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Biomedical subjects

V Tsang

Publications and source records attributed to V Tsang.

54 records · Page 3Linked to original sources
PubMed1990

Pleuroperitoneal shunt for recurrent malignant pleural effusions.

The therapeutic options available for the management of malignant pleural effusions associated with a restricting malignant cortex remain unsatisfactory. The efficacy of pleuroperitoneal shunts was evaluated in 16 patients with recurrent malignant effusions. There were no operative deaths; one patient died on the third postoperative day as a result of lymphangitis carcinomatosa. The median hospital stay was five (range 3-21) days. Palliation was obtained in all but one of the other 15 patients. There was no appreciable reaccumulation of pleural fluid as judged by radiography. Two patients developed occlusion of the shunt. In one case this was due to blood clots in the pleural catheter and necessitated insertion of a new shunt. The other shunt was removed because of obstructing infected fibrin debris, and a rib resection was performed. There were eight deaths related to the underlying malignancy after a mean interval of 7.3 (range 1.5-23) months. The other six patients are still alive, with a mean survival of 11.0 (range 5-20) months, and have achieved good symptomatic relief. The insertion of a pleuroperitoneal shunt can offer effective palliation for patients with recurrent malignant pleural effusions.

Adult↗
PubMed1989

Slide tracheoplasty for congenital funnel-shaped tracheal stenosis.

Congenital funnel-shaped trachea is a serious condition, and the survival rate in infants is poor. A slide tracheoplasty is described, with a brief review of other methods of repair. Two cases that demonstrate the operability of congenital funnel-shaped trachea in infancy are reported.

Female↗
PubMed1989

A clinical study of 407 cases of nasopharyngeal carcinoma in Hong Kong.

Four hundred and seven cases of nasopharyngeal carcinoma were analyzed retrospectively; 403/407 were evaluable for recurrence and survival. Parapharyngeal boost significantly decreased local recurrences in parapharyngeal diseases without base of skull involvement (T2p), but not with base of skull involvement (T3p). Enhanced local control of T2p with boost was significant without neoadjuvant chemotherapy. Tumors localized within the nasopharynx (T1) and tumors with nasal involvement (T2n) suffering from local persistences after external radiation therapy were treated with an intracavitary afterloading method. They had survival and recurrence rates comparable to complete responders to external radiation therapy. Patients with bulky cervical nodes (maximal diameter greater than or equal to 4 cm, N1-N3), treated with neoadjuvant chemotherapy with cis-diamminedichloroplatinum II and 5-fluorouracil, had a regional failure rate, distant metastasis rate, actuarial survival rate, and disease-free survival rate comparable to those with smaller nodes treated with external radiation therapy alone. A simple modification of the Ho's classification by regrouping the T-stages into 'early T-stages' and 'advanced T-stages' and by combining the N1 and the N2 has greatly increased the power of the system in predicting local recurrence and distant metastasis, respectively. There was an overall improvement of the actuarial survival rate and disease-free survival rate over the historical control, and its significance is discussed.

Adult↗
PubMed1989

Endobronchial stenting for anastomotic stenosis after sleeve resection.

Bronchial anastomotic stenosis is a potentially serious complication of sleeve resection. A Silastic endobronchial stent that prevents progressive narrowing at the anastomotic site is described. Insertion of the stent offers a simple and effective treatment that allows improved pulmonary performance, clearing of infection, and good quality of life. The long-term prognosis, however, remains questionable.

Aged↗
PubMed1989

Gallium-67 scintigraphy in the detection of infected polycystic kidneys in renal transplant recipients.

Renal transplant recipients with underlying polycystic kidney disease (PKD) may present with recurrent urinary tract infection (UTI). This is often due to persistent infection in one or both of the native polycystic kidneys. It may be necessary to remove the infected kidney in order to remove the source of persistent infection. Gallium-67 scintigraphy was performed in 11 renal transplant recipients with underlying PKD. Positive studies were obtained in four recipients who had recurrent UTI. The scan also localized which of the kidneys (native or transplant) was the site of persistent infection. These four recipients subsequently had nephrectomy of the infected polycystic kidneys as suggested by the scan. Negative scans were obtained in seven recipients who did not have recurrent UTI. Gallium scintigraphy is a useful test for detecting and localizing the site of persistent UTI in renal transplant recipients with underlying PKD who present with recurrent UTI.

