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Paulose AK, Hou YJ, Huang YS, Chakkalaparambil Dileep N, Chiu CL, Pal A, Kalaimani VM, Lin ZH, Chang CR, Chen CP, Lin YC, Cheng CY, Cheng SH, Cheng CM, Wang YL. Rapid Escherichia coli Cloned DNA Detection in Serum Using an Electrical Double Layer-Gated Field-Effect Transistor-Based DNA Sensor. Anal Chem 2023; 95:6871-6878. [PMID: 37080900 DOI: 10.1021/acs.analchem.2c05719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
In this study, a rapid diagnosis platform was developed for the detection of Escherichia coli O157:H7. An electrical double layer (EDL)-gated field-effect transistor-based biosensor (BioFET) as a point-of-care testing device is demonstrated with its high sensitivity, portability, high selectivity, quick response, and ease of use. The specially designed ssDNA probe was immobilized on the extended gate electrode to bind the target complementary DNA segment of E. coli, resulting in a sharp drain current change within minutes. The limit of detection for target DNA is validated to a concentration of 1 fM in buffer solution and serum. Meanwhile, the results of a Kelvin probe force microscope were shown to have reduced surface potential of the DNA immobilized sensors before and after the cDNA detection, which is consistent with the decreased drain current of the BioFET. A 1.2 kb E. coli duplex DNA synthesized in plasmid was sonicated and detected in serum samples with the sensor array. Gel electrophoresis was used to confirm the efficiency of sonication by elucidating the length of DNA. Those results show that the EDL-gated BioFET system is a promising platform for rapid identification of pathogens for future clinical needs.
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Affiliation(s)
- Akhil K Paulose
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Yueh-Ju Hou
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung 811726, Taiwan, ROC
| | - Yu-Shan Huang
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | | | - Chia-Lin Chiu
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Arnab Pal
- International Intercollegiate PhD Program, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Vishal Mani Kalaimani
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Zong-Hong Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan, ROC
| | - Chuang-Rung Chang
- Institute of Biotechnology, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
| | - Yu-Lin Wang
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
- College of Semiconductor Research, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
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Chiu CL, Wong KH, Lai MH, Lai YM. Anti-N-methyl-D-aspartate Receptor Encephalitis Magnetic Resonance Imaging and Clinical Features: A Case Series. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2117278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- CL Chiu
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - KH Wong
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - MH Lai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - YM Lai
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
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Abstract
This is a preliminary report on the use of the modified Airway Management Device in 50 spontaneously breathing patients undergoing elective day care surgery. We were successful in establishing a clear airway in all 50 patients, 46 of these patients had a patent airway on the first attempt. All patients were successfully managed with the Airway Management Device throughout the surgery. Partial airway obstruction during maintenance of anaesthesia occurred in three cases requiring only minor manipulations. Our result showed that the Airway Management Device may be used as an alternative airway management in anaesthesia.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL. Randomized Double-blind Comparison of Ketamine-Propofol, Fentanyl-Propofol and Propofol-Saline on Haemodynamics and Laryngeal Mask Airway Insertion Conditions. Anaesth Intensive Care 2019; 33:223-8. [PMID: 15960405 DOI: 10.1177/0310057x0503300211] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg.kg-1 (n=30), fentanyl 1 μg.kg-1 (n=30) or normal saline (n=30), before induction of anaesthesia with propofol 2.5 mg.kg-1. Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P=0.010) or saline (P=0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0–8.0)] and fentanyl groups [median 7.0, interquartile range (6.0–8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75–9.25); P=0.024]. The incidence of prolonged apnoea (>120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg.kg–1 improves haemo-dynamics when compared to fentanyl 1 μg.kg–1, with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
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Affiliation(s)
- P K Goh
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Surmon L, Bobek G, Chiu CL, Young S, Makris A, Lind JM, Hennessy A. The expression of placental soluble fms-like tyrosine kinase 1 in mouse placenta varies significantly across different litters from normal pregnant mice. Hypertens Pregnancy 2014; 33:371-4. [PMID: 24702464 DOI: 10.3109/10641955.2014.903963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Gene expression studies often pool tissues from multiple placentas when using animal models of preeclampsia without accounting for the potential confounders of litter origin or pup sex. We aimed to determine whether placental gene expression differs based on sex or litter. METHODS We examined the differential expression of soluble fms-like tyrosine kinase 1 (Flt-1) using 35 pups from six normal pregnant mice. RESULTS Expression of sFlt-1 (p = 0.003) was significantly different between litters but not between sexes (p = 0.17). CONCLUSIONS These findings highlight the importance of adequate sampling from multiple litters in expression studies when using animal models in clinical research.
