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Biomedical subjects

H J Yu

Publications and source records attributed to H J Yu.

At least 37 records · Page 2Linked to original sources
PubMed1998

Surgery in the aged in Korea.

OBJECTIVE: To compare clinical characteristics, including postoperative outcomes, in Korean patients 65 years and older with those of younger patients. DESIGN: A retrospective medical record review. SETTING: An adult university hospital. PARTICIPANTS: All patients who underwent various operative procedures, especially for stomach cancer, acute surgical abdomen, and abdominal wall hernia, in the Department of Surgery at Seoul National University Hospital, Seoul, Korea, in 1994 and 1995. MAIN OUTCOME MEASURES: Demographics, disease pattern, length and extent of operation, hospital course including postoperative complications, and mortality. RESULTS: A clear increase in the patients 65 years and older was found. Of 2893 patients who underwent surgery in 1994, 735 were 40 years and younger (group 1), 1691 were 41 to 64 years old (group 2), and 467 were 65 years and older (group 3). The most common disease was stomach cancer in all age groups, with the highest incidence in group 3. Emergency operations were performed most often in group 1 (P<.05; chi2 test). Malignant neoplasm requiring a surgical procedure was identified more frequently with age (P<.001). Among patients with acute surgical abdomen, acute appendicitis was the most common disease in all age groups, whereas more serious diseases were found with age. In the analysis of stomach cancer, male patients increased with age (P<.001). Patients in group 3 had a poor preoperative physical status, and their perioperative courses were the most eventful among all groups (P<.05). However, no statistical differences among groups were present for resectability, postoperative length of hospitalization, postoperative complication, and mortality. In the analysis of operations for acute surgical abdomen including acute appendicitis, with their unfavorable preoperative physical status and eventful postoperative courses, perforation of the appendix and postoperative complications were most common in group 3 (P<.001). No statistical differences among groups were noted for operative mortality. In addition, in the analysis of abdominal wall hernia, no statistical differences among groups were found for postoperative complication and mortality. CONCLUSIONS: The proportion of patients 65 years and older among all surgical cases has increased in recent years. The proportion of malignant neoplasms, especially stomach cancer, was higher in the aged patients. Most operations were performed electively on the aged patients, as were those on younger patients. In the case of the acute surgical abdomen, severe diseases with an underlying malignant neoplasm were more frequently found in the aged patients. Despite their generally poor physical status, the patients 65 years and older proved to be able to tolerate elective major operations, such as radical gastrectomy for stomach cancer, when optimal perioperative management was provided. However, results of emergency operations in these elderly patients were poorer, with a higher complication rate. Therefore, the aged patient should be regarded as a candidate for surgery but with a more careful and comprehensive approach to his or her treatment perioperatively.

Abdomen, Acute↗
PubMed1998

The usefulness of prostate-specific antigen (PSA) density in patients with intermediate serum PSA level in a country with low incidence of prostate cancer.

OBJECTIVES: To evaluate if a calculated PSA density (PSAD) prior to biopsy could be useful to determine the need for prostate biopsies in patients with serum PSA levels of 4.1-20.0 ng/mL in a country with low incidence of prostate cancer (PCa). METHODS: A total of 185 consecutive patients aged 50-79 years who underwent prostate biopsies were evaluated by correlating the biopsy results with the results of digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA levels, and PSAD. Prostate volume was calculated from TRUS using prolate ellipse formula and PSAD was obtained by dividing serum PSA level by prostate volume. RESULTS: In this study population, 27 cases (14.6%) had positive biopsies. Of 158 cases with negative biopsies, 43 (23.2%) had histologically verified prostatic inflammation. The diagnostic value of DRE and TRUS was hampered by unsatisfactory sensitivity and specificity in differentiating patients with positive biopsies from those with negative biopsies. The use of PSAD alone as an indicator for biopsy was also limited by its low specificity. A PSAD cutoff value of 0.15 resulted in a sensitivity of 100% and a specificity of only 12%. Prostatic inflammation was a confounding factor for the inadequate specificity of DRE, TRUS and PSAD. Combined use of DRE and PSAD provided the best information regarding the need for biopsies. Accordingly, if the 47 patients (25.4%) who presented with both a negative DRE and a PSAD < or = 0.20 were not biopsied, the rate of positive biopsy could have increased to 19.6% (27 of 138) without missing any cancer detection. CONCLUSIONS: It is concluded from this study that for patients with serum PSA levels of 4.1-20.0 ng/mL, biopsies should only be recommended for those with abnormal DRE and/or PSAD >0.20.

