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Biomedical subjects

M S Chern

Publications and source records attributed to M S Chern.

At least 55 records · Page 3Linked to original sources
PubMed1995

Decision support system for individualized nursing procedures: SAPIEN-Tx.

The present work proposes a Decision Support System for nursing procedures: SAPIEN-Tx. The discussion includes the acquisition, modeling , and implementation of nursing expertise professionals in Renal Transplant. It was developed to obtain better quality healthcare services, as well as an effective contribution to the nursing professional in the global assistance of their clientele. We used the KADS methodology to develop the system knowledge base. This methodology permitted us to perform the knowledge modeling with quality and organization. In opposition to the old method, errors were detected before the implementation, avoiding possible modification on the whole project structure.

Brazil↗
PubMed1994

Urgent/emergent percutaneous transvenous mitral commissurotomy.

Urgent/emergent percutaneous transvenous mitral commissurotomy (PTMC) was performed in 10 patients (two men and eight women, aged 21 to 60 yr). All patients had arterial hypoxemia and four required mechanical respirators. PTMC was performed in the semi-recumbent position in four patients. The seven patients with pliable valves (group 1) achieved good hemodynamic and echocardiographic results after PTMC, but one died 2 wk later because of sepsis complicating preexisting pneumonitis. The two pregnant patients uneventfully delivered normal babies at term. There was continued clinical improvement in the six surviving patients at last follow-up at 11 to 39 mon (median 26). Of the three patients with calcified valves and severe subvalvular lesions (group 2), the premoribund patient in whom last-resort PTMC created severe mitral regurgitation died 3 days later of multiple organ failure. The other two patients underwent mitral valve replacement 1-6 days later because of lack of clinical improvement due to creation of severe mitral regurgitation and ineffective mitral valve dilation, respectively. In conclusion, urgent/emergent PTMC is feasible and safe. However, its outcomes are dictated by the status of diseased mitral valve and coexisting illness.

Adult↗
PubMed1994

Estimation of pulmonary artery pressure from pulmonary vein wedge pressure.

Correlations between pulmonary artery and pulmonary vein wedge pressures were investigated in 13 patients with atrial septal defect and 1 patient with Tetralogy of Fallot. Pulmonary vein wedge pressure wave form resembled that of pulmonary artery pressure, and the former lagged behind the latter by 70 to 110 msec (mean 88 +/- 14) as observed by the fluid-filled catheter system. Diastolic pulmonary artery and diastolic pulmonary vein wedge pressures were nearly identical. Although systolic and mean pulmonary artery pressures correlated well with respective pulmonary vein wedge pressures, there were discrepancies when systolic and mean pulmonary artery pressure exceeded 35 and 20 mm Hg, respectively. However, systolic and mean pulmonary artery pressures could be estimated by adding the difference between the diastolic pulmonary vein wedge pressure and the mean left atrial pressure to corresponding systolic or mean pulmonary artery pressure. In conclusion, pulmonary artery pressures can be estimated by measuring pulmonary vein wedge pressures and the mean left atrial pressure.

Adult↗
PubMed1994

Increased frequency of apolipoprotein B signal peptide sp24/24 in patients with coronary artery disease. General allele survey in the population of Taiwan and comparison with Caucasians.

Apolipoprotein B (apoB) signal peptide (sp) polymorphism was characterized by polymerase chain reaction in blood samples of 58 coronary artery disease (CAD) patients and 319 control individuals of Chinese Han ethnic origin in Taiwan. In the CAD group, 77% of the observed alleles were sp27 (sp with 27 amino acids), and the remaining 23% sp24 (sp with 24 amino acids). The frequency distributions of the apoB sp allele in the control group were 0.81 for sp27 and 0.19 for sp24. The genotype distributions were 0.64 sp27/27, 0.26 sp27/24 and 0.10 sp24/24 in the CAD group; 0.64 sp27/27, 0.33 sp27/24 and 0.03 sp24/24 in the control group. The frequency of sp24/24 was significantly higher (p = 0.012) in the CAD group than in the control group. Several studies have shown that the frequency of sp24/24 is higher in hyperlipidemic than in normolipidemic groups. This marker is probably in linkage disequilibrium with some other atherogenic genes. Our study shows that the differences in both apoB signal peptide alleles and sp27/27 and sp27/24 genotype distributions are statistically significant between the Taiwanese and Caucasians.

Adult↗
PubMed1994

Anomalous systemic arterial supply to normal basilar segments of the left lower lobe of the lung: a case report.

We present a patient who had suffered from mild hemoptysis for six years. Abnormal bronchovesicular breath sounds over the left lower lung filed were noted. The chest film also revealed infiltration over the left lower lung field. High-resolution computed tomography (HRCT), aortogram and pulmonary angiography demonstrated anomalous arterial supply to the basilar segments of the left lower lung without coexistence of pulmonary sequestration. Only total nine cases have been reported in English or Chinese literature. The improvement of diagnostic method has enabled an accurate diagnosis before operation with non-invasive examination. Also, this congenital abnormality may not be so rare if meticulously surveyed.

