Biomedical subjects

Robert J Chen

Publications and source records attributed to Robert J Chen.

At least 19 recordsLinked to original sources

PubMed2007

Long-term outcome and effects of oral bosentan therapy in Taiwanese patients with advanced idiopathic pulmonary arterial hypertension.

STUDY DESIGN: We report on the long-term outcome and effects of bosentan treatment in Taiwanese patients with advanced (functional class III or IV) idiopathic pulmonary arterial hypertension (IPAH). MATERIALS AND METHODS: IPAH patients on stable bosentan therapy for more than 12 months and regularly monitored were eligible for this prospective uncontrolled study. Patients were evaluated for several clinical parameters, both measured at the time of initiation of bosentan therapy and after 12 months on therapy: New York Heart Association functional class (NYHA FC), change in 6-min walk distance (6MWD), right ventricle ejection fraction (RVEF), cardiothoracic ratio (CTR), and pulmonary functional status. RESULTS: Twelve of 15 patients met eligibility requirements and were enrolled. Their mean age was 37.6+/-12.9 years and 92% were female. Six (50%) patients were in NYHA FC IV and the others were in NYHA FC III at baseline. Three (25%) patients were chronic hepatitis C virus (HCV) carriers, with normal liver function. After 12 months of bosentan treatment, 6-MWD, RVEF, and pulmonary function all increased significantly. CTR and NYHA FC both decreased significantly. Oral bosentan was well tolerated and there was no episode of liver dysfunction that required adjustment of the bosentan dosage or discontinuance of therapy. CONCLUSION: Long-term treatment with oral bosentan appears to have beneficial effects on functional status, exercise capacity, right heart function, and pulmonary function in Taiwanese patients with advanced IPAH, regardless of whether or not they presented with chronic HCV infection.

Adult↗

PubMed2006

Effect of connective tissue growth factor on hypoxia-inducible factor 1alpha degradation and tumor angiogenesis.

BACKGROUND: Connective tissue growth factor (CTGF) inhibits the metastatic activity of human lung cancer cells in a mouse model; however, the mechanism of this modulation is unclear. We investigated the role of angiogenesis in this process. METHODS: CL1-5 and A549 human lung adenocarcinoma cells were stably transfected with vectors containing CTGF or hypoxia-inducible factor (HIF) 1alpha or with vector controls. Transfected cells were injected into nude mice (n = 10 per group), and tumor growth, metastasis, and mouse survival were measured. Excised xenograft tumors and primary human lung adenocarcinomas (n = 24) were subjected to immunohistochemistry with antibodies to the endothelial cell marker CD31 and to CTGF. Expression of HIF-1alpha and vascular endothelial growth factor (VEGF) A was assessed in vitro by using reporter gene assays. Cells were transiently transfected with HIF-1alpha mutant and antisense arrest-defective 1 protein (ARD-1), and HIF-1alpha acetylation was assayed by immunoprecipitation. All statistical tests were two-sided. RESULTS: Xenograft tumors derived from CTGF transfectants grew more slowly than those from control-transfected cells and had reduced expression of HIF-1alpha and VEGF-A, vascularization (as assessed by CD31 expression), and metastasis (all P<.001). Xenograft tumors derived from CTGF-overexpressing cells that were transfected with HIF-1alpha had higher VEGF-A expression than CTGF-overexpressing xenografts. Mice with CTGF/HIF-1alpha xenografts had lower survival than mice carrying CTGF-overexpressing xenografts (CL1-5/Neo, mean = 69.6 days, 95% confidence interval [CI] = 53.9 to 85.3 days versus CL1-5/CTGF, mean = 102.1 days, 95% CI = 92.1 to 112.1 days; P = .001, CL1-5/CTGF, mean = 102.1 days, 95% CI = 92.1 to 112.1 days versus CL1-5/CTGF/HIF-1alpha, mean = 81.7 days, 95% CI = 66.5 to 96.9 days; P = .011, CL1-5/Neo, mean = 69.6 days, 95% CI = 53.9 to 85.3 days versus CL1-5/CTGF/HIF-1alpha, mean = 81.7 days, 95% CI = 66.5 to 96.9 days; P = .122). Tumors of patients with the same disease stage but with high CTGF protein expression had reduced microvessel density compared with tumors with low expression. Transfection with antisense-ARD1 decreased the level of acetylated HIF-1alpha and restored HIF-1alpha and VEGF-A expression in CTGF-overexpressing cells. CONCLUSION: CTGF inhibition of metastasis involves the inhibition of VEGF-A-dependent angiogenesis, possibly by promoting HIF-1alpha protein degradation.

