PubMed Health⌕ Search

Biomedical subjects

Shu-Hsun Chu

Publications and source records attributed to Shu-Hsun Chu.

At least 37 records · Page 2Linked to original sources
PubMed2005

Cell saver does not increase pro-inflammatory cytokine levels and expression of adhesive molecules in the salvaged blood of patients undergoing off-pump coronary artery bypass surgery.

BACKGROUND: Autotransfusion has been developed to avoid the risks of contaminating with infectious diseases and susceptivity to other complications of allogeneic blood transfusion. Previous studies have shown significant pro-inflammatory cytokine release and complement activation during blood salvage with cell saver (CS) in the course of on-pump coronary artery bypass grafting (CABG) surgery. Because both extracorporeal pump and CS machine are possible to induce the adverse cytokines release, thus, in this study, we investigated the influence of CS alone on the levels of pro-inflammatory cytokines and the expression of leukocyte surface antigens in patients undergoing off-pump CABG. METHODS: Thirty patients proposed to undergo off-pump CABG were enrolled in this study. Five perioperative blood samples (peripheral blood before operation, blood in pericardial sac at operation, blood in the cell saver container, blood in the blood bag before transfusion, and peripheral blood one hour after operation) were obtained from each patient. The expression of activated leukocyte adhesive molecules (CD11b and CD18) and cytokine-inducible leukocyte-endothelial adhesive molecule (CD62P) were studied by flow cytometry. Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the levels of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6) and IL-8. RESULTS: All blood samples except the one obtained one hour after operation showed no difference of the expression of CD11b, and CD62P and the levels of TNF-alpha, IL-6 and IL-8 (P> 0.05). However, the expression of CD18 was decreased during the course of blood salvage. The peripheral blood obtained one hour after operation had significantly higher expression of the three tested leukocyte surface antigens and higher levels of three studied cytokines (P < 0.05). CONCLUSIONS: Our investigation indicated that the blood processing in cell saver alone did not increase the expression of either CD11b, CD18, or CD62P, and the levels of TNF-alpha, IL-6 and IL-8. The results suggest that cell saver seems not to significantly activate the leukocytes or cause inflammatory responses in the salvaged blood.

Adult↗
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

Impact of methicillin resistance on clinical features and outcomes of infective endocarditis due to Staphylococcus aureus.

BACKGROUND: This study sought to determine the impact of methicillin resistance on clinical features and outcomes in patients with Staphylococcus aureus (SA) infective endocarditis (IE). METHODS: Retrospective chart review. Univariate and forward stepwise logistic regressions were conducted to determine which factors significantly affected death and systemic embolism. RESULTS: From October 1995 to April 2002, 57 patients with a definite diagnosis of IE caused by SA were included: 28 cases of methicillin-sensitive SA infection and 29 methicillin-resistant SA (MRSA) infection. Patients with MRSA infection are more likely to have old age, underlying diseases, history of hospitalization within the last 6 months, nosocomial infection, and antibiotic use within the last 3 months. Patients with MRSA infection had clinical presentation of less systemic embolism and more sepsis and had a higher 3-month mortality rate. Methicillin resistance is an independent positive predictor of death and a negative predictor of systemic embolism. CONCLUSIONS: MRSA became a dominant cause of SA IE. Although it caused a lower incidence of systemic embolism, MRSA infection had a higher mortality rate because of sepsis.

Adolescent↗
PubMed2004

Delayed occurrence of cardiac allograft vasculopathy in Chinese heart transplant recipients compared with their western counterparts.