False Negative Reactions↗
PubMed1989

Elective deep hypothermia with total circulatory arrest: changes in plasma creatine kinase BB, blood glucose, and clinical variables.

Serial measurements of a marker of brain ischemia, creatine kinase isoenzyme BB, were performed in arterial and internal jugular venous blood from 20 infants younger than 1 year of age before and during the first 20 hours after deep hypothermic total circulatory arrest procedures. A two-site monoclonal method was used, and the results were analyzed in relation to age, size, type of cardiac lesion, hemoglobin level, blood glucose level, pH, and duration of the total circulatory arrest. The creatine kinase BB concentrations increased after the arrest, more so in venous than in arterial blood, from 3.2 +/- 0.5 ng/ml to 17.5 +/- 4.5 in arterial blood and from 3.5 +/- 0.5 ng/ml to 18.1 +/- 5.8 in venous blood. Arterial-venous concentration differences correlated with venous concentrations (r = 0.92, p less than 0.01). The duration of the arrest correlated with creatine kinase BB concentrations during reperfusion with correlation coefficients between 0.50 to 0.90 depending of what sequence of the 20-hour sampling period was analyzed. The best correlation was obtained during the first 4 hours of reperfusion. Age, size of the child, and preoperative cyanosis correlated with postoperative creatine kinase BB but were less important than the arrest time, blood glucose level (r = 0.62, p less than 0.01), pH (r = -0.78, p less than 0.01), and hemoglobin level (r = 0.76, p less than 0.01) during reperfusion. It is suggested that a different control of blood glucose level and pH during reperfusion may be of importance to reduce biochemical signs of cerebral dysfunction after deep hypothermic total circulatory arrest procedures.

Blood Glucose↗
PubMed1988

Release of prostacyclin from the human aorta.

Prostacyclin (PGI2) release by human aortic tissue obtained at surgery was assessed in patients (n = 23) with ischaemic heart disease undergoing coronary artery bypass grafting (group 1) patients (n = 14) undergoing surgery for aortic stenosis (group 2), patients (n = 4) undergoing surgery for aortic regurgitation (group 3), and patients (n = 8) with ischaemic heart disease taking aspirin (group 4). Although there was a highly significant correlation between (a) intimal and medial PGI2 production and (b) medial PGI2 production and aortic diameter, there was no correlation between intimal PGI2 production and aortic diameter. Aspirin intake (75-150 mg daily) was associated with a pronounced inhibition (95%) of aortic PGI2 production. This inhibition of aortic PGI2 secretion by aspirin may account for the variable efficiency of aspirin in altering the natural history of vascular disease.

Adult↗
PubMed1987

A randomised cross-over trial comparing low-dose metoclopramide and chlorpromazine with high-dose metoclopramide in Chinese patients with advanced cancer receiving cisplatinum and 5-fluorouracil.

Nineteen Chinese patients receiving chemotherapy for advanced cancer were studied for chemotherapy-induced acute nausea and vomiting. The chemotherapy consisted of cisplatinum 100 mg/m2 i.v. infusion over 4 h on day 1 and 5-fluorouracil (5-FU) 1000 mg/m2 120-h continuous infusion from day 2 to day 6, repeated every 3 weeks. At the first course of chemotherapy the patients were randomized to receive either low-dose metoclopramide and chlorpromazine or high-dose metoclopramide, and then crossed over for the second course. In the high-dose metoclopramide group there was a suggestion of an earlier onset of emesis, with slightly more frequent retching and vomiting and less food consumed. However, the duration of emesis was shorter in the high-dose group. These differences were not statistically significant. There were no major side effects. Mild salutary drowsiness was noticed in patients receiving low-dose metoclopramide and chlorpromazine. This trial suggests that, in the dosage, route and schedule described, high-dose metoclopramide is no more effective than low-dose metoclopramide together with chlorpromazine in preventing cisplatinum-induced nausea and vomiting. The low-dose scheme is more economic and suitable for patients with advanced cancer.

Adult↗
PubMed1987

Eicosanoid synthesis by human urinary bladder mucosa: pathological implications.