Acetylation↗

PubMed2006

Controlled precipitation of solubilized carbon nanotubes by delamination of DNA.

Polyaromatic molecules, such as rhodamine 6G and methylene blue, were found capable of precipitating DNA-solubilized single-walled carbon nanotubes from solution through a competitive binding mechanism whereby DNA is displaced from the nanotube surface, allowing the nanotubes to rebundle. This delamination of DNA also occurred when complementary oligonucleotides were used to hybridize specifically to the DNA coating on the nanotubes. These findings were expanded to include techniques for controlled desolubilization and to provide additional elucidation into the interaction of SWNTs and noncovalent solubilizing agents.

Binding, Competitive↗

PubMed2006

Role of appendectomy in laparoscopic training.

PURPOSE: This study aimed to evaluate whether laparoscopic appendectomy is suitable for training residents to become proficient in laparoscopic surgery. MATERIALS AND METHODS: A total of 1574 laparoscopic appendectomies were performed at En-Chu-Kong Hospital between January 1998 and December 2003 (788 men and 786 women). These cases were divided into three groups: 543 cases (in 1998-1999) performed by 5 attending surgeons during the learning and trial stage; 536 cases (in 2000-2001) performed by 5 attending surgeons assisted by 2 senior residents with prior experience in open appendectomy; and 495 cases (in 2002-2003) done by these 2 senior residents, supervised by the attending surgeons. Demographic data, intraoperative findings, operative time, conversion rate, frequency of analgesic injection, timing of oral intake, hospital stay, morbidity, and mortality were analyzed. RESULTS: There were no statistically significant differences in the operations performed by attending surgeons (mature stage) vs. senior residents in terms of intraoperative findings, operative time (60.1 +/- 60.4 minutes vs. 56.3 +/- 25.6 minutes), conversion rate (1.12% vs. 0.81%), frequency of analgesic injection (0.57 +/- 1.37 times/stay vs. 0.43 +/- 0.94 times/stay), timing of oral intake (23.7 +/- 30.2 hours vs. 20.8 +/- 27.5 hours), hospital stay (73.9 +/- 61.8 hours vs. 70.3 +/- 51.6 hours), morbidity, or mortality (0% vs. 0.2%). CONCLUSION: Laparoscopic appendectomy can be safely incorporated into the training of surgical residents under the supervision of experienced surgeons. Laparoscopic appendectomy also provides knowledge of the basics of laparoscopic technique before going on to more complex operations.

Analysis of Variance↗

PubMed2005

Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax.

RATIONALE: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. OBJECTIVES: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. METHODS: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). MAIN RESULTS: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. CONCLUSIONS: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

Adult↗

PubMed2005

Influence of ciprofloxacin resistance on risk factors for endovascular infection in patients with infection due to group C nontyphoid salmonellae.

From January 2000 through September 2004, a total of 54 patients with infection due to group C nontyphoid salmonellae were evaluated; 8 patients had gastroenteritis alone, and 46 patients had bacteremia. Of the 46 patients who had bacteremia, 12 had endovascular infection and 34 did not. The number of infections due to ciprofloxacin-resistant Salmonella organisms is increasing. Ciprofloxacin-resistant Salmonella organisms predisposed patients to acquire bacteremia, but they did not seem to predispose patients to acquire endovascular infection.

Adolescent↗

PubMed2005

Outcome of medical and surgical treatment in patients with acute type B aortic dissection.

BACKGROUND: Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. METHODS: In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. RESULTS: Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 +/- 1.9%, 95.2% +/- 2.1%, and 95.2% +/- 2.1%. CONCLUSIONS: Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.

