhancing cyclooxygenase 2 (COX-2) gene expression. Inflamm Res 1998; 47:167-73. [PMID: 9628259 DOI: 10.1007/s000110050312] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate whether interleukin-13 (IL-13) can affect arachidonic acid metabolism and phagocytic activity of normal human polymorphonuclear neutrophils (PMN). METHODS Normal human PMN (1 x 10(6) cells/ml) were incubated with different concentrations of IL-13 (0.1-10 ng/ml) for a variety of times (30-120 min). Phagocytosis and intracellular cyclooxygenase-2 (COX-2) were detected by flow cytometry. The expression of COX-1 and COX-2 mRNA was detected by RT-PCR. The concentration of PGE2 in the PMN cultured supernatants was determined by EIA. RESULTS We found that IL-13 at an optimal concentration of 1 ng/ml significantly enhanced COX-2 gene expression and PGE2 production (121.57 +/- 22.17 pg/ml in IL-13 stimulation vs. 73.16 +/- 11.72 pg/ml in controls) by PMN. In addition, IL-13 stimulated PMN phagocytosis via increased complement receptor type 1 (CR1) and type 3 (CR3), but not IgG Fcgamma receptor type 3 (FcgammaRIII). The cytoplasmic neutral esterase activity of PMN was also enhanced by IL-13 stimulation for 24 h. CONCLUSIONS These results suggest that IL-13 can stimulate PMN and modulates the inflammatory reactions via the cyclooxygenase pathway.
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Yu CL, Huang MH, Tsai CY, Tsai YY, Tsai ST, Sun KH, Han SH, Yu HS. The effect of human polyclonal anti-dsDNA autoantibodies on apoptotic gene expression in cultured rat glomerular mesangial cells. Scand J Rheumatol 1998; 27:54-60. [PMID: 9506879 DOI: 10.1080/030097498441182] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In our previous studies, we found that polyclonal anti-double-stranded DNA antibodies (anti-dsDNA) purified from sera of patients with active systemic lupus erythematosus (SLE) were cytotoxic to cultured rat glomerular mesangial cells (RMC) through an apoptotic mechanism. In order to determine whether these nephritogenic antibodies affect the expression of apoptosis-related genes in the tissues, the expression of Fas, p53, c-myc, and bcl-2 genes in the kidneys and livers of 12-week-old normal BALB/c and autoimmune MRL-lpr/lpr mice was detected by a reverse transcription-assisted polymerase chain reaction (RT-PCR). We found the mRNA of the four genes were expressed in the tissues of the normal mice. In contrast, decreased expression of the four genes in the kidney and absent expression of bcl-2 in the liver of the lpr mice were noted. Interestingly, RMC only expressed p53 and c-myc, but not Fas or bcl-2, in culture. The purified polyclonal anti-dsDNA dose-responsively (50-200 IU/ml) suppressed the 3H-thymidine incorporation of RMC after incubation for 48 h. However, the incubation of 100 IU/ml of anti-dsDNA with RMC for 4 h did not affect the expression of these apoptotic genes. The results suggest that anti-dsDNA induce RMC apoptosis via an unidentified mechanism different from Fas, c-myc or p53 pathway.
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Wang LS, Lin HY, Chang CJ, Fahn HJ, Huang MH, Lin CF. Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma. J Surg Oncol 1998. [PMID: 9486779 DOI: 10.1002/(sici)1096-9098(199802)67:2<90::aid-jso4>3.0.co;2-g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. METHODS Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-alpha and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. RESULTS All the parameters in nutritional assessment declined profoundly by the third postoperative day (P < 0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (> 1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P < 0.05), but immunoglobulins and complements decreased significantly yet variably (P < 0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P < 0.05). CONCLUSIONS Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.
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Huang MH, Lee ST, Rajendran K. Anatomic basis of cleft palate and velopharyngeal surgery: implications from a fresh cadaveric study. Plast Reconstr Surg 1998; 101:613-27; discussion 628-9. [PMID: 9500378 DOI: 10.1097/00006534-199803000-00007] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this investigation was to apply the findings of an anatomic study of the levator veli palatini, palatopharyngeus, and superior constrictor muscles in 18 fresh cadaveric specimens of normal adults to analyze current controversies in velopharyngeal function and cleft palate surgery. The levator veli palatini was observed to form a muscular sling, suspending the velum from the cranial base. Its fibers occupied the middle 50 percent of the velum, lying in transverse orientation and without significant overlap across the midline. It is well placed to function as the prime mover in the velar component of velopharyngeal closure. The velar component of the palatopharyngeus consisted of two heads clasping the levator and inserting into the latter just short of the midline. Its pharyngeal component inserted into the superior constrictor in the lateral and posterior pharyngeal walls. Together, these two muscles formed a sphincter around the velopharyngeal port, suggesting that both muscles are involved in the pharyngeal component of velopharyngeal closure. Based on the premise that the goal of palatoplasty is to restore normal anatomy, the intravelar veloplasty has a sound basis, and theoretically improves both velar and pharyngeal wall function because it corrects the dysmorphology of both the levator and palatopharyngeus. Although the Furlow palatoplasty also reorients these velar muscles correctly in the transverse position, the resulting overlap of the levator and palatopharyngeus across the midline is morphologically abnormal. In addition, the use of large Z-plasty flaps in wide clefts may cause excessive lateral tension, increasing the risk of fistula formation and causing an impairment of velar stretch capacity. The raising of a vertical pharyngeal flap divides the fibers of the superior constrictor and has the potential to impair pharyngeal wall function. The sphincter pharyngoplasty interferes less with pharyngeal wall anatomy. The potential for an obstructive outcome seems to be related to the use of wide, long flaps and a tight, overlapping type of flap inset. In addition, the level of flap inset is important: an inset at the level of the uvula has the greatest risk of causing obstruction, whereas a higher inset at the level of attempted velopharyngeal closure seems to provide the best opportunity for achieving velopharyngeal competence while avoiding hyponasality and obstruction.
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