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Wang HQ, Lai ST, Liu JB, Shao HJ, Chen RY, Kang J. Two new baccharane triterpenes isolated from Rhus chinensis. J Asian Nat Prod Res 2024; 26:189-194. [PMID: 37882670 DOI: 10.1080/10286020.2023.2260757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
Two new baccharane triterpenes, 17,24-epoxy-23-en-baccharan-3-one (1) and 17,24(S)-epoxy-25-en-21-hydroxy-baccharan-3-one (2) were isolated from Rhus chinensis Mill. The structures were established on the basis of UV, IR, HR-ESI-MS, 1D and 2D NMR spectroscopy and X-ray diffraction analysis.
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Affiliation(s)
- Hong-Qing Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Sheng-Tian Lai
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jian-Bo Liu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Hong-Jie Shao
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Ruo-Yun Chen
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jie Kang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
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2
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Liu JB, Xie J, Wang HQ, Lai ST, Shao HJ, Chen RY, Kang J. Four sesquiterpenes isolated from Taraxacum mongolicum. J Asian Nat Prod Res 2023; 25:1038-1043. [PMID: 37071690 DOI: 10.1080/10286020.2023.2197225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
One new sesquiterpene, (6S,7R,11S)-13-carboxy-1(10)-en-dihydroartemisinic acid (1), together with three known sesquiterpenes, ainsliaea acid B (2), mongolicumin B (3), and 11β,13-dihydroxydeacetylmatricarin (4) were isolated from Taraxacum mongolicum Hand.-Mazz. The structures were established on the basis of UV, IR, HR-ESI-MS, 1D and 2D NMR spectroscopy, ECD spectroscopy, and X-ray diffraction analysis. Compound 1 was found to have potential anti-inflammatory activity and could reduce LPS-induced NO levels in murine macrophage, with inhibitory rate of 37%.
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Affiliation(s)
- Jian-Bo Liu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jun Xie
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Hong-Qing Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Sheng-Tian Lai
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Hong-Jie Shao
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Ruo-Yun Chen
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jie Kang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
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Lai ST, Zhang T, Wang HQ, Xie J, Liu JB, Chen RY, Kang J. Two new sesquiterpene dimers isolated from the roots of Saussurea lappa (Yunmuxiang). J Asian Nat Prod Res 2022; 24:490-495. [PMID: 35068288 DOI: 10.1080/10286020.2021.2025049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Two new sesquiterpene dimers, lappadimers A and B, were isolated from the roots of Saussurea lappa (Yunmuxiang). Their structures were established on the basis of spectroscopic methods. They were found to have potential anti-inflammatory activity at 10 µM and could reduce LPS-induced NO levels in murine macrophage, with inhibitory rates of 67% and 47%, respectively.
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Affiliation(s)
- Sheng-Tian Lai
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Ting Zhang
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
| | - Hong-Qing Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jun Xie
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jian-Bo Liu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Ruo-Yun Chen
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jie Kang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
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Leung WK, Ng SC, Chow DKL, Lao WC, Leung VKS, Li MKK, Hui YT, Ng SSM, Hui AJ, Lai ST, Lam JTW, Poon JTC, Chan AOO, Yuen H, Wu JCY. Use of biologics for inflammatory bowel disease in Hong Kong: consensus statement. Hong Kong Med J 2013; 19:61-68. [PMID: 23378357] [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: 06/01/2023] Open
Abstract
UNLABELLED OBJECTIVE; With the increasing use of biologics in patients with inflammatory bowel disease, the Hong Kong IBD Society developed a set of consensus statements intended to serve as local recommendations for clinicians about the appropriate use of biologics for treating inflammatory bowel disease. PARTICIPANTS The consensus meeting was held on 9 July 2011 in Hong Kong. Draft consensus statements were developed by core members of the Hong Kong IBD Society, including local gastroenterologists and colorectal surgeons experienced in managing patients with inflammatory bowel disease. EVIDENCE Published literature and conference proceedings on the use of biologics in management of inflammatory bowel disease, and guidelines and consensus issued by different international and regional societies on recommendations for biologics in inflammatory bowel disease patients were reviewed. CONSENSUS PROCESS Four core members of the consensus group drafted 19 consensus statements through the modified Delphi process. The statements were first circulated among a clinical expert panel of 15 members for review and comments, and were finalised at the consensus meeting through a voting session. A consensus statement was accepted if at least 80% of the participants voted "accepted completely or "accepted with some reservation". CONCLUSIONS Nineteen consensus statements about inflammatory bowel disease were generated by the clinical expert panel meeting. The statements were divided into four parts which covered: (1) epidemiology of the disease in Hong Kong; (2) treatment of the disease with biologics; (3) screening and contra-indications pertaining to biologics; and (4) patient monitoring after use of biologics. The current statements are the first to describe the appropriate use of biologics in the management of inflammatory bowel disease in Hong Kong, with an aim to provide guidance for local clinical practice.
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Affiliation(s)
- W K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Tsang KY, Luk S, Lo JYC, Tsang TY, Lai ST, Ng TK. Hong Kong experiences the 'Ultimate superbug': NDM-1 Enterobacteriaceae. Hong Kong Med J 2012; 18:439-441. [PMID: 23018074] [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: 06/01/2023] Open
Abstract
We report the second imported case of New Delhi metallo-beta-lactamase (NDM-1) Enterobacteriaceae encountered in Hong Kong soon after the patient's arrival in the territory for medical care. As NDM-1 is spreading throughout the world via international travel, being an international city, Hong Kong was always expected to encounter the same public health threat. This case also illustrates the importance of active surveillance of at-risk patients in preventing the spread of this 'superbug'.
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Affiliation(s)
- K Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong.
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Lam THJ, Cheng RS, Lai ST, Tsang TY, Cheng VCC, Ho SL, Yam WC. Evaluation of in-house and commercial genotyping assays for molecular typing of hepatitis C virus in Hong Kong. Br J Biomed Sci 2011; 67:82-5. [PMID: 20669764 DOI: 10.1080/09674845.2010.11730296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to evaluate genotyping assays for hepatitis C virus (HCV). An in-house nucleic acid sequencing method is performed in parallel with the Roche Linear Array HCV genotyping test on 73 HCV-positive (66 clinical samples and seven proficiency testing quality control samples) and 12 HCV-negative samples (11 clinical samples and one proficiency testing sample). The performance of the in-house method was comparable with that of the Roche assay (concordance rate: 89.4%). Discordant results included four mixed infections missed by the in-house method, two false-negatives with the Roche assay, and three discrepant results. The in-house method exhibited a higher resolution (subtype vs. genotype level) at a lower running cost (25% of the commercial assay). The in-house method was also used to genotype 375 HCV clinical isolates to determine the genotypic distribution of HCV in Hong Kong between 2005 and 2008. A total of 441 (52.8%) clinical isolates proved to be genotype 1, which shows a poorer response to interferon therapy. Genotype 6 was the next most common (32.0%). Prevalence of genotypes 2 and 3 was 7.7% and 6.6%, respectively, and prevalence of genotypes 4 and 5 was 0.9% and 0%, respectively. Although the in-house nucleic acid sequencing method failed to detect a few cases of mixed HCV infection, its high resolution and low running cost make it suitable for surveillance and outbreak investigation.
