Chi-Hsiang Huang

Efficacy of Ultrafiltration in Removing Inflammatory Mediators During Pediatric Cardiac Operations

BACKGROUND Conventional and modified ultrafiltration was used in pediatric cardiac operations to reduce volume overload and total body water. The purpose of this study was to compare the efficacy of these techniques in removing inflammatory mediators during cardiopulmonary bypass. METHODS Fifty pediatric patients undergoing cardiac operations were randomized into a modified or conventional ultrafiltration group. Blood samples were obtained before and after ultrafiltration to assess the plasma concentrations of leukocyte elastase, tumor necrosis factor-alpha, interleukin-6, and interleukin-8. RESULTS Except for plasma concentrations of tumor necrosis factor-alpha in the modified ultrafiltration group, the plasma concentrations of all the mediators measured increased after ultrafiltration in both groups of patients. The volume of ultrafiltrate and the total amounts of tumor necrosis factor-alpha and interleukin-6 removed by ultrafiltration were significantly greater in the modified group. The concentrations of mediators in the ultrafiltrate and the ratio of ultrafiltrate to plasma concentrations of the mediators did not differ between the groups. Ultrafiltration was more efficient in removing tumor necrosis factor-alpha than the other mediators. CONCLUSIONS The efficacy in removing the inflammatory mediators generated during cardiopulmonary bypass did not differ between modified and conventional ultrafiltration.

Usefulness of intravenous propofol anesthesia for radiofrequency catheter ablation in patients with tachyarrhythmias: infeasibility for pediatric patients with ectopic atrial tachycardia.

General anesthesia is sometimes required during radiofrequency catheter ablation (RFCA) of various tachyarrhythmias because of an anticipated prolonged procedure and the need to ensure stability during critical ablation. In this study, we examine the feasibility of using propofol anesthesia for RFCA procedure. There were 150 patients (78 male, 72 female; mean age 30 years, range 4–96 years) in the study. Electro physiologic study was performed before and during propofol infusion in the initial 20 patients and was performed only during propofol infusion in the remaining 130 patients. In the initial 20 patients, propofol infusion increased the sinus rate and facilitated AV nodal conduction. The accessory pathway effective refractory period, as well as the sinus node recovery time, atrial effective refractory period, and ventricular effective refractory period were not significantly changed. There were 152 tachyarrhythmias in 150 patients (24 atrial flutter, 31 AV nodal reentrant tachycardia, 68 AV reciprocating tachycardia, 12 ventricular tachycardia, and 17 atrial tachycardia). Most (148/152) tachycardias remained inducible after anesthesia and RFCA was performed uneventfully. However, in four of the seven pediatric patients with ectopic atrial tachycardia, the tachycardia terminated after propofol infusion and could not be induced by isoproterenol infusion. Consequently, RFCA could not be performed. Intravenous propofol anesthesia is feasible during RFCA for most tachyarrhythmias except for ectopic atrial tachycardia in children

Analgesic Effect of Lidocaine Patch 5% in the Treatment of Acute Herpes Zoster: A Double-Blind and Vehicle-Controlled Study

Background and Objectives: Although lidocaine patch 5% has been widely used for postherpetic neuralgia, its analgesic effect on the intense pain associated with acute herpes zoster has not been investigated because of its potential hazard to damaged skin. Methods: Forty‐six patients suffering from moderate to severe pain caused by acute herpes zoster infection (within 4 weeks of onset) were enrolled in a randomized, double‐blind, vehicle‐controlled, parallel study. Lidocaine patch 5% or vehicle patch were applied to the intact portion of the painful skin area without blisters at 12‐hour intervals twice a day for 2 consecutive days. Analgesic efficacy and side effect profiles were assessed before and 48 hours after patch application. Results: We found that both groups of patients experienced significant pain relief during rest and movement. Differences of mean reduction of pain intensity between the two groups were 14.7 (4.7‐24.8, P = 0.005) during rest and 10.4 (1.6‐19.3, P = 0.007) during movement, favoring the lidocaine patch. The lidocaine patch produced a greater percentage change in a patients global impression than the vehicle patch. The incidence and severity of adverse events were low with both treatments. Conclusions: This study demonstrates that lidocaine patch 5%, applied twice a day, could serve as a well tolerated and effective modality to relieve moderate to severe pain associated with acute herpes zoster presumably through its pharmacological action and physical barrier effect on sensitized skin.

