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Biomedical subjects

C S Chang

Publications and source records attributed to C S Chang.

At least 127 records · Page 7Linked to original sources
PubMed1995

Effect of oral erythromycin on patients with diabetic gastroparesis.

BACKGROUND: Abnormal gastrointestinal motility is a well recognized complication of diabetes mellitus, and disordered gastric emptying may hamper glycemic control. The objects of this study were to investigate the effect of oral erythromycin on gastric emptying and to evaluate the effect of corrected gastric emptying on glycemic control in patients with diabetic gastroparesis. METHODS: Twenty patients of Type II (non-insulin-dependent) diabetes mellitus with typical symptoms of gastroparesis and delayed solid phase gastric emptying were studied. There were 18 males and 2 females, aged 49 to 72 years. Erythromycin (erythromycin estolate) was given orally at a dose of 250 mg, 3 times daily, 30 minutes before each meal. Radionuclide-labelled solid phase gastric emptying and fasting blood sugar (FBS) were studied after one day of erythromycin therapy, and again after 2 weeks of the therapy. The half time of gastric emptying (GETt1/2) represented the time needed for 50 percent of the initial radioactivity to leave the stomach, and was used to express the gastric emptying status. RESULTS: The GETt1/2 decreased from 198.0 +/- 58.9 minutes at baseline to 139.1 +/- 67.6 minutes following one day of erythromycin therapy (p < 0.01), and to 137.1 +/- 71.2 minutes after two weeks of treatment (vs. baseline p < 0.01). The FBS decreased from 159.0 +/- 40.2 mg/dl at baseline to 149.0 +/- 38.5 mg/dl following one day of therapy (p = 0.12, NS), and to 139.2 +/- 39.8 mg/dl after two weeks of treatment (vs. baseline p < 0.02). CONCLUSIONS: It was concluded that erythromycin is an effective prokinetic agent for diabetic gastroparesis, and that corrected gastric emptying may improve glycemic control.

Administration, Oral↗
PubMed1995

Effect of coffee on solid-phase gastric emptying in patients with non-ulcer dyspepsia.

The purpose of this study was to evaluate the effect of coffee on solid phase gastric emptying in patients with non-ulcer dyspepsia (NUD). Twenty-one NUD patients with an endoscopic negative finding or superficial gastritis were included in this study. Radionuclide labeled solid meals were used to assess the gastric emptying times (GET) of the stomach. A control meal was composed of radionuclide solid meal and 500ml 5% of glucose water. The study meal was made from addition of 4g of instant coffee into the control meal. Of the 21 total cases, 1 demonstrated prolonged GET, 6 had shortened GET, and the other 14 showed no significant difference in GET. There were no statistically significant differences (p > 0.05) between the control and the study meal after coffee intake. Our data suggests that there may be some ingredient in coffee that promotes gastric motility, but this effect is counteracted by intestinal feedback, and the net effect is not significant.

Adult↗
PubMed1995

Effects of intravenous erythromycin on antroduodenal motility in humans: non-invasive observations with real-time ultrasound.

Erythromycin has been shown to act on motilin receptors on gastrointestinal smooth muscle in vitro and to accelerate gastric emptying in normal subjects as well as in patients with diabetic mellitus. To evaluate the motor pattern that accounts for this accelerated emptying, the effects of 12.5 mg/min erythromycin vs. placebo on postprandial motility of the antroduodenum was examined with real-time ultrasound in 15 normal subjects. During 10 minutes of observation, erythromycin significantly increased forward transpyloric flow episode (1.04 +/- 0.19 vs. 0.37 +/- 0.41; p < 0.05), forward transpyloric flow duration (5.79 < 4.49 vs. 3.19 < 1.72 seconds; p < 0.05) and improved antro-pyloro-duodenal coordination (0.43 +/- 0.23 vs. 0.21 +/- 0.17; p < 0.05). However, no significant differences were found for gastric peristaltic cycle (22.62 +/- 3.06 vs. 23.40 +/- 2.14 seconds; p > 0.05), retrograde transpyloric flow episode (0.13 +/- 0.16 vs. 0.18 +/- 0.29; p > 0.05), and retrograde transpyloric flow duration (1.24 +/- 0.30 vs. 1.38 +/- 0.58 seconds; p > 0.05). We conclude that erythromycin increases episode and duration of forward transpyloric flow, and improves antro-pyloro-duodenal coordination, which may play a role in accelerating gastric emptying.

