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Biomedical subjects

T J Yu

Publications and source records attributed to T J Yu.

At least 19 recordsLinked to original sources
PubMed2001

Improvement of sexual function in male patients after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: Clinically, the severity of uremia is known to be inversely proportional to sexual desire and activity in patients with chronic renal failure. We studied sexual function and sex hormones in male patients with symptomatic hyperparathyroidism before and 3 months after parathyroidectomy. STUDY DESIGN: From October 1998 to December 2000, 20 male patients with symptomatic secondary hyperparathyroidism were enrolled in this study. They underwent total parathyridectomy and autotransplantation of 90 mg of tissue to the subcutaneous tissue of the forearm or thigh. They all had regular sexual partners and were sexually active. Preoperatively, hemoglobin, hematocrit, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), prolactin, testosterone, leutenizing hormone (LH), and follicle stimulation hormone (FSH) were checked routinely. Three months after operation those data were checked again. Sexual function was evaluated with the International Index of Erectile Function (IIEF). Monthly frequency of attempted sexual intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse were individually analyzed preoperatively and 3 months postoperatively. RESULTS: Hemoglobin, hematocrit, testosterone, and LH were noted to have not significantly changed 3 months after surgery. Serum levels of calcium, phosphorus, alkaline phosphatase, FSH, and iPTH were significantly reduced, as were the levels of prolactin. But preoperative and postoperative FSH levels were within normal limits, and 70% of the postoperative alkaline phosphatase levels were above normal. Sexual function increased significantly 3 months after parathyroidectomy, as did monthly frequency of attempted intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse. CONCLUSIONS: Sexual function of male patients with symptomatic hyperparathyroidism can possibly be improved by parathyroidectomy and autotransplantation. Decreases in the levels of prolactin, calcium, phosphorus, and iPTH are also noticed after parathyroidectomy.

Adult↗
PubMed2000

Causes of venous thrombosis in fifty Chinese patients.

In a whole year from July 1997 to June 1998, a total of 50 patients with sonogram-proved venous thrombosis who called on our hematology clinic consecutively entered into the study. Their mean age was 59.1 +/- 17.5 years, range 18-83 years, and 29 were male. A series of examinations were performed in order to find out the cause of venous thrombosis. These examinations included antithrombin, protein C, protein S, plasminogen, heparin cofactor II, activated protein C ratio, factor V Leiden mutation, fibrinogen, factors VIII and XII, euglobulin lysis time, 677 C-->T mutation of methylenetetrahydrofolate reductase (MTHFR), prothrombin 20210 (PT 20210) A allele mutation, lupus anticoagulant, anticardiolipin antibody, and complete blood count. Five patients (10%) were found to have malignancy; an inferior vena cava thrombosis in one patient was due to venous compression by hydronephrosis; two patients had lupus anticoagulant; two had varicose veins of legs; two had protein C deficiency; four had protein S deficiency; two had plasminogen deficiency; two had antithrombin deficiency. No activated protein C resistance, elevated factor VIII level, factor V Leiden, PT 20210 A allele or heparin cofactor II deficiency was found in the present study. Homozygous MTHFR 677 C-->T gene mutation was found in 7 patients (14%); one of them also had a plasminogen deficiency. No possible risk factor of venous thrombosis could be found in 24 patients (48%). In conclusion, malignancy and protein S deficiency were the most frequent acquired and congenital causes of venous thrombosis in the Chinese, respectively.

Adenocarcinoma↗
PubMed2000

Ipsilateral renal dysplasia with hypertensive heart disease in an infant with cutaneous varicella lesions: an unusual presentation of congenital varicella syndrome.

A child with congenital varicella syndrome including cutaneous lesions and ipsilateral renal dysplasia with hypertensive heart disease is described. Varicella was contracted during the tenth week of gestation. Typical congenital varicella bullae, high titer of anti-varicella-zoster virus IgM, and a small right kidney were noted after birth. Hypertensive heart disease resulting from renal dysplasia occurred at 1 year of age. The cutaneous lesions and the dysplastic kidney involved the same dermatomes. Nephrectomy proved to be the treatment of choice for hypertension and congestive heart failure.

Chickenpox↗
PubMed2000

Surgical repair of postinfarction ventricular septal defect.