Cardiac allograft vasculopathy (CAV) is a leading limiting factor to long-term survival after cardiac transplantation. We investigated the prevalence of CAV and its associated factors in Chinese heart transplant recipients. From July 1987 to July 2000, we performed 140 consecutive heart transplantations at the National Taiwan University Hospital. Of the 140 patients, 98 who were > or = 17-yr old at the time of transplantation, had survived for more than 1 yr after transplantation, and who had normal findings at the 1-month coronary angiogram study, were included in this study. Group I consisted of 25 patients who eventually developed CAV in the follow-up, and group II consisted of 73 patients who were free from CAV in the follow-up. CAV was defined by coronary angiogram study.The donor and recipient characteristics were not statistically different between the two groups except the older donor age (p = 0.02), higher first-year mean rejection score (p = 0.03) and more prevalent cytomegalovirus infection rate (p = 0.03) in group I. Multivariate Cox regression analysis revealed that only higher first-year mean rejection score (p = 0.01), and older donor age (p = 0.04) were important risk factors for developing CAV. The 1-5 yr of actuarial freedom from the presence of CAV were 97, 93, 86, 80 and 69% in our study patients. In summary, these data show that CAV occurred later in Chinese heart transplant recipients in comparison with their western counterparts, but the risk factors for developing CAV were not different.

Asian People↗
PubMed2004

Acute hemodynamic study of Tai-Ta left ventricular assist device in a canine model.

A revised Tai-Ta centrifugal impeller pump was designed to study the interaction of the left ventricular assist device (LVAD) with the cardiovascular system in a canine model. Six healthy dogs weighing 12-16 kg were used. Blood flows in the aortic arch, the pulmonary artery (PA), and the LVAD outlet were measured simultaneously with the arterial blood pressure (ABP), the pump outflow pressure (POP), and the electrocardiograph (ECG). Normally, the blood flows in the aorta and the PA started at the S-wave of the ECG. When the LVAD was operated at a higher rotational speed (increased from 2900 to 5400 rpm), the ABP, POP, the pump flow, and the maximum rate of change of PA flow increased. However, the fluctuating amplitudes of ABP, POP, and the pump flow decreased significantly. The cardiovascular hemodynamics change with the pump speeds. For a typical 1.1-1.5 L/min cardiac output in canine, the revised LVAD was able to deliver a flow bypass ratio from 15% up to 100%. The LVAD outflow appeared to be pulsatile and matched the cardiac cycle, showing that the centrifugal impeller pump could be used as a pediatric assist device when cardiac function was impeded.

Animals↗
PubMed2004

Risk factor screening scale to optimize treatment for potential heart transplant candidates under extracorporeal membrane oxygenation.

We developed a risk factor-scaling score (RFSS) to select which patients supported by extracorporeal membrane oxygenation (ECMO) were suitable for ventricular assist device (VAD) implantation or heart transplantation (HTx). A total of 78 patients supported with ECMO for more than 48 h due to cardiac origin were included in this study. Patients were categorized into two groups based on the outcomes: the poor outcome group (n = 33) consisted of for those who later died or were later excluded from VAD or HTx; the favorable outcome group (n = 45) consisted of those who were weaned off ECMO finally and survived or were deemed suitable candidates for VAD or HTx. Seven risk factors were significant according to univariate analyses. Based on the regression coefficients of multivariate analysis, the RFSS was developed: (lung dysfunction x 7) + (systemic infection x 3) + (peak lactate > 3 mmole/L x 3) + (kidney dysfunction x 2) + (creatine kinase > 10,000 U/L x 1). Patients with an RFSS of 7 or more were be allocated to the poor outcome group. The RFSS was validated by another group of 30 patients with good correlation. The RFSS provides a way to predict which ECMO-supported patients are suitable candidates for VAD implantation or HTx.

Adolescent↗
PubMed2004

Molecular epidemiology and control of nosocomial methicillin-resistant Staphylococcus aureus infection in a teaching hospital.