Adult↗
PubMed1995

Chronic neutrophilic leukemia--a case report.

We describe a 77-year-old patient with chronic neutrophilic leukemia (CNL). Diagnosis of CNL was made by marked increase of mature neutrophils without increased immature granulocytes, splenomegaly and elevated serum vitamin B12 level and by ruling out any infection or occult malignancy. The chromosome analysis showed one abnormal karyotype out of 14 metaphases. The neutrophilic function with nitroblue tetrazolium test revealed impaired phagocytic function in this patient. The neutrophil count became normal gradually after hydroxyurea treatment. However, it still maintained a high percentage of mature neutrophils. Background literature and the prognosis of CNL are discussed.

Aged↗
PubMed1995

Use of real-time ultrasound for detection of gastric motility.

BACKGROUND: To evaluate the clinical applications and reproducibility of real-time ultrasound in detecting gastric motility, result of study of gastric motility in normal volunteers is reported. METHODS: From January to May 1994, 21 normal volunteers, with a mean age of 31.7 years, 10 females and 11 males, entered this study. They fasted overnight. After consuming a liquid test meal (500 cc, 80.627 Kcal, containing sieved bran particles), they received real-time ultrasound examinations immediately to detect gastric peristalsis and transpyloric fluid flow. To evaluate the reproducibility of real-time ultrasound methods in gastric motility, four of the volunteers repeated this examination at an interval of one week. RESULTS: The results showed that the mean gastric peristaltic cycle in humans is 24.29 seconds (s); mean forward transpyloric flow duration is 4.00 s; mean retrograde transpyloric flow duration is 1.45 s and mean time needed for initiating gastric peristaltic contractions after the test meal is 138.06 s. Age, body weight and body surface have a positive correlation to the mean gastric peristaltic cycle. Females, with a less body weight and body surface than males, exhibit a faster gastric peristaltic cycle. Real-time ultrasound is a reproducible method for studying gastric motility. CONCLUSIONS: Real-time ultrasound is an inexpensive, reproducible and practical method for studying gastric motility. In addition, age, body weight and body surface have a positive correlation to gastric peristaltic cycle, with females, whose body weight and body surface are less than males, showing a shorter gastric peristaltic cycle.

Adult↗
PubMed1994

Sclerotherapy for esophageal variceal bleeding in advanced hepatocellular carcinoma: an 8-year experience in Taiwan.

Between August 1983 and December 1991 at the Taichung Veterans General Hospital, Taiwan, 65 advanced hepatocellular carcinoma (HCC) patients with esophageal variceal bleeding received endoscopic injection sclerotherapy (EIS) and 60 such patients received conservative medical treatment without EIS. The rate of successful control of acute bleeding was 72.5% (27/40 patients) in the EIS group and 56.7% (34/60 patients) in the non-EIS group. The rebleeding rate was lower in the EIS group than in the non-EIS group (26.9% vs 73.5%). Thirty-one of the EIS and 44 of the non-EIS treatment patients, mainly Child's B and C patients, died within 2 months after the first bleeding. In the short term, EIS decreased the mortality due to esophageal variceal bleeding, but the survivors still had to face hepatic failure and tumor growth. Thus, benefits of EIS were noted on short- but not on long-term survival. The mean survival times were 2.38 months for the EIS group and 1.79 months for the non-EIS group. Since EIS had no beneficial effects on long-term survival it is doubtful whether sclerotherapy applied to esophageal variceal bleeding in patients with advanced HCC would be worthwhile, as the endoscopic procedure would only add to their suffering.

Acute Disease↗
PubMed1994

Sclerotherapy on liver cirrhosis with esophageal variceal bleeding: eight years of experience.