Acute Disease↗

PubMed2005

Antimicrobial drug resistance in salmonella-infected aortic aneurysms.

BACKGROUND: Salmonella infection of the aorta and adjacent arteries is rare, but life-threatening. There is an increasing number of infections caused by antimicrobial drug resistant Salmonella. This study sought to assess the association between antimicrobial drug resistance and clinical outcomes of patients with Salmonella-infected aortic aneurysm. METHODS: Data were collected by retrospective chart review. Between October 1995 and October 2004, 34 patients with Salmonella-infected aortic aneurysm were included. Aneurysm-related deaths were defined as hospital deaths and late deaths due to prosthetic graft infection. Analysis was performed using the chi2 test, Fisher's exact test, and Mann-Whitney test. RESULTS: Nineteen patients had a suprarenal and 15 patients had an infrarenal aortic infection. The most common responsible pathogen was group C Salmonella (47%). Ciprofloxacin-resistant Salmonella infection occurred since March 2001 and the rate increased from 0 per 15 in the years before March 2001 to 5 per 19 in the years after March 2001 (p = 0.005 by Fisher's exact test). Among the 26 patients who had combined medical and surgical therapy, 4 died in the hospital and 4 died of late prosthetic graft infection 3 to 6 months after operation, whereas 4 of the 8 who had medical therapy alone died of aneurysm rupture during hospitalization. The actuarial survival rates by the Kaplan-Meier method were 64% at 6 months, 61% at 1 year, and 56% at 5 years. The risk factors for aneurysm-related death were old age (78.5 +/- 9.7 years vs 63.5 +/- 11.4 years; p < 0.001) and ciprofloxacin-resistant Salmonella infection (4 of 5 vs 8 of 29; p = 0.042). CONCLUSIONS: There was an increased mortality associated with ciprofloxacin resistance in infected aortic aneurysms with Salmonella. With an increasing incidence of ciprofloxacin resistant Salmonella, third generation cephalosporin is the antibiotic of choice for Salmonella-infected aneurysm.

Adult↗

PubMed2005

Nontyphoid Salmonella bacteremia in patients with liver cirrhosis.

BACKGROUND: Bacteremia is reported to occur in 4% to 9% of hospitalized patients with liver cirrhosis. Escherichia coli and Klebsiella pneumoniae are the most commonly isolated organisms. Only sporadic cases of nontyphoid Salmonella bacteremia are reported in the literature. In this study, we sought to determine the clinical features and prognosis of patients with liver cirrhosis and bacteremia due to nontyphoid Salmonella. METHOD: Data were collected by retrospective chart review. RESULTS: From December 1996 to May 2003, we identified 23 patients (18 males, 5 females) with a median age of 58 years. The Child classification for liver cirrhosis was A in 4, B in 9, and C in 10 patients. Solid organ cancers were present in 14 patients: hepatocellular carcinoma in 13 patients and gastric carcinoma in 1 patient. Hospital death occurred in 11 patients (48%): 7 died of sepsis and 4 of hepatic failure. Using a logistic regression model, the independent risk factors for death in patients with nontyphoid Salmonella bacteremia were young age and an advanced stage of liver cirrhosis. CONCLUSION: Most nontyphoid Salmonella bacteremia in patients with liver cirrhosis was community-acquired. An advanced stage of liver cirrhosis and hepatocellular carcinoma were common. The prognosis for young patients was unfavorable; this was seemingly due to hepatocellular carcinoma producing more unfavorable results in younger cirrhotic patients.

Adult↗

PubMed2005

Association of angiotensin-converting enzyme insertion/deletion polymorphism with serum level and development of pulmonary complications following esophagectomy.

