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Tsai FC, Ghorbani S, Greenwald BD, Jang S, Dumot JA, McKinley MJ, Shaheen NJ, Habr F, Wolfsen HC, Abrams JA, Lightdale CJ, Nishioka NS, Johnston MH, Zfass A, Coyle WJ. Safety and efficacy of endoscopic spray cryotherapy for esophageal cancer. Dis Esophagus 2017; 30:1-7. [PMID: 28881903 DOI: 10.1093/dote/dox087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/03/2017] [Indexed: 12/11/2022]
Abstract
Although surgery is traditionally the standard of care for esophageal cancer, esophagectomy carries significant morbidity. Alternative endoscopic therapies are needed for patients who are not candidates for conventional treatment. The objective of this study is to assess the safety, efficacy, and tolerability of spray cryotherapy of esophageal adenocarcinoma. This study includes patients with esophageal adenocarcinoma who had failed or were not candidates for conventional therapy enrolled retrospectively and prospectively in an open-label registry and patients in a retrospective cohort from 11 academic and community practices. Endoscopic spray cryotherapy was performed until biopsy proven local tumor eradication or until treatment was halted due to progression of disease, patient withdrawal or comorbidities. Eighty-eight patients with esophageal adenocarcinoma (median age 76, 80.7% male, mean length 5.1 cm) underwent 359 treatments (mean 4.4 per patient). Tumor stages included 39 with T1a, 25 with T1b, 9 with unspecified T1, and 15 with T2. Eighty-six patients completed treatment with complete response of intraluminal disease in 55.8%, including complete response in 76.3% for T1a, 45.8% for T1b, 66.2% for all T1, and 6.7% for T2. Mean follow-up was 18.4 months. There were no deaths or perforations related to spray cryotherapy. Strictures developed in 12 of 88 patients (13.6%) but were present before spray cryotherapy in 3 of 12. This study suggests that endoscopic spray cryotherapy is a safe, well-tolerated, and effective treatment option for early esophageal adenocarcinoma.
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Affiliation(s)
- F C Tsai
- Scripps Clinic, La Jolla, California
| | | | - B D Greenwald
- University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Maryland
| | - S Jang
- Cleveland Clinic, Cleveland, Ohio
| | | | - M J McKinley
- North Shore LIJ Health System and ProHEALTHcare Associates, Syosset & Lake Success, New York
| | - N J Shaheen
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - F Habr
- Alpert School of Medicine of Brown University, Providence, Rhode Island
| | - H C Wolfsen
- Mayo Clinic Jacksonville, Jacksonville, Florida
| | - J A Abrams
- Columbia University Medical Center, New York, New York
| | - C J Lightdale
- Columbia University Medical Center, New York, New York
| | - N S Nishioka
- Massachusetts General Hospital, Boston, Massachusetts
| | - M H Johnston
- Lancaster Gastroenterology, Inc., Lancaster, Pennsylvania
| | - A Zfass
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - W J Coyle
- Scripps Clinic, La Jolla, California
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Ghorbani S, Tsai FC, Greenwald BD, Jang S, Dumot JA, McKinley MJ, Shaheen NJ, Habr F, Coyle WJ. Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry. Dis Esophagus 2016; 29:241-7. [PMID: 25708903 DOI: 10.1111/dote.12330] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high-grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low-grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open-label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2-3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE-D) and complete eradication of all intestinal metaplasia (CE-IM). Ninety-six subjects with Barrett's dysplasia (67% HGD; 65% long-segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow-up endoscopy (mean duration 21 months). In patients with LGD, rate of CE-D was 91% (21/23) and rate of CE-IM was 61% (14/23). In HGD, CE-D rate was 81% (46/57) and CE-IM was 65% (37/57). In patients with short-segment BE (SSBE) with any dysplasia, CE-D was achieved in 97% (30/31) and CE-IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non-steroidal anti-inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.
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Affiliation(s)
- S Ghorbani
- Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA
| | - F C Tsai
- Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA
| | - B D Greenwald
- Department of Gastroenterology, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, MD, USA
| | - S Jang
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - J A Dumot
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - M J McKinley
- Department of Gastroenterology, North Shore LIJ Health System and ProHEALTHcare Associates, Syosset and Lake Success, Nassau County, NY, USA
| | - N J Shaheen
- Department of Gastroenterology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - F Habr
- Department of Gastroenterology, Alpert School of Medicine of Brown University, Providence, RI, USA
| | - W J Coyle
- Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA
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Abstract
Mesothelial/monocytic incidental cardiac excrescences (MICE) of the heart are rare benign entities that have only been diagnosed incidentally, following cardiac surgical procedure. To date, totally 35 cases have been reported in the English literature. We describe an additional case of cardiac MICE presenting with severe aortic regurgitation for aortic valve replacement in a 20-year-old Chinese male patient. On microscopic examination, the findings initially were confused with true neoplasm. However, the related gross appearance, clinical history and further immunohistochemical staining enabled an accurate diagnosis. We review the relevant literature and found that immunohistochemical staining, especially the anti-cytokeratin antibody (AE1/AE3) and KP1 (CD-68) that were used by most investigators previously, was significant while making the diagnosis, because the two components of the cells show a contrast immunoreactivity to these two makers. The pathologists should always be alert to this entity while diagnose a cardiac surgery specimen.
