Partially paralyzed: a personal experience.
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Atracurium↗
Biomedical subjects
D C Chung
Publications and source records attributed to D C Chung.
Do fetal pulse oximetry readings at delivery correlate with cord blood oxygenation and acidaemia?
OBJECTIVE: To assess the accuracy of a pulse oximeter in the fetus. DESIGN: A prospective descriptive study, comparing oxygenation and acidaemia of cord blood with oxygen saturation in the arteries of the fetal scalp measured by a pulse oximeter just before delivery. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry. SETTING: The labour ward in a teaching hospital. SUBJECTS: Thirty seven Caucasian fetuses presenting by the vertex in normal uncomplicated labour. MAIN OUTCOME MEASURE: Fetal pulse oximetry reading shortly before birth, umbilical cord oxygenation and pH, and Apgar scores. RESULTS: Data of sufficient quality were obtained from 28 fetuses. There was a highly significant correlation between pulse oximetry reading and umbilical vein oxygen saturation r = 0.59, P = < 0.001). There was also a significant correlation between the pulse oximeter reading and cord blood pH (vein: r = 0.57, P = 0.002, artery: r = 0.63, P = 0.001). Apgar scores were not related to the oximetry results. CONCLUSION: Pulse oximetry readings reflect fetal oxygenation at birth.
Apgar Score↗
Transmission of hepatitis B virus infection by iatrogenic intramuscular injections in an endemic area.
The authors followed 95 people from the general and aboriginal population of Taiwan, aged 5 to 69 years for two years. All of subjects studied were susceptible to hepatitis B virus (HBV) infection. In all, 56 of the 95 persons received iatrogenic intramuscular (IM) injections, and 28 of the 95 became newly infected with HBV during the study period. The relative risk of being infected with HBV was higher in people who received an IM injection (IRR = 5.8, 95% CI 1.9-17.9) than in those who did not. New HBV infections were found to correlate significantly with the frequency of injections (Ptrend less than 0.000) and therefore, we concluded that (A) intramuscular injections played an important role in horizontal transmission of HBV, particularly among Aborigines and that (B) the infection was transmitted via inadequately sterilized syringes used for iatrogenic IM injections in a community in which the hepatitis B virus was prevalent and IM injections were common.
Adolescent↗
Intramuscular-injection-associated gluteal fibrotic contracture and hepatitis B virus infection among school children.
A case control study was carried out to determine the exposure factors of gluteal fibrotic contracture (GFC). Sixty two school children were taken as the case group and were matched for sex, age and village of residence with 62 of their classmates constituting the control group. It was found that all 62 members of the case group had received intramuscular (IM) injections at some time prior to the onset of GFC, while only 57 of the control group had received IM injections. This difference is a statistically significant (p = 0.029). Injection sites on both buttocks were higher in the case group than among the controls. The odds ratio for the prevalence of hepatitis B virus infection (HBV) in the case group as compared to the control group was 3.0 (95% CI 1.1-7.8). A trend correlation was found between the annual frequency of IM injection, GFC and HBV infection. We concluded that IM injections played an important role in GFC and added to the risk of HBV infection, because they had been administered by improperly sterilized reusable syringes in an area where both GFC and HBV infections were prevalent and IM injection was common.
Adolescent↗
Correlation between integrated evoked EMG and respiratory function following atracurium administration in unanaesthetized humans.
In six healthy volunteers, integrated evoked electromyography (IEEMG) measured in response to ulnar nerve stimulation was correlated with respiratory function-tidal volume (VT), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum negative inspiratory pressure (NIP), hand grip (HG) and head-lift during steady-state infusion of subparalytic doses of atracurium. Studies were carried out at train-of-four T4/T1 = 0.2 and T4/T1 = 0.6. When T4/T1 = 0.2, all subjects had difficulty with swallowing and phonation, none could sustain any head-lift and HG was 26 per cent of control. However, VT was normal, FVC was 80 per cent, FEV1 was 82 per cent, and NIP was 50 per cent of control. AT T4/T1 = 0.6, all assessments of peripheral strength were normal, and all respiratory measurements were not significantly different from control, except for NIP which was 73 per cent of control (P less than 0.05). We conclude that an IEEMG of 0.6, recorded from the hypothenar muscles, in unanaesthetized subjects is consistent with near normal respiratory function.