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Affiliation(s)
- T H J Lam
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
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Chan KYK, Xu MS, Ching JCY, Chan VS, Ip YC, Yam L, Chu CM, Lai ST, So KM, Wong TY, Chung PH, Tam P, Yip SP, Sham P, Lin CL, Leung GM, Peiris JSM, Khoo US. Association of a single nucleotide polymorphism in the CD209 (DC-SIGN) promoter with SARS severity. Hong Kong Med J 2010; 16:37-42. [PMID: 20864747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- K Y K Chan
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, SAR, China
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Khoo US, Chan KY, Ching JCY, Chan VS, Ip YC, Yam L, Chu CM, Lai ST, So KM, Wong TY, Chung PH, Tam P, Yip SP, Sham P, Leung GM, Lin CL, Peiris JSM. Functional role of ICAM-3 polymorphism in genetic susceptibility to SARS infection. Hong Kong Med J 2009; 15 Suppl 6:26-29. [PMID: 19801714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- U S Khoo
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Chan KH, Lai ST, Poon LLM, Guan Y, Yuen KY, Peiris JSM. Analytical sensitivity of rapid influenza antigen detection tests for swine-origin influenza virus (H1N1). J Clin Virol 2009; 45:205-7. [PMID: 19539521 DOI: 10.1016/j.jcv.2009.05.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 05/22/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND A novel swine origin influenza virus (S-OIV) (H1N1) is spreading worldwide and threatens to become pandemic. OBJECTIVES Determine analytical sensitivity of selected commercially available rapid influenza antigen detection tests in detecting S-OIV H1N1. STUDY DESIGN Serial dilutions of two S-OIV isolates, one seasonal influenza A (H1N1) isolate and a nasopharyngeal aspirate from a patient with S-OIV disease were tested in five commercially available influenza antigen detection tests and by virus isolation in cell culture. Viral M gene copy number was determined by quantitative PCR methods. RESULTS The analytical sensitivity of the five influenza antigen detection tests for S-OIV (tissue culture infectious dose 50 (TCID(50)) log(10)3.3-4.7 was comparable with that of seasonal influenza (TCID(50) log(10)4.0-4.5). CONCLUSION The analytical sensitivity of the selected influenza A antigen detection tests for detection of S-IOV was comparable with that of seasonal influenza H1N1.
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Affiliation(s)
- K H Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
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10
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Khoo US, Chan KY, Chan VS, Ching JCY, Yam L, Chu CM, Lai ST, Wong TY, Tam P, Yip SP, Leung GM, Lin CL, Peiris JSM. Role of polymorphisms of the inflammatory response genes and DC-SIGNR in genetic susceptibility to SARS and other infections. Hong Kong Med J 2008; 14 Suppl 4:31-35. [PMID: 18708672] [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: 05/26/2023] Open
Abstract
1. A genetic risk-association study involving more than 1200 subjects showed individuals homozygous for L-SIGN tandem repeats are less susceptible to SARS infection. 2. This was supported by in vitro binding studies that demonstrated homozygous L-SIGN, compared to heterozygous, had higher binding capacity for SARS coronavirus (SARS-CoV), with higher proteasome-dependent viral degradation. In contrast, homozygous L-SIGN demonstrated lower binding capacity for HIV1-gp120.3. Genetic-association studies for single nucleotide polymorphisms of the inflammatory response genes, namely TNF-alpha, INF-alpha, INF-beta, INF-gamma, IL1-alpha, IL1-beta, IL-4, IL-6 and iNOS, failed to show a significant association with SARS clinical outcomes or susceptibility.
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Affiliation(s)
- U S Khoo
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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11
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Chau TN, Yim KF, Mok NS, Chan WK, Leung VKS, Leung MF, Lai ST. Clopidogrel-induced hepatotoxicity after percutaneous coronary stenting. Hong Kong Med J 2005; 11:414-6. [PMID: 16219965] [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: 05/04/2023] Open
Abstract
Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in acute coronary syndrome and percutaneous coronary stenting. The occurrence of hepatotoxicity is rare. We describe the occurrence of symptomatic liver disease in a 74-year-old man 5 weeks following commencement of therapy with clopidogrel. The reported cases of clopidogrel-induced hepatotoxicity are reviewed and the clinical significance of this event are discussed.
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Affiliation(s)
- T N Chau
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
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12
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Abstract
The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication. The effectiveness of corticosteroids has only been suggested by uncontrolled observations, and the role of these agents in therapy remains to be established by randomized controlled studies. Both ribavirin and corticosteroids have very significant side effects. The lopinavir/ritonavir combination has been shown to reduce the intubation rate and the incidence of adverse clinical outcomes when used with ribavirin. When patients deteriorate clinically despite treatment with ribavirin and corticosteroids, rescue treatment with convalescent plasma and immunoglobulin may be beneficial. Noninvasive positive pressure ventilation is a sound treatment for SARS patients with respiratory failure if administered with due precaution in the correct environment. Interferons and other novel agents may hold promise as useful anti-SARS therapies in the future. The experience with traditional Chinese medicine is encouraging, and its use as an adjuvant should be further investigated.
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Affiliation(s)
- S T Lai
- Division of Infectious Disease, Department of Medicine, Princess Margaret Hospital, 2-10, Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong Special Administrative Region, China.
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13
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Chan KCA, Tang NLS, Hui DSC, Chung GTY, Wu AKL, Chim SSC, Chiu RWK, Lee N, Choi KW, Sung YM, Chan PKS, Tong YK, Lai ST, Yu WC, Tsang O, Lo YMD. Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study. BMC Infect Dis 2005; 5:26. [PMID: 15819995 PMCID: PMC1090578 DOI: 10.1186/1471-2334-5-26] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 04/09/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. METHOD One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. RESULTS There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. CONCLUSION The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.
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Affiliation(s)
- KC Allen Chan
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Nelson LS Tang
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - David SC Hui
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Grace TY Chung
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Alan KL Wu
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Stephen SC Chim
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Rossa WK Chiu
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Nelson Lee
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - KW Choi
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - YM Sung
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Paul KS Chan
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - YK Tong
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - ST Lai
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - WC Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Owen Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - YM Dennis Lo
- The Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Abstract
Safety in blood transfusion has all along been focused on blood borne viruses like HIV, hepatitis B and C. However, infective agents that are not usually transmitted through blood may also pose risk to transfusion if the donor gives blood in the early-viraemic phase. A case report of potential transfusion-transmitted hepatitis E (HEV) is described. It shows the virus can be transmissible via blood because of the presence of HEV RNA in the blood donated. Pre-donation health screening was unable to exclude this asymptomatic donor. But donor-initiated call back system which acts as an additional safety net prevented the release of the potential infective blood products.
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Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong.
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15
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Wong ATY, Tsang OTY, Wong MYF, Lim WL, Zheng BJ, Lee SS, Lai ST, Yuen KY, Choi KW, Tso EYK, Chau TN, Tong WL, Chiu MC, Yu WC. Coronavirus infection in an AIDS patient. AIDS 2004; 18:829-30. [PMID: 15075525 DOI: 10.1097/00002030-200403260-00021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Peiris JSM, Yu WC, Leung CW, Cheung CY, Ng WF, Nicholls JM, Ng TK, Chan KH, Lai ST, Lim WL, Yuen KY, Guan Y. Re-emergence of fatal human influenza A subtype H5N1 disease. Lancet 2004; 363:617-9. [PMID: 14987888 PMCID: PMC7112424 DOI: 10.1016/s0140-6736(04)15595-5] [Citation(s) in RCA: 589] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Human disease associated with influenza A subtype H5N1 re-emerged in January, 2003, for the first time since an outbreak in Hong Kong in 1997. Patients with H5N1 disease had unusually high serum concentrations of chemokines (eg, interferon induced protein-10 [IP-10] and monokine induced by interferon gamma [MIG]). Taken together with a previous report that H5N1 influenza viruses induce large amounts of proinflammatory cytokines from macrophage cultures in vitro, our findings suggest that cytokine dysfunction contributes to the pathogenesis of H5N1 disease. Development of vaccines against influenza A (H5N1) virus should be made a priority.
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Affiliation(s)
- J S M Peiris
- Department of Microbiology and Pathology, University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong SAR, People's Republic of China.
