Biomedical subjects

K Y Hsu

Publications and source records attributed to K Y Hsu.

At least 37 records · Page 2Linked to original sources

PubMed1997

Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report.

Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.

Aged↗

PubMed1997

Low-flow anesthesia in adult orthotopic liver transplantation: a preliminary clinical experience.

BACKGROUND: Anesthesia in orthotopic liver transplantation (OLT) may carry with complex hemodynamic, body temperature, and metabolic alterations. Although OLT cases increased in recent years in Taiwan, experiences remained limited. Notable advantage of low flow anesthesia may include reduced consumption of anesthetic gases and vapors, reduced environmental pollution and cost-saving. This study investigated patient profiles and the feasibility of low-flow rebreathing technique for adult orthotopic liver transplantation. METHODS: Since June 1996, there were six OLT patients who received low flow anesthesia with isoflurane. All patients received hepatic veno-venal anastmosis (so-called piggy back procedure). Two patients were excluded from this study because of different surgical procedure (total occlusion of inferior vena cava and inferior vena cava veno-venal anastmosis). During maintenance of anesthesia, isoflurane was carried by a mixture of oxygen and air at a total fresh gas flow of 0.6 L/min. Alongside with the standard anesthesia machine and physiologic monitors, a newly designed Swan-Ganz catheter was introduced to measure and record cardiac output, systemic vascular resistance, pulmonary artery pressure, central venous pressure, and core temperature in a real-time manner. Blood samples were collected at 6 predetermined time-points in each patient for analysis of arterial blood gases, electrolytes, lactate and glucose concentrations. RESULTS: The anesthetic time was 916 +/- 26 min (900 to 930 min). All patients regained their consciousness within 30 min after completion of surgery. The hemodynamics were relatively stable except after reperfusion of the liver. There was a significant decrease in mean arterial blood pressure, which occurred with accompaniment of a reduction of systemic vascular resistance and increased cardiac output. Arterial blood gas, electrolyte, and glucose were, however, maintained within acceptable limits. Blood lactate was progressively increased and reached its peak after reperfusion of the liver until the end of surgery. The core temperature was well maintained above 34 degrees C. No patient developed hypoxia or hypercapnia. CONCLUSIONS: Low-flow rebreathing anesthetic technique maintained acceptable patient profiles and good body temperature preservation in orthotopic liver transplantation. These characteristics make it a promising method in maintenance of anesthesia for OLT.

Adult↗

PubMed1997

Propofol anesthesia in a patient with Isaacs syndrome--report of a case and literature review.

Isaacs syndrome is an unusual lower motor neuron disease characterized by myokymia (muscle twitching), muscular stiffness, and decreased tendon reflexes. We reported a patient who was affected with this rare disease, with manifestation of involuntary muscular contractions and required general anesthesia for bilateral tonsillectomies. Understanding the presentation and characterization of this unusual disease may be helpful in making choice of anesthetics or anesthetic techniques. Its possible mechanisms of action and its specific considerations in anesthesia in the literature are reviewed and discussed.

Adult↗

PubMed1996

Determination of p-aminobenzoic acid and its metabolites in rabbit plasma by high-performance liquid chromatography with fluorescence detection.