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Affiliation(s)
- C Y Lin
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
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Abstract
UNLABELLED This paper presents summary statistics of airborne culturable bacteria from the US Environmental Protection Agency Building Assessment Survey and Evaluation (BASE) study. Air samples were collected with single-stage, multiple-hole, agar impactors in 100 large office buildings in 1994-1998 to obtain normative data on indoor environmental quality. Bacterial concentrations were compared by incubation temperature, location, season, and climate zone. Forty-one percent of the samples were below the 2- or 5-min detection limits (18 or 7 CFU/m3, respectively) but less than 1% were overgrown. Mesophilic bacteria (30 degrees C) accounted for >95% of culturable bacteria, both indoors and outdoors. Average concentrations were higher outdoors, except for Gram-positive cocci, which were the only group that were significantly higher indoors (39 vs. 24 CFU/m3), and Gram-negative cocci, for which both concentrations were low and the difference were not significant. Outdoor concentrations of culturable bacteria were somewhat higher in winter (194 vs.165 CFU/m3), and the two dominant outdoor groups were unknown bacteria and Gram-positive rods. Conversely, indoor concentrations were significantly higher in summer (116 vs. 87 CFU/m3), consisting primarily of unknown bacteria and Gram-positive cocci. Bacterial concentrations were within the ranges reported in previous studies of non-problem buildings, and the extreme aggregated indoor concentrations (e.g. the 90th percentile, 175 CFU/m3) of these 100 representative buildings may serve as upper bounds to develop interpretation guidelines for office environments and similar non-manufacturing workplaces in various climate zones. PRACTICAL IMPLICATIONS The Building Assessment Survey and Evaluation (BASE) study was one of the most comprehensive investigations of indoor environmental quality in which a standardized protocol was used to measure bioaerosols in 100 typical US office buildings. The information on the indoor and outdoor concentrations of airborne bacteria in different climate zones during the heating and cooling seasons has expanded the baseline data available for interpretation of measurements from building investigations. With suggested refinements, the BASE protocol may serve as a guide for future studies of bioaerosol concentrations, building characteristics, and occupant perceptions of the indoor environment.
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Affiliation(s)
- F C Tsai
- Environmental Health Laboratory Branch, California Department of Health Services, Richmond, CA 94804-6403, USA.
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Macher JM, Tsai FC, Burton LE, Liu KS. Concentrations of cat and dust-mite allergens in dust samples from 92 large US office buildings from the BASE Study. Indoor Air 2005; 15 Suppl 9:82-8. [PMID: 15910533 DOI: 10.1111/j.1600-0668.2005.00347.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED The concentrations of cat (Fel d1) and dust-mite (Der f1 and Der p1) allergens were measured in 92 large office buildings in the US Environmental Protection Agency's Building Assessment Survey and Evaluation (BASE) Study (251 dust samples; one to four samples per building). Fel d1 was detected in almost all buildings and samples (91 buildings, 99%; 235 samples, 94%; range: <0.01-19 microg/g; median: 0.3 microg/g). Cat allergen exceeded 1 microg/g (a lower symptom threshold) in 56 samples (22%) from 45 buildings, but exceeded 8 microg/g (a sensitization threshold) in only two samples (1%) from two buildings. Der f1 or Der p1 was found in approximately half of all buildings and samples (63 and 70% of buildings; 45 and 51% of samples; range: <0.01-53 microg/g and <0.01-25 microg/g; median: <0.02 and 0.03 microg/g, respectively). Mite allergen exceeded 2 microg/g (a sensitization threshold) in seven samples (3%) from five buildings and exceeded 10 microg/g (a symptom threshold) in three samples (1%) from three buildings. Fel d1 concentration was significantly higher in samples collected in summer (June to September, 48 buildings), but cat allergen was not correlated with either mite allergen. Der f1, but not Der p1, concentration tended to be higher in samples collected in winter (December to April, 44 buildings), and the two mite allergens were significantly correlated only in winter. Cat and mite allergens were detected in 78% of representative US office buildings, but the concentrations seldom exceeded levels associated with sensitization or symptom provocation. PRACTICAL IMPLICATIONS The information on the concentrations of cat and dust-mite allergens in representative large US offices has expanded the baseline data available for interpretation of measurements from other building investigations. With suggested refinements, the BASE protocol for measurement of allergen concentrations in dust samples may serve as a guide to future studies of building characteristics, bioaerosol concentrations, and occupant perceptions of the indoor environment.
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Affiliation(s)
- J M Macher
- Environmental Health Laboratory Branch, California Department of Health Services, Richmond, CA 94804-6403, USA.
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Abstract
Aspiration has been frequently noted among patients suffering from vocal-fold paralysis. The association between a defect of glottal closure and aspiration in patients with unilateral vocal paralysis appears to have been rarely reported. The current study reviews collected data consisting of videotaped flexible nasoendoscopy and stroboscopy for patients with a unilateral vocal-fold paralysis. Mean normalized glottal gap areas for patients suffering vocal paralysis with associated aspiration are significant greater than that for the non-aspiration group. Subsequent to the surgical correction of the glottal gap, all patients recovered well from their earlier aspiration. The investigation of objectively derived data revealed that poor airway protection due to incomplete closure of the vocal fold was the major cause of aspiration for patients suffering unilateral vocal-fold paralysis. Intracordal autologous fat injection can successfully improve the breath control and eliminate aspiration in patients with vocal-fold paralysis.
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Affiliation(s)
- T J Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
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Marelli D, Laks H, Bresson J, Houston E, Fazio D, Tsai FC, Hamilton M, Moriguchi J, Fonarow GC, Ardehali A, Camara R, Burch C, Alejos JC, George B, Kawata N, Kobashigawa J. Sixteen-year experience with 1,000 heart transplants at UCLA. Clin Transpl 2001:297-310. [PMID: 11512323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
1. The consecutive pre- and post-1994 eras have demonstrated improved survival for all age groups. This is linked to improved preservation methods, surgical technique and immunosuppression agents. 2. The use of marginal donor hearts for Status I and alternate elderly patients has followed the model of matching donor and recipient risk without affecting patient outcome and minimized the use of implantable assist devices. 3. A donor history of systemic gram-negative infection, hypertension, or traumatic intracranial bleeds was an important marker for risk. Younger age and shorter ischemia time could compensate for other hazards. 4. Heart transplantation in carefully selected elderly recipients yielded clinical results similar to those of younger patients with less rejection. 5. An adult alternate recipient list proved useful to prevent diversion of standard donors away from younger recipients. 6. Retransplantation for TCAD is acceptable but much less satisfactory for acute graft failure. 7. Trends show an increase in the use of implantable devices; refinement in technology for mechanical assist and replacement is forthcoming.