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17
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Chan KS, Lai ST, Chu CM, Tsui E, Tam CY, Wong MML, Tse MW, Que TL, Peiris JSM, Sung J, Wong VCW, Yuen KY. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J 2003; 9:399-406. [PMID: 14660806] [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: 04/27/2023] Open
Abstract
OBJECTIVES To investigate the possible benefits and adverse effects of the addition of lopinavir/ritonavir to a standard treatment protocol for the treatment of severe acute respiratory syndrome. DESIGN Retrospective matched cohort study. SETTING Four acute regional hospitals in Hong Kong. PATIENTS AND METHODS Seventy-five patients with severe acute respiratory syndrome treated with lopinavir/ritonavir in addition to a standard treatment protocol adopted by the Hospital Authority were matched with controls retrieved from the Hospital Authority severe acute respiratory syndrome central database. Matching was done with respect to age, sex, the presence of co-morbidities, lactate dehydrogenase level and the use of pulse steroid therapy. The 75 patients treated with lopinavir/ritonavir were divided into two subgroups for analysis: lopinavir/ritonavir as initial treatment, and lopinavir/ritonavir as rescue therapy. These groups were compared with matched cohorts of 634 and 343 patients, respectively. Outcomes including overall death rate, oxygen desaturation, intubation rate, and use of pulse methylprednisolone were reviewed. RESULTS The addition of lopinavir/ritonavir as initial treatment was associated with a reduction in the overall death rate (2.3%) and intubation rate (0%), when compared with a matched cohort who received standard treatment (15.6% and 11.0% respectively, P<0.05) and a lower rate of use of methylprednisolone at a lower mean dose. The subgroup who had received lopinavir/ritonavir as rescue therapy, showed no difference in overall death rate and rates of oxygen desaturation and intubation compared with the matched cohort, and received a higher mean dose of methylprednisolone. CONCLUSION The addition of lopinavir/ritonavir to a standard treatment protocol as an initial treatment for severe acute respiratory syndrome appeared to be associated with improved clinical outcome. A randomised double-blind placebo-controlled trial is recommended during future epidemics to further evaluate this treatment.
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Affiliation(s)
- K S Chan
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong
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Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, Nicholls J, Yee WKS, Yan WW, Cheung MT, Cheng VCC, Chan KH, Tsang DNC, Yung RWH, Ng TK, Yuen KY. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361:1319-25. [PMID: 12711465 PMCID: PMC7112372 DOI: 10.1016/s0140-6736(03)13077-2] [Citation(s) in RCA: 2103] [Impact Index Per Article: 100.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND An outbreak of severe acute respiratory syndrome (SARS) has been reported in Hong Kong. We investigated the viral cause and clinical presentation among 50 patients. METHODS We analysed case notes and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters. We defined the clinical presentation and risk factors associated with severe disease and investigated the causal agents by chest radiography and laboratory testing of nasopharyngeal aspirates and sera samples. We compared the laboratory findings with those submitted for microbiological investigation of other diseases from patients whose identity was masked. FINDINGS Patients' age ranged from 23 to 74 years. Fever, chills, myalgia, and cough were the most frequent complaints. When compared with chest radiographic changes, respiratory symptoms and auscultatory findings were disproportionally mild. Patients who were household contacts of other infected people and had older age, lymphopenia, and liver dysfunction were associated with severe disease. A virus belonging to the family Coronaviridae was isolated from two patients. By use of serological and reverse-transcriptase PCR specific for this virus, 45 of 50 patients with SARS, but no controls, had evidence of infection with this virus. INTERPRETATION A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. Serological and molecular tests specific for the virus permitted a definitive laboratory diagnosis to be made and allowed further investigation to define whether other cofactors play a part in disease progression.
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Affiliation(s)
- JSM Peiris
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong,Correspondence to: Prof J S M Peiris, Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region, China
| | - ST Lai
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - LLM Poon
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Y Guan
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - LYC Yam
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - W Lim
- Government Virus Unit, Department of Health, Hong Kong
| | - J Nicholls
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - WKS Yee
- Department of Medicine, Kwong Wah Hospital, Hong Kong
| | - WW Yan
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - MT Cheung
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - VCC Cheng
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - KH Chan
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - DNC Tsang
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - RWH Yung
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - TK Ng
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - KY Yuen
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
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19
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Tsui PT, Lai ST, Leung WS, Mok NS, Wu CW, Lau ST, Choi YC. Prolonged jaundice following percutaneous coronary intervention and ticlopidine therapy. Hong Kong Med J 2002; 8:57-9. [PMID: 11861996] [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: 02/23/2023] Open
Abstract
Ticlopidine, an adenosine diphosphate receptor blocker, is widely used to prevent subacute stent thrombosis after percutaneous coronary intervention. Along with neutropenia and thrombotic thrombocytopenic purpura, cholestatic hepatitis is one of the most serious potential side-effects of ticlopidine therapy. Four patients with prolonged jaundice after ticlopidine therapy, including one fatal case, are presented. Alternative antithrombotic therapy for subsequent percutaneous coronary intervention is also described. Clopidogrel therapy was found to be safe and effective in two patients with a history of ticlopidine-related cholestatic hepatitis.
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Affiliation(s)
- P T Tsui
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Laichikok, Hong Kong
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20
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Zhang JZ, Im SWK, Lau SH, Chau TN, Lai ST, Ng SP, Peiris M, Tse C, Ng TK, Ng MH. Occurrence of hepatitis E virus IgM, low avidity IgG serum antibodies, and viremia in sporadic cases of non-A, -B, and -C acute hepatitis. J Med Virol 2002; 66:40-8. [PMID: 11748657 DOI: 10.1002/jmv.2109] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [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
Serum samples were taken from 57 patients with sporadic non-A, -B, and -C (Non A, B, C) acute hepatitis at different times after onset of the disease and tested for the presence of the hepatitis E virus (HEV) RNA, IgM, and low avidity IgG antibodies. The viral antibodies were detected using two ELISA. One assay (GL) was produced using a mixture of recombinant peptides specified by ORF2 and ORF3 of the viral genome. The other was produced with an ORF2 specified peptide, pE2. The latter occurs naturally as homodimer, it is recognized strongly in its dimeric form by human sera and, in the primate model, it confers protection against experimental HEV infection. Nineteen samples were positive for one or more of these acute markers of HEV infection, 14 of which were acute sera with elevated ALT levels and 5 were convalescent sera with normal ALT level. The results showed that icteric phase of sporadic hepatitis lasts for about 17 days and it coincides with a period when viremia is subsiding as HEV antibodies are developing. Viremia was intermittent and all but one of the 5 instances were confined to the icteric phase with elevated ALT levels. On two of these occasions, viremia preceded detection of HEV antibody, on another 2 occasions it was concurrent with the detection of pE2 specific IgM and/or low avidity IgG and only in one case of protracted viremia was the viral genome detected concurrently with avid pE2 IgG antibody. Ten (71%) of the 14 acute sera were reactive for pE2 IgM, eight (57%) were reactive for low avidity pE2 IgG, and six (43%) for the GL IgM. The sensitivity for the diagnosis of acute hepatitis E may be increased to 87% by combining pE2 IgM and viremia. GL IgM was detected later, but persisted for a longer period of time than the pE2 antibodies, and it was the only acute antibody detected in the convalescent sera.
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Affiliation(s)
- J Z Zhang
- Department of Microbiology, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, P.R. China
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21
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Hwang SJ, Lee SD, Lu RH, Chu CW, Wu JC, Lai ST, Chang FY. Hepatitis C viral genotype influences the clinical outcome of patients with acute posttransfusion hepatitis C. J Med Virol 2001. [PMID: 11596085 DOI: 10.1002/jmv.2064] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most patients with an acute infection of hepatitis C virus (HCV) will develop chronic hepatitis, and only about 15-20% of the cases will resolve spontaneously. The mechanism for the different outcomes in patients with acute HCV infection remains unclear. HCV genotype has been recognized as an important factor affecting the clinical course and outcome of chronic hepatitis C patients. In order to evaluate the role of HCV genotype in the clinical course and outcome of acute posttransfusion hepatitis C, 67 patients with acute posttransfusion hepatitis C from a prospective study of posttransfusion non-A, non-B hepatitis were enrolled. Thirty-nine patients (58.2%) were HCV genotype 1b. Among the 67 patients with acute posttransfusion hepatitis C, 53 (79.1%) progressed to chronic hepatitis. Significantly more patients with genotype 1b than non-1b genotypes developed chronic hepatitis (89.7% vs. 64.3%; P = 0.019). There was no significant difference in gender, mean age, amount of transfused blood, hepatitis symptoms, jaundice, incubation period, peak serum alanine transaminase, or serum HCV RNA titer between patients with HCV genotype 1b and non-1b infections. Patients who developed chronic hepatitis had a significantly greater incidence of genotype 1b infection (66.0% vs. 28.6%; P = 0.013) and a longer incubation period (7.3 weeks vs. 5.4 weeks; P = 0.052) than patients whose infection was resolved. Patients with a genotype 1b infection that resolved itself spontaneously all had an incubation period of less than 6 weeks. Multivariate logistic regression analysis revealed that genotype 1b and an incubation period > or = 6 weeks were significant predictive factors for the development of chronic hepatitis. Therefore, the HCV genotype can influence the outcome of patients with acute HCV infection.
