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Biomedical subjects

Dong-Zong Hung

Publications and source records attributed to Dong-Zong Hung.

16 recordsLinked to original sources
PubMed2006

Lipid peroxidation and antioxidant status in workers exposed to PCDD/Fs of metal recovery plants.

Secondary copper smelters, which primarily utilize the waste materials that contain organic impurities, and the zinc recovery plant, which handles mostly fly ash and slag from the iron and steel industry, are major emission sources of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) in Taiwan. In this study, we compared the levels of erythrocyte glutathione (GSH), erythrocyte superoxide dismutase (SOD) and plasma malondialdehyde (MDA) in workers at a secondary copper smelting plant and a zinc recovery plant who may have been exposed to PCDD/Fs. Though the PCDD/F levels were higher in workers of zinc recovery plant than those of secondary copper smelting plant, no significant difference was found for serum PCDD/F levels between the two kinds of plants. We observed a significant difference in plasma MDA levels between workers at the zinc recovery plant (2.54 microM) and those at the copper smelting plant (1.79 microM). There was and a significant positive correlation between plasma MDA levels and the PCDD/Fs levels. In addition, we observed that the MDA levels were not affected by smoking and exercise status. Therefore, the data suggest that the MDA levels of the metal recovery workers are influenced by their PCDD/F exposure. The erythrocyte SOD activity in workers from the zinc recovery plant was marginally higher than that from the secondary copper plant (196 vs. 146 units/ml, p<0.06). In both plants, large variations in the MDA and SOD levels were found, especially in the high-PCDD/Fs-exposure group, which may be attributed, at least partially, to the differences in smoking status and the number of cigarettes smoked. Overall, our results indicate a higher oxidative stress in workers of the zinc recovery plant than in workers of the secondary copper smelting plant in Taiwan.

Adult↗
PubMed2005

Antivenom treatment and renal dysfunction in Russell's viper snakebite in Taiwan: a case series.

Formosan Russell's viper (Daboia russelli siamensis) is the sixth most frequent cause of snakebites in Taiwan. Its bite induces greater kidney injury than other Russell's vipers in Southeast Asia. Poor availability of antivenom might be the major reason. To enhance treatment, we supplied the antivenom to the teaching hospitals that are near the areas where D. r. siamensis is found. We also used an ELISA in diagnosis. From June 1999 to December 2001, a total of 13 cases of D. r. siamensis snakebite were diagnosed with serum venom level of 10-98 ng/ml, 1-6 hours after being envenomed. Abnormal coagulation function and acute renal failure occurred early and were the two most important clinical features. Early specific antivenom treatment, 3-6 hours after systemic envenoming, restored the coagulation function in 1-2 days and seemed to be statistically effective in reducing the severity of renal damage compared with the historical and delayed group by the Wilcoxon rank-sum test. Two to four vials of antivenom were needed to block the systemic toxicity and produced few side effects. The antivenom should be administered as early as possible to prevent systemic dysfunction.

Acute Kidney Injury↗
PubMed2005

Case report: the clinical toxicity of dimethylamine borane.

CONTEXT: Dimethylamine borane (DMAB) is a reducing agent used in nonelectric plating of semiconductors. Exposures are usually through occupational contact. We report here four cases of people who suffered from work-related exposure to DMAB. CASE PRESENTATION: Three patients exposed to DMAB decontaminated immediately by drinking a lot of water; they reported dizziness, nausea, diarrhea 6-8 hr later. The other patient did not decontaminate at once, and he suffered from more severe symptoms, including dizziness, nausea, limb numbness, slurred speech, irritable mood, and ataxia 13 hr later. Magnetic resonance imaging showed symmetric lesions with hyperintensity on T2WI and FLAIR in bilateral cerebellar dantate nuclei. This patient was readmitted to the hospital due to difficulty in walking and climbing 18 days after exposure. Lower leg weakness and drop foot were found bilaterally. A nerve conduction study revealed polyneuropathy with motor-predominant axonal degeneration. This patient receives regular outpatient followups and still walks with a clumsy gait and has difficulty with hand-grasping activity. DISCUSSION: This case study demonstrates that DMAB is highly toxic to humans through any route of exposure, and dermal absorption is the major route of neurotoxicity. DMAB induces acute cortical and cerebellar injuries and delayed peripheral neuropathy. RELEVANCE: Further investigation of the toxic mechanism of DMAB is warranted. Early decontamination with copious water is the best current treatment for exposure to DMAB.

Adult↗
PubMed2004

Taiwan's venomous snakebite: epidemiological, evolution and geographic differences.