BACKGROUND: Rupture of the interventricular septum complicates 1% to 2% of all acute myocardial infarction patients and its natural course is ominous. The purpose of this study is to present our experience with surgical ventricular septal defect (VSD) repair and examine the possible risk factors and explanations for surgical mortality. METHODS: Fourteen patients underwent repair of postinfarction VSD from 1996 to 1998 at the Taipei Veterans General Hospital. Thirteen patients were in New York Heart Association (NYHA) Functional Class IV and one was in Functional Class III. Eleven patients were in cardiogenic shock with intra-aortic balloon pumps (IABPs) prior to surgery. The operative techniques for VSD repair range from extensive infarctectomy with reconstruction of the septum and the right and left ventricular free walls using single or double patches, to minimal or no infarctectomy with closure of the VSD by excluding the infarcted muscle from the left ventricular cavity and leaving the right ventricle intact. RESULTS: Overall surgical mortality occurred in four patients. All deaths occurred in patients with cardiogenic shock, two with anterior VSD and two with posterior VSD. Three late survivors had limited exercise tolerance with NYHA Functional Class II to III. Left ventricular function was moderately impaired in most patients with a mean nuclear scan ejection fraction of 0.32. However, all patients were elderly and adapted to their residual symptoms without significant life-style changes. CONCLUSIONS: The surgical mortality for treating patients with postinfarction VSD has decreased with improvements in surgical technique. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.

Aged↗
PubMed2000

Age related testosterone level changes and male andropause syndrome.

BACKGROUND: Much like the menopause syndrome occurring among older women, a similar condition has been defined among men. Testosterone production increases rapidly at the onset of puberty, then dwindles quickly after age 50 to become 20 to 50% of the peak level by age 80. Many men older than age 50 have experienced frailty syndrome, which includes decrease of libido, easy fatigue, mood disturbance, accelerated osteoporosis, and decreased muscle strength. We investigated serum total testosterone levels and andropause syndrome in men. METHODS: Serum total testosterone levels were measured in 53 symptomatic men older than age 50 and in 48 men younger than age 40 for a control group. We also analyzed andropause symptoms among the 53 men older than age 50. RESULTS: The mean serum total testosterone level in the symptomatic men older than age 50 (mean: 2.68 +/- 0.51 ng/ml, range: 1.21 to 4.13 ng/ml) was significantly lower than that in the control group (mean: 7.01 +/- 0.82 ng/ml, range: 5.53 ng/ml to 8.14 ng/ml). Male frailty syndrome in these men older than 50 included: decreased libido (91%), lack of energy (89%), erection problems (79%), falling asleep after dinner (77%), memory impairment (77%), loss of pubic hair (70%), sad or grumpy mood changes (68%), decrease in endurance (66%), loss of axillary hair (55%), and deterioration in work performance (51%). CONCLUSION: The serum total testosterone level showed a decline with aging, especially in the men older than age 50. Low serum testosterone levels were also associated with the symptoms of male andropause syndrome.

Adult↗
PubMed1999

Bladder rupture after inguinal herniotomy.

An 18-month-old male sustained an extensive bladder injury during a routine right inguinal herniotomy. Primary closure of the remaining detrusor was performed. Three months postoperatively he could void spontaneously, but with a small, contracted bladder and bilateral vesicoureteral reflux. He was stable throughout a 6-month follow-up period. Further surgical options will depend upon the bladder capacity and the grade of reflux.

Hernia, Inguinal↗
PubMed1999

Transmyocardial holmium-YAG laser channels in an animal model: a preliminary morphologic and histologic study.

BACKGROUND: Laser transmyocardial revascularization (TMR) appears to improve symptoms in patients with refractory angina. However, it remains a controversial treatment modality for relieving ischemia. We conducted our study in dogs and evaluated the changes in morphology and histology of the myocardium after laser TMR. METHODS: The hearts of 10 mongrel dogs (20-30 kg each) were treated with a holmiumyttrium aluminum garnet (YAG) laser in vivo. After opening the pericardium, the 1-mm fiberoptic device was used to create an average of 30 transmyocardial channels per heart at approximate intervals of 0.5 to 1 cm through normal left ventricular myocardium. All dogs tested survived the procedure. The dogs were sacrificed on the first and 60th postoperative days. RESULTS: In the day-1 postoperative group (n = 4), the transmyocardial channels were obliterated at both epicardial and endocardial ends. The channels were totally occupied by necrotic myocytes and did not appear patent under the microscope. In the day-60 postoperative group (n = 6), the epicardial and endocardial scars were identified at each original laser application site. On cross-section, the channels were invaded by fibrous tissue bands extending from the endocardium to the epicardium, without a prominent central passage. Trichrome stained specimens showed that the channels were replaced by collagen fibers, fat tissue and numerous well-developed capillaries or sinusoids in which plenty of red blood cells were found. CONCLUSIONS: We concluded that laser TMR offers no help for acute myocardial ischemia, but results in neovascularization inside the channels by the 60th postoperative day. Angiogenesis induced by laser TMR could possibly play a role in relieving chronic ischemia.