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Affiliation(s)
- D Marelli
- Department of Cardiothoracic Surgery, UCLA School of Medicine, Los Angeles, California, USA
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Abstract
Although venous thrombosis is a frequently encountered problem in nephrotic syndrome, the occurrence of arterial thrombosis is much less common, and is usually associated with a poor prognosis. To the best of our knowledge, there has been only one reported case of concurrent cerebral and femoral artery thrombosis, that of a 23-year-old male who finally died. Herein, we report a case of a 35-year-old woman with nephrotic syndrome. She developed cerebral and femoral arterial thrombosis simultaneously when the nephrotic syndrome relapsed. Immediate thrombectomy of the femoral artery, followed by anticoagulation and immunosuppressive therapy, were employed. The patient recovered completely and is now doing well. Our experience indicates that multiple artery thrombosis in nephrotic patients may not necessarily carry a poor outcome if early and aggressive treatment can be undertaken.
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Affiliation(s)
- C H Lee
- Division of Nephrology, Keelung Branch, Chung Gung Memorial Hospital, Keelung, Taiwan
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Crewe AV, Ruan S, Korda P, Tsai FC. Studies of a magnetically focused electrostatic mirror. I. Experimental test of the first order properties. J Microsc 2000; 197 (Pt 2):110-7. [PMID: 10652005 DOI: 10.1046/j.1365-2818.2000.00649.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When a uniform magnetic field is superimposed on a uniform electrostatic field, the combination can act as a magnetically focused mirror. This mirror is predicted to have aberrations of opposite sign to those of a magnetic lens and may therefore be useful as a corrector. We have built an electron optical system to test these ideas. The results are presented in two papers. This first paper describes the general design and the results of the measurements of the first order properties. The second paper (Tsai, F., J. Microsc. 197 (2000) 118-135) will describe the measurements of the aberration properties.
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Affiliation(s)
- AV Crewe
- Department of Physics and the Enrico Fermi Institute, The University of Chicago, 5640 S. Ellis Ave., Chicago, IL 60636, USA
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Abstract
A magnetically focused electrostatic mirror is shown to be able to correct the spherical and chromatic aberrations of a probe forming system simultaneously. The probe forming system comprises a uniform magnetic lens and a uniform electrostatic mirror. Previous theoretical investigations showed that the spherical and chromatic aberration coefficients of these two components are the same values but with opposite sign, whose combination will therefore be free from aberrations. The experimental arrangement used a solenoid to produce a uniform magnetic field, and a series of plate electrodes to produce a uniform electrostatic field. These fields are shown to satisfy the experimental requirements. By deliberately changing the extraction voltage to defocus the electron beam, the author is able to observe correction of chromatic aberration by one order of magnitude. By deliberately changing the lens field and the mirror field, the author is able to observe the reduction of the asymmetry caused by the spherical aberration, which the author believes also indicates correction by one order of magnitude.
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Affiliation(s)
- FC Tsai
- Department of Physics and the Enrico Fermi Institute, The University of Chicago, 5640 S. Ellis Ave, Chicago, IL 60636, USA
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Tsai FC, Smith KR, Vichit-Vadakan N, Ostro BD, Chestnut LG, Kungskulniti N. Indoor/outdoor PM10 and PM2.5 in Bangkok, Thailand. J Expo Anal Environ Epidemiol 2000; 10:15-26. [PMID: 10703844 DOI: 10.1038/sj.jea.7500071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Twenty-four-hour averaged PM10 and PM2.5 concentrations were obtained by using 4-liter-per-minute-pumps and impactors in microenvironments of a busy shopping district and a university hospital campus. In both areas, most people live directly adjacent to their worksites--minimizing the need to measure commuting exposure as part of total daily exposure. Co-located samplers were set in indoor microenvironments, the near-ambient zone of the households, and at nearby streetside central ambient monitoring stations. Smoking and use of other indoor PM sources were recorded daily via questionnaires. Consistent with previous studies, smoking and the use of charcoal stoves increased indoor particulate matter levels. The sampled air-conditioned hospital area had substantially lower particle concentrations than outdoors. A simple total exposure model was used to estimate the human exposure. The averaged ratios of co-located PM2.5/PM10 concentrations in various microenvironments are reported for each location. A single daily indoor average PM10 concentration for all households measured in a given sampling day is calculated for correlation analysis. Results showed that day-to-day fluctuations of these calculated indoor PM10 levels correlated well with near-ambient data and moderately well with ambient data collected at the nearby central monitoring site. This implies that ambient monitors are able to capture the daily variations of indoor PM levels or even personal exposure and may help explain the robust association of ambient PM levels and health effects found in many epidemiological studies. Absolute PM exposures, however, were substantially underestimated by ambient monitors in the shopping district, probably because of strong local sources.
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Affiliation(s)
- F C Tsai
- School of Public Health, University of California, Berkeley 94720-7360, USA
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Abstract
Blunt chest trauma with flail chest is common. The mortality attributes initially to the associated pulmonary contusion, massive hemothorax and later to the occurrence of adult respiratory distress syndrome. We report a case of flail chest with segmental fractures near the costovertebral junction and delayed hemothorax attacked 14 h later. The final diagnosis of the penetrating aortic injury by detached rib fragment was appreciated by aortogram. Unfortunately, active aortic hemorrhage made prompt thoracotomy in vain for life salvage.
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Affiliation(s)
- F C Tsai
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Abstract
OBJECTIVE Minimally invasive cardiac surgery has recently been applied to the correction of intracardiac lesions. This report reviews our experience of minimally invasive cardiac surgery in 119 patients with intracardiac congenital lesions. METHODS From October 1995 to April 1997, 119 patients (48 male and 71 female, aged 0.9-65 years old, 18.5+/-17.8) received elective minimally invasive cardiac surgery at Chang Gung Memorial Hospital, Taipei, Taiwan for repair of atrial septal defect (96 patients) or ventricular septal defect (23 patients). The operations were performed through right submammary incision (ASD) or left parasternal minithoracotomy (VSD), under femoro-femoral or femoro-atrial cardiopulmonary bypass with fibrillatory arrest. RESULTS All of the defects were repaired successfully. The bypass time was 25-125 min (46+/-18). The operation time was 1.5-5.2 h (2.8+/-0.8). The postoperative course was uneventful in all patients. Follow-up (1.0-18.2 months, mean 7.3) was complete, with no late deaths or residual shunt. All patients were found to be in NYHA functional class I or II. CONCLUSION Our experience demonstrate that minimally invasive cardiac surgery is a technically feasible, safe, and effective procedure in surgical correction of selective simple intracardiac congenital lesions, yielding good short-term results.