BACKGROUND: Patients with liver cirrhosis usually die of hepatic failure and variceal bleeding. Successful treatment of the latter can reduce mortality. Sclerotherapy is one method often used. This study compared (a) the successful rate of acute bleeding control; (b) short- and long-term survival rate between those with and without treatment with sclerotherapy to evaluate the clinical benefit of sclerotherapy for liver cirrhosis patients with esophageal variceal bleeding. METHODS: Between August 1983 and December 1991, 183 cirrhotic patients with esophageal variceal bleeding receiving endoscopic injection sclerotherapy (EIS) was compared with 123 patients without sclerotherapy treatment retrospectively. The severity of underlying liver disease was classified using a modified Child's classification. Sclerotherapy was done within 48 hours after active bleeding in the sclerotherapy-treated group, while the medical treatment group received Sengstaken-Blakemore (SB) tube or pitressin infusion only. RESULTS: Successful rate of acute bleeding control was 81.63% (120/147) in the EIS group and 59.35% (73/123) in the medical treatment group. The worse the hepatic function of the patients, the lower the success of acute bleeding control in both groups. Fifty subjects (74.63%) had varices eradicated in 67 sclerotherapy treatment patients with regular follow-up. Patients receiving EIS had a better long-term survival than those without treatment. Benefit of EIS on long-term survival was more significant in Child B patients and less in Child C and Child A patients. Death from variceal bleeding was lower in the EIS group than in the medical treatment group (32% vs 62.6%). Complications of EIS were rare. Eight patients died of aspiration pneumonia, spontaneous bacterial peritonitis or acute renal failure after sclerotherapy, and most were Child B and C patients. Sixteen patients had esophageal stricture. Four needed dilatation treatment. CONCLUSIONS: The sclerotherapy-treated group had a higher control rate of acute bleeding and lower mortality rate from esophageal variceal bleeding compared with the medical-treated group. The procedure prolonged long-term survival in Child B patients but did so less frequently in Child A and Child C patients. The incidence of complications was low. As a whole, EIS is a safe and efficient method for control of esophageal variceal bleeding.

Adult↗
PubMed1994

[Rhinocerebral mucormycosis in a case of malignant lymphoma].

Mucormycosis, an uncommon opportunistic fungal infection, usually occurs in immunocompromised patients. It is rapidly progressive and almost always fatal. Patients with lymphoma are susceptible to pulmonary or disseminated mucormycosis, whereas rhinocerebral mucormycosis in such patients, as far as we know, is rarely reported. We present a patient with malignant lymphoma who exhibited such an acute rhinocerebral infection after chemotherapy which manifested initially as a stuffy nose and intractable headache. Then ptosis, proptosis, chemosis and multiple cranial nerve palsies appeared. Eschar was found in the nasal cavity. Direct KOH smear and tissue biopsy revealed mucormycotic infection. He survived because of early diagnosis and prompt treatment.

Brain Diseases↗
PubMed1994

Hematophagic histiocytosis: a clinicopathologic analysis of 23 cases with special reference to the association with peripheral T-cell lymphoma.

The clinicopathologic features of 23 patients with hematophagic histiocytosis (HH) are described. All of them exhibited increased histiocytes associated with hemophagocytosis in the marrow. The patients usually presented with fever, hepatosplenomegaly, lymphadenopathy, and cytopenia. The underlying illnesses were heterogeneous, including non-Hodgkin's lymphoma in 17, systemic lupus erythematosus in one, diabetes mellitus in one, acute myelomonocytic leukemia in one, myelodysplastic syndrome in one, and unknown cause in two. Among 17 non-Hodgkin's lymphoma, 14 were peripheral T-cell lymphoma, two were B-cell lymphoma, and one was an undefined phenotype. Among 14 patients with peripheral T-cell lymphoma, six of the patients had nasal T-cell lymphoma. Five of these 14 patients initially diagnosed as malignant histiocytosis turned out to be T-lineage lymphoma after immunophenotypic studies. Active infections, most of viral origin, were documented in eight patients, including Epstein-Barr virus in three, cytomegalovirus in three, herpes simplex virus in three, Pseudomonas aeruginosa in one, Bacteroides vulgatus in one, and mycoplasma in one. Some of them had mixed virus and bacteria infection. Sixteen (70%) of our patients died of their acute illness within 10 weeks of the diagnosis of HH. In the past, the clinical and histologic differentiation between hematophagic histiocytosis and true histiocytic neoplasm (histiocytic medullary reticulosis/malignant histiocytosis) has proved difficult, but now these can be distinguished with immunohistologic, immunogenetic, and cytogenetic studies, especially in the cases of peripheral T-cell lymphoma with hemophagocytic syndrome.

Acute Disease↗
PubMed1993

An extended X-ray absorption fine structure investigation of the structure of the active site of lactoperoxidase.