Located at the juncture of tropical and subtropical regions, Taiwan has a warm and humid climate with abundant precipitation and food, which coupled with the island's diverse vegetation and landscape, makes it a suitable environment for many snake species. Among these, Naja atra, Bungarus multicinctus, Deinagkistrodon acutus, Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Daboia russelii siamensis are the 6 principal venomous species, and have caused significant injuries and death over the years. The natural environment of Taiwan has changed tremendously in the last 20-30 years, which is likely to have affected the number and distribution of venomous snakes, thus indirectly affecting incidence of snakebite. A retrospective analysis of 286 snakebite cases at a medical center in central Taiwan analyzed the snakebite-related epidemiological data in the past 30 years. The results showed that the bite rates of various venomous snakes vary geographically, which is related to the overlapping of the human living environment and snakes' habitat. In Taiwan, T. mucrosquamatus and T. stejnegeri bites are most common. Bites by Deinagkistrodon acutus and Daboia russelii siamensis generally occur in the south and east parts of the island and attacks by Naja atra are most common in central Taiwan. Aggressive antivenom treatment can reduce snakebite mortality rate, but for Bungarus multicinctus bites, maintaining the patient's airway and supporting their ventilation is vital to reducing mortality rate in addition to antivenom treatment.

Female↗
PubMed2003

The clinical significance of venom detection in patients of cobra snakebite.

Cobra snakebites are one of the most frequent occurrences among the poisonous snakebites. The correlation between the serum concentrations of cobra venom in the victims with the severity of systemic and local symptoms after envenoming is still awaited for investigation. In this paper, we have developed an enzyme-linked immunosorbent assay (ELISA) to detect Taiwan cobra venom existed in the serum of the cobra snakebite victims. This established technique allowed us to detect as low as 1 ng/ml. Totally, 31 serum samples of 27 recognized and suspected cobra snakebite patients were analyzed by the developed ELISA technique. The highest venom level detected was 1270 ng/ml in a case 2 h after being envenomed. We found that the serum concentrations of the venom in the bitten patients were well correlated with the severity of local tissue destruction. Venom levels might remain high 48 h after snakebite. Two or more vials of specific antivenom administered soon after snakebite were effective in neutralizing the circulating venom as revealed by ELISA. Higher doses of antivenom may be indicated in cases of cobra venom-induced local tissue destruction. In conclusion, these results indicate that venom detection in snakebite victims is valuable in diagnosis and severity assessment of Taiwan cobra snakebite.

Adolescent↗
PubMed2002

Russell's viper snakebite in Taiwan: differences from other Asian countries.

Formosan Russell's viper (Daboia russelli siamensis) is the sixth most frequent cause of snakebite in Taiwan. Its venom has been thought to have both neurotoxic and hematoxic properties. This viper's snakebite is rare and thus scarcely subjected to systemic studies. In this paper, we retrospectively analyzed and described 18 cases of viper snakebite from 1987 to 1999. Like that of the Russell's viper snakebite in other South East Asian areas, varied degrees of acute renal failure, incoagulable blood with bleeding diathesis and hemolysis were the major symptoms found in the systemic envenoming patients. Systemic thrombosis seems to be the distinguishing feature in Formosan Russell's viper snakebite. Neither symptoms nor signs of neuromuscular junction blocking effects were observed, which is another difference from symptoms observed after bites of some other Russell's viper subspecies, suggesting a significant geographic variation. These findings confirmed the clinical importance of Russell's viper snakebite in Taiwan.

Acute Kidney Injury↗
PubMed2002

Multiple thrombotic occlusions of vessels after Russell's viper envenoming.

Systemic bleeding due to consumption coagulopathy and thrombocytopenia due to activation of procoagulants is the leading manifestation and cause of death in Russell's viper systemic envenoming. Thrombotic occlusion of the blood vessels is rare in cases of snakebite. In this report, two adult patients with Russell's viper systemic envenoming presented multiple cerebral infarctions, digital gangrenes and ischaemic organs in addition to typical clinical manifestations of bleeding diathesis and renal involvement. Our findings in these two special cases suggest that the venom-induced coagulopathy and endothelium damage, predisposed by toxin-induced vasoconstriction, might be the possible mechanism of multiple thrombotic vascular occlusions in systemic envenoming of Formosan Russell's viper.

Aged↗
PubMed2002

Hemolytic anemia after methylene blue therapy for aniline-induced methemoglobinemia.

Methylene blue is utilized as the main treatment of methemoglobinemia conventionally, but it may be ineffective in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We report a G6PD-deficient patient who suffered from aniline-induced methemoglobinemia with initial good response Heinz body but hemolytic anemia appeared later 3 d after methylene blue therapy. G6PD deficiency was identified. He recovered uneventfully with hydration, packed blood transfusion and adjuvant luvela-N(dl-alpha-tocopheryl nicotinate) medication. Caution should be taken in using methylene blue as antidote of acute methemoglobinemia, especially when a history of G6PD deficiency is obscure.