A simple, accurate and sensitive high-performance liquid chromatographic method with fluorescence detection was used for measuring plasma concentrations of p-aminobenzoic acid (PABA) and its three metabolites: p-acetaminobenzoic acid (PAABA), p-aminohippuric acid (PAHA) and p-acetaminohippuric acid (PAAHA). A Cosmosil MS-C18 column (250 x 4.6 mm, 5 microns) was used under temperature control at 40 degrees C. The mobile phase was H2O-CH3CN-CH3COOH (100:3:1, pH 4.0) with a flow-rate of 1.5 ml/min. The excitation and emission wavelengths for fluorescence detection were set at 270 and 350 nm, respectively. Plasma samples (200 microliters) were acidified by the addition of 150 microliters of 1 m HClO4 solution containing salicylic acid (SA) as the internal standard. After centrifugation, 30 microliters of the supernatant were injected onto the column. Using this method, PABA and its three metabolites could be determined within 25 min. Within the investigated concentration ranges of PABA (0.1-50 micrograms/ml), PAABA (0.2-50 micrograms/ml), PAHA (0.1-50 micrograms/ml) and PAAHA (0.5-50 micrograms /ml), good linearity (r > 0.99) for the standard curves was obtained. The validation of this method showed coefficient of variance (C.V.) that was well below 15% for all compounds. After intravenous (i.v.) administration of PABA (20 mg/kg) to rabbits (n = 7), PABA followed a one-compartment open model elimination with a half-life of 10.90 +/- 1.03 min. The mean half lives for PAABA, PAHA and PAAHA were 24.61 +/- 6.42, 12.81 +/- 6.04 and 11.27 +/- 2.77 min, respectively.

4-Aminobenzoic Acid↗

PubMed1996

Comparison of "inside-out" and "outside-in" interference screw fixation for anterior cruciate ligament surgery in a bovine knee.

Despite numerous advances in graft fixation with anterior cruciate ligament (ACL) reconstruction, few studies have compared the fixation strength of interference screws placed "outside-in" and from "inside-out" techniques. To compare techniques, a bovine model was designed to fail at the femoral tunnel bone-screw interface. Twenty-four fresh bovine knees were stripped of all soft tissues except the ACL. The native ACL was loaded the failure at a strain rate of 50 cm/min with the knee flexed 45 degrees. One standardized femoral tunnel was created on all specimens. A 3/32-inch guide pin was drilled into the center of the ACL femoral origin and overreamed with an 11-mm reamer from inside-out until the lateral cortex was reamed. Consistently sized patellar bone blocks were created (8 x 5 x 25 mm) with an 8-mm tendon width. The bone blocks were randomized to an "inside-out" (group 1) and "outside-in" (group 2) technique. Bone blocks were secured with a 7 x 25 interference screw. Specimens were mounted with the femoral tunnel and bone block aligned parallel to the tensile force and strained to failure at 50 cm/min. Failure of the native bovine ACL occurred at a mean of 2,304 N (SD +/- 472 N; n = 24). The mode of failure for group 1 was 9 of 13 at the bone-screw interface and 4 of 13 interligamentous failures. The mode of failure for group 2 was 7 of 11 at the bone-screw interface, 3 of 11 interligamentous, and 1 bone block failure. The mean load to failure for group 1 was 1,151 N (SD +/- 320 N, n = 13) including the four ligamentous failures and 1,143 N (SD +/- 306 N, n = 9) excluding the ligamentous failures. The mean load to failure for group 2 was 1,017 N (SD +/- 262 N, n = 11), including all specimens and 843 N (SD +/- 262 N, n = 7) excluding the interligamentous and bone block failure specimens. The "inside-out" technique averaged 100 N greater fixation strength than the "outside-in" technique. Statistical analysis using two-sample Student's t-test showed no statistically significant differences between group 1 and group 2. Both techniques demonstrate comparable maximum load to failure in a bovine model tested at 50 cm/min.

Animals↗

PubMed1996

Ankle arthrodesis with cross screw fixation. Good results in 36/40 cases followed 3-7 years.

Tibiotalar arthrodesis by an anterior approach, using internal compression with cancellous crews, offers wide exposure, good possibilities of correcting deformities, and good bony apposition. From 1987 to 1991, we used this technique in 42 ankle joints (40 patients). The indications were posttraumatic arthrosis, sequelae of septic arthritis, necrosis of the talus and failed ankle arthrodesis. In 13 ankles with severe deformity, a bone graft was also used. 38 patients (40 ankle joints) were available for follow-up after 4 (3-7) years. Solid union was achieved in 38 ankles after an average of 13 weeks. The clinical result was good-to-excellent in 36 ankles. We conclude tha this is a simple and effective method for ankle arthrodesis in both low-risk and, coupled with bone grafting, in properly selected high-risk patients.

