Assessment of electromyocardial continuity in conjoined (thoracopagus) twins.
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Electrocardiography↗
Biomedical subjects
M H Wu
Publications and source records attributed to M H Wu.
Surgical implications of juxtaposed atrial appendages and the associated anomalies.
Juxtaposition of the atrial appendages (JAA) is an uncommon anomaly of the heart that is frequently associated with other cardiac abnormalities, such as transposition of the great arteries and tricuspid atresia. We encountered 7 patients with JAA from July 1984 to July 1989 at National Taiwan University Hospital. The JAA was right-sided in 1 patient and left-sided in 6. The patients' ages ranged from 10 months to 12 years. The cardiac anomalies in the patient with right JAA were double-outlet right ventricle and ventricular septal defect, which was repaired with a patch. Of the 6 patients with left JAA, 5 had transposition of the great arteries, and in 3 of them obstructive tricuspid lesions (tricuspid stenosis in 1, tricuspid atresia in 2) were noted. Three patients with left JAA and normal tricuspid valve underwent total correction (one Senning operation and two Rastelli operations). The other 3 patients with tricuspid obstruction underwent total cavopulmonary connection (2) and Fontan operation (1). We concluded that, first, left JAA was more frequently seen and associated with more morbid anatomy than right JAA. Second, if left JAA is discovered in planning biventricular repair for transposition of the great arteries, the tricuspid valve should be inspected carefully to rule out tricuspid obstruction.
Child↗
Aortoesophageal fistula induced by foreign bodies.
Two patients with aortoesophageal fistula induced by foreign bodies were surgically treated during a period of 10 years. The first patient was surgically treated through a right thoracotomy, which failed on account of exsanguination. In the second patient, a Sengstaken-Blakemore tube was inserted for esophageal tamponade. The aorta was successfully repaired through a left thoracotomy after occlusion of the esophagus and the aorta above and below the fistula. Therefore, we recommend preoperative esophageal tamponade and occlusion of the esophagus and the aorta through a left thoracotomy as the most successful approach.
Adult↗
Esophageal reconstruction for esophageal strictures or resection after corrosive injury.
A total of 75 esophageal reconstructions were performed for caustic esophageal strictures (65 patients) or postcaustic resection (10 patients) at Naval General Hospital and National Cheng-Kung University Hospital from September 1976 to April 1991. Reconstructive procedures included bypass in 61 patients, replacement of the esophagus through the substernal route in 10, and replacement of the esophagus through the posterior mediastinum in 4. Esophageal substitutes used for reconstruction were a long segment of the ileum and the ascending colon in 42 patients; a short segment of the ileum and the ascending colon in 18; the ascending colon and transverse colon in 3; the ascending, transverse, and left colon in 1; the transverse and left colon in 6; the jejunum in 2; and the stomach in 3. All but two of the esophageal substitutes were isoperistaltic. There were 28 postoperative complications in 24 (32%) of the 75 patients. Cervical anastomotic leakage occurred in 5 patients (6.7%). There were no operative deaths. Postoperatively, swallow function was considered good in 67 patients (89.3%). In this experience, isoperistaltic transposition of the transverse and left colon provided the best results.
Adolescent↗
[Determination of oleanolic acid in Achyranthes bidentata BLume and its preparations by supercritical fluid chromatography].
Capillary SFC was used for the determination of oleanolic acid in Achyranthes bidentata BLume and its preparations Tianmawan, Jinguishenqiwan and Hechedazaowan. The amount of oleanolic acid in the root of Achyranthes bidentata BLume was 1.75-2.19% (mean +/- SD = 1.94 +/- 0.17%). The limit of detection was 9.605 x 10(-11) g. The method is highly sensitive, accurate, reproducible, simple, rapid and specific, so, it can be extensively used for the determination of other preparations and crude herbs.
Chromatography↗
Surgery for malignant involvement of the superior vena cava.
This study reviews surgical operations on seven patients with intrathoracic tumors involving the superior vena cava (SVC). Among these patients, five were found to have advanced bronchogenic carcinoma; one was found to have thyroid carcinoma; and another was found to have thymic carcinoma. The incidence of SVC involvement in resectable lung cancer patients at the National Cheng-Kung University Hospital was 5.8% (5/85). Total excision of SVC was done in three patients and three different prostheses (ringed GoreTex, woven Dacron and pericardial tube graft) were interposed. Four patients underwent partial excision and repair: one by direct suture and three by autologous pericardial patch. A temporary SVC-right atrium internal shunt was used in two of these seven patients. The mean time of SVC cross-clamping in five patients was 20 minutes (10-28 minutes), and the mean value of the central venous pressure at the time of SVC cross-clamping was 34 mmHg (18-54 mmHg). There were no operative deaths or neurologic sequels. Venography or computed tomography obtained 7-100 days after surgery demonstrated all but one to be patent. In conclusion, SVC reconstruction with concomitant tumor resection can be performed if a patient fulfills the following criteria: 1) there is no distant metastasis; 2) a radiosensitive or chemotherapy-effective tumor has been ruled out; and 3) total SVC occlusion or prominent collateral circulation should be avoided.