BACKGROUND: Pulmonary complications remain the major cause of postoperative mortality in patients with esophageal cancer undergoing esophagectomy. It was unclear whether this dismal complication has a genetic predisposition. We therefore investigated the role of an angiotensin-converting enzyme (ACE) insertion/deletion polymorphism in developing these complications. METHODS: We conducted a prospective study including 152 patients with esophageal cancer who underwent esophagectomy in National Taiwan University Hospital between 1996 and 2002. The ACE genotype was determined by polymerase chain reaction amplification of leukocyte DNA obtained before surgery. The serum ACE concentration was determined by enzyme-linked immunosorbent assay. RESULTS: Thirty-five patients (23%) developed pulmonary complications following esophagectomy. As compared with patients with the I/I and I/D genotypes, those with the D/D genotype had a higher risk for pulmonary complications (adjusted odds ratio [OR], 3.12; 95% confidence interval [CI], 1.01-9.65). The risk was additively enhanced by combination of the ACE D/D genotype with other clinical risk factors (old age, hypoalbuminemia, and poor pulmonary function). The circulating ACE level was also dose-dependently with the presence of ACE D allele. As compared with the patients with circulating ACE less than 200 ng/mL, the patients with circulating ACE of 200 to 400 ng/mL and over 400 ng/mL had ORs (95% CI) of 2.75 (1.12-6.67) and 15.00 (4.3-52.34) to present with ACE D allele, respectively. CONCLUSIONS: An ACE insertion/deletion polymorphism might modulate the function of ACE gene and play a role in affecting individual susceptibility to pulmonary injury following esophagectomy in patients of esophageal cancer.

Adult↗

PubMed2005

Incidence of serum creatine kinase elevation and its relation to medications used after heart transplantation.

BACKGROUND: Rhabdomyolysis after heart transplantation is well described as a drug-related phenomenon. The incidence of serum creatine kinase (CK) elevation after heart transplantation is not formally reported in previous clinical studies. This study sought to find the incidence of asymptomatic serum CK elevation after heart transplantation and assess its relation to medications that are commonly used after transplantation. METHODS: Data were collected in outpatient basis between August 2002 and August 2003. Patients with acute rejection, infection or muscle pain were excluded. All patients were followed monthly at a special clinic. Physical examinations and routine blood tests including serum CK were performed monthly. We evaluated the results of 106 asymptomatic patients and 765 serial data to determine the incidence of serum CK elevation after transplantation. Logistic regression was used to identify its risk factors. RESULTS: The incidence of serum CK elevation in asymptomatic heart transplant recipients was 16.2%. Risk factors of its elevation were diabetes mellitus and use of medications including cyclosporine, drugs for hypertriglyceridemia, antihypertensives, and prednisolone. Among the antihypertensives commonly used, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium antagonists were associated with a higher incidence of serum CK elevation, but beta-blockers protected patients from serum CK elevation. CONCLUSION: The incidence of serum CK elevation in asymptomatic heart transplant recipients was not low. Serum CK measurements should be part of the routine follow-up in transplant recipients, especially when patients had diabetes mellitus. Medications commonly used after heart transplantation significantly affected the incidence of serum CK elevation.

Adolescent↗

PubMed2005

Low incidence of malignancy after transplantation in Chinese heart allograft recipients.

This study sought to assess the incidence of neoplastic disease after transplantation in Chinese heart allograft recipients. A total of 156 patients (130 male and 26 female; mean age, 45.8 +/- 15.7 years), surviving more than 30 days after transplantation, were enrolled in this study. The mean follow up duration was 51.2 +/- 33.0 months. Six patients (3.8%) developed neoplastic diseases after transplantation: post-transplant lymphoproliferative diseases in four and solid tumors in two patients. There was no skin cancer or Kaposi's sarcoma. Solid tumors affected the prostate, liver and urinary bladder in two patients. The cumulative incidence of neoplastic disease was 2.1% at 1 year, 3.6% at 5 years, and 10.1% at 10 years after transplantation. The incidence of post-transplant neoplastic disease was low in Chinese heart allograft recipients. It resulted from a relative paucity of Kaposi's sarcoma and skin cancers in Chinese population.

Adolescent↗

PubMed2005

Renal dysfunction after heart transplantation: incidence, prognosis and risk factors.