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Affiliation(s)
- S J Hwang
- Department of Family Medicine, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, 201 Shih-Pai Road, Section 2, Taipei, 11217, Taiwan, Republic of China
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22
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Kan CB, Hsu CP, Tsao NW, Lai ST, Huang CH. Effects of verapamil on coronary vascular resistance in rabbits: measurement with pulsed Doppler velocimetry. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:715-20. [PMID: 11922492] [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: 02/24/2023]
Abstract
BACKGROUND Verapamil is an effective vasodilator. The purpose of this study was to investigate the in vivo effect of verapamil on coronary blood flow velocity and vascular resistance in anesthetized, open-chest rabbits. METHODS Twenty-one male New Zealand white rabbits were anesthetized, and a 3-mm suction-type pulsed Doppler velocimeter probe was applied to the proximal part of the left anterior descending coronary artery after median sternotomy. The rabbits received intravenous bolus infusion of 4 different doses of verapamil (0.01 mg/kg, n = 5; 0.1 mg/kg, n = 5; 1 mg/kg, n = 5, and 10 mg/kg, n = 6). The percent changes in coronary blood flow velocity and coronary vascular resistance were examined. RESULTS There was 10.0+/-1.6% increase in coronary blood flow (CBF) and 12.5+/-1.9% reduction in coronary vascular resistance (CVR) after infusion of 0.01 mg/kg of verapamil. The CBF increased 23.0+/-9.5% and CVR decreased 24.2+/-5.2% after infusion of 0.1 mg/kg of verapamil. Infusion of 1 mg/kg of verapamil induced 34.8+/-10.5% increase in CBF and 32.6+/-2.5% reduction in CVR. The CBF increased 41.1+/-14.8% and CVR decreased 45.1+/-5.4% after infusion of 10 mg/kg of verapamil. CONCLUSIONS Compared with baseline condition, all doses of verapamil increased coronary blood flow velocity and decreased coronary vascular resistance significantly in anesthetized, open-chest rabbits.
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Affiliation(s)
- C B Kan
- Division of Cardiovascular Surgery, Taipei Veterans General Hospital, University School of Medicine, Taiwan, ROC
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23
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Kan CB, Shih CC, Chang J, Lai ST. Combined innominate artery reconstruction and coronary artery bypass grafting. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:641-6. [PMID: 11853218] [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: 02/23/2023]
Abstract
Two patients having significant coronary artery disease with innominate artery near-total occlusion presented neurological deficit of syncope events or cerebellar and brain stem infarct. Both of them were successfully treated with one-stage reconstruction combined with aorto-carotid-subclavian bypass and coronary artery bypass grafting (CABG). While it could not be over-emphasized how to protect both myocardium and cerebrum during CABG, cerebral perfusion through the reconstructed carotid bypass graft is the key maneuver during cardiac arrest and moderate hypothermia. Hypoperfused cerebral hemispheres were both improved extensively in the follow-up angiography. The absence of cerebral deficit and the free from coronary angina suggested that surgical technique to combine innominate with coronary artery surgery is feasible with acceptable mortality and morbidity rate.
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Affiliation(s)
- C B Kan
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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24
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Tsang SW, Chan HL, Leung NW, Chau TN, Lai ST, Chan FK, Sung JJ. Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection. Aliment Pharmacol Ther 2001; 15:1737-44. [PMID: 11683687 DOI: 10.1046/j.1365-2036.2001.01107.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [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: 01/16/2023]
Abstract
BACKGROUND Exacerbation of chronic hepatitis B infection can lead to fulminant hepatic failure with a mortality of up to 90%. AIM To evaluate the efficacy of lamivudine in the treatment of this subgroup of patients. METHODS Twenty-four patients with exacerbation of chronic hepatitis B infection and fulminant hepatic failure were treated with lamivudine, 100 mg daily. Hepatitis A, C, D and human immunodeficiency virus co-infections and hepatocellular carcinoma were excluded. RESULTS The median age was 53 years (range, 24-77 years) with a male predominance of 20:4. Seventeen patients were hepatitis B e antigen positive. Mean hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (group A). Thirteen patients died and three patients received liver transplantation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferase, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis and renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sustained in four patients. CONCLUSIONS Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e antigen seroconversion was less durable in this subgroup of patients and long-term therapy may be required.
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Affiliation(s)
- S W Tsang
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, New Territories, Hong Kong, China.
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Shih CC, Chen CC, Chang J, Shih CM, Tseng HS, Ko JS, Lai ST. Endovascular aortic graft exclusion of abdominal aortic aneurysm. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:661-6. [PMID: 11853222] [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: 02/23/2023]
Abstract
Endovascular repair of abdominal aortic aneurysms has evolved dramatically within the past few years. This study reports the first successful case in Taiwan area of infrarenal abdominal aortic aneurysm treated with endovascular aortic bifurcational stent-graft. Minimally invasive surgery leading to early recovery, mobilization and shortened hospital day was promising. In addition, there were no local, remote or systemic complications during a 18-month follow-up. Thus, the procedure is an attractive alternative in its potential to reduce morbidity and mortality associated with open surgical repair, especially for patients who are not surgical candidates because of comorbidities. Careful patient selection and more experiences with refined endograft models will elucidate the feasible alternative to conventional surgical repair.
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Affiliation(s)
- C C Shih
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC.
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Chau TN, Lai ST, Tse C, Ng TK, Ng MH, Lai JY, Yuen H. Parenteral and sexual transmission are not risk factors for acute hepatitis E infection in Hong Kong. Am J Gastroenterol 2001; 96:3046-7. [PMID: 11693359 DOI: 10.1111/j.1572-0241.2001.04699.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kan CB, Wang JS, Hsu CP, Lai ST. Ascending aorta to lower limbs revascularization for reoperation via ministernotomy. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:531-4. [PMID: 11768284] [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: 02/23/2023]
Abstract
The extra-anatomic bypasses, femorofemoral or axillofemoral, have been performed in selected patients for lower extremity revascularization of aortoiliac occlusion. However, significant graft occlusion rate does exist and reoperation constitutes an increasing proportion of vascular surgery practice. We presented our experience in a high-risk patient who received bypass surgery for the third time using the ascending aorta as the source of inflow with good result.
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Affiliation(s)
- C B Kan
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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28
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Wong TY, Chiu SI, So MK, Tsang MK, Lai ST, Tse KK, Io IY. Septic metastatic endophthalmitis complicating Klebsiella pneumoniae liver abscess in a non-diabetic Chinese man. Hong Kong Med J 2001; 7:303-6. [PMID: 11590274] [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: 02/21/2023] Open
Abstract
Septic metastatic endophthalmitis is a rare but serious disease. Endophthalmitis arising from Klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition, but is rarely seen in patients without diabetes. A non-diabetic patient with liver abscess complained of right eye discomfort and floaters 3 days after admission. Both blood and liver aspirate cultured Klebsiella pneumoniae. The patient was treated initially with systemic and subconjunctival antibiotics followed by intravitreal antibiotics with successful visual salvation. Previous reports from the literature showed poor visual outcome despite treatment and delayed recognition was often the cause. Clinicians should be alert to endophthalmitis whenever a patient with Klebsiella pneumoniae liver abscess complains of ocular symptoms. Urgent ophthalmological assessment should be sought.