Aged↗
PubMed1998

Steroid acne vs. Pityrosporum folliculitis: the incidence of Pityrosporum ovale and the effect of antifungal drugs in steroid acne.

BACKGROUND: Steroid acne is a folliculitis that can result from systemic or topical administration of steroid, and has been described as showing a similar clinical picture to Pityrosporum folliculitis, but there have been few reports about the incidence of Pityrosporum ovale and the effect of antimycotic drugs in steroid acne and other acneiform eruptions. Our purpose was to describe the association between steroid acne and P. ovale, and to confirm the superior efficacy of oral antifungal drugs over anti-acne drugs in the treatment of steroid acne. METHODS: The history, clinical features direct microscopy, histopathologic analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared. RESULTS: Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of P. ovale in the lesional follicle. Furthermore, oral antifungal drug (itraconazole) showed significantly better clinical and mycologic effects than any other group of medications used in this study. CONCLUSIONS: Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk and acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Pityrosporum folliculitis. In addition, oral antifungal drugs recommended for Pityrosporum folliculitis; however, it will require a larger case-control study to confirm the superiority of antifungal therapy over anti-acne treatment.

Acne Vulgaris↗
PubMed1998

High prevalence of voiding symptoms in Taiwanese women.

OBJECTIVE: To describe the voiding symptoms of Taiwanese women using the International Prostate Symptom Score (IPSS). SUBJECTS AND METHODS: A self-administered questionnaire was used to collect information on demographic characteristics and the IPSS used to determine the voiding symptoms of 583 consecutive women undergoing a health examination. The symptom scores of different age groups were compared using a one-way analysis of variance with a posteriori comparisons made using Scheffe's test. RESULTS: The seven symptom scores could be separated by factor analysis into two factors which corresponded with obstructive (incomplete emptying, intermittency, weak stream, and hesitancy) and irritative (frequency, urgency, and nocturia) symptoms. Various degrees of frequency and nocturia were commonly reported by the respondents, whereas obstructive symptoms were infrequently reported, except in the elderly (age > or = 65 years). The irritative scores, obstructive scores and total scores increased significantly with age (all P<0.001). The total symptom scores correlated significantly with the quality-of-life score (Pearson's r = 0.70, P < 0.001). Overall, 124 (21%) of the respondents reported an IPSS of > 7, and 98 (17%) of the respondents reported being 'mostly dissatisfied' with their urination. However, only nine (1.5%) of the respondents had ever consulted a urologist about their voiding problems. CONCLUSIONS: There was an age-dependent change in voiding symptoms in these Taiwanese women. The prevalence of voiding symptoms in women is much higher than encountered in clinical practice.

Adult↗
PubMed1998

The Veterans Affairs medical care system: hospital and clinic utilization statistics for 1994.