Adult↗
Failed intubation: a different perspective.
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Cricoid Cartilage↗
Heymann antigen GP330 demonstrates affinity for fibronectin, laminin, and type I collagen and mediates rat proximal tubule epithelial cell adherence to such matrices in vitro.
We have utilized monoclonal antibodies directed against glycoproteins on the surface of proximal tubule epithelial cells (PTEC) to study their interaction with matrix components. PTEC exposed to monoclonal antibodies directed against a 330-kDa cell surface glycoprotein exhibited a significant epitope-specific inhibition of attachment and proliferation on type I collagen-, fibronectin-, laminin-, and gelatin-coated tissue culture surfaces. This effect was not due to antibody toxicity since such cells did not exhibit metabolic dysfunction in suspension cultures and the inhibition could be reversed upon removal of the antibody from the cell surface. Furthermore, detergent-solubilized gp330 demonstrated specific affinity for fibronectin, laminin, and type I collagen which was not inhibited by Arg-Gly-Asp-containing peptides. A monoclonal antibody directed against the receptor epitope was capable of promoting PTEC adherence and growth when such an antibody was immobilized on cell culture dishes. Although gp330 acted as a receptor for matrix proteins in primary cultures of freshly isolated PTEC, this effect was not demonstrable in established cultures. These results suggest that freshly isolated PTEC depend on gp330 for their attachment to matrix molecules while in vitro-adapted PTEC rely on other receptors activated by culture conditions. The affinity of gp330 for matrix molecules may be of pathogenic relevance in the persistence of gp330-containing immune complexes formed in the glomerular capillary wall in experimental membranous nephropathy (Heymann nephritis).
Animals↗
Seroepidemiology of hepatitis B virus, hepatitis D virus, and human immunodeficiency virus infections among parenteral drug abusers in southern Taiwan.
A total of 390 parenteral drug abusers (PDAs) at the Kaohsiung Municipal Narcotics Abstention Institute were examined for markers of hepatitis B virus (HBV), hepatitis D virus (HDV), and human immunodeficiency virus (HIV). All sera were tested for hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs), and core antibody (anti-HBc) by radioimmunoassay (RIA) and for antibody to HIV (anti-HIV) by enzyme-linked immunosorbent assay (ELISA). Hepatitis B e antigen (HBeAg) and antibody to HDV (anti-HDV) were also tested for HBsAg-positive serum samples. Although the HBsAg-positive rate (22.1%) among PDAs was similar to that of the general population in southern Taiwan, the HBV infection rate (99.2%) and the anti-HDV-positive rate (78.5%) among HBsAg-positive subjects were significantly higher than those of the general population in southern Taiwan (P less than 0.0001). None of the PDAs studied were positive for anti-HIV. The levels of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) among PDAs were significantly higher than those of the general population in southern Taiwan (P less than 0.0001). The more frequent the institutionalisation, the higher the infection rates with HBV and HDV and elevated levels of SGOT and SGPT. Horizontal transmission through parenteral drug abuse may be considered a possible reason for the significantly higher rates of HBV and HDV among parenteral drug abusers.
Acquired Immunodeficiency Syndrome↗
Impedance to transesophageal atrial pacing: significance regarding power sources.
Transesophageal stimulation is an expeditious method of atrial pacing. Using pulse widths of 10 msec results in reduction of current requirement to values that are usually less than 15 mA. An unknown variable in transesophageal atrial pacing has been impedance. In this study, we investigated the impedance to transesophageal atrial pacing in ten patients using a stimulator with a 63 V power source capable of delivering constant current to 20 mA against an impedance of 2,000 ohms. A bipolar electrode was used to deliver stimuli with a current of 15 mA. Voltage across a known resistance and current were measured on an oscilloscope and the impedance was calculated. Pacing thresholds were also performed and ranged from 6.2 to 16.5 mA (mean 9.4 +/- 2.9 mA, SD). Impedance varied between 720 and 2,670 ohms (mean 1,750 +/- 540 ohms). The stimulator used to measure impedance in man and two other commercially available stimulators were bench tested against known resistances of 500 to 2,000 ohms. The other stimulators with power sources of 12.5 and 15 V had attenuation of the delivered current at resistances of between 1,000 and 2,000 ohms. Thus, this study has demonstrated that transesophageal atrial pacing incurs impedances two to five times greater than incurred with intracardiac pacing leads. Therefore stimulators with high power sources are required to deliver the programmed current against these impedances.