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Affiliation(s)
- Y C Wu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Abstract
OBJECTIVE To present our experience in surgical excision of intracardiac tumors in three patients using video-assisted cardiac surgical techniques. METHODS Three patients received emergency video-assisted cardiac surgery for excision of right atrial or left atrial tumors. These surgeries were performed through right anterior submammary minithoracotomies and guided by video-assisted endoscopic techniques by projected images on a video monitor while under femoro-femoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with fibrillatory arrest. Conventional instruments were used. RESULTS All but one of the tumors were excised completely. The bypass time was 88-148 min. The operation time was 3.5-4.4 h. There were no operative deaths. Pathological examination of the tumors showed left atrial myxoma, metastatic left atrial choriocarcinoma, and right atrial lymphoma. One patient died from non-cardiac origin 5 weeks after discharge. Follow-up was completed with the two survivors. Transthoracic echocardiographic examination showed good ventricular function without any residual tumors. They were both in New York Heart Association functional class I or II. They were satisfied with the cosmetic healing of their incisions. CONCLUSION Video-assisted cardiac surgery is technically feasible and can be performed in surgical excision of intracardiac tumors.
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Affiliation(s)
- Y S Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Yeh CH, Chang CH, Lin PJ, Tsai FC, Yang MW, Tan PP. Totally minimally invasive cardiac surgery for coronary artery disease. Eur J Cardiothorac Surg 1998; 14 Suppl 1:S43-7. [PMID: 9814791 DOI: 10.1016/s1010-7940(98)00103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE We report our experience using minimally invasive techniques both to perform coronary artery bypass and harvesting of saphenous vein grafts in 25 patients with left main or triple vessels disease. METHODS From March 1997 to June 1997, 25 patients received elective coronary artery bypass grafting using minimally invasive surgical techniques for left main or triple vessels disease. Saphenous vein grafts were harvested using minimally invasive techniques under direct vision. The coronary artery bypass grafting was performed through a limited left anterior parasternal minithoracotomy under femoro-femoral or aorto-atrial cardiopulmonary bypass. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. RESULTS Three to four distal anastomoses were performed with the saphenous vein graft and the left internal thoracic arterial graft. The aortic cross-clamp time was 60-135 min. The duration of cardiopulmonary bypass was 89-172 min. The postoperative course was uneventful for all patients. All patients were found to be in New York Heart Association functional class I or II on follow-up from 3-7 months after surgery. CONCLUSIONS Minimally invasive coronary artery surgery is technically feasible and can be performed in left main or triple vessel disease safely and effectively for complete revascularization.
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Affiliation(s)
- C H Yeh
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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18
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Abstract
BACKGROUND Minimal access surgery with video-assisted endoscopy has been applied to the correction of intracardiac lesions. We report our experience using this technique in surgical excision of left atrial myxoma in 3 patients. METHODS From November 1995 to March 1997, 3 female patients, ages 45 to 80 years (mean, 62.7 years), received emergency operations for excision of left atrial myxoma. These operations were performed through a right anterior submammary minithoracotomy or right parasternal incision with the assistance of endoscopy during femoro-femoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with fibrillatory arrest or cardioplegic arrest with aortic cross-clamping. RESULTS All the tumors were excised completely through the right atrial approach. The bypass time was 92 to 148 minutes (mean, 111 minutes). The operation time was 3.2 to 4.4 hours (mean, 3.7 hours). There were no hospital deaths. Follow-up, which ranged from 6 to 19 months (mean, 10.5 months), was complete in all patients. Transthoracic echocardiographic examination showed good ventricular function without any residual tumors. Patients were found to be in New York Heart Association functional class I or II. They were satisfied with the good cosmetic healing of the incision. CONCLUSIONS Our experience demonstrates that minimal access surgery is a technically feasible, safe, and effective procedure in surgical excision of left atrial myxoma.
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Affiliation(s)
- P J Ko
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Chang CH, Lin PJ, Chu JJ, Liu HP, Tsai FC, Chung YY, Kung CC, Lin FC, Chiang CW, Su WJ, Yang MW, Tan PP. Surgical closure of atrial septal defect. Minimally invasive cardiac surgery or median sternotomy? Surg Endosc 1998; 12:820-4. [PMID: 9601998 DOI: 10.1007/s004649900721] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. METHODS We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. RESULTS The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 +/- 12) and 14 to 158 min (27 +/- 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. CONCLUSION Our results suggest that MICS is a good option for surgical closure of ASD.
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Affiliation(s)
- C H Chang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Chu JJ, Chang CH, Lin PJ, Liu HP, Tsai FC, Wu D, Chiang CW, Lin FC, Su WJ, Tan PP. Video-assisted cardiac surgery: preliminary results in Chang Gung Memorial Hospital. Chin Med J (Engl) 1998; 111:422-7. [PMID: 10374351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE To summarize the experience of utilization of video-assisted endoscopy in 91 patients operated on at Chang Gung Memorial Hospital, Taipei, China. METHODS From October 1995, through August 1996, 91 patients (44 male and 47 female) received video-assisted cardiac surgery (VACS). Their ages ranged from 1 year to 79.5 years (25.7 +/- 21.7). Indications for surgery were atrial septal defect (59 patients), ventricular septal defect (15), coronary artery disease (4), severe mitral regurgitation (4), severe tricuspid regurgitation (3), thrombosis of mitral mechanical prosthesis (3), left atrial tumor (2), and left ventricular thrombus with dilated cardiomyopathy (1). The VACS was performed through right or left anterior minithoracotomy and guided by video-assisted endoscopic techniques by means of projected images on the video monitor under extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature 22.6 +/- 4.0 degrees C). Conventional instruments were used. RESULTS All lesions were corrected successfully. The bypass time was 27 to 335 minutes (72.8 +/- 52.7). The operative time was 1.3 to 8.5 hours (3.0 +/- 1.7). There were no operative deaths and 3 late deaths. Follow-up was complete in all survivors (6 to 16 months, mean 8.7). Most of them were found to be in NYHA functional I or II. CONCLUSION Our preliminary experiences demonstrate that VACS is simple and effective in surgical correction of selected cardiac lesions. Short-term results show good outcomes.