OBJECTIVES: The authors describe the role the Veterans Affairs (VA) medical system plays as a provider of clinic and hospital services by examining utilization levels and users' characteristics. METHODS: The Veterans Affairs hospital discharge database, the Veterans Affairs outpatient clinic files, and the veteran population files were used to estimate the number of persons using the Veterans Affairs medical care system in 1994 and the intensity of their clinic and hospital use. Demographic and clinical characteristics of users were tabulated. RESULTS: In 1994, 2.7 million veterans, 10.3% of all US veterans, and approximately 23% of veterans who would have met the statutory eligibility requirements for Veterans Affairs care, used the hospital and/or clinic components of the Veterans Affairs medical system. Sixty-three percent of the system's users were younger than age 65, and 10.5% were women. These 2.7 million veterans had 901,665 Veterans Affairs hospital stays, 15.5 million bed-days, and 31.2 million outpatient visits in fiscal year 1994. The average number of hospitalizations per hospital user was 1.71; the average number of visits per clinic user was 11.7. Medical, surgical, and psychiatric diagnosis-related groups (DRGs) accounted for 56%, 21%, and 23%, respectively, of hospitalizations, but psychiatric diagnosis-related groups accounted for 43% of all inpatient days. Principal medicine clinic visits and psychiatry clinic visits accounted for 21% and 16% of Veterans Affairs ambulatory care. CONCLUSIONS: Because the patient population served by the Veterans Affairs system is skewed in a number of ways, its contribution as a provider of health services in the United States varies by gender, age, socioeconomic status, and diagnosis.

Adult↗
PubMed1998

Behavioral and endocrine traits of obesity-prone and obesity-resistant rats on macronutrient diets.

Patterns of eating behavior, body weight gain, and hormone changes were examined in normal-weight albino Sprague-Dawley rats on macronutrient diets. These diets consisted of either three separate jars with pure macronutrients, fat, carbohydrate and protein, from which to choose, or a single diet with different concentrations of fat and carbohydrate. Similar patterns on the choice-diet and single-diet paradigms were observed. During the first 7-10 days on these diets but not subsequently, the rats consuming a fat-rich diet exhibit significant hyperphagia, an increase in both total and fat intake that produces higher body weight gain. Compared with a 10% fat diet, a 30% fat diet is associated with a decline in insulin and corticosterone (CORT) levels, whereas a 60% fat diet produces an increase in circulating glucose. Levels of glucose are positively correlated with fat intake, and together these measures are consistently related to body fat. These relationships are most strongly expressed in rats that consume a fat-rich diet with >30% fat. Whereas insulin levels are also positively related to body fat, CORT is inversely related in these normal-weight subjects. In animals consuming a high-fat diet, a clear separation can be seen between "obesity-prone" (OP) rats with 100% greater body fat than "obesity-resistant" (OR) rats. The OP rats, which consume 15% more total calories, have significantly higher insulin and glucose levels. In animals that consume a diet with >30% fat, it is the OP but not the OR rats that exhibit a positive relation between fat intake, glucose levels, and body fat and reveal an additional association between carbohydrate intake, insulin, and body fat. Thus these rats on macronutrient diets exhibit distinct traits that relate behavior to hormone disturbances and adiposity and distinguish subjects that are prone vs. resistant to obesity.

Adipose Tissue↗
PubMed1998

A case of leukemia cutis.

We report a case of leukemia cutis with atypical skin manifestations, presented with generalized various sized dark brownish to erythematous patches with plaques on the whole body of a 42-year-old man. Skin lesions developed 6 months ago and had no signs of itching or tenderness. He complained of sustaining fevers with abdominal discomfort. Laboratory findings showed elevation of leukocyte count and peripheral blood smear revealed 86% of lymphocyte. Histologic examination showed diffuse infiltration of abnormal cells that appeared to be leukemic in nature.

Adult↗
PubMed1998

Factors related to delayed treatment and posttreatment symptom severity in Taiwanese patients with benign prostatic hyperplasia.