BACKGROUND AND PURPOSE: Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection is difficult to control. Due to a dramatic increase in the nosocomial MRSA infection rate at our hospital from 2000 to 2001, this study was conducted to identify the source of these infections and the effectiveness of control measures. METHODS: 179 healthcare workers (HCWs) were screened for carriage of MRSA. Starting in April 2001, all patients with MRSA infection or colonization were put in strict contact and cohort isolation. The bacterial isolates of HCW carriers and patients with MRSA infection from April 2001 to September 2001 were subjected to antimicrobial susceptibility testing by disk-diffusion method and molecular typing by pulsed-field gel electrophoresis (PFGE). RESULTS: Fifteen HCWs were found to be carriers of MRSA. They were all given topical mupirocin treatment. After these interventions, the nosocomial MRSA infection rate decreased from 1.23 to 0.53 per 1000 patient-days. All 61 MRSA isolates available for antimicrobial susceptibility testing and molecular typing were multidrug resistant. PFGE study revealed 2 predominant types, type C and type Y, comprising 36 and 12 isolates, respectively. CONCLUSIONS: The current study demonstrates the importance of measures to control nosocomial MRSA infections in hospitals that already have a high incidence of endemic MRSA infection. Elimination of carriage by healthcare workers, and strict contact and cohort isolation are the main effective measures.

Anti-Bacterial Agents↗
PubMed2004

Use of extracorporeal membrane oxygenation to rescue a newborn with early-onset group B streptococcal sepsis and cardiopulmonary failure.

Group B streptococcal (GBS) infection is an important cause of perinatal morbidity and mortality. We report the use of extracorporeal membrane oxygenation (ECMO) to rescue a newborn with refractory GBS sepsis and meningitis who developed cardiopulmonary failure. This 2-day-old infant weighed 2640 g and was born to a healthy mother at full term. Respiratory distress, hypotension, and persistent pulmonary hypertension developed on the second day of life. The clinical condition deteriorated rapidly despite conventional treatment, and venoarterial ECMO was established to rescue this moribund newborn. During ECMO, the patient regained stable hemodynamics and good oxygenation, and infection was controlled. ECMO was used for 90 hours and the baby was weaned smoothly. Neurologic assessment after ECMO revealed hydrocephalus, abnormal electroencephalogram, and increased brain auditory evoked potential threshold. This report emphasizes that ECMO may be considered to rescue neonatal patients with cardiopulmonary failure due to GBS sepsis. Possible neurologic complications after ECMO should be carefully monitored.

Extracorporeal Membrane Oxygenation↗
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↗
PubMed2004

Hand-assisted laparoscopic surgery for abdominal aortic aneurysm.

There is a trend toward the use of minimally invasive surgery and limited incision for the surgical repair of abdominal aortic aneurysm (AAA). Conventional AAA repair is performed with a large laparotomy wound and uses either a transperitoneal or retroperitoneal approach. Due to the older age of this patient population, they often suffer more from the surgical wound, require prolonged hospital stay and have a slower recovery. We describe the use of hand-assisted laparoscopic surgery for grafting of a 5.5-cm infrarenal AAA identified by computed tomography scan. The operator inserted the left hand with a Pneumo Sleeve device in the abdomen through a 7-cm midline supraumbilical incision for laparoscopic surgery. Using the left hand and laparoscopic instruments to do the surgery provided control over the operation and sensation of touch. At the completion of the laparoscopic dissection, the first Clawford clamp was applied above the aortic bifurcation through the laparoscopic incision. The second Clawford clamp was applied below the renal arteries through the midline laparotomy incision. After cross-clamping the AAA, the aneurysm was incised, the clot removed, and lumbar bleeding points were oversewn with 3-O prolene suture. Then, the aneurysmal segment was grafted with a Dacron prosthesis using conventional suturing technique. The patient was extubated 3 hours after the operation, stayed in the intensive care unit for 1 night and was discharged 7 days later. He resumed oral intake on the postoperative day 1. There were no complications. This case illustrates that hand-assisted laparoscopic surgery for AAA can allow quick recovery of bowel function, quick progression to regular diet, short length of hospital stay, and probably a reduction in the total cost of care.

Aged↗
PubMed2004

Comparison of the clinical manifestations of severe acute respiratory syndrome and Mycoplasma pneumoniae pneumonia.