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Affiliation(s)
- J J Chu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, China
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Lin PJ, Chang CH, Chu JJ, Tsai FC, Tan PP. Minimally invasive coronary surgery in women. Chin Med J (Engl) 1998; 111:302-5. [PMID: 10374391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE To evaluate the minimally invasive surgery in coronary artery bypass grafting and the feasibility for revascularization of triple vessel coronary artery disease. METHODS Nine female patients, aged 49.1 to 81.6 years (mean 64.3), were operated on for triple vessel disease through minimally invasive surgical techniques. The surgeries were performed through limited left parasternal incision under femorofemoral extracorporeal circulation. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch and posterior descending branch, and the left internal thoracic arterial graft was anastomosed to the left anterior descending artery in each patient. RESULTS The number of distal anastomoses was 3 to 4 with a mean of 3.7. The aortic crossclamp time was 52 to 130 minutes (82 +/- 25 minutes). The duration of extracorporeal circulation was 78 to 151 minutes (115 +/- 29 minutes). The postoperative course was uneventful in all patients. The postoperative length of stay was 4 to 12 days (7.2 +/- 2.0 days). Follow-up (4.2 to 8.7 months, mean 6.4) was complete in all patients and there were no late deaths or angina. Coronary angiography of 2 patients showed patent grafts. All patients were satisfied with the good cosmetic healing of the incision. CONCLUSION Our experience demonstrates that minimally invasive surgery in coronary artery bypass grafting is technically feasible and may be an alternative approach in surgical revascularization of triple vessel coronary artery disease, especially in female patients.
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Affiliation(s)
- P J Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan, China
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Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Lin FC, Chiang CW, Tan PP. Minimal access surgical techniques in coronary artery bypass grafting for triple-vessel disease. Ann Thorac Surg 1998; 65:407-12. [PMID: 9485237 DOI: 10.1016/s0003-4975(97)01153-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimal access surgical techniques in coronary artery bypass grafting have been used mainly in the management of single-vessel disease. METHODS Fifteen patients, 11 men and 4 women with a mean age of 64.1 years (range, 35.7 to 78.0 years), underwent operation for triple-vessel disease using minimal access techniques. The procedures were performed through a limited left parasternal thoracotomy using femorofemoral extracorporeal circulation. The myocardium was protected by the antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. RESULTS Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch, and posterior descending branch, and the left internal thoracic artery graft was anastomosed to the left anterior descending artery in each patient. The mean aortic cross-clamp time was 86 +/- 17 minutes (range, 67 to 125 minutes). The mean duration of extracorporeal circulation was 112 +/- 22 minutes (range, 82 to 162 minutes). The postoperative course was uneventful in all patients. Follow-up was complete in all patients at a mean of 7.4 months (range, 6.0 to 8.5 months), and there were no late deaths or angina. Coronary angiography in 8 patients showed patent grafts. CONCLUSIONS Our experience demonstrates that minimal access surgical techniques in coronary artery bypass grafting are technically feasible and may be an alternative approach in the surgical revascularization of triple-vessel disease.
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Affiliation(s)
- P J Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Su WJ, Yang MW, Tan PP. Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach. Ann Thorac Surg 1998; 65:165-9; discussion 169-70. [PMID: 9456111 DOI: 10.1016/s0003-4975(97)01109-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimally invasive cardiac surgical techniques recently have been applied in the management of a variety of intracardiac lesions. METHODS Fourteen patients (6 boys and 8 girls; age, 8.9 +/- 5.5 years; body weight, 29.0 +/- 13.5 kg) were operated on using minimally invasive cardiac surgical techniques for the closure of a ventricular septal defect (subarterial in 11 patients and perimembranous in 3 patients). The operations were performed through a left anterior minithoracotomy and were guided by video-assisted endoscopic techniques under femorofemoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. The right ventricular outflow tract was entered after pericardiotomy was performed. RESULTS Closure of the defect (directly in 4 patients and by patch in 10 patients) was performed successfully in all patients. A right ventricular outflow tract obstruction and ruptured sinus of Valsalva aneurysm also were repaired in 1 patient each. The duration of cardiopulmonary bypass was 41 +/- 10 minutes (range, 28 to 100 minutes) and the total operative time was 2.2 +/- 0.8 hours (range, 1.3 to 3.5 hours). All the patients recovered rapidly from their operation and had an uneventful postoperative course. Follow-up (mean, 6.2 months; range, 6 to 9 months) was complete in all patients. There were no late deaths. Transthoracic echocardiographic examination showed no residual shunt and no aortic regurgitation in all patients. CONCLUSIONS Our experience demonstrates that minimally invasive cardiac surgical techniques are technically feasible and an alternative option for the repair of a ventricular septal defect.