We evaluated the sociodemographic and clinical factors of delayed treatment and posttreatment symptom severity in outpatients with benign prostatic hyperplasia (BPH). The study included 146 BPH patients treated at the National Taiwan University Hospital in early 1997. All patients were treated with alpha-adrenergic antagonists or finasteride for at least 2 weeks. A questionnaire based on Andersen's Health Behavior Model was used to assess various sociodemographic features, while the pre- and posttreatment symptoms severity was rated according to the International Prostate Symptom Score (IPSS). Multiple logistic regression was used to assess the associations of these factors with delayed treatment and posttreatment symptom severity. Subjects who had recently quit smoking or were blue-collar workers tended to delay treatment, while those who chose a medical center as the care provider for chronic diseases tended to be less likely to delay treatment. However, none of these associations were statistically significant. No enabling factors (income, insurance) or need factors (symptom scores) evaluated were associated with delayed treatment. Predisposing factors associated with higher posttreatment symptom severity were delayed treatment (over 12 months) (adjusted odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.16-6.16), quitting smoking (adjusted OR: 4.47, 95% CI: 1.34-14.94), and having never smoked (adjusted OR: 3.73, 95% CI: 1.15-12.11). Subjects with severe pretreatment symptoms were far more likely than subjects with mild pretreatment symptoms to have severe symptoms after treatment (adjusted OR: 52.69, 95% CI: 54.46-621.90). Our findings, though based on a limited number of subjects, suggest sociodemographic factors rather than objective clinical attributes (prostate specific antigen level, prostate volume, and urodynamic results) are associated with delayed treatment in Taiwanese men with BPH. Both pretreatment symptom severity and sociodemographic factors are related to posttreatment symptom severity.

Adult↗
PubMed1997

Ability of obstructed bladders to empty is dependent on method of stimulation.

PURPOSE: To correlate pharmacologic changes that occur in the bladder after a partial outlet obstruction with the bladder's ability to perform work and empty. METHODS: After 2 weeks of partial outlet obstruction, rabbit bladders were stimulated in vitro both isovolumetrically [field stimulation (FS)] and to empty (FS, bethanechol, and KCl). RESULTS: The obstructed bladders were separated into two groups according to their ability to empty when stimulated with FS. Compensated bladders were those that could empty as much as controls. Decompensated bladders emptied significantly less than controls. With FS and bethanechol, the compensated obstructed bladders showed no difference from the control bladders in their ability to empty. In contrast, with KCl, the compensated bladders generated significantly less pressure, performed less work, and emptied less than controls. When the decompensated bladders were stimulated with all three types of stimulation, all parameters, including emptying ability, were significantly decreased. CONCLUSIONS: The reduction in the response of compensated bladders to KCl stimulation suggested that the initial defects to the bladder after an outlet obstruction involved the interaction of smooth muscle proteins with calcium and ATP. In contrast, the response of decompensated bladders to all three forms of stimulation was equally reduced, suggesting that the degenerative processes were directly related to significant cellular damage to metabolic processes involved in energy synthesis, storage, and utilization.

Animals↗
PubMed1997

Secular trend and age-period-cohort analysis of prostate cancer mortality in Taiwan.

PURPOSE: We evaluated the secular mortality trend of prostate cancer in Taiwan from 1964 through 1994. MATERIALS AND METHODS: Analyses were based on vital statistics. Relative risks associated with each of the age, period and cohort effects on secular mortality were estimated from a log-linear Poisson model. RESULTS: Age adjusted mortality rates increased more than 2-fold during the last 30 years in Taiwan. Age-period-cohort analysis showed that the age effect was the strongest. CONCLUSIONS: Factors related to aging are the main reason for the increase in prostate cancer mortality in Taiwan during the least 3 decades.

Adult↗
PubMed1997

Effect of age and outlet resistance on rabbit urinary bladder emptying.

PURPOSE: To investigate the influence of age and effect of increased outlet resistance on the ability of rabbit bladders to empty in response to various methods of stimulation. MATERIALS AND METHODS: Bladders from six-month-old (young) and three-year-old rabbits (aged) were mounted in an in vitro whole organ bath system and filled with 15 ml. saline. The ability of the bladders to empty against low outlet resistance (LOR) and high outlet resistance (HOR) in response to field stimulation, bethanechol, and KCl was measured. The following parameters were measured: intravesical pressure and volume emptied. From these, flow rate, power, and external mechanical work were calculated. RESULTS: Maximum isometric pressure did not change with age. All bladders emptied with increased pressure and decreased flow rate at HOR. The young bladders generated a greater maximum power in response to bethanechol and KCl than the aged bladders at both outlet resistances, and maximum power did not change with increased resistance. The aged bladders did less work and emptied significantly less than the young bladders at the HOR. CONCLUSIONS: The aged rabbit bladders were unable to maintain the bladder contraction long enough to empty completely through an increased outlet resistance. Because maximum power remained constant when the outlet resistance was increased, it might be useful clinically to determine the emptying ability of the urinary bladder, independent of changes in outlet resistance. In addition, bladder work could be used to evaluate bladder function if the volume emptied is also taken into consideration.