Adult↗
PubMed2002

Sandwich enzyme-linked immunosorbent assay for Taiwan cobra venom.

Poisonous snake bite victims usually have difficulty identifying the species, and clinical manifestations alone are not reliable because of overlapping symptoms. Thus, it is important to develop a quick and reliable mean of identifying the snake responsible. We describe the development of a sandwich-ELISA method for detection of venom in biological samples and apply it to a case of snakebite to confirm the clinical diagnosis. The sandwich-ELISA takes 6 h to complete. Cobra venom antigen gave positive absorbance at about 500 pg/ml. Good linearity with R2 values over 0.99 were observed in dilution series of 1:100 ng/mL of cobra venom in calf serum and human urine. A snakebite initially thought to be Trimeresurus mucrosquamatus was proven cobra with a serum venom level up to 288 ngmL 3 h after envenoming. Sandwich-ELISA provides a rapid and accurate method for clinical identification and evaluation of toxic antigens circulating in individuals bitten by the Taiwan cobra snake.

Animals↗
PubMed2002

Anticholinergic poisoning from a large dose of Scopolia extract.

Scopolia extract (SE) contains hyoscyamine and scopolamine, which are both anticholinergic. It is usually used as a patent medicine to treat gastrointestinal disorders, to relieve spasmotic discomfort, or to decrease the secretion of gastric acid. Poisoning by SE presents similar symptoms and signs as other types of anticholinergic poisoning. We report a case of severe anticholinergic poisoning after accidentally drinking 8 ml of SE. The patient presented with acute delirium and was successfully treated with physostigmine.

Administration, Oral↗
PubMed2002

Relationship of paraoxonase and serum lipids in Taiwan.

Paraoxonase (PON) is structurally associated with the high-density lipoprotein fraction of serum, suggesting a role for this enzyme in lipoprotein metabolism. In Chinese Singaporeans, triglycerides (TG) had significant positive correlation with PON but high-density lipoprotein cholesterol (HDL-C) did not. Our paper investigates the influence of PON on serum lipids under controlling confounding factors in Taiwanese. Blood samples and questionnaires were collected from 476 Taiwanese with no participant excluded for any reason. Cases were examined for biochemistry, PON, TG, cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and HDL-C. PON phenotypes were determined by Hardy-Weinberg equilibrium. We compared median differences in PON, TG, TC, HDL-C and LDL-C between genders by means of the Wilcoxon Rank Sums test. Relationships among PON, TG, TC, HDL-C and LDL-C were represented by Pearson's correlation. A rank multiple regression analysis was also used to analyze the association between PON, TG, TC, HDL-C and LDL-C adjusted for age, gender and diabetes mellitus, since no uremia, acute myocardial infarction or peripheral neuropathy was present in our cases. Median TG and LDL-C were higher in males than in females, but median HDL-C was higher in females. For women and the total group, TC and HDL-C showed a significant positive correlation with PON. Only HDL-C showed a positive correlation with PON adjusted for age, gender and diabetes mellitus. PON is influenced by many confounding factors. Only after adjusting for the confounding factors in this study, HDL-C is positively correlated to PON like the structural relationship.

Aryldialkylphosphatase↗
PubMed2002

The effect of codeine in anti-cough syrup on morphine screen.

BACKGROUND: Codeine is a lawfully permitted ingredient of over-the-counter cold and cough medicines readily available to the public in Taiwan. Drug abusers often use it as a substitute for morphine and heroin, attributing the morphine in the urine test to therapeutic cough medicine. In the literature, several criteria for taking codeine, using a single large-dose model, have been proposed. Here, we evaluate whether these criteria still fit in therapeutic situation. METHODS: Ten healthy volunteers each received, over two days, a total of 8 doses of cough syrup containing 4.5 mg of codeine phosphate per dose. Urine specimens were collected regularly during and in the 3 days after syrup consumption. The urine specimens were analyzed by an enzyme immunoassay screening test and a gas chromatography-mass spectrometry (GC-MS) confirmation test. RESULTS: Positive screen was noted during syrup use and 12-30 hours after the last dose of medication. The morphine:codeine ratio was < 1 during syrup use and 12 hour after the last dose of syrup. In only 1.4% of the urine specimens was the morphine:codeine ratio 1-3.0, and in these, the concentrations of morphine and codeine were both below 300 ng/mL. CONCLUSIONS: The results are compatible with the findings of the single large-dose model and may be used as a reference for the interpretation of urine analysis after the intake of multiple therapeutic doses of cough syrup with codeine.