Adult↗

PubMed1996

Anatomic position of a herniated nucleus pulposus predicts the outcome of lumbar discectomy.

The purpose of this study was to determine whether the anatomic position of a lumbar disc herniation has any significant effect on the clinical outcome of lumbar discectomy. Between January 1988 and March 1993, 80 patients with simple disc herniations underwent lumbar discectomy for herniated nucleus pulposus. We reviewed preoperative computed tomography scans after discography and magnetic resonance imaging of the lumbar spine. Disc herniations were classified as central, paracentral, intraforaminal, extraforaminal, or multiregional broad-based protrusions. The Smiley-Webster evaluation scale, which divided patients into groups with excellent, good, fair, and poor clinical outcome and evaluated the long-term need for pain medication, was applied. The post-operative evaluation period ranged from 6 to 48 months. The clinical outcome was then correlated with the different positions of herniations. The frequencies of the clinical outcomes were compared using the chi 2 test. We found a poorer clinical outcome that was statistically significant in patients with central herniations and with multiregional protrusions. Most herniations occurred at the L4-L5 level (58.7%). However, the level of disc herniation was not found to be a predictor of clinical outcome. Form and anatomic position of the lumbar disc herniation are of prognostic value for the outcome of lumbar discectomy. Further studies are required to confirm our preliminary results and eventually help improve surgical indications for lumbar discectomy.

Adult↗

PubMed1996

Distal chevron osteotomy with intra-articular lateral soft-tissue release for treatment of moderate to severe hallux valgus deformity.

We retrospectively reviewed the results of 32 patients (38 feet), with hallux valgus angles between 35 degrees and 60 degrees, who were treated by standard distal chevron osteotomy and intra-articular lateral soft tissue release. The average follow-up period was 5.2 years (4-7 years). The preoperative intermetatarsal angle averaged 14.4 degrees, and the postoperative angle averaged 7.7 degrees. The preoperative hallux valgus angle averaged 42.7 degrees, and the postoperative angle averaged 18.8 degrees. Subjectively, the satisfaction rate in terms of symptom improvement, cosmetic appearance and function was over 90%. Avascular necrosis of the first metatarsal head was not found in our series, which indicated that additional lateral soft tissue release is not contraindicated in combination with chevron osteotomy. Based on the level of satisfaction in our series, we conclude that the combination of distal chevron osteotomy and intraarticular lateral soft tissue release has broader application than the chevron osteotomy alone for patients with hallux valgus deformity.

Hallux Valgus↗

PubMed1995

Determination of caffeic acid in rabbit plasma by high-performance liquid chromatography.

A simple and sensitive high-performance liquid chromatographic method involving UV detection was developed for determination of caffeic acid in rabbit plasma. A Lichrosphere CN column (250 mm x 4 mm I.D., 5 microns) was used as the stationary phase and the mobile phase consisted of 2% acetic acid solution at a flow-rate of 1.0 ml/min. The UV absorbance was monitored at 320 nm. The plasma sample was acidified by the addition of 0.01 parts of concentrated phosphoric acid (85%) to maintain caffeic acid stability. After a simple clean-up procedure, the limit of quantitation achieved was 0.1 micrograms/ml, and the standard curve was found to be linear over the concentration ranges of 0.1-2.0 micrograms/ml and 0.1-40 micrograms/ml. The coefficient of variation for within- and between-run precision and accuracy was less than 10%, and the recovery was 82.3%.

Animals↗

PubMed1995

Instrumented laparoscopic spinal fusion. Preliminary Results.