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Affiliation(s)
- T Y Wong
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong
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Zhang JZ, Ng MH, Xia NS, Lau SH, Che XY, Chau TN, Lai ST, Im SW. Conformational antigenic determinants generated by interactions between a bacterially expressed recombinant peptide of the hepatitis E virus structural protein. J Med Virol 2001; 64:125-32. [PMID: 11360244 DOI: 10.1002/jmv.1027] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [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: 01/03/2023]
Abstract
A 23 kDa peptide locating to amino acid residues 394 to 604 of the major Hepatitis E Virus (HEV) structural protein was expressed in E. coli. This peptide was found to interact naturally with one another to form homodimers and it was recognized strongly and commonly in its dimeric form by HEV reactive human sera. The antigenic activity associated with the dimeric form was abrogated when the dimer was dissociated into monomer and the activity was reconstituted after the monomer was re-associated into dimer again. The dimeric form of the peptide elicited a vigorous antibody response in experimental animals and the resulting antisera were found to cross-react against HEV, effecting an efficient immune capture of the virus. These results attributed the antigenic activity associated with the dimeric form of the peptide to conformational antigenic determinants generated as a result of interaction between the peptide molecules. It is suggested that some of these antigenic determinants may be expressed by the HEV capsid and raised the possibility of this bacterially expressed peptide as an HEV vaccine candidate.
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Affiliation(s)
- J Z Zhang
- Department of Microbiology, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China
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30
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Tsang TY, Lai ST. A case of thoracic empyema due to suppurative melioidosis. Hong Kong Med J 2001; 7:201-4. [PMID: 11514758] [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: 02/21/2023] Open
Abstract
Melioidosis is considered a rare disease in Hong Kong, and its diagnosis and treatment can be difficult. We report the case of a patient who presented with thoracic empyema. The material sampled from the empyema was initially labelled Burkholderia cepacia. The diagnosis of melioidosis due to Burkholderia pseudomallei could only be made after repeated cultures, and performing arginine dihydrolase and serological tests. The patient was initially treated with imipenem for 2 weeks, and then with ciprofloxacin as maintenance therapy. A resistant strain of the organism developed after 7 months of treatment. The patient was then given co-amoxiclav. Repeated courses of surgical drainage and debridement were also instituted. Subsequent computed tomographic scanning of the thorax showed gradual resolution of the empyema.
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Affiliation(s)
- T Y Tsang
- Department of Medicine, Princess Margaret Hospital, Princess Margaret Hospital Road, Laichikok, Kowloon, Hong Kong
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Huang CH, Lai ST, Weng ZC. Risk factors for mortality in primary isolated coronary artery bypass grafting surgery. J Formos Med Assoc 2001; 100:299-303. [PMID: 11432307] [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: 02/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Identifying the risk factors for mortality in coronary artery bypass grafting (CABG) surgery is important to improve surgical results. The purpose of this study was to identify the risk factors for mortality in primary isolated CABG in a series of Taiwanese patients. METHODS Medical records of 914 patients who underwent primary isolated CABG surgery in Veterans General Hospital-Taipei during the period from January 1, 1991, to December 31, 1995, were reviewed. Eighteen clinical and seven operative variables were included in the univariate and multivariate analyses to identify the determinants of mortality in CABG surgery. RESULTS Thirty-one patients (3.4%) died within 30 days after surgery; 41 (4.5%) died during hospitalization for the procedure. After univariate and multivariate analyses, emergency surgery, history of myocardial infarction, concomitant peripheral artery occlusive disease (PAOD), and prolonged cardiopulmonary bypass (CPB) were found to be significant determinants of mortality in primary isolated CABG. Other variables, including age, sex, angina class, NYHA class, diabetes mellitus, the number of anastomoses, aortic cross-clamp time, stenosis of the left main coronary artery, the number of stenotic coronary arteries, history of congestive heart failure, and a left ventricular ejection fraction less than 35%, were not significant determinants of mortality. Patients undergoing emergency surgery were found to be at highest risk of mortality. CONCLUSIONS Patients undergoing emergency surgery who had a history of myocardial infarction, concomitant PAOD, or prolonged CPB were at higher risk of mortality in CABG surgery. More comprehensive techniques in myocardial protection, surgical procedures, and postoperative care should be used in the treatment of high-risk patients to reduce mortality.
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Affiliation(s)
- C H Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Huang CH, Lai ST, Weng ZC. The pressure waveform of coronary sinus in human hearts. Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64:147-52. [PMID: 11458619] [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: 02/20/2023]
Abstract
BACKGROUND The pressure waveform of coronary sinus in human hearts has never been well described. Retrograde cardioplegia perfusion has become a popular method of myocardial protection in recent years, and identification of the pressure waveform of the coronary sinus might help intubate the coronary sinus in retrograde cardioplegia perfusion by differentiating it from that of the right atrium. The purpose of this study is to identify the pressure waveform of the coronary sinus. METHODS We inserted a catheter into the coronary sinus under direct vision via a right atriotomy after completion of open heart operation in eight patients. The pressure waveforms of coronary sinus and central venous line, as well as the electrocardiogram (EKG), were recorded simultaneously after the patient was stable and weaned from the cardiopulmonary bypass. The recorded pressure waveforms of coronary sinus and central venous line were compared. RESULTS The pressure waveform of coronary sinus was found to have three peaks, more prominent than those of the central venous line waveform. CONCLUSIONS The pressure waveform of coronary sinus could be distinguished from that of the central venous line. The difference might help coronary sinus cannulation for retrograde cardioplegia perfusion.
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Affiliation(s)
- C H Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.
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Wong TY, Tsui HY, So MK, Lai JY, Lai ST, Tse CW, Ng TK. Plesiomonas shigelloides infection in Hong Kong: retrospective study of 167 laboratory-confirmed cases. Hong Kong Med J 2000; 6:375-80. [PMID: 11177159] [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: 02/18/2023] Open
Abstract
OBJECTIVE To study the epidemiological, clinical, and microbiological features of Plesiomonas shigelloides infection in Hong Kong. DESIGN Retrospective study. SETTING Infectious Disease Unit of a district hospital, Hong Kong. PATIENTS Patients with laboratory-confirmed cases of Plesiomonas shigelloides infection between 1 January 1995 and 31 December 1998. MAIN OUTCOME MEASURES Epidemiological and clinical data, antibiotic sensitivity, and clinical outcome. RESULTS There was an increasing trend in the number of isolates of Plesiomonas shigelloides obtained and the prevalence of the bacterium. A total of 197 isolates were obtained from 188 patients, and most isolates (172; 87.3%) were obtained during the summer. Clinical and epidemiological data were available for 167 patients (85 males, 82 females). Patient age ranged from 1 month to 95 years; the mean and median ages of the patients older than 15 years were 51.0 and 40.5 years, respectively (n=132). Only 35 (21.0%) of the 167 patients had a history of travel outside Hong Kong, whereas 21 (12.6%) had a history of consuming seafood or uncooked food; 39 (23.4%) had underlying medical conditions. Most patients (165; 98.8%) had symptoms of Plesiomonas shigelloides infection. Nine (5.4%) patients had had chronic diarrhoea for more than 2 weeks; watery and bloody diarrhoea was discharged by 122 (73.1%) and 42 (25.1%) of the patients, respectively. All 197 Plesiomonas shigelloides isolates were sensitive to ofloxacin, or levofloxacin and ceftriaxone. Resistance or partial resistance was recorded for ampicillin (72%), tetracycline (67%), co-trimoxazole (12%), and chloramphenicol (5%). The majority of patients (142/167; 85.0%) had self-limiting cases of infection, but 25 patients were given antibiotics for more severe symptoms at the time of presentation; there were two deaths. CONCLUSIONS The occurrence of Plesiomonas shigelloides infection in Hong Kong is increasing, although most cases of are self-limiting.