Animals↗
PubMed1998

Extravesical detrusorrhaphy for vesicoureteral reflux in children.

Extravesical detrusorrhaphy is a simple and safe approach to antireflux surgery; however, its use in Taiwan has seldom been reported. We report the outcomes of 15 patients (23 ureters) with primary vesicoureteral reflux who underwent extravesical detrusorrhaphy between January 1995 and April 1996, and describe the surgical technique. Overall, vesicoureteral reflux was cured in 22 of 23 ureters. Postoperative morbidity and complications were minimal. None of the patients had obstruction or significant hematuria. The discomfort related to bladder spasms during the postoperative period was subjectively decreased compared to the conventional transvesical technique. There was transient voiding inefficiency in three patients, as well as urinary retention in one, which resolved spontaneously after 4 weeks of Foley catheter drainage. Our experience showed that detrusorrhaphy is an effective way to correct vesicoureteral reflux with minimal morbidity and discomfort. Proper patient selection and strict adherence to the surgical principle are important for high success rates.

Child↗
PubMed1998

Endoscopic vein harvest for coronary artery bypass surgery.

BACKGROUND: Despite increased awareness of risk factors, wound complications continue to be a problem following coronary artery bypass graft (CABG) surgery. A minimally invasive alternative was therefore developed to reduce the risk of complications while providing the same benefits as the standard open vein harvest procedure. METHODS: Video-assisted endoscopic technique for vein harvest was introduced in our medical center in October 1996. The procedure was evaluated and compared with the standard open vein harvest procedure. With the endoscopic technique, small incisions were made, each about 2-3 cm at the selected access sites (groin and above and below the knee). An endopath subcutaneous dissector was subsequently inserted along the anterior surface of the saphenous vein with the assistance of an endoscope and video monitor. The venous side branches were detected and positioned using a vessel dissector. A ligaclip was applied and the branches were divided using endopath-scissors. In some cases, the venous branches were divided directly using the endopath-scissors. Therefore, the distal and proximal ends of the saphenous vein were isolated, ligated and divided. The harvested veins were used for CABG. Each patient was evaluated for length of surgery, hospital stay and morbidity. RESULTS: From October 1996 through May 1997, we performed 50 procedures using video-assisted endoscopic vein harvest. The results were compared with those from 106 patients who underwent standard open vein harvest during the same period. The rate of complications was 2% in the endoscopic group compared with 13.2% in the open group (p < 0.05). The average hospital stay was 7.2 days in the endoscopic group and 11.5 days in the open group (p < 0.05). Twelve weeks after the operation, all of the incisions healed with good cosmetic results in the endoscopic group. However, long visible scars were found in the patients in the open group. CONCLUSIONS: Endoscopic saphenous vein harvest provides a minimally invasive alternative to open vein harvest. It provides good cosmetic results without a hypertrophic scar and enables the patient to regain early ambulation.

Aged↗
PubMed1998

Minimally-invasive, direct coronary artery bypass grafting.

BACKGROUND: Minimally-invasive, direct vision coronary artery bypass grafting (MIDCAB) is a new surgical technique performed via limited thoracotomy in a beating heart without cardiopulmonary bypass. METHODS: From June 1996 to December 1996, MIDCAB was performed in 12 patients (all male, average age, 65.9 years). In 11 patients with left anterior descending coronary artery lesions, thoracotomy was performed via the left, fourth intercostal space and the pericardium was incised to identify the target site. About 8 cm of the left internal mammary artery was harvested. Bilateral anterolateral thoractomy was performed in one patient with left anterior descending and right coronary artery lesions. Anastomosis was performed under direct vision in the beating heart without cardiopulmonary bypass. RESULTS: MIDCAB was performed successfully without morbidity. The patients' average stay in the intensive care unit was 1.8 days. No patient had any early cardiac event requiring additional surgery or percutaneous transluminal coronary angioplasty. Postoperatively, all patients were asymptomatic and their recovery was uneventful. CONCLUSIONS: Our initial experience indicates that MIDCAB offers good results and is a treatment option for selected patients with left anterior descending and/or right coronary artery lesions.