Aging↗
PubMed1997

Etiology of bladder dysfunction secondary to partial outlet obstruction. Calcium disregulation in bladder power generation and the ability to perform work.

Similar to all smooth muscle, contraction of urinary bladder smooth muscle depends upon a rise in intracellular free calcium, which results from both calcium influx from extracellular spaces and calcium release from intracellular stores (calcium-induced calcium release [CICR]). Recent studies from our laboratory demonstrate that one of the major dysfunctions induced by partial outlet obstruction is a marked reduction in the participation of CICR (from IP3-sensitive and IP3-insensitive sites on the sarcoplasmic reticulum [SR]) during stimulation by both field stimulation (neurotransmitter release) and by direct muscarinic stimulation (bethanechol). Experimentally, rabbit urinary bladder function can be evaluated using an isolated whole bladder model. The current study utilizes the isolated whole bladder model to compare the effects of partial outlet obstruction on the responses to field stimulation and bethanechol with the responses of normal bladders following inhibition of CICR with the combination of thapsigargin+ryanodine. The parameters measured include the magnitude of pressure generation, rate of pressure generation, time to maximal pressure generation, percent volume emptied, rate of emptying, power generation, and work performed (both total work and work per ml emptied). Partial outlet obstruction resulted in virtually identical alterations in the responses of the bladder to stimulation (field stimulation and bethanechol) to that of inhibition of CICR by thapsigargin+ryanodine. Thus, these studies provide strong support for our hypothesis that the contractile dysfunctions secondary to partial outlet obstruction are directly related to a marked inhibition of the CICR component of the response to both field stimulation and bethanechol.

Animals↗
PubMed1996

Effectiveness of live-attenuated Japanese encephalitis vaccine (SA14-14-2): a case-control study.

BACKGROUND: Japanese encephalitis is a major cause of death and disability throughout Asia, including the Indian subcontinent. Although an effective vaccine for Japanese encephalitis is available, hundreds of millions of susceptible individuals remain unimmunised because of the vaccine's cost. In 1988, an inexpensive live-attenuated vaccine (SA14-14-2) was licensed in China. We have measured the effectiveness of this vaccine. METHODS: In a case-control study in rural Sichuan Province, China, the 56 cases consisted of children admitted to hospital with acute Japanese encephalitis, and were confirmed serologically. 1299 village-matched and age-matched controls were identified, and vaccination histories obtained from pre-existing written records. FINDINGS: The effectiveness of one dose was 80% (95% Cl 44 to 93%); that of two doses was 97.5% (86 to 99.6%). Controlling for multiple potential confounders did not alter these results. INTERPRETATION: We conclude that a regimen of two doses of live-attenuated Japanese encephalitis vaccine, administered 1 year apart, is effective in the prevention of clinically important disease. Subsequent study is needed to assure the safety of this vaccine.

Animals↗
PubMed1996

Age-related differential susceptibility to calcium channel blocker and low calcium medium in rat detrusor muscle: response to field stimulation.