STUDY DESIGN: Seventeen consecutive patients underwent laparoscopic instrumented interbody fusions using custom-designed delivery instrumentation and "BAK" fusion cages; both are manufactured by Spinetech and the former was developed by the authors. The cases were performed at two spine centers under Food and Drug Administration investigational device evaluation clinical trials. OBJECTIVES: We expect this approach will maintain a high fusion rate with diminished hospitalization time, recovery time, patient discomfort, and expense. The rehabilitative aspects of the procedure are a great improvement over traditional fusion approaches. SUMMARY AND BACKGROUND DATA: Extraordinary advances in many endoscopic surgical fields have resulted in many endoscopic surgical fields have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The authors have developed prototype of delivery instruments for the current laparoscopic fusion cage delivery system. METHODS: The procedure is performed transperitoneally with carbon dioxide insufflation to enable video-assisted visualization through a 10-mm endoscope. Three 10-mm incisions and one 13- to 20-mm incision are required for one-level procedures. Two hollow titanium-threaded interbody implants are packed with autologous bone and inserted into the diseased interspace. RESULTS: Seventeen patients, with an average follow-up period of 8 months and a range of 6-12 months, underwent the procedure. There were 14 single-level fusions and three two-level fusions, all involving L4-S1 levels. There were two cases that required conversion to open procedures without sequelae; two patients had remote donor site wound infections eradicated with incision and drainage and antibiotics, and one patient required subsequent posterior spinal decompression because of a displaced endplate fracture. Average hospital stay was an average of 2 days, excluding two patients with complications and very prolonged stay. CONCLUSIONS: Although this procedure is associated with a long learning curve, the technique, once mastered, is effective and advantageous over current approaches to lumbar fusion. Operative time and hospital stay are expected to decrease with future instrumentation development and surgeon experience.

Adult↗

PubMed1995

Determination of (+)-catechin in plasma by high-performance liquid chromatography using fluorescence detection.

A high-performance liquid chromatographic method, using fluorescence detection, was developed for the determination of (+)-catechin in rabbit plasma. The procedure involved the precipitation of plasma protein using acetonitrile, followed by solid-phase adsorption onto alumina. After washing with water and methanol, the residue was vortex-mixed with perchloric acid solution to release the adsorbed (+)-catechin. Separation was performed on a reversed-phase column using an eluent consisting of phosphoric acid solution with 12% acetonitrile. The excitation and emission wavelengths were set at 280 and 310 nm, respectively. The retention times for (+)-catechin and the internal standard (deoxyhigenamine) were 6.87 and 8.47 min respectively, without any interference. Validations of accuracy and precision were satisfactory in both within- and between-run assays. All coefficients of variance were less than 6% and mean relative errors were within +/- 3.75%. The average recovery was 73.77%. The limit of detection and quantitation were 1 ng and 0.02 micrograms/ml, respectively. Application of this method was successfully assessed by intravenous administration of a 15 mg/kg dose of (+)-catechin in rabbits. This new method provides a simple, specific and sensitive determination for (+)-catechin in rabbit plasma and is suitable for pharmacokinetic studies.

Acetonitriles↗

PubMed1995

Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment.

STUDY DESIGN: This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period. OBJECTIVES: The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments. SUMMARY OF BACKGROUND DATA: The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3. METHODS: The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed. RESULTS: Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome. CONCLUSIONS: Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Adrenal Cortex Hormones↗

PubMed1995

The influence of pyruvic acid on the pharmacokinetics of sulphadiazine in rabbits.

During the past few years, acetylation polymorphism has been shown to be a proven, established fact, and N-acetyltransferase, an enzyme that transfers an acetyl group to the substrate, has been recognized as the main factor in acetylation polymorphism. In a recent study, a significant difference between the acetylation phenotype and plasma pyruvic acid (PA) concentration in rabbits was found. In this report, the influence of PA on the pharmacokinetics of sulphadiazine (SDZ), a drug that has been used in pharmacogenetic studies of acetylation, was studied. By using a loading dose of 300 mg kg-1, and an infusion rate of 7.5 mg min-1 kg-1 of PA, the concentration of PA reached a steady state (Css approximately equal to 100 micrograms mL-1) in 30 min. During PA infusion in rapid-acetylation rabbits, no significant changes were found in any of the pharmacokinetic parameters for SDZ. However, differences were found in the beta half-life, AUC, clearance, and k10 of SDZ in slow acetylators: the beta half-life decreased from 115.74 +/- 12.47 min to 62.96 +/- 4.36 min (p < 0.001); AUC decreased from 10,617.38 +/- 1179.81 micrograms min mL-1 to 6217.14 +/- 391.32 micrograms min mL-1 (p < 0.001); clearance increased from 0.0044 +/- 0.0008 L min-1 kg-1 to 0.0068 +/- 0.0007 L min-1 kg-1 (p < 0.001); and k10 increased from 0.0090 +/- 0.0009 min-1 to 0.0193 +/- 0.0028 min-1 (p < 0.005). The reason for this may be that PA influences the elimination of SDZ in slow-acetylation rabbits.

