Biomedical subjects

Ming-Chih Chou

Publications and source records attributed to Ming-Chih Chou.

44 records · Page 3Linked to original sources

PubMedDate not supplied

Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis.

The bronchiectasis process is irreversible, and only resection of the involved bronchiectatic segments offers the possibility of potential cure. We present our experience in video-assisted thoracoscopic lobectomy for localized right middle lobe bronchiectasis in 16 patients. From July 1994 to June 2002, we enrolled 16 patients with right middle lobe bronchiectasis. There were nine women and seven men, with a mean age of 39.7 years (range, 21-67 years). The mean duration of symptoms such as hemoptysis and chronic purulent productive cough was 7.3 years (range, 2-19 years). Surgical indications included repeat pulmonary infection with often abundant purulent, sometimes fetid, expectoration in eight patients (50%), frequent massive hemoptysis in four patients (25%), and both repeat pulmonary infection and hemoptysis in four patients (25%). During operation, all patients were placed in left lateral position under double-lumen intubated anesthesia. Three incisions were needed. One 1-cm incision for the camera port was created at the seventh intercostal space along the anterior axillary line and the other 1- and 4-cm incisions were created at the seventh and fifth intercostal spaces along the midclavicular line. Right middle lobectomy could be completed by use of either traditional or endoscopic instruments. The mean total operative time was 87 minutes (range, 60-110 minutes). The mean hospital stay was 6 days (range, 4-11 days). One patient suffered from a mild hemothorax complication that needed 10 days of pleural drainage. There was no surgical mortality in this study. The mean follow-up period was 45 months (range, 10-94 months). Overall, 14 (87.5%) patients were asymptomatic, and the other 2 (12.5%) obtained apparent symptomatic improvement after operation. Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis is technically feasible using our approach and is potential safe in treating patients with localized right middle lobe bronchiectasis.

Adult↗

PubMedDate not supplied

Video-assisted thoracic surgery for spontaneous pneumothorax: outcome of 189 cases.

The crucial role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is well acknowledged today. Experiences of such patients undergoing VATS were reported to evaluate the feasibility of such surgical approach. From January 1, 1996 to January 1, 2002, 189 patients (18.3%) underwent VATS treatment for first onset or recurrent primary pneumothorax (n = 134), secondary pneumothorax (n = 49), and re-do VATS (n = 6) pneumothorax of 1034 VATS procedures performed by one surgeon. The surgical approaches for these patients were through scope and working ports, and in six (3.2%) of them, the procedures were converted to open thoracotomy because of pleural adhesion or other causes. Bullae over apices or other sites of lung were identified in 164 (86.8%) patients. Mechanical pleurodesis with gauze abrasion or electrocoagulation was performed on all patients, and chemical pleurodesis with minocycline intrapleural injection or talc powder poudrage was performed on 144 (76.2%) of them. The bullae was excised with endo-GIA (n = 122), endo-loop (n = 23), electroablation (n = 9), and suturing through open or endoscopic port (n = 10). The operation time ranged from 23 to 355 minutes (42.4 +/- 12.6 minutes). The mean postoperative chest tube duration and hospital stay were 2.4 +/- 1.3 (range, 1-26) and 4.3 +/- 1.2 (range, 1-35) days. Complication occurred in 15 cases (7.9%), including 9 patients with persistent air-leakage (> 7 days), 3 patients with bleeding, 6 patients with pneumonia or ventilator dependence, and 3 patients with wound infection. Recurrence occurred in six (3.2%) patients. Two patients (1.1%) died of complications related to underlying disease (severe emphysema) postoperatively. VATS treatment is a good choice for the treatment of recurrent primary spontaneous pneumothorax. It can also be used for patients with first onset spontaneous or traumatic pneumothorax with persistent air leakage or secondary pneumothorax. We preferred bullectomy with endo-GIA because it was safer, and the specimen could possibly reveal the underlying disease.

Adolescent↗

PubMedDate not supplied

Effect of Surgecel coverage with topical electrocauterization for preventing and sealing pulmonary air leakage.

Pleural tears usually occur after pneumolysis for dense adhesion or after cone biopsy of lung parenchyma. Repair of the tears is sometimes very difficult. Herein we compared different methods on a pig lung air leak model. Twenty pigs with pleural tears by surgical manipulation through sternotomy were not treated (n = 5) or treated by simple electroablation (n = 5), pleural coverage (n = 5), or Surgecel coverage with surface electroablation (n = 5). We evaluated their immediate and delayed treatment effect by measuring the critical leak pressure, degree of air leakage, and air leakage period and histological examination. It was found that Surgecel coverage with surface electrocauterization had similar early and delayed effects in sealing air leakage to pleural coverage and was much better than the other two groups (P < 0.05). We conclude that coverage with Surgicel with local electroablation can significantly decrease immediate and late air leakage from pleural tears.

Analysis of Variance↗

PubMedDate not supplied

Treatment of palmar hyperhidrosis using needlescopic T2 sympathetic block by clipping: analysis of 102 cases.