The influences of aging on the response of urinary bladder detrusor smooth muscle in response to neurogenic stimulation (electric field stimulation) were investigated in rats aged 3-4 months (young) and 18-20 months (old). In addition, age-associated changes in calcium homeostasis were evaluated by comparing the basal intracellular free calcium concentration ([Ca2+]i), the change of [Ca2+]i in response to field stimulation, the contractile response at different extracellular calcium concentrations (Ca2+ = 1.8, 0.6, and 0 mM), and the sensitivity to the L-type calcium channel blocker. In both groups, the frequency-response curve in response to field stimulation (1-32 Hz) was similar. The contractile response to field stimulation was biphasic (phasic and tonic). The phasic/tonic ratio at different frequencies was similar between the two groups. The contractile responses were equally inhibited by atropine (1 microM) and preincubation with alpha, beta-methylene ATP (50 microM). Tetrodotoxin (1 microM) virtually abolished the responses to field stimulation in both groups. The biphasic components showed different sensitivities to diltiazem and low calcium. The tonic component was more readily inhibited by diltiazem, whereas the phasic component was more sensitive to low calcium medium. In general, the response to lower frequency stimulations was more sensitive to both diltiazem and low calcium. The aged group was more sensitive to the inhibitory effects of both low calcium and diltiazem. In Ca2(+)-free medium, the contractile response to higher frequency (e.g., 32 Hz) was temporarily preserved in most of the preparations. This response disappeared after repeated stimulation. The magnitude of this Ca2(+)-free response to 32 Hz stimulation was significantly lower in the aged group than in the young group (18.1 +/- 1.4 vs.29.1 +/- 3.2% of the control response in normal Tyrode medium, P < 0.05). The basal [Ca2+]i levels were similar in the two groups (young: 131 +/- 12 nM, n = 5; old: 118 +/- 10 nM, n = 4, P > 0.05). The magnitude and time course of the [Ca2+]i response to field stimulation were also similar in the two groups. It is concluded that aging seems to have little effect on the neuromuscular activities of rat urinary bladder. However, the calcium homeostasis may be altered as evidenced by the increased sensitivity to diltiazem and low extracellular calcium.

Aging↗
PubMed1996

Q-switched ruby laser in the treatment of nevus of Ota.

The purpose of this study is to evaluate the efficacy of Q-switched ruby laser in the treatment of nevus of Ota, a pigmented lesion on the face. The Q-switched ruby laser has been shown to remove tattoos without scarring. With this in mind, the nevus of Ota with pigmented cells in the dermis could be effectively treated with Q-switched ruby laser. Eighty patients (19 men, and 61 women) with nevus of Ota on the face were enlisted to be tested in evaluating the efficiency of Q-switched ruby laser therapy. The age of patients ranged from 1 to 62 years. The energy fluence used varied from 6 to 8.5 J/cm2. Treatment intervals ranged from 4 to 16 weeks, and the number of treatment sessions varied between 1 to 9 visits. During a 2-year follow-up period, more than fifty percent removal of nevus-pigment was noted in 64 of the 80 patients. Transient hyperpigmentation was noted in 32 patients lasting for 2 to 6 months after treatment; transient hypopigmentation was seen in 3 cases which recovered within one year. No patients had permanent textural or pigmentary changes or scarring. Q-switched ruby laser therapy appears to be an effective and safe modality for the treatment of nevus of Ota.

Adolescent↗
PubMed1996

Treating benign prostatic hyperplasia with finasteride in Chinese men: one-year experience.

To evaluate the long-term efficacy and safety of finasteride in the treatment of symptomatic benign prostatic hyperplasia (BPH), 50 patients with symptomatic BPH were initially evaluated in a double blind, placebo-controlled study for 6 months. The patients were then treated with finasteride in an open extension study in which all received the same dose of finasteride (5 mg/day) for another 6 months. Among the patients (n = 23) who completed the extension study, prostate volume was significantly reduced from baseline by 15%, maximum urine flow rate improved by 1.9 mL/second, symptom scores improved by 37% and serum prostatic specific antigen (PSA) level decreased by 1.34 ng/mL. Other than serum PSA level, these data differed insignificantly from data at the end of the first 6 months. The adverse events observed at the end of the first 6 months (two patients with decreased sexual libido and two with impotency) persisted throughout the study extension period. At the end of the 12 months study, one more patient reported decreased libido. The sustained clinical efficacy and low incidence of side-effects of daily treatment with finasteride 5 mg for 1 year indicate that finasteride is safe and effective for managing symptomatic BPH in Chinese men.

Aged↗