Atrial Function↗
[A study on the prevalence and risk factors of muscular fibrotic contracture in Jia-Dong Township, Pingtung County, Taiwan].
In order to examine the prevalence and risk factors of muscular fibrotic contracture (MFC) among school children in Jia-Dong Township, Pingtung County, a prevalence survey combined case-control study was carried out from January to April, 1988. All the school children aged from 6 to 19 years old were first screened at schools and then referred to the Provincial Pingtung Hospital for confirmatory diagnosis based on the non-invasion criteria. A total of 83 MFC cases were identified including 79 gluteal fibrotic contracture (GFC) patients, 3 deltoid fibrotic contracture (DFC) patients, and 1 affected both GFC and DFC. The prevalence was significantly higher in males (17.3 per 1,000) than in females (10.5 per 1,000). The prevalence was found to increase with age after 6 years of age, peaked at the age group of 13-15 years, and decline thereafter. Most MFC cases clustered in both Wen-Fon and Yuan-Wen villages locate in the southern coast of Taiwan Island. Among 83 MFC patients, 65 were further interviewed to obtain information on the risk factors of MFC. A total of 65 healthy classmates one-to-one matched with MFC cases on aged, sex, and living villages were selected as the control group which was also interviewed. The case-control study showed a positive association between the frequency of injection and the MFC in a dose-response relationship. The injection site also correlated with the development of the GFC and DFC. It was reasoned that the injection might be the most important risk factor of MFC. Follow-up study of 65 operated MFC cases indicated a high percentage (89.2%) of hyperscar formation in the incision region.
Adolescent↗
Termination of sustained ventricular tachycardia by transesophageal atrial pacing.
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Atrioventricular Node↗
Seroepidemiological studies on hepatitis B and D viruses infection among five ethnic groups in southern Taiwan.
In order to compare the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection among five ethnic groups in Pingtung County of southern Taiwan, a total of 240 serum samples were collected from September to October, 1985, from the following five ethnic groups: Taiwanese, Hakka, Mainland Chinese, aboriginal Paiwanese, and aboriginal Rukaiese. Ages of subjects ranged from 5 to 69 years. All sera were tested for hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs), and core antibody (anti-HBc) by radioimmunoassay (RIA). Hepatitis B e antigen (HBeAg) and antibody to hepatitis D antigen (anti-HDV) were also tested for those with HBsAg-positive sera. Results showed that 44.1% of all sera examined were negative for HBsAG but positive for both anti-HBs and anti-HBc; additionally, 24.6% were negative for both HBsAg and anti-HBs but positive for anti-HBc. Only 134 serum samples showed negative results for HBV markers, indicating an HBV infection rate of 88.8%. The anti-HDV positive rate was estimated to be 2.7% among HBsAg-positive subjects. The HBsAg-positive rates among Rukaiese, Paiwanese, Hakka, Taiwanese, and Mainland Chinese were 25.8, 22.5, 16.7, 12.9, and 10.0%, respectively; while the prevalence rates of HBV infection among the above five groups were 94.2, 94.6, 85.4, 87.5, and 82.5%, respectively. Differences in the HBsAg-positive rate and HBV infection rate among these ethnic groups were statistically significant. We conclude that people living in Pingtung County are more frequently infected with HBV when compared with inhabitants in northern Taiwan.
Adolescent↗
Spectral analysis of ventilation in elderly subjects awake and asleep.
We studied the periodicities of ventilation in elderly subjects using digital comb filtering. Two groups of subjects were studied, those with and without sleep apnea. Measurements were made in wakefulness, stage 1-2 sleep, and where possible in stage 3-4 sleep. For each of the digital filters we calculated the average power of the oscillatory output. To compare subject groups we first specifically determined the average power in the filter with the maximum output. The mean of this measurement was greater in elderly subjects with apnea compared with those without apnea, both during wakefulness and stage 1-2 sleep. In both groups of subjects the cycle time of the major ventilatory oscillations was on the order of 40-60 s. There was no difference in this cycle time between the two groups of subjects in wakefulness or stage 1-2 sleep. Thus, whereas similar oscillatory processes occur in subjects with and without apnea, it is the magnitude of the oscillation that differs between the two groups. These conclusions are supported by analysis of the output of individual filters of the digital comb filter. In both groups, stage 1-2 sleep produced significantly increased oscillations in ventilation. Both in wakefulness and stage 1-2 sleep, significantly greater periodicities occurred in the apneic compared with the nonapneic group. In the few subjects who had sufficient data in stage 3-4 sleep for spectral analysis, ventilatory oscillations were virtually absent in this state. Our data suggest that subjects who develop apnea during sleep have an increased propensity for periodic breathing even while awake.