Hyperbilirubinemia after cardiac operation: Incidence, risk factors, and clinical significance

Three hundred and two consecutive patients who had undergone cardiac operation for various cardiac lesions were studied prospectively to evaluate the incidence, risk factors, and the associated mortality of postoperative hyperbilirubinemia after cardiopulmonary bypass. Concentrations of the serum total (conjugated and unconjugated) bilirubin, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, albumin, globulin, and serum haptoglobin were measured before the operation and again on the first, second, and seventh postoperative days. Postoperative hyperbilirubinemia was defined as occurrence of a serum total bilirubin concentration of more than 3 mg/dl in any measurement during the postoperative period. Logistic regression was done to identify possible risk factors for postoperative hyperbilirubinemia. Overall incidence of postoperative hyperbilirubinemia was 35.1%; the incidence of postoperative hyperbilirubinemia was higher in patients whose valves were replaced with mechanical prostheses than in those without prostheses (p < 0.00001). In patients with postoperative hyperbilirubinemia, 70% of the increase of total bilirubin on the first postoperative day came about from an increase in unconjugated bilirubin. Serum haptoglobin decreased significantly at the same time (p < 0.01). Development of the postoperative hyperbilirubinemia was associated with a higher mortality (5.6% versus 0.5%, p < 0.01) and higher frequency of use of intraaortic balloon counterpulsation, especially for patients in whom the highest postoperative total bilirubin occurred after the first 2 days. The numbers of valves replaced, preoperative right atrial pressure, and preoperative total bilirubin concentration are the significant risk factors that, in combination, correctly predict the occurrence of postoperative hyperbilirubinemia in 80% of the patients. We concluded that postoperative hyperbilirubinemia results mainly from an increase in unconjugated bilirubin and is associated with higher mortality, especially for patients in whom highest postoperative total bilirubin occurred late after operation. Patients with the higher preoperative right atrial pressure and total bilirubin level who then underwent multiple valve replacement procedures are at greater risk for development of postoperative hyperbilirubinemia.

A randomised double-blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

We studied the hypothermic effect of adding 150 μg morphine during spinal anaesthesia in 60 parturients scheduled for elective caesarean section. All the parturients received intrathecal injection of a solution containing 150 μg morphine or normal saline in addition to 10–12 mg hyperbaric bupivacaine 0.5%. In both groups, a significant decrease in body temperature was noted. There was no difference in the area under the curve for temperature against time for the two groups; however, the maximum decrease in temperature from baseline was significantly larger after morphine than after saline injection (mean (SD) 1.11 (0.61) °C vs 0.76 (0.39) °C, respectively; p = 0.01) and the time to nadir temperature was significantly longer (59.5 (17.6) min vs 50.4 (15.9) min, respectively; p = 0.047). The lowest temperature observed in the morphine group was 34.3 °C. We conclude that intrathecal injection of 150 μg morphine intensified the intra‐operative hypothermic effect of bupivacaine spinal anaesthesia for caesarean section.

Polymorphisms in the Endothelial Nitric Oxide Synthase Gene May Be Protective Against Preeclampsia in a Chinese Population

The association between the endothelial nitric oxide synthase (eNOS) gene with vascular diseases in Western populations and with severe preeclampsia (PE) in the Japanese population have been demonstrated, lacing the data in Chinese population. The authors examine the association between PE and 2 polymorphisms of the eNOS gene in a Chinese population, consisting of 92 pregnant women with PE and 256 healthy controls. All were genotyped for the Glu298Asp polymorphism in exon 7 and the number of 27 base pair repeats in intron 4 of the eNOS gene. The frequencies of both the variant T allele and eNOS 4a (small allele with 4 repeats of 27 bp) were significantly lower in the PE group than in the control group. The genotype distribution of Glu298Glu, Glu298Asp, and Asp298Asp in eNOS exon 7 and bb type and ab type in eNOS intron 4 revealed statistically significant differences between control and PE groups. This is the first study to evaluate the association between 2 polymorphisms in the maternal eNOS gene with PE simultaneously in a Chinese population. Similar to the findings in Western populations, polymorphisms in the eNOS gene may be protective against PE in a Chinese population, in contrast to the results in the Japanese population.

Intravenous tenoxicam reduces uterine cramps after Cesarean delivery.