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Affiliation(s)
- T Y Wong
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong
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Shih CC, Lin SJ, Chen YL, Su YY, Lai ST, Wu GJ, Kwok CF, Chung KH. The cytotoxicity of corrosion products of nitinol stent wire on cultured smooth muscle cells. J Biomed Mater Res 2000; 52:395-403. [PMID: 10951381 DOI: 10.1002/1097-4636(200011)52:2<395::aid-jbm21>3.0.co;2-b] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although nitinol is one of most popular materials of intravascular stents, there are still few confirmative biocompatibility data available, especially in vascular smooth muscle cells. In this report, the nitinol wires were corroded in Dulbecco's modified Eagle's medium with constant electrochemical breakdown voltage and the supernatant and precipitates of corrosion products were prepared as culture media. The dose and time effects of different concentrations of corrosion products on the growth and morphology of smooth muscle cells were evaluated with [(3)H]-thymidine uptake ratio and cell cycle sorter. Both the supernatant and precipitate of the corrosive products of nitinol wire were toxic to the primary cultured rat aortic smooth muscle cells. The growth inhibition was correlated well with the increased concentrations of the corrosion products. Although small stimulation was found with released nickel concentration of 0.95 +/- 0.23 ppm, the growth inhibition became significant when the nickel concentration was above 9 ppm. The corrosion products also altered cell morphology, induced cell necrosis, and decreased cell numbers. The cell replication was inhibited at the G0-G1 to S transition phase. This was the first study to demonstrate the cytotoxicity of corrosion products of current nitinol stent wire on smooth muscle cells, which might affect the postimplantation neointimal hyperplasia and the patency rate of cardiovascular stents.
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Affiliation(s)
- C C Shih
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei 112, Taiwan
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Kan CB, Huang CH, Lai ST. Surgical management of traumatic thoracic aortic rupture from falling. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:779-83. [PMID: 11076437] [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: 02/18/2023]
Abstract
A 40-year-male was admitted to our hospital after falling from a four-story height. Thoracic aortic rupture was suspected based on chest roentgenography and helical computed tomography. The patient was in the operating room within 6 hours after admission to the hospital. A median sternotomy with a left thoracotomy in the fifth intercostal space was done after left femoral arterial cannulation. Profound hypothermic circulation arrest with retrograde cerebral perfusion was applied. The site of aortic rupture was the descending aorta, just distal to the origin of the left subclavian artery. There were two areas of rupture within 2 cm of each other. The ruptured aorta was grafted with a 20-mm woven double-velour Hemashield graft. The total circulatory arrest time was 80 minutes and the cardiopulmonary bypass time was 290 minutes. The postoperative course was complicated by prolonged mechanical ventilation support due to pulmonary contusion. The patient was discharged 30 days after surgery without neurologic deficit.
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Affiliation(s)
- C B Kan
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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Huang CH, Hong CY, Tsai SK, Lai ST, Weng ZC, Chih CL, Hsieh YH. Intravenous pretreatment with magnolol protects myocardium against stunning. Planta Med 2000; 66:516-520. [PMID: 10985076 DOI: 10.1055/s-2000-8653] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Magnolol, an antioxidant, has been reported to possess various protective effects on the cardiovascular system. However, its effect on myocardial stunning has not been elucidated. The purpose of this study was to investigate the antistunning effect of magnolol by evaluating the recovery of regional myocardial function after 10-minute coronary artery occlusion in anesthetized, open-chest rabbits. There was no significant hemodynamic change after intravenous infusion of magnolol. Systolic wall thickening fraction (WThF) measured with an epicardial Doppler sensor in animals pretreated with normal saline and vehicle solution remained significantly depressed (60 +/- 7% and 77 +/- 4% of baseline WThF, respectively) 3 hours after coronary artery reperfusion (CAR). Pretreatment with magnolol (10(-7) and 10(-6) g/kg, intravenous infusion) significantly enhanced the recovery of systolic wall thickening fraction (98 +/- 1 and 99 +/- 1% of baseline WThF, respectively) 60 minutes after CAR. This study demonstrated that intravenous pretreatment with magnolol protected myocardium against stunning.
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Affiliation(s)
- C H Huang
- Department of Surgery, Veterans General Hospital, Taipei, Taiwan, R.O.C
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Huang CH, Hong CY, Tsai SK, Lai ST. Effect of magnolol on coronary vascular resistance in rabbits: measurement with pulsed Doppler velocimetry. J Formos Med Assoc 2000; 99:554-8. [PMID: 10925566] [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: 02/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Magnolol is an active component purified from Magnolia officinalis that has been reported to protect the myocardium against infarction and reperfusion injury. The purpose of this study was to investigate the effect of magnolol on the coronary circulation and to determine whether a change in coronary vascular resistance could be the mechanism underlying its myocardial protective effect. METHODS Male New Zealand white rabbits were anesthetized. A 3-mm suction-type pulsed Doppler velocimetry probe was applied to the proximal part of the left anterior descending coronary artery after median sternotomy. The 39 rabbits received intravenous injection of either vehicle (n = 5), magnolol (10(-6) g/kg, n = 6; 10(-5) g/kg, n = 5; 10(-4) g/kg, n = 5), or nitroglycerin (10(-5) g/kg, n = 6; 10(-4) g/kg, n = 6; 10(-3) g/kg, n = 6). The effects of magnolol and nitroglycerin on coronary vascular resistance were compared. RESULTS Magnolol did not change blood pressure or coronary blood flow velocity. However, at a dose of 10(-4) g/kg, it decreased coronary vascular resistance significantly more than vehicle (88 +/- 1% vs 95 +/- 1% of baseline coronary vascular resistance, p < 0.001). Nitroglycerin increased coronary blood flow velocity and decreased coronary vascular resistance in a dose-dependent manner (p < 0.01). CONCLUSIONS Magnolol reduced coronary vascular resistance in anesthetized, open-chest rabbits only at a high concentration. Its effect was modest compared with that of nitroglycerin. Since magnolol protects the myocardium at relatively low doses, coronary vasodilatation is unlikely to be the underlying mechanism responsible for its myocardial protective effects.
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Affiliation(s)
- C H Huang
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Yung MC, Wang JS, Lai ST. Minimally invasive mitral valve surgery via submammary hidden incision. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:322-8. [PMID: 10820912] [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: 02/16/2023]
Abstract
BACKGROUND With the recent advancement in minimally invasive cardiac surgery based on the needs of decreasing costs, hospital stay, recovery time and improving cosmetic appearance, minimally invasive mitral valve surgery (MIMS) is being actively pursued. The objective of this study was to compare our submammary hidden incision method to two other more proven methods of MIMS with respect to length of operation, clinical outcome and cosmetic satisfaction. METHODS From July, 1996 to June, 1998, a total of 14 patients underwent MIMS in our hospital. Three different approaches were used: the limited right-side thoracotomy approach, the parasternal incision approach and our submammary hidden incision approach, of which, this is the first report. All relevant clinical results are reported, including general characteristics of the operations, morbidity and mortality, length of hospitalization, pain relief and patient satisfaction. RESULTS Five patients underwent MIMS via limited thoracotomy, four via parasternotomy and five with our submammary hidden incision method. There were six mitral valves repaired and eight replaced. Conversion to traditional sternotomy was not necessary in any of the three groups. The results from the three different approaches did not differ significantly across the different parameters measured. Nonetheless, the submammary hidden incision approach showed promise in the areas of length of stay for both intensive care patients (36.3 +/- 5.0 hours) and total hospitalization (10.7 +/- 0.6 days), pain relief and patient satisfaction. CONCLUSIONS The submammary hidden incision method does not result in any significant disadvantage in clinical outcome. The method resulted in more satisfied patients due to less pain, shorter hospital stay, and most importantly, cosmetic appearance of the resulting surgical scar. We will make the submammary hidden incision approach the MIMS approach of choice at our institution and continue to monitor the long-term results.
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Affiliation(s)
- M C Yung
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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Wang JS, Hsu CP, Yu TJ, Hwang JS, Shiu CT, Lai ST. Surgical repair of postinfarction ventricular septal defect. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:213-9. [PMID: 10746417] [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: 02/16/2023]
Abstract
BACKGROUND Rupture of the interventricular septum complicates 1% to 2% of all acute myocardial infarction patients and its natural course is ominous. The purpose of this study is to present our experience with surgical ventricular septal defect (VSD) repair and examine the possible risk factors and explanations for surgical mortality. METHODS Fourteen patients underwent repair of postinfarction VSD from 1996 to 1998 at the Taipei Veterans General Hospital. Thirteen patients were in New York Heart Association (NYHA) Functional Class IV and one was in Functional Class III. Eleven patients were in cardiogenic shock with intra-aortic balloon pumps (IABPs) prior to surgery. The operative techniques for VSD repair range from extensive infarctectomy with reconstruction of the septum and the right and left ventricular free walls using single or double patches, to minimal or no infarctectomy with closure of the VSD by excluding the infarcted muscle from the left ventricular cavity and leaving the right ventricle intact. RESULTS Overall surgical mortality occurred in four patients. All deaths occurred in patients with cardiogenic shock, two with anterior VSD and two with posterior VSD. Three late survivors had limited exercise tolerance with NYHA Functional Class II to III. Left ventricular function was moderately impaired in most patients with a mean nuclear scan ejection fraction of 0.32. However, all patients were elderly and adapted to their residual symptoms without significant life-style changes. CONCLUSIONS The surgical mortality for treating patients with postinfarction VSD has decreased with improvements in surgical technique. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.