Aged↗
PubMed1997

Early versus late surgical management of fetal reflux nephropathy.

PURPOSE: Considering that infants with reflux nephropathy may be susceptible to urinary tract infection or longer postnatal vesicoureteral reflux, an early antireflux procedure rather than chemoprophylaxis may be indicated after birth. MATERIALS AND METHODS: In 15 male and 7 female neonates bilateral and unilateral primary high grade vesicoureteral reflux was detected prenatally in 15 and 7, respectively, on the basis of dilatation of the urinary tract. There was grade III or IV reflux in the 37 refluxing renal units and all patients received chemoprophylaxis after birth. In 11 neonates congenital reflux nephropathy was diagnosed during month 1 of life, including 5 (9 refluxing renal units) who underwent early antireflux surgery without evidence of urinary tract infection and 6 (11 refluxing renal units) who underwent late surgery with a history of urinary tract infection. All patients treated nonsurgically and surgically were monitored up to 2 years and for 2 years postoperatively, respectively. RESULTS: Of the 11 patients (17 renal units) without congenital reflux nephropathy reflux improved in 53%, a documented urinary tract infection occurred in 2 and there was no development of new scars in a previously normal kidney. In the 11 patients (20 renal units) with congenital reflux nephropathy the parenchymal defect detected during month 1 of life was general or focal, that is at the mid zone as well as the poles. Surgery was performed at a mean of 8 weeks of life in 5 patients without a documented urinary tract infection, 24 weeks earlier than in the 6 with a history of urinary tract infections. Postoperative breakthrough infections occurred in all 6 infants who underwent late surgery and in none who underwent early surgery (p < 0.05). New scarring developed in previously scarred renal units but there was more new scarring in the renal units treated with late surgery (10 of 11, 90%) than in those treated with early surgery (2 of 9, 22%, p < 0.001). In both groups retardation of growth was identified in the renal units with general nephropathy. CONCLUSIONS: Renal units with fetal reflux nephropathy were susceptible to urinary tract infections and new scar formation. Early antireflux surgery performed before a urinary tract infection develops offers a better prognosis than late surgery.

Female↗
PubMed1997

Surgical management of grades III and IV primary vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections: a comparative analysis.

PURPOSE: Although high grade vesicoureteral reflux associated with breakthrough infection may be an indication for surgical intervention, it remains uncertain whether acute pyelonephritis as breakthrough infection is a risk for renal scar formation and whether surgery performed without it has any advantage. We assessed the results of antireflux surgery for high grade vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections. MATERIALS AND METHODS: A total of 33 boys and 27 girls (102 refluxing units) less than 3 years old with grades III and IV vesicoureteral reflux who underwent surgical management because of breakthrough infections were retrospectively studied in a 3-year period. Of the 60 patients 30 (group 1) presented with breakthrough infections of acute pyelonephritis, although they were maintained on prophylactic antibacterials. The remaining 30 patients (group 2) underwent surgery without acute pyelonephritis as the breakthrough infections. There was no renal scar formation at the diagnosis of vesicoureteral reflux in either group. Patients with renal scars were excluded from study. There was no significant difference in patient gender (p = 0.795) or distribution of bilateral vesicoureteral reflux (p = 0.781) in the groups. Group 1 patients were significantly younger at the diagnosis of vesicoureteral reflux (p = 0.006). RESULTS: Although 55 patients presented with a febrile urinary tract infection at the diagnosis of vesicoureteral reflux, the infection was not significantly related to the development of renal scars (p = 0.066). Of the 55 patients 12 presented with acute pyelonephritis as the initial episode of urinary tract infection. The presence of acute pyelonephritis at the diagnosis of vesicoureteral reflux was also not significantly related to renal scar formation (p = 0.207). Postoperative urinary tract infections developed in 34 patients but there was no significant correlation between postoperative urinary tract infections and renal scar formation (p = 0.235). At followup 17 group 1 and 7 group 2 patients (29 renal units) were found to have renal scars. CONCLUSIONS: Renal scars were significantly more common in younger children with than without acute pyelonephritis as breakthrough infections (p = 0.010). Although breakthrough infections in high grade reflux may be an indication for antireflux surgery, the most appropriate results were achieved when acute pyelonephritis was not a breakthrough infection.