PurposePostpartum uterine contraction pain is a common phenomenon after Cesarean delivery. We investigated the effectiveness of tenoxicam in reducing uterine contraction pain.MethodsWe enrolled 120 consecutive non-breastfeeding women who were scheduled for elective Cesarean delivery. After the administration of spinal anesthesia with bupivacaine and intrathecal morphine 0.15 mg injection, the patients were randomly divided into two groups. Group I received placebo (normal saline) iv injection, and Group II received tenoxicam 40 mg iv injection after clamping the umbilical cord. Verbal analogue scale of wound pain and uterine contraction pain were recorded at two, four, eight, 16, and 24 hr after Cesarean delivery.ResultsThere was no significant difference in wound pain scores between the two groups (all scores ≤3). However, the tenoxicam group had significant lower uterine contraction pain scores and required less supplemental meperidine medication than did the placebo group (8.5% vs 41.4%,P < 0.05). The incidences of nausea or vomiting, pruritus, and bleeding were not significantly different between groups.ConclusionIntravenous tenoxicam 40 mg significantly reduced the intensity of uterine cramps in patients undergoing Cesarean delivery without increasing side effects.RésuméObjectifLa douleur des contractions utérines du postpartum est un phénomène fréquent après la césarienne. Nous avons vérifié l’efficacité du ténoxicam à réduire ces douleurs.MéthodeNous avons recruté 120 femmes qui devaient subir une césarienne non urgente et qui ne devaient pas allaiter leur bébé. Après la rachianesthésie avec de la bupivacaïne et une injection intrathécale de 0,15 mg de morphine, nous avons formé deux groupes. Les patientes du Groupe I ont reçu un placebo (soluté physiologique) iv et celles du Groupe II 40 mg iv de ténoxicam après le clampage du cordon ombilical. L’échelle verbale analogique a servi à enregistrer la douleur postopératoire liée à l’incision et aux contractions utérines à deux, quatre, huit, 16 et 24 h.RésultatsLes scores de douleurs liées à l’incision n’ont pas différé d’un groupe à l’autre (tous les scores ont été ≤ 3). Par ailleurs, dans le groupe ténoxicam, les scores liées aux contractions utérines ont été plus bas et les demandes d’analgésie supplémentaire avec mépéridine moins importantes que dans le groupe placebo (8,5 % vs 41,4%, P < 0,05). Nausées, vomissements, prurit ou saignements n’ont pas présenté de différence intergroupe significative.ConclusionUne dose intraveineuse de 40 mg de ténoxicam a réduit significativement l’intensité des crampes utérines sans causer d’effets secondaires à la suite d’une césarienne.

A genetic linkage map of Nicotiana plumbaginifolia/ Nicotiana longiflora based on RFLP and RAPD markers

Abstract  We have constructed a genetic linkage map for Nicotiana plumbaginifolia/Nicotiana longiflora (2n= 2x=20), based on the segregation of 69 RFLP and 102 RAPD loci in 99 F2 plants from the cross N. plumbaginifolia×N. longiflora. The map consists of nine major linkage groups, each containing more than nine marker loci, and spans 1062 cM. Twenty of the RFLP markers were mapped previously to Nicotiana sylvestris (2n=2x=24) chromosomes using monosomic alien addition lines. Taxonomically, N. plumbaginifolia and N. sylvestris belong to the same section, namely the Alatae; however, cytogenetic evidence indicates that they are not closely related. Comparison of the distribution of markers common to both maps suggests that genome reorganization has occurred during the evolution of these two species. Evidence is also presented that genome reorganization may be accompanied by gain and loss of specific classes of DNA sequences in their genomes.

Abdominal compartment syndrome secondary to ovarian mucinous cystadenoma.

BACKGROUND: Abdominal compartment syndrome secondary to a very large benign ovarian tumor has been rarely reported in gynecology. With the increase of intraabdominal pressure in abdominal compartment syndrome, all major organ systems are adversely affected, causing a potentially fatal condition. CASE: A 43-year-old woman presenting with a tensely distended abdomen developed hypotension, difficulty in ventilation, and anuria. An ovarian tumor complicated by abdominal compartment syndrome was diagnosed, along with hemodynamic decompensation. Prompt resuscitation with immediate surgical removal of the tumor reversed the life-threatening situation. CONCLUSION: Timely aggressive resuscitation, prompt surgical decompression, and intensive perioperative hemodynamic management are required for patients with ovarian mucinous cystadenoma complicated by abdominal compartment syndrome.

Complications of Intraoperative Transesophageal Echocardiography in Adult Cardiac Surgical Patients—Experience of Two Institutions in Taiwan

There is some safety concern about transesophageal echocardiography (TEE) when it is used routinely during cardiac operations. The purpose of this investigation was to study the incidence of intraoperative TEE-associated complications in adult cardiac surgical patients. The study population comprised 6255 consecutive adult cardiac surgical patients with intraoperative TEE examinations. TEE-associated complications occurred in 25 patients (0.4%). Most of these complications consisted of oropharyngeal mucosal bleeding (15/25, 60%). Esophageal perforation occurred in one patient. Two patients experienced upper gastrointestinal bleeding. Seven patients experienced dental injuries, and TEE probe insertion failed in 10 patients. We conclude that intraoperative TEE-associated complications in cardiac operations is very low; the complication rate we found was comparable to previously reported values.