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Affiliation(s)
- P J Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Abstract
Forty-two patients, 33 male and 9 female, aged 35.7 to 81.6 years old (mean 62.7), were operated on for left main and/or triple vessel coronary artery disease by using minimally invasive cardiac surgical techniques. A myocardial infarction had occurred in 26 patients (61.9%). The left ventricular ejection fraction ranged from 17 to 83% (52+/-22). The surgeries were performed through left parasternal minithoracotomy (8 to 12 cm in length) under femoro-femoral or aorto-atrial cardiopulmonary bypass. The myocardium was protected by blood cardioplegic solution with the aorta crossclamped. Under direct vision, average 3.8 distal anastomoses were performed in each patient, with the saphenous vein grafts and the left internal thoracic arterial graft. The aortic crossclamp time was 62 to 137 min (80+/-15). The duration of cardiopulmonary bypass was 88 to 168 min (115+/-24). The postoperative course was uneventful in all patients. Follow-up (1.0 to 5.6 months, mean 2.9) was complete in all patients and there were no late deaths or angina. Coronary angiography of ten patients showed patent grafts. Our experience demonstrates that minimally invasive cardiac surgery during cardioplegic arrest is technically feasible and can be performed in coronary artery disease safely and effectively for complete revascularization.
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Affiliation(s)
- Y C Wu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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Tsai GJ, Tsai FC, Kong ZL. Effects of temperature, medium composition, pH, salt and dissolved oxygen on haemolysin and cytotoxin production by Aeromonas hydrophila isolated from oyster. Int J Food Microbiol 1997; 38:111-6. [PMID: 9506276 DOI: 10.1016/s0168-1605(97)00094-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of temperature, medium composition, pH, salt content and dissolved oxygen (DO) on the production of haemolysin and cytotoxin by one strain of Aeromonas hydrophila isolated from oyster were investigated. Four media were tested: brain heart infusion broth (BHIB), casamino acid-yeast extract broth (CAYEB), nutrient broth (NB), and trypticase soy broth (TSB). BHIB was the best for toxin production even though the growth rates for Aeromonas hydrophila in all of these media were quite similar. Aeromonas hydrophila could produce haemolysin and cytotoxin at 37, 28 and 5 degrees C; however, the toxins were produced faster and were more stable at 28 degrees C than at 37 degrees C. Although Aeromonas hydrophila itself is tolerant to 5% (w/v) salt in BHIB and a pH range of pH 5.5 to 10.0, the production of haemolysin and cytotoxin was apparently decreased in the presence of 1-5% (w/v) NaCl or when the pH of the medium was greater or less than 7.2. The DO values in the culture medium during the stationary growth phase also seemed to affect toxin production; greater quantities of toxins were produced when the DO values were higher.
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Affiliation(s)
- G J Tsai
- Department of Marine Food Science, National Taiwan Ocean University, Keelung, Taiwan, ROC
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Tsai KT, Lin PJ, Changchien CR, Tsai FC, Hsieh HC. Internal iliac artery aneurysmo-rectal fistula associated with multiple aortoiliac aneurysms. Changgeng Yi Xue Za Zhi 1997; 20:226-31. [PMID: 9397615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fistular communication between an internal iliac artery aneurysm and rectum presenting as massive lower gastrointestinal tract bleeding is a rare entity in clinical practice. Prompt diagnosis and experienced therapeutic application determine the outcome. Herein we report the successful management of such a complication. A 68-year-old male had multiple aneurysms over the abdominal aorta and bilateral iliac arteries. It was the largest aneurysm arising from the right internal iliac artery which ruptured into the rectum and resulted in massive hematochezia. After extraanatomical bypass with right axillo-femoral and femoro-femoral crossover grafts to restore the circulation to the bilateral lower limbs, the infrarenal abdominal aorta just immediately above the proximal aneurysm was transected and closed as a blind stump. All the aneurysms were included in this resection and as much of the infected aneurysm tissue was debrided as possible. The rectum was exteriorized using Hartmann's procedure. The patient survived the operation and was discharged in good condition.
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Affiliation(s)
- K T Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Lin FC, Chiang CW, Yang MW, Tan PP. Video-assisted coronary artery bypass grafting during hypothermic fibrillatory arrest. Ann Thorac Surg 1997; 63:1113-7. [PMID: 9124915 DOI: 10.1016/s0003-4975(97)00064-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hypothermic fibrillatory arrest without aortic cross-clamping is a technique for quieting the heart during coronary artery bypass grafting. This report reviews the preliminary results with this technique in 4 patients having video-assisted coronary artery bypass grafting. METHODS Four male patients 28.5 to 64.5 years old (mean age, 45.4 years) underwent operation for unstable angina. With video-assisted techniques, coronary artery bypass grafting was performed through a left anterior minithoracotomy with femoral-femoral cardiopulmonary bypass without cross-clamping the aorta. The myocardium was protected by continuous coronary perfusion during hypothermic fibrillatory arrest. RESULTS A left internal thoracic artery graft was anastomosed to the left anterior descending coronary artery in each patient. The posterior descending branch of the right coronary artery was grafted with a pedicled right gastroepiploic artery in 1 patient. The duration of cardiopulmonary bypass was 72 to 127 minutes (mean duration, 92 +/- 21 minutes). The postoperative course of each patient was uneventful. Follow-up (range, 3.9 to 5.8 months; mean follow-up, 4.9 months) was complete for all patients. There were no late deaths. Coronary angiography showed patent grafts. All patients were in New York Heart Association functional class I or II (mean class, 1.25). CONCLUSIONS Hypothermic fibrillatory arrest is a simple and effective method of quieting the heart, thereby providing a motionless operative field for video-assisted coronary artery bypass grafting.
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Affiliation(s)
- P J Lin
- Divisions of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Tsai FC, Wang CC, Fang JF, Lin PJ, Kao CL, Hsieh HC, Chu JJ, Chen RJ, Chang CH. Isolated common iliac artery occlusion secondary to atherosclerotic plaque rupture from blunt abdominal trauma: case report and review of the literature. J Trauma 1997; 42:133-6. [PMID: 9003272 DOI: 10.1097/00005373-199701000-00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic isolated common iliac artery occlusion is unusual. Only rare cases of common iliac arterial injuries resulting from blunt abdominal trauma have been reported, and most of them were attributed to the seat-belt syndrome and associated with visceral organ perforation or pelvic fracture. We reported an unusual isolated common iliac artery occlusion secondary to atherosclerotic plaque rupture from blunt abdominal compressive trauma without other visceral injury. This case presented with acute limb ischemia and paralysis that was successfully treated by thromboendarterectomy. The symptoms and signs, surgical modalities, and associated injuries were reported and the literature was also reviewed.