Aged↗
Changes in compartmental ventilation in association with eye movements during REM sleep.
The effect of phasic eye movement activity on ventilation during rapid-eye-movement (REM) sleep was studied in seven healthy young adults by use of the respiratory inductive plethysmograph. Mean ventilation (VE) and ventilatory components during REM sleep were not significantly different from that seen in either stages 1-2 or 3-4 sleep. The percent of rib cage contribution to ventilation in REM sleep, 29.3 +/- 5.1%, was reduced compared with 54.4 +/- 5.8% in stage 1-2 and 52.2 +/- 4.3% in stage 3-4 sleep (P less than 0.005). When one separated breaths by the degree of associated phasic eye movement activity, it became apparent that breathing during REM sleep is very heterogeneous. Increasing eye movement activity was associated with inhibition of ventilation with a reduction in VE from 5.1 +/- 0.3 to 3.8 +/- 0.3 l/min. Tidal volume and frequency both fell, whereas inspiratory duration was unchanged. Compartmental ventilation was also affected, with the fall in the rib cage contribution from 37.8 +/- 6.4 to 15.3 +/- 5.6%. Chest wall and abdominal movement became more asynchronous as phasic-eye-movement activity increased and frank paradoxical breathing was seen.
Adult↗
Lewis lung carcinoma variants with differing metastatic specificities adhere preferentially to different defined extracellular matrix molecules.
Differential cell adhesion has been proposed to play a role in organ-specific tumor metastasis. To further explore this hypothesis, we have employed a Lewis lung carcinoma cell line and 2 variants that differ in their ability to metastasize to lung and liver. The three cell lines were tested for their ability to adhere to defined extracellular matrix components that had been previously adsorbed to nylon membranes. Our results demonstrate that the parental cell line adheres preferentially to fibronectin relative to all other adhesion molecules tested. The lung colonizing variant, M27, adheres well to fibronectin and also to type V collagen but adheres poorly to laminin, to types I and VI collagen or to heparan sulfate. In contrast, the liver colonizing H59 cell line was highly adherent to laminin as well as to fibronectin but did not adhere to heparan sulfate or to any of the collagen types tested. These results demonstrate that three related cell lines with differing metastatic specificities have marked differences in their abilities to bind to defined matrix molecules. Such differences may play a role in the preferential localization to specific organ beds in vivo.
Animals↗
Termination of spontaneous atrial flutter by transesophageal pacing.
Transesophageal atrial pacing using the constant-rate technique was performed in 26 patients presenting with spontaneous atrial flutter (atrial cycle length between 180 and 270 ms). All but one patient had been treated with one or more antiarrhythmic agents (digoxin, quinidine, procainamide, propranolol, verapamil, diltiazem, and propafenone) within the previous 12 hours. Transesophageal atrial pacing at cycle lengths between 80 and 180 ms was successful in terminating atrial flutter in 22 patients: immediate reversion to sinus rhythm in 16, following transient sinus pause in one, following a brief period of atrial fibrillation in three, and following longer periods of atrial fibrillation in another two. No post-conversion ventricular arrhythmia and no other complications were observed. All patients experienced only a mild burning discomfort during the procedure. It is concluded that atrial pacing via the esophagus is a safe and noninvasive technique of terminating spontaneous atrial flutter. The effectiveness of this technique is comparable to endocardial or epicardial atrial pacing.
Adolescent↗
[Epidemiological study on hepatitis B virus infection among five ethnic groups in Pingtung County, Taiwan].
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Adolescent↗
The quick-mount pipeline connector: failure of a "fail-safe" device.
This report describes the absence of gas flow despite the apparent proper mounting of a Canadian Liquid Air nitrous oxide quick-mount connector to its wall outlet. A similar but potentially more dangerous malfunction can occur with oxygen quick-mount connectors. The nature and cause of this defect are examined.
Anesthesiology↗