BACKGROUND AND PURPOSE: The clinical manifestations of severe acute respiratory syndrome (SARS) and mycoplasma pneumonia are similar. However, administration of corticosteroid to Mycoplasma pneumoniae patients suspected of having SARS may unnecessarily increase the risk of opportunistic infection. We compared the clinical course of 13 SARS patients and 6 patients with mycoplasma pneumonia treated during the outbreak of SARS in Taiwan. METHODS: Patients admitted due to suspicion of SARS with a subsequent diagnosis of SARS or Mycoplasma pneumoniae pneumonia were included. RESULTS: The initial clinical manifestations were similar in patients with SARS and those with M. pneumoniae infection. However, SARS patients had more severe lymphopenia (p = 0.013) and anemia (p = 0.007), and more persistent pulmonary infiltrates (p = 0.023). Respiratory failure developed in 15.4% of the SARS patients and in none of the M. pneumoniae patients. Recovery from thrombocytopenia was associated with defervescence in 12 SARS patients and radiographic improvement in 6 in the following 5 days. In those with unsatisfactory resolution of the pulmonary infiltrates, corticosteroid therapy was associated with rapid radiographic improvement. CONCLUSIONS: Because of similar initial presentations, differentiating SARS from M. pneumoniae pneumonia is very difficult based on symptomatology. In this series, lymphopenia and anemia were more severe in SARS than in M. pneumoniae infection, and SARS patients had more persistent and more new pulmonary infiltrates after hospitalization.

Adolescent↗
PubMed2003

Poststernotomy mediastinitis due to methicillin-resistant Staphylococcus aureus endemic in a hospital.

The objective of this study was to determine the incidence of and risk factors for poststernotomy mediastinitis (PSM) due to methicillin-resistant Staphylococcus aureus (MRSA) infection in a hospital in which MRSA was endemic. A retrospective case-control study of patients with PSM after cardiac surgery during January 1997 through July 2002 was conducted. The incidence of PSM was 1.01% (48 of 4746 patients), and 31 episodes (64.6%) were due to MRSA infection. We analyzed the findings for 48 case and 65 control patients. Univariate analysis revealed that the risk factors for PSM were previous hospitalization, resternotomy, chronic renal insufficiency, longer operation time, postoperative heart failure, postoperative renal failure, and reoperation for bleeding. Multivariate analysis revealed that the independent risk factors for PSM were previous hospitalization and reoperation for bleeding. Previous hospitalization was the only significant risk factor for PSM due to MRSA infection. The hospital mortality rate associated with PSM was 41.7%, and there was a higher mortality rate associated with PSM due to MRSA infection.

Adolescent↗
PubMed2003

Risk factors for primary bacteremia and endovascular infection in patients without acquired immunodeficiency syndrome who have nontyphoid salmonellosis.

This study sought to find the risk factors for primary bacteremia, endovascular infection, and in-hospital death for patients without acquired immunodeficiency syndrome who have nontyphoid salmonellosis. From September 1995 through September 2001, 301 patients with nontyphoid salmonellosis were admitted to our hospital; of these patients, 121 had primary bacteremia, and 28 had endovascular infection. Of the 121 patients with primary bacteremia, 64 were aged >50 years, and 26 had endovascular infection. Overall, 90 patients (29.9%) had immunodeficiency. Predictors of primary bacteremia were age; presence of systemic lupus erythematosus; group B, group C, or group D Salmonella infection; and immunodeficiency. The positive predictor of endovascular infection in adult patients with primary bacteremia was group C Salmonella infection, and negative predictors were immunodeficiency and solid-organ cancer. The overall in-hospital mortality rate was 12%; for primary bacteremia, it was 24.8%; for endovascular infection, it was 14.3%. Predictors of in-hospital death were age, extraintestinal infection, and solid-organ malignancy.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Long-term evaluation of Carpentier-Edwards porcine bioprosthesis for rheumatic heart disease.