Native lactoperoxidase, compound III, and the reduced forms (at pH 6 and 9) were studied using X-ray absorption spectroscopy (XAS). Native lactoperoxidase has four pyrrole nitrogen ligands at an average distance of 2.04 +/- 0.01 A, a proximal ligand at 1.91 +/- 0.02 A, and a sixth (distal) ligand at 2.16 +/- 0.03 A. Lactoperoxidase native enzyme has a first coordination shell structure that is similar to that of native lignin peroxidase [Sinclair, R., Yamazaki, I., Bumpus, J., Brock, B., Chang, C.-S., Albo, A., & Powers, L. (1992) Biochemistry 31, 4892-4900] and different from that of horseradish peroxidase [Chance, B., Powers, L., Ching, Y., Poulos, T., Schonbaum, G., Yamazaki, I., & Paul, K. (1984) Arch. Biochem. Biophys. 235, 596-611]. Similarly, lactoperoxidase compound III resembles lignin peroxidase compound III. The five-coordinated ferrous form was stable at pH 9, but at pH 6 it was rapidly converted to the six-coordinated form with a distal ligand at 2.18 +/- 0.03 A. No evidence typical of changes in spin state was obtained at the different pH values.

Absorptiometry, Photon↗
PubMed1993

pH dependence of the active site of horseradish peroxidase compound II.

Using X-ray absorption spectroscopy, we investigated the active site of horseradish peroxidase (HRP) compound II at two different pH values. The results indicate that the bond length of the sixth coordinated ligand of the active site was 1.90 +/- 0.02 A at pH 7, decreasing to 1.72 +/- 0.02 A at pH 10. The average iron-to-pyrrole nitrogen and the proximal ligand bond lengths showed no significant changes. The position of higher coordination shells around the iron center changed, implying that some movement or deformation of nearby amino acid residues and/or of the heme occurred. Results of this study suggest that the decrease of the Fe-O bond length of HRP compound II at the higher pH might be attributed to the loss of a hydrogen bond which is present between the oxygen ligand and an amino acid residue in the heme pocket at pH 7.

Absorptiometry, Photon↗
PubMed1993

Blunt chest trauma causing right atrial tear, hemopericardium and cardiac tamponade successfully treated with cardiorrhaphy.

A 26-year-old female was involved in a car accident with impaction of the steering wheel to the anterior chest. She became unconscious immediately. Blood pressure was unmeasurable, central venous pressure was measured at 25 cm H2O. Cross-sectional echocardiography revealed pericardial effusion and a band-like blood clot in the posterior inferior aspect of the heart. At operation, a right atrial tear measuring 1 cm in length was noted and was repaired with cardiorrhaphy. She recovered uneventfully.

Accidents, Traffic↗
PubMed1993

Clinical features and splenic pathologic changes in patients with autoimmune hemolytic anemia and congenital hemolytic anemia.

We characterized the pathologic changes in 50 spleens from patients with autoimmune hemolytic anemia and in 13 spleens from patients with congenital hemolytic anemia. The major pathologic findings in autoimmune hemolytic anemia were mild to pronounced cord congestion and variable white pulp area, erythrophagocytosis in conjunction with an increased polymorphonuclear neutrophil reaction, and increased deposition of hemosiderin and extramedullary hematopoiesis. In contrast, both the severity and the frequency of polymorphonuclear neutrophil reactions, deposition of hemosiderin, and extramedullary hematopoiesis were less in patients with congenital hemolytic anemia, and prominent cord congestion associated with an empty or collapsed sinus was noted in patients with hereditary spherocytosis. The activity of erythrophagocytosis in the sinus was more distinct in patients with congenital hemolytic anemia, especially those with nonspherocytic congenital hemolytic anemia, than in patients with autoimmune hemolytic anemia. These findings are consistent with the existence of different mechanisms of trapping and destruction of erythrocytes in autoimmune hemolytic anemia and congenital hemolytic anemia.

Adolescent↗
PubMed1993

Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies.