Acetylation↗

PubMed1995

Surgical treatment of second primary lung cancer: report of eight cases.

Of 312 patients undergoing resection for lung cancer at National Taiwan University Hospital during 1980 to 1990, eight presented with second primary lung cancer. One patient had synchronous and seven patients had metachronous primaries. There were five males and three females with ages ranging from 41 to 77 years. In the metachronous group, two patients had a different histology between the first and the second tumor, and the intervals between the two tumors varied from 12 to 60 months. The initial resections included pneumonectomy in one and lobectomy in six patients. At the second operation, the surgical procedures included lobectomy in three, completed pneumonectomy in one, segmentectomy in another, and wedge resection in two patients. There was no operative mortality and all patients were regularly followed up from 6 months to 6 years after the second operation. Two patients died, one from repeated respiratory tract infection and the other from brain metastasis. Kaplan-Meier analysis showed 2-year and 3-year survivals of 80% and 60%, respectively. It can be concluded that surgical resection for second primary lung cancer is justified, as it can prolong the patient's survival. Lobectomy can be performed for patients with a second primary lung cancer and sufficient lung reserve, but limited resection should be chosen for patients with poor lung reserve.

Adult↗

PubMed1995

Correction of foot deformity by the Ilizarov method in a patient with Segawa disease.

Hereditary progressive dystonia, or Segawa disease, is rare. Diagnosis depends on typical clinical features with normal laboratory findings. It responds well to levodopa treatment. This article contains a case report of a patient with Segawa disease with a fixed equinovarus foot. A 21-year-old woman was diagnosed with Segawa disease since she was 8 years old; she became wheelchair dependent at the age of 15. The dystonia responded well to levodopa, except for the fixed-foot deformity. The deformity was corrected successfully by the Ilizarov method. The patient returned to independent ambulation after surgery. Because similar types of foot deformities appeared in several progressive degenerative neurologic diseases, the treatable Segawa disease should be added to the list of differential diagnoses of progressive degenerative neurological diseases with talipes equinovarus.

Adult↗

PubMed1994

Successful treatment of hereditary progressive dystonia--a case report.

Hereditary progressive dystonia or Segawa disease is a very rare disease. Diagnosis depends on typical clinical features with remarkably good response to levodopa and normal laboratory findings. Here, we report on a unique case of Segawa disease with a fixed equinovarus foot. The patient was a twenty one year old female with the typical clinical manifestations since eight years of age who became wheel-chair dependent at the age of fifteen. The dystonia responded well to levodopa except for the foot deformities. The foot deformities were successfully corrected by use of the Ilizarov apparatus and she ambulated freely at follow up. Since several similar foot deformities appeared in the early stage of a progressive neurological degenerative disease, the treatable Segawa disease should be added to the differential diagnosis when facing a patient with pes equinovarus.

Adult↗

PubMed1994

Irreducible volar rotatory dislocation of the proximal interphalangeal joint.

Volar rotatory dislocation of the proximal interphalangeal (PIP) joint often cannot be reduced by closed manipulation because of interposition of soft tissues. In this case, the condyle of the proximal phalanx was trapped between the central slip and the lateral band. This case is reported to reemphasize the importance of recognizing serious injuries involving the soft tissues around the PIP joint. Deprival of its normal dorsal stabilizing forces can cause a loss of both static and dynamic joint support. Secondary scarring and contractures affect all damaged structures of the joint.

Adult↗

PubMed1994

Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.

Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.

Adult↗