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Affiliation(s)
- J S Wang
- Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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Lu CH, Yu TJ, Lai ST. Transmyocardial holmium-YAG laser channels in an animal model: a preliminary morphologic and histologic study. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:614-8. [PMID: 10502852] [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: 02/14/2023]
Abstract
BACKGROUND Laser transmyocardial revascularization (TMR) appears to improve symptoms in patients with refractory angina. However, it remains a controversial treatment modality for relieving ischemia. We conducted our study in dogs and evaluated the changes in morphology and histology of the myocardium after laser TMR. METHODS The hearts of 10 mongrel dogs (20-30 kg each) were treated with a holmiumyttrium aluminum garnet (YAG) laser in vivo. After opening the pericardium, the 1-mm fiberoptic device was used to create an average of 30 transmyocardial channels per heart at approximate intervals of 0.5 to 1 cm through normal left ventricular myocardium. All dogs tested survived the procedure. The dogs were sacrificed on the first and 60th postoperative days. RESULTS In the day-1 postoperative group (n = 4), the transmyocardial channels were obliterated at both epicardial and endocardial ends. The channels were totally occupied by necrotic myocytes and did not appear patent under the microscope. In the day-60 postoperative group (n = 6), the epicardial and endocardial scars were identified at each original laser application site. On cross-section, the channels were invaded by fibrous tissue bands extending from the endocardium to the epicardium, without a prominent central passage. Trichrome stained specimens showed that the channels were replaced by collagen fibers, fat tissue and numerous well-developed capillaries or sinusoids in which plenty of red blood cells were found. CONCLUSIONS We concluded that laser TMR offers no help for acute myocardial ischemia, but results in neovascularization inside the channels by the 60th postoperative day. Angiogenesis induced by laser TMR could possibly play a role in relieving chronic ischemia.
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Affiliation(s)
- C H Lu
- Division of Cardiovascular Surgery, Veterans General Hospital-Taipei, Taiwan, ROC
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Huang CH, Hong CY, Lai ST, Tsai SK. Effects of dipyridamole, nitroglycerin, and nitroprusside on coronary vascular resistance in rabbits: measurement with pulsed Doppler velocimetry. J Formos Med Assoc 1999; 98:480-5. [PMID: 10462996] [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: 02/13/2023] Open
Abstract
Dipyridamole, nitroglycerin, and nitroprusside are all effective vasodilators. However, few studies have compared their in vivo coronary vasodilatation effects. The purpose of this study was to compare the effects of these agents on coronary blood flow velocity and vascular resistance in anesthetized, open-chest rabbits. Male New Zealand white rabbits were anesthetized, and a 3-mm, suction-type, pulsed Doppler velocimeter probe was applied to the proximal part of the left anterior descending coronary artery after median sternotomy. The rabbits received infusion of various doses of dipyridamole (0.1 mg/kg, n = 5; 1 mg/kg, n = 5; 10 mg/kg, n = 9), nitroglycerin (0.01 mg/kg, n = 8; 0.1 mg/kg, n = 5; 1 mg/kg, n = 5; 10 mg/kg, n = 7), or nitroprusside (0.01 mg/kg, n = 5; 0.1 mg/kg, n = 5; 1 mg/kg, n = 5). The percent changes in coronary blood flow velocity and coronary vascular resistance were measured. All three vasodilators increased coronary blood flow velocity significantly and decreased coronary vascular resistance dose-dependently. The dose-response curves of dipyridamole, nitroglycerin, and nitroprusside were significantly different from one another (p < 0.01). Dipyridamole at a dose of 10 mg/kg produced the greatest increase in coronary blood flow velocity and the greatest reduction in coronary vascular resistance in anesthetized, open-chest rabbits.
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Affiliation(s)
- C H Huang
- Department of Surgery, National Yang-Ming University School of Medicine, Veterans General Hospital, Taipei
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Or KKH, Sung JJY, Luk YW, Lai ST, Tiu SC. Physicians' practice patterns of treating Helicobacter pylori-associated peptic ulceration in public hospitals in Hong Kong: questionnaire survey. Coordinator Group of the Quality Assurance Subcommittee (Medicine), Hospital Authority, Hong Kong. Hong Kong Med J 1999; 5:187-190. [PMID: 11821590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
To survey the practice patterns of physicians in public hospitals in Hong Kong when treating Helicobacter pylori-associated peptic ulceration, the records of all patients from 22 medical units who had new peptic ulcers that had been diagnosed endoscopically during August 1996 were examined systematically. Patient data were entered on a one-page questionnaire. Five hundred and twelve patients with peptic ulceration were studied; 173 (34%) of whom had presented with gastro-intestinal bleeding. The Helicobacter pylori status had been determined in 449 (88%) patients, 280 (62%) of whom had subsequently tested positive for Helicobacter pylori. The biopsy urease test or histological examination had been performed for more than 95% of patients. Of 260 patients who had tested positive for Helicobacter pylori, 244 (94%) had received eradication therapy to eliminate this organism; a total of 291 patients, however, were receiving eradication therapy. The most commonly used regimen was proton pump inhibitor triple therapy (151 [52%] of 291 patients). Confirmation of the eradication of Helicobacter pylori had been planned for 152 (52%) of the 291 patients, whereas ulcer-healing drugs--mainly H2-receptor antagonists--had been prescribed for 87 (30%) patients after eradication. Curing Helicobacter pylori infection is therefore widely accepted in the management of peptic ulcer disease among physicians working in Hong Kong public hospitals.
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Affiliation(s)
- K KH Or
- Department of Medicine and Geriatrics, Shatin Hospital, A Kung Kok Street, Shatin, Hong Kong
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Ng FH, Chau TN, Cheung TC, Kng C, Wong SY, Ng WF, Lee KC, Chan E, Lai ST, Yuen WC, Chang CM. Cytomegalovirus colitis in individuals without apparent cause of immunodeficiency. Dig Dis Sci 1999; 44:945-52. [PMID: 10235602 DOI: 10.1023/a:1026604529393] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 01/29/2023]
Abstract
Cytomegalovirus infection is usually reported in immunocompromised patients. In this study, apparently immunocompetent patients with cytomegaloviral colitis were reviewed. Records with a diagnosis of cytomegaloviral colitis from January 1989 to June 1996 were retrieved for analysis. Ten patients were included (median age 70 yr). The major presenting symptoms were diarrhea and hematochezia. Ulceration was the main macroscopic finding. Rectal bleeding was mostly self-limiting. Three patients developed local complications (rectovaginal fistula in two; rectal stricture in one). In the two patients with rectovaginal fistula, lymphocytes subsets and proliferative response were entirely normal. In the other patient, low B lymphocyte count and low response to mitogen were demonstrated. However, the immunoglobulins were not suppressed and rectal biopsies revealed noncaseating granulomas, suggesting activated cell-mediated immunity. In conclusion, a high index of suspicion is crucial for early diagnosis of cytomegaloviral colitis in patients with bloody diarrhea, even though obvious evidence of immunodeficiency is lacking.
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Affiliation(s)
- F H Ng
- Department of Medicine, Ruttonjee Hospital, Hong Kong, China
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Abstract
Heart rate variability (HRV) decreased soon after coronary artery bypass grafting and returned to the preoperative level within 2 months; however, HRV did not exceed the preoperative level, even 6 months after coronary artery bypass grafting. Although myocardial ischemia can be improved by coronary artery bypass grafting, HRV did not benefit from coronary artery bypass grafting within 6 months.
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Affiliation(s)
- C D Kuo
- Respiratory Therapy Department, Veterans General Hospital-Taipei, Taiwan, Republic of China.