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Affiliation(s)
- L Surmon
- School of Medicine, University of Western Sydney , Campbelltown, NSW , Australia
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Surmon L, Young S, Bobek G, Chiu CL, Xu B, Makris A, Lind JM, Hennessy A. OS055. Sex-dependent differences in expression of FLT-1 variants andJMJD6 in mouse placenta. Pregnancy Hypertens 2012; 2:206-7. [PMID: 26105269 DOI: 10.1016/j.preghy.2012.04.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION There is evidence for fetal sex-dependent differences in the way in which preeclamptic pregnancies proceed, and in maternal and neonatal outcomes. Mouse models are common in the study of preeclampsia and pooled tissue from multiple placentae is often used to obtain samples for expression studies. Potential concerns regarding this practice are the sex-dependent differences in placental expression of candidate factors. One biomolecule of interest is soluble fms-like tyrosine kinase 1 (sFLT-1) which is a known marker of preeclampsia and commonly used to determine the severity of the induced preeclampsia-like syndrome in rodent models. OBJECTIVES It was the aim of this preliminary study to determine whether variation exists in the expression of different genes in murine placenta based on pup sex in C57BL/6JArc mice. A novel gene, Jumonji domain-containing protein 6 (Jmjd6) that may prove to have a role in the pathogenesis of preeclampsia, mFLT-1 and sFLT-1 were selected as targets. METHODS Seventeen pups were retrieved from three normal pregnant female mice euthanized via cervical dislocation (CD) on day 17.5 or 18.5. Tails and corresponding placentas were collected from the pups, snap frozen in liquid nitrogen and stored at -80°C. Tails were used to accurately determine pup sex via PCR amplification of sex chromosome-specific sequences and revealed the presence of 3 females and 14 males. Quantitative PCR was used to determine the relative expression of the FLT-1 and Jmjd6 transcripts in each placenta. The placenta collected from the first pup of the first pregnant female served as the reference sample and transcript expression in the remaining samples was expressed relative to this sample. General linear modelling using linear regression with categorical variables was used to evaluate the difference in transcript expression between the sexes and Pearson's correlation coefficient used to examine relationships between variables. RESULTS Pup sex was found to have a significant effect on the relative expression of sFLT-1 after controlling for litter, pup weight and gestational age (p=0.013), with 1.5 times more expression in the placentas of female pups. The expression of sFLT-1 was highly correlated with mFLT-1 (r=0.690,p=0.002). The relative expression of Jmjd6 was not significantly different in male and female placentas and sFlt-1 was not correlated with Jmjd6. CONCLUSION This is the first study to demonstrate a link between fetal sex and placental sFLT-1 expression in mice, finding increased levels of this gene in the placentas of female pups. It is possible that in normal pregnancies, female placentas produce more sFLT-1 which acts to condition them and offer some protection during the sFLT-1 spike seen in preeclampsia. The findings of this study also highlight a possible need to consider sex as a variable in placental expression studies using mice to ensure the accuracy of results.
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Affiliation(s)
- L Surmon
- School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - S Young
- School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - G Bobek
- School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - C L Chiu
- School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - B Xu
- School of Medicine, University of Western Sydney, Campbelltown, Australia; The Heart Research Institute, University of Sydney, Sydney, Australia
| | - A Makris
- School of Medicine, University of Western Sydney, Campbelltown, Australia; The Heart Research Institute, University of Sydney, Sydney, Australia; Liverpool Hospital, Liverpool, Australia
| | - J M Lind
- School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - A Hennessy
- School of Medicine, University of Western Sydney, Campbelltown, Australia; The Heart Research Institute, University of Sydney, Sydney, Australia
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Abstract
Propofol anaesthesia using target control infusion during cardiac surgery has become more popular recently. However, without depth of anaesthesia monitoring, the standard target concentration used may be higher than necessary to maintain adequate hypnosis during hypothermic cardiopulmonary bypass. The purpose of this study was to evaluate the effect of bispectral index monitoring on propofol administration during hypothermic cardiopulmonary bypass. After ethics committee approval and written informed consent, 20 New York Heart Association class I-III patients scheduled for elective cardiac surgery requiring hypothermic cardiopulmonary bypass were studied in this prospective randomised controlled trial. In group C, routine anaesthesia was practised, where patients received propofol at target concentration between 1.5 to 2.5 microg/ml during cardiopulmonary bypass. In group B, the target concentration was titrated to a bispectral index value of 40 to 50. Mean arterial pressure and bispectral index were recorded at various time intervals. The use of propofol, phenylephrine, sodium nitroprusside and adrenaline were recorded. The median propofol administration in group B was significantly less than that in group C (2.9 mg/kg/h compared to 6.0 mg/kg/h). The bispectral index value during bypass was significantly lower in group C than in group B, reflecting a deeper state of anaesthesia. There was no difference in the use of inotropes, vasoconstrictors or vasodilators. Bispectral index monitoring enables a 50% reduction in propofol administration at this standard dose during hypothermic cardiopulmonary bypass.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya Medical Centre, Lembah Pantai, Kuala Lumpur 50603, Malaysia.