Adult↗
PubMed2002

Eight cases of acute renal failure from Vipera russelli formosensis venom after administration of antivenom.

The six-valent antivenom from Vipera russelli formosensis in Taiwan has recently become available in Taiwan. Between June 1998 and December 2001 8 Vipera russelli formosensis snakebite victims were treated with antivenom within 24 h of snakebite. Bleeding stopped and coagulopathy improved after antivenom use, and neurotoxic symptoms were mild. Prothrombin time was prolonged on the 1st day and thrombocytopenia changed within 2 d. In the majority of cases, renal dysfunction persisted for several days after coagulation abnormalities normalized: 3 cases required hemodialysis. Although Vipera russelli formosensis antivenom is capable of preventing hemorrhage, antivenom administration may not alter the course of severe renal damage.

Acute Kidney Injury↗
PubMed2002

Paraoxonase activities in Minnan and Hakka.

Three phenotypes of paraoxonase (PON) have been found in population studies. The B type gene frequency varies among different populations. The Singaporean Chinese gene frequency is trimodal. The gene frequency of British Chinese populations was neither bimodal nor trimodal. We conducted a study to determine the frequency distribution of PON in the Minnan and Hakka populations. We collected blood samples and questionnaires from Minnan and Hakka subjects from Nantou County, Taiwan, excluding those with PON confounding factors. The blood samples were then examined for PON-non-NaCl (PON without salt stimulation), PON-NaCl (PON with salt stimulation) and arylesterase activities. We compared median differences in age, sex, PON-non-NaCl, PON-NaCl, arylesterase, and PON-NaCl/arylesterase between Minnan and Hakka populations using chi-square and rank analysis of variance (ANOVA), adjusted for age. There were 258 Minnan and 67 Hakka subjects without confounding factors. None of the frequency distributions for PON-non-NaCl, PON-NaCl, or PON-NaCl/arylesterase was clearly bimodal or trimodal. Hakka were older and had increased PON-non-NaCl, PON-NaCl, and PON-NaCl/arylesterase when compared with Minnan, but only age and PON-non-NaCl were significantly different. Hakka and Minnan may have more heterozygous AB phenotype for PON, which might explain why the frequency distribution is not trimodal or bimodal. Marriage among Minnan, Hakka, Aborigines, and other Mainland Chinese in Taiwan may be responsible for difficulty in differentiating gene frequencies among subpopulations by PON phenotype. Nonetheless, the Hakka appeared to have greater PON activity than the Minnan. Subpopulation in itself may be a factor for higher PON activity among the Hakka after controlling for confounding factors.

Adult↗
PubMedDate not supplied

Extremely high levels of alkaline phosphatase in adult patients as a manifestation of bacteremia.

BACKGROUND/AIMS: Jaundice resulting from severe bacterial infection is well known, particularly in pediatric literature. Extremely high levels of alkaline phosphatase (ALP) have rarely been emphasized as a manifestation of bacteremia in adults. The aim of this study was to evaluate the characteristics of extremely high levels of ALP in adult patients as a manifestation of bacteremia. METHODOLOGY: Extremely high levels of ALP were defined as being more than 1000 U/L. From April 1998 to May 1999, we retrospectively reviewed those patients' charts who had ALP above 1000 U/L. Sixteen patients that had bacteremia among 96 patients with extremely high levels of ALP at the emergency department of Taichung Veterans General Hospital were included in this study. RESULTS: Sixteen patients had bacteremia with extremely high levels of ALP, including 9 patients with malignant biliary obstruction (MBO), and 7 patients without MBO. The ALP levels ranged from 1002 to 2061 (1430.13+/-353.84) U/L. Ten patients were male, and 6 were female. Their ages ranged from 19 to 83 (56.13+/-16.51) years. A variety of gram-negative, and gram-positive organisms were identified, and Escherichia coli was the most common pathogen. Among the seven patients of bacteremia without MBO, 5 patients had underlying diabetes mellitus as the predisposing factor for development of the bacteremia. The ages of the bacteremia patients with MBO were older than those of patients without MBO (66.3+/-10.1 us. 43.0+/-13.7 years, P=0.0025). CONCLUSIONS: Bacteremia from a variety of organisms is a common cause for extreme elevation of ALP. Escherichia coli is the most common pathogen and presented more often in patients with MBO than those without MBO. In the setting o f extremely high levels of ALP as a manifestation of bacteremia, the patients with MBO are as common as those without MBO. We have demonstrated clinically that hepatic dysfunction during bacteremia may be manifested predominantly by extreme elevation of alkaline phosphatase with little abnormality in serum bilirubin.

Adolescent↗