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Sheu JJ, Wang JS, Lai ST, Yu TJ, Weng ZC, Shih CC. Minimally-invasive, direct coronary artery bypass grafting. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:507-12. [PMID: 9798298] [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: 04/11/2023]
Abstract
BACKGROUND Minimally-invasive, direct vision coronary artery bypass grafting (MIDCAB) is a new surgical technique performed via limited thoracotomy in a beating heart without cardiopulmonary bypass. METHODS From June 1996 to December 1996, MIDCAB was performed in 12 patients (all male, average age, 65.9 years). In 11 patients with left anterior descending coronary artery lesions, thoracotomy was performed via the left, fourth intercostal space and the pericardium was incised to identify the target site. About 8 cm of the left internal mammary artery was harvested. Bilateral anterolateral thoractomy was performed in one patient with left anterior descending and right coronary artery lesions. Anastomosis was performed under direct vision in the beating heart without cardiopulmonary bypass. RESULTS MIDCAB was performed successfully without morbidity. The patients' average stay in the intensive care unit was 1.8 days. No patient had any early cardiac event requiring additional surgery or percutaneous transluminal coronary angioplasty. Postoperatively, all patients were asymptomatic and their recovery was uneventful. CONCLUSIONS Our initial experience indicates that MIDCAB offers good results and is a treatment option for selected patients with left anterior descending and/or right coronary artery lesions.
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Affiliation(s)
- J J Sheu
- Department of Surgery, Veterans General Hospital-Taipei, Taiwan, ROC
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Lau KK, Lai ST, Lai JY, Yan WW, So TMK, Wong TY. Acute encephalitis complicating rubella. Hong Kong Med J 1998; 4:325-328. [PMID: 11830692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
During an epidemic of rubella in Hong Kong between October 1996 and June 1997, four male patients presented with rubella complicated by encephalitis, the symptoms of which started 1 to 5 days after the appearance of the rash characteristic of rubella. Two patients recovered completely within 1 week and one complained of a slight impairment of short-term memory. Severe cerebral oedema, and herniation across the brainstem and cerebellum developed in the fourth patient, who died 15 days later. The presence of serum immunoglobulin M antibody against rubella virus was demonstrated in all four patients; one patient also had immunoglobulin M antibody against rubella virus in his cerebrospinal fluid. No virus could be isolated during post-mortem examination of the fourth patient.
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Affiliation(s)
- K K Lau
- Department of Medicine, Princess Margaret Hospital, Kwai Chung, Kowloon, Hong Kong
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Abstract
Perforation occurring at a remote site of the bowel after diagnostic colonoscopy is rare. A 61-year-old man presenting with bloody diarrhoea underwent colonoscopy. A dynamic ileus developed in less than 1 day, and mid-ileal perforation occurred 7 days after the procedure. It is suggested that high air pressure during colonoscopy further compromised the reduced blood flow in the mid-ileum, which had underlying chronic ischaemia, leading to perforation. Our patient constitutes the first reported case of small-bowel perforation after colonoscopy due to pre-existent ileal ischaemia.
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Affiliation(s)
- T N Chau
- Dept. of Medicine, Princess Margaret Hospital, Hong Kong, China
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Chau TN, Lai ST, Lai JY, Yuen H. Haemolysis complicating acute viral hepatitis in patients with normal or deficient glucose-6-phosphate dehydrogenase activity. Scand J Infect Dis 1998; 29:551-3. [PMID: 9571732 DOI: 10.3109/00365549709035892] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Haemolytic anaemia as a complication of acute hepatitis has been reported in up to 23% of patients. However, the incidence may rise up to 70-87% in patients who have glucose-6-phosphate dehydrogenase (G6PD) deficiency. Massive intravascular haemolysis with renal failure, hepatic encephalopathy and even death have been reported. In our retrospective study of patients with acute viral hepatitis, the overall incidence of acute haemolysis was 4% (17/434). Only 53% (9/17) of them had G6PD deficiency. Patients with acute haemolysis had a significantly higher peak bilirubin level and required more prolonged hospitalization. Since hepatitis A virus vaccination, unlike hepatitis B virus vaccination, is not yet recommended for routine immunization, we suggest subjects who are G6PD-deficient should be vaccinated against hepatitis A. In endemic areas of hepatitis A virus infection, universal immunization remains the definitive answer.
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Affiliation(s)
- T N Chau
- Department of Medicine, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong, PRC
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Li CY, Lai ST, Yu TJ, Wang JS. Endoscopic vein harvest for coronary artery bypass surgery. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:276-80. [PMID: 9650431] [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: 02/08/2023]
Abstract
BACKGROUND Despite increased awareness of risk factors, wound complications continue to be a problem following coronary artery bypass graft (CABG) surgery. A minimally invasive alternative was therefore developed to reduce the risk of complications while providing the same benefits as the standard open vein harvest procedure. METHODS Video-assisted endoscopic technique for vein harvest was introduced in our medical center in October 1996. The procedure was evaluated and compared with the standard open vein harvest procedure. With the endoscopic technique, small incisions were made, each about 2-3 cm at the selected access sites (groin and above and below the knee). An endopath subcutaneous dissector was subsequently inserted along the anterior surface of the saphenous vein with the assistance of an endoscope and video monitor. The venous side branches were detected and positioned using a vessel dissector. A ligaclip was applied and the branches were divided using endopath-scissors. In some cases, the venous branches were divided directly using the endopath-scissors. Therefore, the distal and proximal ends of the saphenous vein were isolated, ligated and divided. The harvested veins were used for CABG. Each patient was evaluated for length of surgery, hospital stay and morbidity. RESULTS From October 1996 through May 1997, we performed 50 procedures using video-assisted endoscopic vein harvest. The results were compared with those from 106 patients who underwent standard open vein harvest during the same period. The rate of complications was 2% in the endoscopic group compared with 13.2% in the open group (p < 0.05). The average hospital stay was 7.2 days in the endoscopic group and 11.5 days in the open group (p < 0.05). Twelve weeks after the operation, all of the incisions healed with good cosmetic results in the endoscopic group. However, long visible scars were found in the patients in the open group. CONCLUSIONS Endoscopic saphenous vein harvest provides a minimally invasive alternative to open vein harvest. It provides good cosmetic results without a hypertrophic scar and enables the patient to regain early ambulation.
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Affiliation(s)
- C Y Li
- Department of Surgery, National Yang-Ming University, Taipei, Taiwan, ROC
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Shih CC, Lai ST, Chang Y. Computed tomography in the determination of surgical emergency for symptomatic abdominal aortic aneurysm. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:210-5. [PMID: 9614779] [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: 02/07/2023]
Abstract
BACKGROUND What is the best surgical timing for symptomatic AAA? Surely, the answer depends on accurate and prompt diagnosis of 'rupture or not'. Abdominal CT is one of the reliable and familiar diagnostic tools. We will present our own CT classification method for symptomatic AAA which is used as the guideline for 'emergency or not'. METHODS From January 1989 to January 1995, 52 patients with symptomatic AAA received diagnostic CT scan for quick disease differentiation and determination of surgical emergency. The findings were classified into four categories. Category I included 26 patients with intact aorta; Category II included four patients with contained retroperitoneal abdominal aortic leakage; Category III included 14 patients with contained massive retroperitoneal hematoma; and Category IV included eight patients with retroperitoneal or intraperitoneal active bleeding. RESULTS Compared with the standard diagnosis of rupture via laparotomy, CT is an excellent tool, showing 88% sensitivity and 88% specificity. This is better than sonography, which has a high false-positive rate of 33% and low specificity of 62%. Hospital mortality was distinctive with 4.3% in Category I, none in Category II, 25% in Category III and 87.5% in Category IV. CONCLUSIONS In our experience, CT scan is a better diagnostic tool than sonography for symptomatic AAA. Even the delay imposed by obtaining a preoperative CT scan in patients with possible ruptured aneurysm does not adversely affect the patient's outcome. The information obtained significantly aids not only preoperative but also intraoperative management.
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Affiliation(s)
- C C Shih
- Department of Surgery, National Yang-Ming University, Taipei, Taiwan, ROC
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