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Chu JJ, Chang CH, Lin PJ, Liu HP, Tsai FC, Wu D, Chiang CW, Lin FC, Tan PP. Video-assisted thoracoscopic operation for interruption of patent ductus arteriosus in adults. Ann Thorac Surg 1997; 63:175-8; discussion 178-9. [PMID: 8993261 DOI: 10.1016/s0003-4975(96)01026-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a frequent congenital heart disease encountered in premature neonates, infants, and children. Video-assisted endoscopic techniques have been used in PDA interruption since 1993. Almost all the experiences are in pediatric patients. Applications in adults with PDA have been limited. METHODS We report our experience of video-assisted thoracoscopic surgical ligation of PDA in adults. From August 1995 to January 1996, 60 patients with PDA were operated on with a video-assisted thoracoscopic technique. Twelve adults were identified with mean age of 30 years (range, 20 to 57 years). With the patient under general anesthesia and double-lumen endotracheal intubation, two 5-mm holes were made in the left lateral chest wall. Another 4-cm incision was made in the left third intercostal space for manipulation, dissection, and ligation. Conventional surgical instruments were used except an endoscopic grasper and an endoscopic tube that connected to a video camera. The surgical procedure was viewed on a video screen. Transesophageal echocardiography was used for monitoring during PDA ligation. RESULTS All patients had successful ligation of the PDA. There was no surgical mortality, but there was one morbidity; transient recurrent nerve injury, which recovered 3 months later. Ten patients were extubated in operative room and 2 patients were extubated 2 hours after the operation. Tube thoracostomy was performed in the first 2 cases; it was omitted thereafter. No patients needed narcotic to control chest pain. Postoperative follow-up by echocardiography showed faint ductal flow in 1 patient without any murmur. All patients were discharged within 3 days after the operation. CONCLUSIONS Our experience suggests that with refinement of instruments and surgical technique, video-assisted thoracoscopic surgical ligation can be safely applied not only in pediatric patients, but also in adults with PDA.
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Affiliation(s)
- J J Chu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Tsai FC, Lin PJ, Wu WJ, Kuo TT, Chang CH. Primary chondrosarcoma of the heart: a case report. Changgeng Yi Xue Za Zhi 1996; 19:348-51. [PMID: 9041766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chondrosarcoma involving the heart has been previously reported but is extremely rare. Most chondrosarcoma described in the literature are secondary, and the primary site can be identified. We present an unusual case of primary cardiac chondrosarcoma which originated in the left atrium. Severe pulmonary edema was the first presentation. The sarcoma subsequently metastasized to the mandible and finally recurred in the right heart causing severe pulmonary emboli and myocardial failure.
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Tsai FC, Lin PJ, Chang CH, Liu HP, Tan PP, Lin FC, Chiang CW. Video-assisted cardiac surgery. Preliminary experience in reoperative mitral valve surgery. Chest 1996; 110:1603-7. [PMID: 8989084 DOI: 10.1378/chest.110.6.1603] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Video-assisted endoscopic techniques had been applied in the surgical correction of patent ductus arteriosus, vascular ring, or coronary artery disease. However, it has been used only recently in the correction of reoperative mitral valve lesions. DESIGN Video-assisted cardiac operations were performed on four patients who had received surgical interventions on their mitral valves and needed emergent reoperation. PATIENTS Four patients (3 men and 1 woman) received emergency surgery from September to December 1995 for thrombosis of mechanical mitral prosthesis (2 patients) and severe mitral regurgitation with previously failed mitral valve repair (2 patients). Six previous operations had been performed on these mitral valves. Patient ages ranged from 26.7 to 68.1 years (mean, 47.3 years). Preoperatively, acute pulmonary edema occurred in two patients, cerebral emboli occurred in one patient, and sepsis was found in one patient. Mechanical ventilatory support was used in two patients before operation. INTERVENTION The operations were performed through right anterior minithoracotomy, guided by video-assisted endoscopic techniques with femoro-femoral extracorporeal circulation. The operative procedures were thrombectomy of mitral prosthesis in two patients, mitral valve repair in one patient, and mitral valve replacement in one patient. RESULTS The duration of extracorporeal circulation was 166 to 320 min (222 +/- 67 min) and the operation time was 4.6 to 6.8 h (6.1 +/- 1.0 h). All patients recovered from the operations rapidly with uneventful postoperative courses except 1 patient who had sepsis preoperatively and died 2 months later. CONCLUSION Our experience demonstrates that video-assisted cardiac surgery is technically feasible and could be performed in reoperation of the mitral valve.
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Affiliation(s)
- F C Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Wang JT, Tsai FC, Lee CZ, Chen PJ, Sheu JC, Wang TH, Chen DS. A prospective study of transfusion-transmitted GB virus C infection: similar frequency but different clinical presentation compared with hepatitis C virus. Blood 1996; 88:1881-6. [PMID: 8781448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To study the incidence and outcome of GB virus C (GBV-C) infection in blood recipients. Serum samples collected in a prospective study were examined for GBV-C RNA by a nested polymerase chain reaction assay. Among the 400 adults who underwent cardiac surgery, 40 were positive for GBV-C RNA, including six whose pretransfusion sera were already positive and seven coinfected with hepatitis C virus (HCV) during transfusion. The risk of transmission was estimated to be approximately 0.46% per donor. GBV-C viremia was detectable 1 week after transfusion and could persist for 8 years. However, no evident symptoms or signs were noted in the 25 patients infected by GBV-C alone, and the average peak serum alanine aminotransferase activity was 31 IU/L only (range, 12 to 123), with persistently normal levels in 20 patients. In the seven patients coinfected with HCV, the clinical courses of posttransfusion hepatitis were similar to those infected by HCV alone. In eight patients with posttransfusion non-A approximately E hepatitis, only one was positive for GBV-C RNA. Sixty samples were chosen to test hepatitis G virus (HGV) sequences, 26 of the 30 GBV-C positives were positive for HGV RNA in contrast to none of the 30 GBV-C negative samples. In conclusion, GBV-C can be transmitted by transfusion in approximately 9% of patients who underwent cardiac surgery. Nevertheless, this virus does not seem to cause classic hepatitis in most instances.