Acute Disease↗
PubMed1997

Surgical repair of Ebstein's anomaly.

BACKGROUND: Ebstein's anomaly represents a congenital structural deformity of the tricuspid valve associated with a wide spectrum of morphologic and physiologic abnormalities. Valvuloplasty and tricuspid valve replacement are the main surgical treatments. Plication of the atrialized right ventricle and valvuloplasty of the tricuspid valve can achieve satisfactory clinical results. Two surgical techniques, known as Danielson's and Quaegebeur's methods, are often used clinically. This study was conducted to compare the postoperative results between both methods in treatment of Ebstein's anomaly. METHODS: Valvuloplasty of tricuspid valve and the plication of atrialized right ventricle were performed in 8 out of 17 patients with Ebstein's anomaly in our hospital from January 1986 to August 1996. Danielson's method was used in six of eight patients, and Quaegebeur's method was used in the remaining two patients. There were three males and five females, aged from 8 months to 61 years (mean: 14.1 years). RESULTS: All patients achieved clinical improvement in cardiothoracic ratio and heart functional class. Cardiac arrhythmia was the likely cause of death in two patients treated by Danielson's method, and one patient developed complete atrioventricular (A-V) block postoperatively. By Quaegebeur's method, all patients survived, but a permanent pacemaker was implanted for both patients due to their preoperative complete A-V block. CONCLUSIONS: Both methods achieved satisfactory postoperative results. However, Quaegebeur's method seems to be more effective because it provided a simultaneous reconstruction of both tricuspid valve and right ventricle without the need for additional excision of the right atrium.

Adolescent↗
PubMed1996

Pulmonary actinomycosis appearing as a "ball-in-hole" on chest radiography and bronchoscopy.

A 40 year old diabetic man with pulmonary actinomycosis was admitted to hospital with recurrent haemoptysis. The chest radiograph showed an air meniscus in the left upper lobe, a rare presentation of pulmonary actinomycosis. Bronchoscopic examination revealed a mass in a cavity which has never been reported previously. He underwent lobectomy and the surgical specimen revealed sulphur granules, the typical pathological finding of actinomycosis, without evidence of fungal or mycobacterial infection.

Actinomycosis↗
PubMed1996

Antituberculosis drug resistance in Keelung area-1993 to 1994.

Patterns of drug resistance of 176 isolates of Mycobacterium tuberculosis collected from 1993 to 1994 were reviewed retrospectively. The rates of resistance to isoniazid, rifampicin, ethambutol and streptomycin were 84.1%, 17.6%, 23.3% and 11.9% respectively and the incidence of multidrug-resistant M. tuberculosis was 17.0%. Comparisons between 1993 and 1994 showed decrease in rates of resistance to rifampicin (25% vs. 7.5%) and ethambutol (36.5% vs. 7.5%) and the incidence of multidrug-resistant tuberculosis (25% vs. 7.5%). In contrast, the rate of resistance to isoniazid increased from 79.2% to 84.1%. Due to the high frequency of resistance to multiple drugs in tuberculosis isolates at Chang Gung Memorial Hospital, Keelung, three-combined (isoniazid+rifampicin+ethambutol) regimen of antituberculosis drugs may be ineffective as initial therapy for one-fourth of patients in our hospital. Of epidemiological factors, previous treatment was found to influence the rates of drug resistance. Of roentgenographic features, stage of chest roentgenography was found to be a positive predictor of infection with multidrug-resistant tuberculosis. The information provided in this study may help us understanding the epidemiology of M. tuberculosis in Keelung and refining antituberculosis treatment for our patients.

Adult↗
PubMed1995

Two-stage orchiopexy with laparoscopic clip ligation of the spermatic vessels in prune-belly syndrome.

A 1-year-old boy with prune-belly syndrome underwent unilateral laparoscopic clip ligation of the spermatic vessels with the hope of developing vasal collateral circulation. Six months later, the patient underwent ipsilateral second-stage orchiopexy on the right testis after division if the ligated spermatic vessels and contralateral Fowler-Stephens orchiopexy on the left testis in combination with major urinary tract reconstructions and abdominoplasty. For the following 1-year period, both testes were growing and comparable in size.

Cryptorchidism↗