BACKGROUND AND PURPOSE: Despite more than 20 years of experience in heart transplantation, the risk factors for development of chronic renal insufficiency in recipients are not well established. This study assessed the incidence, prognosis and risk factors for renal dysfunction after heart transplantation. METHODS: We conducted a retrospective analysis of all adult patients (n = 132) who survived for more than 1 year after heart transplantation at our institutions from March 1992 through November 2002. Renal dysfunction was defined as serum creatinine of > or = 2.0 mg/dL. The incidence and prognosis of renal dysfunction after heart transplantation was estimated by the Kaplan-Meier method and compared by log rank test. Risk factors for renal dysfunction at 1 year after transplantation were evaluated using a logistic regression model. RESULTS: Renal dysfunction was present in 9 patients (7%) before heart transplantation. The cumulative incidence of renal dysfunction after heart transplantation was 23.0 +/- 3.8%, 36.1 +/- 4.3%, 53.9 +/- 4.9%, and 57.3 +/- 5.8% at 6 months, 1 year, 5 years and 10 years, respectively, after transplantation. The actuarial survival rate in patients without renal dysfunction at 1 year after transplantation was better than for patients with renal dysfunction at 1 year after transplantation (p = 0.046 by log-rank test). Independent risk factors for renal dysfunction at 1 year after transplantation were age at transplantation (odds ratio, 1.07; p = 0.02), pretransplant serum blood urea nitrogen (odds ratio, 1.07; p = 0.048), and serum creatinine at 6 months after transplantation (odds ratio, 17.0; p < 0.001). CONCLUSIONS: There was a high incidence of renal dysfunction after heart transplantation. Patients with renal dysfunction had poor long-term prognosis. Serum creatinine at 6 months after transplantation was the most significant major risk factor, followed by age at transplantation and pretransplant blood urea nitrogen.

Adolescent↗

PubMed2004

An investigation of the mechanisms of electronic sensing of protein adsorption on carbon nanotube devices.

It has been reported that protein adsorption on single-walled carbon nanotube field effect transistors (FETs) leads to appreciable changes in the electrical conductance of the devices, a phenomenon that can be exploited for label-free detection of biomolecules with a high potential for miniaturization. This work presents an elucidation of the electronic biosensing mechanisms with a newly developed microarray of nanotube "micromat" sensors. Chemical functionalization schemes are devised to block selected components of the devices from protein adsorption, self-assembled monolayers (SAMs) of methoxy(poly(ethylene glycol))thiol (mPEG-SH) on the metal electrodes (Au, Pd) and PEG-containing surfactants on the nanotubes. Extensive characterization reveals that electronic effects occurring at the metal-nanotube contacts due to protein adsorption constitute a more significant contribution to the electronic biosensing signal than adsorption solely along the exposed lengths of the nanotubes.

Adsorption↗

PubMed2004

Infected aortic aneurysms: clinical outcome and risk factor analysis.

PURPOSE: Infected aortic aneurysms are difficult to treat, and are associated with significant mortality. Hospital survival is poor in patients with severe aortic infection, Salmonella species infection, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location. We reviewed the clinical outcome in 46 patients with primary infected aortic aneurysms and identified clinical variables associated with prognosis. METHODS: Data were collected by means of retrospective chart review. Univariate and multivariate logistic regression models were used for risk factor analysis. RESULTS: Between August 1995 and March 2003, 48 patients with primary infected aortic aneurysms were treated at our hospitals. Two patients with negative culture results were excluded. Of the remaining 46 patients, 35 patients had aortic aneurysms infected with Salmonella species and 11 patients had aortic aneurysms infected with microorganisms other than Salmonella species. There were 20 suprarenal infections and 26 infrarenal infections. Surgical debridement and in situ graft replacement were performed in 35 patients, with an early mortality rate of 11%. The incidence of late prosthetic graft infection was 10%. The 90-day mortality rate in patients operated on was 0% for elective operation and 36% for nonelective operation (P =.006, Fisher exact test). Independent predictors of aneurysm-related death were advanced age, non-Salmonella infection, and no operation. CONCLUSION: With timely surgical intervention and prolonged antibiotic treatment, in situ graft replacement provides an excellent outcome in patients with primary infected aortic aneurysms and elective operation. Mortality is still high in patients undergoing urgent operation. Advanced age, non-Salmonella infection, and no operation are major determinants of mortality.