Endoscopic thoracic sympathicotomy, or sympathectomy by a 2-mm scope, is an effective method for treating palmar hyperhidrosis. However, postoperative compensatory sweating may be troublesome in some patients. We report needlescopic T2 sympathetic block by clipping, which may provide reverse operation for patients encountering compensatory sweating. Between January 1998 and January 2002, a total of 102 patients with palmar hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T2 ganglion. There were 47 males and 55 females (mean age, 24.1 years; range, 9-50 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed T2 sympathetic block by clipping at the second and third intercostal spaces using a 2-mm, 0 degrees thoracoscope. Among these 102 patients, all bilateral T2 sympathetic blockings were achieved. The operation was usually accomplished within 30 minutes (range, 16-40 minutes). All patients were discharged within 4 hours after the operation. There were no surgical complications or surgical mortality cases. The mean postoperative follow-up period was 37.1 months (range, 16-64 months). Improvement of palmar hyperhidrosis can be obtained in all patients. Eighty-six patients (84%) have developed compensatory sweating of the trunk and lower limbs. Two patients had a reverse operation and had improvement of compensatory sweating at 2 and 13 days after removal of endo clips. Needlescopic T2 sympathetic block by clipping is a safe and effective method for treating palmar hyperhidrosis; compensatory sweating may be improved after reverse operation removal of endo clip.

Adolescent↗

PubMedDate not supplied

Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases).

Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 +/- 17.56 years in the VATT group and 35.6 +/- 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6%), 13 (41.9%); class IIA: 18 (35.3%), 11 (35.5%); class IIB: 18 (35.3%), 5 (16.1%); class III: 2 (3.9%), 0; and class IV: 2 (3.9%), 2 (6.5%), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45 degrees left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 +/- 3.3 and 26.9 +/- 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 +/- 1.1 and 3.2 +/- 2.3 days, respectively (P = 0.018). Operative times were 180.0 +/- 53.4 and 248.2 +/- 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 +/- 22.5 and 52.2 +/- 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the postoperative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5%) patients had complete remission without any medication, 14 (27.5%) patients were in class II, 21 (41.1%) patients were in class III, 2 (3.9%) patients were in class IV, and 0 (0%) patients were in class V, according to postoperative classification of DeFilippi et al. We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.

Adult↗

PubMedDate not supplied

Glutathione S-transferase M1 gene null genotype and gastric cancer risk in Taiwan.

BACKGROUND/AIMS: Glutathione S-transferases (GST) are involved in the detoxification of many potential carcinogens and appear to play an important role in the protection from carcinogens. The association between different GSTM1 genotypes and gastric cancer risk is still controversial. The aim of this study was to determine the association between the GSTM1-null genotype and gastric cancer risk. METHODOLOGY: A retrospective, hospital-based case-control study of 123 primary gastric cancer patients and 121 healthy controls was conducted to evaluate the presence or absence of the GSTM1 gene from peripheral blood samples by a PCR-based method. RESULTS: The frequency of the GSTM1-null was 59.3% in the gastric cancer group and 45.5% in the control group. An increase in risk for gastric cancer was found among carriers of GSTM1-null genotype. The odds ratio (OR) was 1.752, with 95% confidence interval (CI) = 2.963 approximately 1.035. CONCLUSIONS: GSTM1-null polymorphism was associated with genetic susceptibility of gastric cancer in Taiwan.

Adult↗

PubMedDate not supplied

Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.

Postoperative complications of endoscopic thoracic sympathectomy may be troublesome in some patients. Between January 1998 and September 2002, a total of 16 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic T2 and T3 sympathetic block. There were seven men and nine women, with a mean age of 21.1 years (range, 12-35 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the T2 sympathetic block for patients with still intact T2 ganglion using an 8-mm, 0 degrees thoracoscope. An additional T3 block should be given if patients received either previous T2 sympathectomy or elevated palmar temperature <1 degrees C after T2 sympathetic block. The mean operation time was 30 minutes. The level of sympathetic blocks were the T2 and T3 in five patients, only T2 block in four, patients, and only T3 block in seven patients. Improvement of palmar hyperhidrosis can be obtained in all patients. One patient received a reverse operation 12 days after the T2 and T3 clipping and obtained improvement of troublesome compensatory sweating and dry hands 1 day after removal of all clips. All patients obtained improvement of palmar hyperhidrosis without recurrence after a mean of 37.1 months of follow-up (range, 12-56 months). Endoscopic thoracic T2 with or without T3 sympathetic block by clipping is a safe and effective method in treating patients with recurrent palmar hyperhidrosis.

Adolescent↗

PubMedDate not supplied

Predictability of early onset atopic dermatitis by cord blood IgE and parental history.

Cord blood IgE and atopic family history have been used as predictors of atopic disease in infants for more than 20 years. In recent years, the value of cord blood IgE in predicting the development of atopic dermatitis has been questioned, while family history of atopy has consistently been regarded as a useful predictor for atopic dermatitis. A birth cohort was followed-up to 6 months of age to record the development of atopic dermatitis and to study its association with cord blood IgE levels and parental history of atopy. The cumulative incidence of atopic dermatitis over the 1st, 3rd and 6th months of life amounted to 5.0%, 8.2% and 14.0%, respectively. When the cutoff value for cord blood IgE was set at 0.5 kU/L, there was a significant association between elevated cord blood IgE level and atopic dermatitis at 1, 3 and 6 months of age; when the cutoff value was set at 0.9 kU/L, the association was only found at 3 months of age. There was a significant association with atopic history of the mother. The effect of maternal atopic history on atopic dermatitis seen only at 1 month was lost by 3 months of age. There was no correlation between paternal history and atopic dermatitis. In our study, the predictive capacity of maternal history and cord blood IgE was not high enough to recommend them as screening factors.

Dermatitis, Atopic↗