Biopsies of human urinary bladder mucosa obtained during cystoscopy were shown to release eicosanoids in the following order: prostacyclin (PGI2), prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha) and thromboxane A2 (TXA2). The total and the relative amounts of eicosanoids released were similar to those reported for the rat urinary bladder. These eicosanoids may play a role in modulating the tone and contractility of the bladder as well as affecting cytoprotection of the mucosa. In view of the abundant release of eicosanoids by the bladder, caution must be exercised when considering urinary eicosanoid excretion as reflecting production by the systemic vasculature and/or the kidneys.

Dinoprost↗
PubMed1987

Ultrasound-guided tissue-core biopsy of thoracic lesions with Trucut and Surecut needles.

The value of ultrasound-guided tissue-core needle biopsy was assessed in 54 patients with thoracic lesions adjacent to the chest wall. Of these, six were apical and two mediastinal. Biopsy was performed with Trucut or Surecut (modified Menghini) needles in 22 patients, and with both in 32 patients in order to compare the two types of needle. Definitive diagnosis was made in 46 patients (85 percent), of whom 41 had malignancy of various cell types, and five had benign lesions. Of the remaining eight, three had apical lesions, and two had consolidation distal to a proximal tumor. There was complete histologic agreement in 25 of 32 patients where biopsy was performed with both needles. Roentgenographic size of the lesion had relatively little influence on the diagnostic yield. Complications comprise moderate hemoptysis in one patient (2 percent), trivial hemoptysis or hemothorax in three, and symptomless pneumothorax in two which resolved spontaneously. We conclude that tissue core needle biopsy of thoracic lesions under ultrasound guidance is an accurate and safe technique which provides specimens adequate for routine histologic examination. The diagnostic yield from Trucut and Surecut biopsies is comparable.

Adult↗
PubMed1986

Detection of cerebral injury after total circulatory arrest and profound hypothermia by estimation of specific creatine kinase isoenzyme levels using monoclonal antibody techniques.

New 2-site labeled monoclonal antibody techniques were used to measure serially plasma levels of brain-type creatine kinase (CK-BB), heart-type creatine kinase (CK-MB) and muscle-type creatine kinase (CK-MM) during a 20-hour postoperative period in 24 infants after deep hypothermia and total circulatory arrest used in pediatric cardiac surgery. A control group of 7 children undergoing cardiovascular procedures without extracorporeal circulation or circulatory arrest also were studied. There were marked increases in CK-MB and CK-BB levels in the circulatory arrest group but not in the closed group. CK-BB increased from 3.2 +/- 0.5 to 27 +/- 10 ng/ml and CK-MB from 5.9 +/- 2.1 to 137 +/- 12 ng/ml. The CK-MM concentrations increased from 299 +/- 91 and 194 +/- 49 ng/ml to 1,220 +/- 274 and 1,322 +/- 142 ng/ml in the closed and circulatory arrest groups, respectively. Peak levels of CK-MB and CK-BB occurred an average of 133 and 127 minutes, respectively, after reperfusion. The half-time of CK-BB differed significantly from that of CK-MB (149 +/- 15 vs 359 +/- 20 minutes). The arrest time had a more marked effect on CK-BB concentration than on CK-MB and CK-MM concentrations. Arteriointernal jugular venous concentration differences were consistently negative for CK-BB in the circulatory arrest group, but not for CK-MM and CK-MB.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗
PubMed1986

Serial measurement of arterial and internal jugular venous creatine kinase isoenzyme BB (CK-BB) after deep hypothermic total circulatory arrest in pediatric cardiac surgery.

Profound hypothermia and circulatory arrest in infants and children undergoing cardiac surgery were followed by abnormally high plasma levels of creatine kinase isoenzyme BB (CK-BB). Differences in the levels of enzymes in the femoral arterial and jugular venous blood indicated that the origin of the additional enzyme was the brain. The extent of the rise in enzyme levels was related to the duration of circulatory arrest. These data suggest that measurements of the CK-BB enzyme in plasma provide quantitative information about cerebral damage during cardiac surgery.

Brain↗
PubMed1986

Cholangitis after endoscopic sphincterotomy in patients with stricture of the biliary duct.