We have compared the spread of spinal anaesthesia in parturients with singleton and those with twin pregnancies. Fifty-five unpremedicated patients with uncomplicated pregnancy scheduled for Caesarean section were allocated to two groups: group I = 35 singleton mothers; group II = 20 with twin pregnancy. Both groups received spinal anaesthesia with hyperbaric bupivacaine 10 mg (2 ml of 0.5%). Mean birthweight was 3290 (SD 452) g and 5008 (495) g in groups I and II (combined birthweights), respectively. We found a statistically significant difference in onset and maximal cephalad spread of spinal anaesthesia (group I median T5, range T8-T4; group II T3, range T6-T2). The mechanisms of higher cephalad spread of spinal anaesthesia in parturients may be a decrease in cerebrospinal fluid volume secondary to shunting of blood from the obstructed inferior vena cava to the extradural venous plexus and increased nerve sensitivity to local anaesthetics because of increased concentrations of progesterone. The twin pregnancy group had heavier, larger uteri and greater daily production of progesterone.

Adult↗
PubMed1993

Chronic idiopathic thrombocytopenic purpura. Splenic pathologic features and their clinical correlation.

We studied 83 patients who had chronic idiopathic thrombocytopenic purpura refractory to steroid therapy and who underwent splenectomy. The positive rates of antiplatelet and antinuclear antibodies were 40% (30/75 patients tested) and 41% (25/61 patients tested), respectively. The morphologic characteristics of splenic pathologic findings included prominent secondary follicles and foamy macrophages, present in 23 (28%) and 56 (67%) of patients, respectively. Extramedullary hematopoiesis was noted in 50 (60%) of the patients. Eight patients (10%) presented with periarterial fibrosis, and three of them had systemic lupus erythematosus. The 23 patients (28%) with prominent secondary follicles were younger than the other patients, were preponderantly female, and had a higher rate of antiplatelet antibody production, and all had an initial response with a greater increase in platelets postoperatively. Eight patients (10%) had neither prominent secondary follicles nor foamy macrophages and lower splenic weights; their initial response compared with that of other patients was significantly poorer. The thrombocytopenia in these patients might have a different mechanism.

Adolescent↗
PubMed1992

Structure of bis(4-chlorophenolato)[hydrotris(3,5-dimethyl-1- pyrazolyl)borato]oxomolybdenum(V).

[Mo(C15H22BN6)(C6H4ClO)2O], M(r) = 664.24, triclinic, P1, a = 10.585 (2), b = 12.068 (3), c = 13.728 (3) A, alpha = 88.01, beta = 69.94, gamma = 65.78 degrees, V = 1490.8 A3, Z = 2, Dx = 1.48 g cm-3, Mo K alpha, lambda = 0.71073 A, mu = 6.5 cm-1, F(000) = 678, T = 296 (1) K, R = 0.034, wR = 0.049 for 4634 observed independent reflections with F2 greater than 3 sigma (F2). This is the second structurally characterized mononuclear monooxo transition-metal complex containing the phenolato ligand. The molecule exhibits a distorted octahedral coordination geometry, and the Mo atom is ligated by a terminal O atom, two p-chloro-substituted phenolato groups, and a tridentate facially coordinated hydrotris(3,5-dimethylpyrazolyl)borate ligand (L).

Models, Molecular↗
PubMed1992

Structure of the active site of lignin peroxidase isozyme H2: native enzyme, compound III, and reduced form.

The wood-degrading fungus Phanerochaete chrysosporium secretes a number of extracellular enzymes called lignin peroxidases which are involved in the degradation of both lignin and a number of persistent environmental pollutants. Lignin peroxidase isozyme H2, a glycosylated protein of approximately 40 kDa, contains a single heme. X-ray absorption spectroscopy (XAS) has been used to probe the local environment of the iron in the active site of resting enzyme, reduced enzyme, and compound III. For the native and reduced forms, respectively, the average Fe-pyrrole nitrogen distances are 2.055 and 2.02 A (+/- 0.015 A); the Fe-proximal nitrogen distance is 1.93 and 1.91 A (+/- 0.02 A) while the Fe-distal ligand distance is 2.17 and 2.10 A (+/- 0.03 A). Although the results are not as well-defined, the active-site structure of compound III is largely 2.02 +/- 0.015 A for the average Fe-pyrrole nitrogen distance, 1.90 +/- 0.02 for the Fe-proximal nitrogen, and 1.74 +/- 0.03 A for the Fe-distal ligand distance. The heme iron-pyrrole nitrogen distance is more expanded in ligninase H2 than in other peroxidases. The possible significance of this is discussed in relation to other heme proteins.

Basidiomycota↗