OBJECTIVES: The clinical results of Carpentier-Edwards standard bioprosthesis have been extensively studied for valvular heart surgery in America and Europe. However, the data of long-term performance of Carpentier-Edwards standard porcine valve in areas with a high prevalence of rheumatic heart disease are still lacking. In this study, we assessed the clinical performance of Carpentier-Edwards standard porcine bioprostheses in a patient group with high prevalence of rheumatic heart disease. METHODS: A total of 872 patients underwent valvular heart surgery with Carpentier-Edwards standard porcine bioprostheses replacement between 1975 and 1999 and the results were analyzed. Rheumatic etiology counts for 95% of the patients. Mean age of operation was 40 +/- 14 years (mitral valve), 43 +/- 19 years (aortic valve), and 45 +/- 13 years (double valve). Follow-up was 95.6% complete and continued up to 24 years (total 7017 patient-years) with mean of 8.9 +/- 5.1 years. RESULTS: The operative mortality rate was 5.85%. Actuarial patient survival rates after discharge at 5, 10, 15, and 20 years were 92.5%, 83.8%, 72.3%, and 35.8%, respectively. A total of 442 cases received reoperation due to failure of bioprostheses. The mean duration to valve failure is 12.2 +/- 0.4 years. Actuarial estimate of freedom from structural valvular failure at 5, 10, 15, and 20 years were 96.3%, 63.7%, 24.4%, and 7.7%, respectively. CONCLUSION: The long-term result of Carpentier-Edwards standard bioprostheses in the present patient group is satisfactory. However, freedom from valve failure is lower than that of Western series. Younger age at operation and higher prevalence of rheumatic etiology in this area are possible causes.

Adolescent↗
PubMed2003

Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery.

OBJECTIVES: Our objectives were to determine the incidence and severity and the time course of the CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring. METHODS: Four hundred three consecutive patients scheduled for off-pump coronary artery bypass grafting surgery or femoral-to-popliteal artery bypass grafting surgery were prospectively studied. Multiplane transesophageal echocardiography with a new transgastric view was used to monitor CO(2) bubbles in the inferior vena cava and hepatic vein. RESULTS: CO(2) embolisms occurred in 17.1% of patients. Minimal, moderate, and massive CO(2) embolisms occurred in 13.1%, 3.5%, and 0.5%, respectively. The occurrence of moderate and massive CO(2) embolisms was frequently associated with the surgical manipulation of branches of saphenous veins. No significant risk factors were identified in multiple logistic regression analysis. CONCLUSION: The incidence of significant CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation procedures was more than 4%. Continuous transesophageal echocardiographic monitoring of the CO(2) bubbles in the inferior vena cava is essential in early detection and can help to prevent the development of significant CO(2) embolisms in these patients.

Aged↗
PubMed2003

Emergency vectorcardiographic study of acute aortic dissection.

There has been no report in the literature of emergency vectorcardiographic study in patients with acute aortic dissection. A total of 135 consecutive patients with suspected coronary artery disease was studied. On admission to the intensive-care unit through the emergency service, each patient was given electrocardiographic and vectorcardiographic examinations, which were repeated at intervals of 24 hours. Fourteen patients (9 type I, 2 type II, and 3 type III according to DeBakey's classification) had acute aortic dissection indicated by clinical symptoms and proven by angiography. The electrocardiograms all revealed abnormal T-wave inversion in limb or precordial leads except 3 patients. Nine (64%) of the 14 patients had abnormal length/width (L/W) ratios of the T-loop in 2 planes of the emergency vectorcardiogram. Two (22%) among these 9 patients died of ventricular tachyarrhythmia. The inscription direction of the T-loop showed abnormality in 4 (29%) of the 14 patients; 2 (50%) among these 4 patients died of ventricular tachyarrhythmia. The de novo occurrence of sustained ventricular tachyarrhythmia after emergency cardiac surgery in patients with acute aortic dissection has been documented in this report. Furthermore, patients with acute aortic dissection who have (1) an abnormal sense of inscription direction of the T-loop in at least 1 of either the horizontal or left sagittal plane, and (2) an abnormal L/W ratio in at least 2 planes in the preoperational emergency vectorcardiogram, have altered ventricular repolarization and thus are at high risk of postoperationally unexpected ventricular tachyarrhythmia. This information is not available from the electrocardiogram.

Adult↗