Five patients with stricture of the common hepatic bile duct underwent endoscopic treatment without relief from cholangitis or successful stricture dilation. A Roux-en-Y hepaticojejunostomy was performed upon four patients who are now symptom-free. Endoscopic sphincterotomy leads to bactobilia and increases the risk of cholangitis, particularly in patients with residual obstruction of the bile duct. Although endoscopic treatment may have a role in patients at high risk, there is uncertainty about the long term results and the risk of progressive liver damage. In the majority of patients, the results of operation for benign stricture of the bile duct are such that operative repair is the treatment of choice.

Adolescent↗
PubMed1979

Immunization against Schistosoma mansoni in rhesus monkeys and the requirement of activation of both cell-mediated and humoral mechanisms.

When groups of rhesus monkeys were pretreated with BCG plus hyperimmune serum from monkeys with chronic schistosomiasis or with dialyzable transfer factor from uninfected monkeys plus hyperimmune serum and were challenged with 1,500 cercariae of Schistosoma mansoni, the mean worm burdens were significantly lower than that of untreated controls. Pretreatment with neither BCG alone nor Corynebacterium parvum plus a membrane antigen of adult worms of S. mansoni affected susceptibility. Neither lymphocyte proliferation in the presence of mitogens or schistosome antigen nor serological responsiveness (as measured by gel diffusion, Cercarienhüllenreaktion, circumoval precipitation, or enzyme-linked immunoabsorbent assay) correlated with the degree of resistance of the animals to S. mansoni. The pretreatment procedures used did not cause any abnormal histopathological responses and did not alter the characteristic host response to schistosome eggs in the lungs, liver, mesenteric lymph nodes, and colon.

Animals↗
PubMedDate not supplied

The diagnostic importance of species specific and cross-reactive components of Taenia solium, Echinococcus granulosus, and Hymenolepis nana.

Sera from patients infected with Taenia solium, Hymenolepis nana and Echinococcus granulosus were tested against homologous and heterologous parasite antigens using an ELISA assay, and a high degree of cross-reactivity was verified. To identify polypeptides responsible for this cross reactivity, the Enzyme Linked Immunoelectro Transfer Blot (EITB) was used. Sera from infected patients with T.solium, H.nana, and E.granulosus were assessed against crude, ammonium sulphate precipitated (TSASP), and lentil-lectin purified antigens of T.solium and crude antigens of H.nana and E.granulosus. Several bands, recognized by sera from patients with T.solium, H.nana, and E.granulosus infections, were common to either two or all three cestodes. Unique reactive bands in H.nana were noted at 49 and 66 K-Da and in E.granulosus at 17-21 K-Da and at 27-32 K-Da. In the crude cysticercosis extract, a specific non glycoprotein band was present at 61-67 K-Da in addiction to specific glycoprotein bands of 50, 42, 24, 21, 18, 14, and 13 K-Da. None of the sera from patients with H.nana or E.granulosus infection cross reacted with these seven glycoprotein bands considered specific for T.solium infection.

Adolescent↗
PubMedDate not supplied

Heart-lung transplantation for cystic fibrosis and subsequent domino heart transplantation.

Between September 1984 and October 1988, 27 patients underwent combined heart-lung transplantation for treatment of end-stage respiratory disease caused by cystic fibrosis. The actuarial patient survival was 78% at 1 year and 72% at 2 years. Bacterial respiratory infections were common in the early postoperative period and necessitated vigorous medical therapy. The dose of cyclosporine required in these patients was higher than in conventional transplant recipients, and this contributed to an increased cost of postoperative care. Lung function was greatly improved after transplantation, and long-term survivors achieved an excellent quality of life. Lymphoproliferative disorders developed in two patients; these disorders regressed after a reduction in immunosuppression. Two patients required retransplantation: one because of obliterative bronchiolitis and the other because of recurrent respiratory infections associated with a moderate tracheal stenosis and severe deterioration in lung function. A modification of the technique used for heart-lung transplantation allowed 20 hearts from cystic fibrosis patients to be used for subsequent heart transplantation. Immediate heart function was satisfactory in all cases. The actuarial survival of the recipients of these domino heart transplants was 75% at 1 year. No coronary artery disease was present in the 12 patients who have undergone coronary angiography at 1 year.

Actuarial Analysis↗