Adult↗
PubMed1994

Allergic bronchopulmonary aspergillosis: a report of three cases.

Allergic bronchopulmonary aspergillosis (ABPA), an uncommon but potentially destructive Aspergillus-associated pulmonary disease, is characterized by recurrent episodes of pulmonary infiltration and central bronchiectasis in patients with pre-existing asthma. It is important but difficult to find out ABPA from asthmatic patients because ABPA may lead to irreversible pulmonary fibrosis and there are much overlap in the clinical and laboratory findings between ABPA and asthma. However, once identified and treated early, patients with ABPA may respond well and the evolution to the end stage may be prevented. Here we report three documented cases of ABPA. One of them had no history of asthma but had the history of allergy to cosmetics. All three cases were suspected by the typical roentgenographic finding ("toothpaste" shadows) and were treated by short course of prednisolone with satisfactory clinical improvement.

Adult↗
PubMed1993

Pulmonary valvuloplasty in adults using the Inoue balloon catheter.

This report describes a new balloon pulmonary valvuloplasty technique using the Inoue balloon catheter performed in 14 consecutive adult patients, aged 17-47 years (mean 27). The mean right ventricular systolic pressure and the pulmonary valvular peak-to-peak systolic gradient decreased from 102 +/- 41 to 52 +/- 19 mm Hg (p = 0.001) and 81 +/- 40 to 7 +/- 7 mm Hg (p = 0.0002), respectively. An infundibular peak-to-peak systolic gradient either developed (n = 13) or increased (n = 1). None of the patients were treated with beta-adrenergic blockers before or after the valvuloplasty. Eight patients underwent repeat hemodynamic study 12-30 months (mean 17) after treatment, and had no evidence of valvular restenosis. The mean right ventricular systolic pressure and the mean infundibular peak-to-peak systolic gradient decreased, compared to the values immediately after valvuloplasty (54 to 40 mm Hg, p = 0.03, and 28 to 10 mm Hg, p = 0.03, respectively). The study suggests that pulmonary valvuloplasty in adults using the Inoue balloon catheter technique is feasible, safe, and effective.

Adolescent↗
PubMed1993

Prognosis after a first Q-wave myocardial infarction in ethnic Chinese people: a prospective study.

The prognosis after a first Q-wave myocardial infarction was investigated in 206 Chinese patients of 65 years or younger who had a predischarge cardiac catheterization and coronary angiography. Three patients studied were lost to follow-up. In the remaining 203 patients with ages of between 28 and 65 years, 101 (49.8%) had 0- or 1-vessel disease, 56 (27.6%) had 2-, and 38 (18.7%) had 3-vessel disease. Significant left main coronary artery stenosis was noted in 8 (3.9%). During a mean follow-up of 33 months, 33 (16.3%) patients had 36 episodes of cardiac events, and 16 (7.9%) died of cardiac causes. Stepwise logistic regression analysis revealed that the left ventricular ejection fraction and left main coronary artery disease were predictors of cardiac mortality, while age and the extent of coronary artery disease were predictors of total cardiac events. There was no variable that could predict recurrence of myocardial infarction.

Aged↗
PubMed1992

Imaging of multiple coronary artery fistulas to right ventricle by transthoracic and transesophageal echocardiography.

A 20-year-old woman presented with extremely rare multiple coronary artery fistulas with left circumflex and right coronary arteries as the feeding vessels and two distinct sites of drainage into the posterior wall of the right ventricle near the apex in close proximity. The large left fistula was well depicted by transthoracic echocardiography, whereas the transesophageal approach better delineated part of the smaller right fistula.

Adult↗
PubMed1992

Ultrasonically guided needle aspiration biopsy in the diagnosis of advanced superior vena cava syndrome.

From July 1990, 11 cases with advanced superior vena cava (SVC) syndrome were undergone ultrasonically guided needle aspiration or biopsy. Ten cases were diagnosed by thin-needle aspiration cytology. Two cases with cytologic proven lymphoma and one case without cytologic diagnosis were undergone needle biopsy, and two of them were proven to be lymphoma. The diagnostic rate of aspiration cytology was 91.0% (10/11) and of aspiration biopsy was 66.6% (2/3). The diagnostic rate of combination of aspiration cytology and biopsy was 100%. For reducing the incidence of pneumothorax, we strongly recommend this two-stage procedure that needle biopsy was performed only when cytologic diagnosis was not conclusive. Only one case developed pneumothorax in performing needle biopsy. In conclusion, ultrasonically guided needle aspiration biopsy is a safe, convenient, and high-yield diagnostic procedure for selected cases of advanced SVC syndrome.

Adult↗
PubMed1992

[Radiology of diffuse panbronchiolitis: experience in VGH-Taipei].