Adult↗

PubMed2004

Risk factors for recurrent bacteremia in adult patients with nontyphoid salmonellosis.

BACKGROUND: This study sought to find the risk factors for recurrent bacteremia in adult patients with nontyphoid salmonellosis. METHOD: Retrospective chart review. RESULT: Between September 1984 and December 2003, 235 adult (age > or = 18 years old) patients with bacteremia with nontyphoid salmonellosis were admitted to our hospital. Among them, 130 patients (55%) had immunodeficiency, 31 patients (13%) had systemic lupus erythematosus, 26 patients (11%) had hematologic malignancies, 50 patients (21%) had solid organ cancers, and 39 patients (17%) had endovascular infections. Thirty-seven patients had recurrent bacteremia during the study period. Both univariate and multivariate analysis showed that immunodeficiency was the only predictor of recurrent bacteremia (odds ratio, 2.79; P = 0.013). The overall hospital mortality rate was 26%: 8% for patients with recurrent bacteremia and 29% for patients without recurrence. The independent risk factors of hospital death were old age, not recurrent infection, and solid organ cancers. CONCLUSION: Old age, systemic lupus erythematosus, malignancies, and immunodeficiency were common in adult patients with nontyphoid Salmonella bacteremia. The incidence of recurrent bacteremia was 16%. Immunodeficiency predisposed patients to recurrent bacteremia. Recurrent bacteremia was associated with a lower hospital mortality rate, however.

Bacteremia↗

PubMed2004

Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax.

STUDY OBJECTIVE: To evaluate the safety and efficacy of additional minocycline pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. DESIGN: Retrospective comparative study with a historical control. SETTING: Thoracic surgical division of a university-affiliated tertiary medical center. PATIENTS AND METHODS: Between April 1994 and April 2001, 313 consecutive patients (minocycline group) with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. After operation, minocycline hydrochloride, 7 mg/kg, was instilled into the pleural space through a thoracostomy tube. The control group consisted of 51 consecutive patients who underwent the same thoracoscopic procedures alone for primary spontaneous pneumothorax between January 1992 and April 1994. RESULTS: There was no significant difference between the two groups in terms of demographic data, operative findings, and operation time. Chest pain was a common complaint after minocycline pleurodesis, but the total doses of requested analgesics were comparable in both groups. The rate of prolonged air leaks was significantly lower in the minocycline group (7.0% vs 17.6%, p = 0.025). Patients treated with minocycline had shorter periods of postoperative chest drainage and hospitalization. The ipsilateral recurrence rate was also significantly lower in these patients (2.9% vs 9.8%, p = 0.033). CONCLUSIONS: Minocycline pleurodesis is a safe and convenient procedure that may improve the outcome and reduce the rate of recurrence after thoracoscopic treatment for primary spontaneous pneumothorax. A randomized control study may be needed to confirm the findings.

Adolescent↗

PubMed2004

Infective endocarditis in patients with liver cirrhosis.

BACKGROUND AND PURPOSE: Infective endocarditis complicating liver cirrhosis is infrequently reported. This study evaluated the clinical features of infective endocarditis in Taiwanese patients with liver cirrhosis. METHODS: All cases of infective endocarditis occurring in patients with liver cirrhosis from December 1995 to December 2002 were included in this study. Data were collected by retrospective chart review. RESULTS: Twenty six patients (18 males, 8 females) with median age 6 years (range, 43 to 87) were included. The etiology of liver cirrhosis was hepatitis virus infection in 20 patients. There were 7 nosocomial infections. Bacterial pathogens were identified in 25 patients, with Staphylococcus aureus (n = 8), viridans streptococci (n = 4), Streptococcus sanguis (n = 2), Pseudomonas aeruginosa (n = 2), and Enterococcus faecalis (n = 2) the most common isolates. The hospital mortality rate was 27%. Patients with in-hospital death were more likely to have a history of uremia, staphylococcal infection, nosocomial infection and less likely to have aortic valve infection. CONCLUSIONS: The prognosis of patients with infective endocarditis and liver cirrhosis was poor. Infection with Staphylococcus species was a dominant cause and methicillin resistance was common.

Adult↗