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Affiliation(s)
- J T Wang
- Department of Bacteriology, School of Medicine, College of Medicine, National Taiwan University, Taipei
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Abstract
BACKGROUND Video-assisted endoscopy has been applied in the management of a variety of intrathoracic vascular lesions. Here we report its use in the correction of intracardiac congenital defects. METHODS Eight patients (3 male and 5 female) underwent operation for closure of an atrial septal defect. The patients ranged in age from 2.0 to 60.9 years (mean, 19.2 +/- 19.0 years). The patients weighed 11 to 66 kg (mean, 41.3 +/- 23.5 kg). The ratio of pulmonary blood flow to systemic blood flow ranged from 2.0 to 6.0 (mean, 3.4 +/- 1.3). The mean pulmonary artery pressure was 19.7 +/- 4.0 mm Hg (range, 13 to 24 mm Hg). The operations were performed through a right anterior minithoracotomy and guided by video-assisted endoscopic techniques under femorofemoral or femoral-right atrial extracorporeal circulation. The aorta was not cross-clamped, and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature, 22.0 degrees +/- 2.0 degrees C). Transesophageal echocardiographic monitoring was maintained during the operations. The right atrium was entered after pericardiotomy. Primary closure of the defect was performed successfully in all patients. Conventional nondisposable instruments were used for dissection, grasping, suturing, and hemostasis. RESULTS The durations of extracorporeal circulation and operation ranged from 47 to 126 minutes (mean, 80 +/- 31 minutes) and from 2.2 to 4.5 hours (mean, 3.1 +/- 0.8), respectively. All patients recovered from the operation rapidly with an uneventful postoperative course. CONCLUSIONS Our experience demonstrates that video-assisted cardiac surgery is technically feasible and can be used with excellent results for the repair of congenital heart defects in general.
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Affiliation(s)
- C H Chang
- Department of Pediatrics and Anesthesiology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Abstract
BACKGROUND Video-assisted endoscopy has been applied frequently in the management of a variety of surgical diseases. However, it has rarely been applied in mitral valve surgery. METHODS We report 2 patients who received emergency operations for thrombosis of a mitral prosthesis (patient 1, a 68-year-old man) and acute mitral regurgitation due to rupture of anterior chordae (patient 2, a 75-year-old woman). They both had severe congestive heart failure. Cardiogenic shock was noted in patient 2. The mitral valve was approached through a right anterior minithoracotomy with the aid of an endoscope by means of projected images on the video monitor under femorofemoral cardiopulmonary bypass. The aorta was not cross-clamped, and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. The left atrium was entered posterior to the interatrial groove. Thrombectomy and mitral valve repair were performed successfully. RESULTS The duration of extracorporeal circulation was 204 and 147 minutes, respectively. Both patients recovered from the operation rapidly with uneventful postoperative courses. CONCLUSIONS Our preliminary results suggest that video-assisted endoscopic cardiac surgery is technically feasible and could be performed in the milieu of open heart surgery.
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Affiliation(s)
- P J Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Tsai FC, Gardner DK. Nicotinamide, a component of complex culture media, inhibits mouse embryo development in vitro and reduces subsequent developmental potential after transfer. Fertil Steril 1994; 61:376-82. [PMID: 8299799 DOI: 10.1016/s0015-0282(16)56534-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the effects of B-group vitamins present in culture media on mouse embryo development in vitro and subsequent viability. DESIGN Mouse zygotes were cultured in the presence of B-group vitamins. Embryo morphology and cell numbers were determined at 96 and 120 hours after hCG. Viability was assessed by transfer of embryos after 3 days of culture to pseudopregnant recipients. Resultant pregnancy rates (PRs) and fetal weights were determined. RESULTS Supplementation of an amino acid-free medium with minimal essential medium (MEM) B-group vitamins significantly decreased embryo cleavage rates, whereas the inclusion of Ham's F-10 medium B-group vitamins significantly reduced both cleavage rates and morphological development. Subsequent experiments determined that nicotinamide (5 microM) significantly reduced blastocyst cell number, implantation rate, viable PR, and fetal weight. CONCLUSION The data indicate that nicotinamide inhibits mouse embryo development in culture and reduces viability. Nicotinamide is present at high levels in Ham's F-10 and MEM media that are used routinely in human embryo culture. The role of vitamins in human embryo development in vitro warrants investigation.
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Affiliation(s)
- F C Tsai
- Centre for Early Human Development, Monash University, Melbourne, Victoria, Australia
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Tsai FC, Sherman JC. Circular dichroism analysis of a synthetic peptide corresponding to the alpha, alpha-corner motif of hemoglobin. Biochem Biophys Res Commun 1993; 196:435-9. [PMID: 8216325 DOI: 10.1006/bbrc.1993.2268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The alpha, alpha-corner is a helix-turn-helix super-secondary structural protein motif where the two alpha-helices cross at approximately right angles. This motif has been observed in a wide variety of proteins and thus, has been proposed to be a protein folding initiator. We sought to test this hypothesis by synthesizing a peptide corresponding to the alpha, alpha-corner of the alpha-chain of horse methemoglobin (residues 80-108) and examining its structure by circular dichroism. We found that the alpha, alpha-corner peptide is moderately helical in water and fully helical in trifluoroethanol, as solvent that approximates the hydrophobic surroundings of the excised portion of the protein. The helicity of our synthetic peptide suggests that the alpha, alpha-corner may in fact have some stability on its own and thus, may be capable of initiating protein folding.
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Affiliation(s)
- F C Tsai
- Department of Chemistry, University of British Columbia, Vancouver, Canada
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Tsai FC. [Carcinoma in situ of the uterine cervix---a clinical analysis of 166 cases (author's transl)]. Zhonghua Fu Chan Ke Za Zhi 1980; 15:183-5. [PMID: 7472019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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