Eleven cases of diffuse panbronchiolitis (DPB) were reported. According to plain chest film (10 cases) and high-resolution computed tomography (HRCT) (11 cases) findings, all were grouped as x-ray type B or CT type II advanced stage. Among them, 4 cases were grouped between CT type II-III; 3, CT type III-IV. All 11 patients had history of chronic paranasal sinusitis (CPS). Three patients had HLA typing. 1 had positive HLA Bw54; 3, HLA Cw1. We suggested patient with CPS, positive HLA Bw54 and Cw1 typing and clinically suspected DPB, radiological study including HRCT should be done.

Adult↗
PubMed1991

Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy.

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 +/- 5.6 to 15.1 +/- 5.1 mm Hg), mean pulmonary artery pressure (39.7 +/- 13.0 to 30.6 +/- 10.9 mm Hg) and mitral valve gradient (13.0 +/- 5.1 to 5.7 +/- 2.6 mm Hg). Mitral valve area increased from 1.0 +/- 0.3 to 2.0 +/- 0.7 cm2 (p = 0.0001) and cardiac output from 4.4 +/- 1.4 to 4.7 +/- 1.2 liters/min (p less than 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score greater than 8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Erythrocyte Li-Na countertransport in hypertension: lack of atrial natriuretic peptide effect.

The rate of erythrocyte Li-Na countertransport and cellular Na+ and K+ contents have been determined in normotensive (NT) and hypertensive (HT, essential hypertension) subjects in the presence and absence of atrial natriuretic peptide (ANP). The rate of Li-Na countertransport was significantly higher in erythrocytes of HT subjects, while the Na+ and K+ contents were not different between the NT and HT groups. We found that ANP (10(-9) and 10(-7) M) had no effect on either the rate of Li-Na countertransport or the cellular Na+ and K+ contents. Since ANP does not influence erythrocyte Na pump and Na-K-Cl cotransport, our results suggest that the Na transport systems of human erythrocytes do not respond to ANP and this lack of response in Li-Na countertransport is independent of the status of hypertension. These findings are consistent with the view that the rate of Li-Na countertransport of erythrocytes may serve as a useful genetic marker for essential hypertension in Chinese. However, the erythrocyte transport systems cannot provide further differentiation utilizing ANP response for essential hypertension.

Adult↗
PubMed1991

[Bronchopulmonary sequestration and pseudosequestration].

Bronchopulmonary sequestration is a rare congenital anomaly in which part of the pulmonary tissue is detached from the normal lung without normal connection with tracheobronchial trees and pulmonary artery. It is supplied by anomalous systemic artery. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection and coexistent infection. It is presumed that chronically inflamed lung may activate neovascularization from systemic circulation in this strage, we reported 15 cases of all pulmonary sequestration and 1 case of pseudosequestration. Most of the cases were young adults with the mean age of 24.6 years old. The intralobar type comprised 86.6% of all cases. In 84.6% of the cases, the aberrant artery originated from the thoracic aorta. Preoperative diagnosis was gained in 47% of cases. In 80% of all cases, the chest mainly characterized with homogeneous mass lesion or cyst(s) with air-fluid level. The distinction between sequestration and pseudosequestration is a diagnostic challenge because the radiologic findings are similar between both conditions. There are clinically significant complications, such as recurrent infections or massive bleeding during operation.

Adolescent↗
PubMed1990

Long-term hemodynamic results of percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with pliable, non-calcified valves.

Percutaneous transvenous mitral commissurotomy (PTMC) for severe, symptomatic mitral stenosis was successfully performed in 47 of 50 patients with pliable, non-calcified valves. The procedure resulted in immediate hemodynamic and sustained clinical improvements in all patients. Repeat cardiac catheterization was performed in 22 patients at a mean follow-up period of 15 months (range 12 to 29). The patients were similar to the other 25 patients in regard to gender, age, clinical and hemodynamic characteristics. There were 4 males and 18 females with a mean age of 37 years (range 20 to 61). Immediately after PTMC, there were significant increases in the mitral valve area (1.0 +/- 0.2 to 2.4 +/- .9cm2, p less than 0.001) and cardiac index (3.1 +/- 0.7 to 3.3 +/- 0.7 l/min/m2, p less than 0.05) and significant (p less than 0.001) decreases in the left atrial pressure (25.7 +/- 6.4 to 13.2 +/- 3.9 mmHg), the mitral valve gradient (15.7 +/- 5.7 to 3.9 +/- 1.4 mmHg), mean pulmonary arterial pressure (41.5 +/- 10.7 to 29.2 +/- 10.9 mmHg) and the pulmonary vascular resistance (4.2 +/ 3.4 to 3.5 +/- 2.9 Wood unit). At follow-up study, the mitral valve area (2.2 +/- 0.7 cm2) and the left atrial pressure (12.6 +/- 3.7 mmHg) remained unchanged. There were further decreases in the mean pulmonary arterial pressure (22.4 +/- 5.9 mmHg, p less than 0.05) and the pulmonary vascular resistance (2.0 +/- 1.5 Wood unit, p less than 0.05). There were significant (p less than 0.05) increases in the mitral valve gradient (6.6 +/- 2.5 mmHg) and the cardiac output (3.6 +/- 0.7 l/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