Adult↗
Blood levels of platelet-activating factor in endotoxin-sensitive and endotoxin-resistant mice during endotoxemia.
Platelet-activating factor (PAF) is a phosphoglyceride secreted by a variety of cells and has been implicated in endotoxin toxicities. To further confirm its role in endotoxin-induced tissue injuries and death, we conducted an experiment on endotoxin-resistant (C3H/HeJ strain) and endotoxin-sensitive (C3H/HeN strain) mice. The experiment consisted of three parts: 1) the LD50 of endotoxin from E. coli 0127:B8 cells was quantitated in C3H/HeN mice; 2) the lethality of PAF in C3H/HeJ mice at a dose lethal to C3H/HeN mice was determined; and 3) the blood levels of PAF in C3H/HeJ and C3H/HeN mice were measured after a dose of endotoxin lethal to the C3H/HeN strain was injected. PAF contained in the blood samples was extracted by a solid phase procedure and assayed by a radioimmunoassay method. The results showed that endotoxin-resistant and endotoxin-sensitive mice were equally susceptible to death induced by the same lethal dose of PAF. After injection with endotoxin, the blood PAF levels in C3H/HeN mice increased significantly (p < 0.01) at 60 minutes and 90 minutes, with a peak level three times that of the control group. The blood PAF levels in C3H/HeJ mice, however, remained unelevated throughout the experiment. The timing of the occurrence of the peak blood PAF level in the C3H/HeN mice corresponded with the emergence of their illness from the endotoxin injection. These findings shed new light on our understanding of the resistant mechanisms of C3H/HeJ mice to bacterial endotoxin and affirm the possible role of PAF in mediating endotoxin toxicities.
Animals↗
Total cavopulmonary connection for surgical treatment of complex congenital heart disease.
Diversion of vena caval flow directly into the pulmonary circulation--total cavopulmonary connection--has been tried at our hospital for two years as an alternative to the modified Fontan procedure for surgical treatment of complex congenital heart disease other than tricuspid atresia in 26 cases with six operative mortalities. The causes of death were low cardiac output in four, uncontrollable paroxysmal supraventricular tachycardia in one and airway obstruction in one. Except for one late death which occurred three months after surgery due to sepsis, the 19 patients who survived the operation were followed up for four to 27 months (mean 15 months). All of them improved clinically (NYHA Class 1). Graded bicycle exercise tests were performed in five of them at three to 12 months after surgery, and their exercise tolerance was comparable to that of patients with an atriopulmonary connection. In conclusion, total cavopulmonary connection is an acceptable alternative to the modified Fontan operation for surgical treatment of complex congenital heart disease, although longer follow-up is necessary.
Adolescent↗
Efficacy of balloon valvuloplasty in treating mild pulmonary stenosis.
Balloon pulmonary valvuloplasty (BPV) is a well accepted treatment for moderate and severe pulmonary stenosis. However, the efficacy of BPV in treating mild pulmonary stenosis is still unanswered. Therefore, the efficacy of BPV in treating patients with mild pulmonary stenosis was compared to that in treating patients with moderate or severe pulmonary stenosis. A total of 46 patients with pulmonary stenosis were arbitrarily divided into 3 groups; Group I consisted of 9 patients with a pressure gradient less than 40 mm Hg, Group II consisted of 5 patients with a pressure gradient ranged from 40 to 50 mm Hg, and Group III consisted of 32 patients with a gradient greater than 50 mm Hg. Following BPV, the gradient reduced significantly in all 3 groups (p less than 0.05 in each group). The efficacy of BPV in the 3 groups was evaluated and compared by two parameters; one is the percentage of gradient reduction, the other is the right ventricular pressure ratio (RV post-bpv/RV pre-bpv). The percentage of gradient reduction in Group I, II, and III were 28 +/- 20, 55 +/- 17 and 70 +/- 9% respectively. The right ventricular pressure remained 84 +/- 11, 59 +/- 16, and 46 +/- 12% of pre-valvuloplasty level in Group I, II and III respectively. If the efficacy of BPV was compared among the 3 groups. Groups III had the best efficacy and Group I had the worst.(ABSTRACT TRUNCATED AT 250 WORDS)
Catheterization↗
Comparison of the therapeutic efficacy and side effects of a single dose of levo-praziquantel with mixed isomer praziquantel in 278 cases of schistosomiasis japonica.
A randomized double-blind study comparing the therapeutic efficacy of single dose of levo-praziquantel and mixed isomer praziquantel was carried out on 139 matched pairs of patients with schistosomiasis japonica. A single dose of either levo-praziquantel (20 mg/kg) or praziquantel (40 mg/kg) was given to each patient. Four and six months after treatment, the stool ova negative conversion rates were 94.85% and 96.27% for the levo-praziquantel group, and 97.06% and 94.03% for the praziquantel group, respectively; there was no statistically significant difference between the two treatments (P greater than 0.05). For lightly and moderately infected patients, a single 20 mg/kg dose of levo-praziquantel was as efficacious as 40 mg/kg of praziquantel. Moreover, levo-praziquantel produced fewer side effects than praziquantel. These results suggest that levo-praziquantel is the component of the mixed isomer preparation that is antihelminthic. Levo-praziquantel could be used therapeutically at half the current dose of the mixed isomer drug.
Adolescent↗
Junctional ectopic tachycardia in infancy: report of two cases.
Junctional ectopic tachycardia (JET) in infancy is one of the serious arrhythmias which can be fatal. Typical features of JET include rapid and irregular heart beats with atrioventricular dissociation. Two cases of JET are reported: Case 1 was a 35-week-gestational age newborn who was found to have hydropsy and fetal tachycardia at the 21st week of gestational age. Antiarrhythmic agents including digoxin, propranolol and verapamil were administered to his mother to treat the fetal arrhythmia without success. JET was recognized at birth which was spontaneously converted into a sinus rhythm at 1 month of age. The maternal history revealed that two previous pregnancies ended in hydrops fetalis, and one of these was documented to have fetal tachycardia. Case 2 was a 6-month-old male infant with JET and congestive heart failure. After failure of various antiarrhythmic agents, amiodarone finally slowed down his heart rate and controlled his congestive heart failure.
Anti-Arrhythmia Agents↗
Comparative efficacy of levo-praziquantel and praziquantel in treatment of schistosomiasis japonica at a single dose.
The result of a randomized double blind comparison of therapeutic efficacy of single doses of levo-praziquantel (L-PZQ) and praziquantel (PZQ) in the treatment of 139 matched pairs of proved cases of schistosomiasis japonica was reported, 268 were chronic early cases and 10 were late cases. The dosage of L-PQZ was 20 mg/kg, and that of PZQ was 40 mg/kg. Four and 6 months after treatment the stool-ova negative conversion rates were 94.8% and 96.3% for the L-PZQ group, and 97.1% and 94.0% for the PZQ group respectively (P greater than 0.05).
Adolescent↗
Left ventricular-to-right atrial shunt in perimembranous trabecular ventricular septal defect with aneurysmal transformation.
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Heart Aneurysm↗
Unusual phrenic arteriovenous malformation mimicking pulmonary sequestration with heart failure: two cases successfully treated by surgery.
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Aortography↗
Aortico--left ventricular communication: report of a case.
An 11-month-old male infant whose condition had been followed since birth was referred to the National Taiwan University Hospital for management of a congenital heart disease. On admission, this infant was noted to have a systolic and diastolic precordial thrill and a grade 4/6 systolic and diastolic murmur. Echocardiography, cardiac catheterization and cineangiogram revealed aortic stenosis, aortic regurgitation and dilatation of the aortic root. Surgical repair was performed to correct this congenital anomaly due to the progressive congestive heart failure. Intraoperatively, a breach between the aortic valve and the edge of the sinus of Valsalva along the aortic annulus was found. This congenital defect was repaired with a Teflon patch successfully. Postoperatively, this patient convalesced steadily and was discharged. We report this unique case with aortico-left ventricular communication which we believe to be the ninth case in the English-language literature and the first in the Republic of China.
Aortic Aneurysm↗
Sleeve resection of congenital tracheal stenosis associated with pulmonary artery sling: report of a case.
A 20-month-old boy was diagnosed as having congenital tracheal stenosis associated with left pulmonary artery sling. A tracheal segmental resection with transposition of the left pulmonary artery out of the vascular sling via right thoracotomy was performed using high frequency jet ventilation. The above procedure was used instead of traditional vascular transposition through a left thoracotomy. Postoperatively, the bronchoscopic view of the trachea was patent.
Humans↗
Acute duodenal ulcer.
A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers.
Acute Disease↗
Thoracoscopy in the diagnosis of pleural effusions.
Between January 1981 and December 1986, thoracoscopies were carried out on 152 patients in order to evaluate the diagnostic accuracy of the technique in cases of pleural effusion. All patients had previously undergone a thoracentesis together with an unguided pleural biopsy but had remained undiagnosed. Of them, 74 cases were confirmed as malignant; the others were benign. In 71 of the 74 cases of malignant pleural effusion, an accurate diagnosis had been obtained from the thoracoscopy and guided pleural biopsy, a diagnostic accuracy of 94.6%. Among 78 cases, diagnosed by the thoracoscopy as benign pleural effusion, there were 63 cases of tuberculosis and 15 of non-specific pleurisy. Nine of the 15 cases of non-specific pleurisy showed no evidence of malignancy after being under observation for between six and 30 months, the remaining six cases being lost in the follow-up. No complication arose in our series. We conclude that thoracoscopy is a safe and useful diagnostic procedure for pleural effusion.
Adult↗