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Chien SWC, Wang MC, Chiu CL, Lin YM, Lai SY. The contents and forms of solid-phase species of radioactive strontium and cesium in Taiwan soils. Environ Monit Assess 2007; 125:29-39. [PMID: 16927194 DOI: 10.1007/s10661-006-9236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 03/01/2006] [Indexed: 05/11/2023]
Abstract
This study was to investigate the activities and contents of (137)Cs in the profiles of selected arable and forest soils in Taiwan and various solid-phase species of (85)Sr and (137)Cs in selected arable soils in Taiwan. The gamma (gamma) ray spectra of the collected soil samples and some of the soils amended with (85)Sr and (137)Cs were measured. The data indicate that the arable soils from Sanhsing series, Sanhsing Township and Chuangwei series, Chuangwei Township, Ilan County, and from Tunglochuan series, Pinglin Township, Taipei County shows significantly higher radioactivity of (137)Cs (ND - 11.0 +/- 0.2 Bq kg(-1)). Furthermore, the radioactivity of (137)Cs in the mountain soils (1.24 +/- 0.07 - 42 +/- 1 Bq kg(-1)) from Yuanyang Lake Nature Preserve among Ilan, Taoyuan, and Hsinchu Counties is the highest among the investigated mountain forest soils. This may be mainly attributed to the fact that Ilan County is located in the northeastern part of Taiwan and faces the northeastern and northern seasonal winds with lots of precipitation annually from mid-autumn through mid-spring next year and is receiving greater amount of fallouts yearly. Due to longer reaction period (>or=3 y) of (137)Cs with soil components, (137)Cs was mainly in the forms bound to oxides and to organic matter in the soil amended with (137)Cs and in the soil contaminated with (137)Cs. On the contrary, due to shorter reaction period (<60 d) of (85)Sr with soil components, (85)Sr was mainly in exchangeable form and partially in the forms bound to carbonates and oxides in the soils amended with (85)Sr.
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Affiliation(s)
- S W Chang Chien
- Department of Environmental Engineering and Management, Chaoyang University of Technology, 168 Jifong E. Rd., Wufong Township, Taichung County, Taiwan, ROC
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Chiu CL, Mansor M, Majid A. Anaesthetic management of high-risk cardiac patients undergoing thoracic surgery with the support of intra-aortic balloon pump. Br J Anaesth 2005; 94:688-9; author reply 689. [PMID: 15814806 DOI: 10.1093/bja/aei544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chiu CL, Wang CY. Successful use of the airway management device. Br J Anaesth 2004; 92:297; author reply 297. [PMID: 14722193 DOI: 10.1093/bja/aeh516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
A 27-yr-old lady with a past history of prolonged ventilation presented with worsening respiratory distress caused by tracheal stenosis. She required urgent tracheal resection and reconstruction. Because of the risk of an acute respiratory obstruction, spinal anaesthesia was used to establish cardiopulmonary bypass by cannulating the femoral artery and femoral vein. Adequate gas exchange was possible with full flow rate. Thoracotomy was then carried out to mobilize the left main bronchus. After successfully securing an airway by intubation of the left main bronchus, cardiopulmonary bypass was discontinued and tracheal resection and anastomosis was done under conventional one lung anaesthesia.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Abstract
We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. The patients were randomized to receive either a laryngeal mask airway or a laryngeal tube. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. We recorded the speed and the ease of insertion, the number of attempts needed to successfully secure the airway and intraoperative complications, such as partial airway obstruction needing airway manipulation. The airway devices were removed with the patients fully awake at the end of surgery. Systolic arterial blood pressure, heart rate and end-tidal CO2 were recorded at various time intervals. Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
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Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in preeclamptic patients. Int J Obstet Anesth 2003; 12:23-7. [PMID: 15676316 DOI: 10.1016/s0959-289x(02)00137-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2002] [Indexed: 10/27/2022]
Abstract
A 5-year retrospective survey of anaesthesia for caesarean section for mild/moderate and severe preeclampsia was performed, covering the period between 1 January 1996 and 31 December 2000. One hundred and twenty-one cases of non-labouring preeclamptic patients receiving spinal or epidural anaesthesia for caesarean section were included for analysis. Comparisons were made of the lowest blood pressures recorded before induction of anaesthesia, during the period from induction to delivery and the period from delivery to the end of operation. The decreases in blood pressure were similar after spinal and epidural anaesthesia. The use of intravenous fluids and ephedrine were also comparable in the two anaesthetic groups. There was no difference in maternal or neonatal outcome. Our result supports the use of spinal anaesthesia in preeclamptic women.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Wang CY, Chiu CL, Har KO, Chan C, Rahman ZAA. A comparative study of sevoflurane sedation with nitrous oxide sedation for dental surgery. Int J Oral Maxillofac Surg 2002; 31:506-10. [PMID: 12418566 DOI: 10.1054/ijom.2002.0293] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study compares the use of inhalation sedation using sevoflurane (group S) with inhalation sedation using nitrous oxide (group N) in patients undergoing bilateral extraction of third molar teeth under local anaesthesia. The study was designed as a cross-over study. Seventeen ASA I, day surgery patients were studied. Patients were randomly allocated to receive either 8 l/min 50% nitrous oxide in oxygen (group N) or same flow of 1% sevoflurane (group S) for the first procedure. Each patient then had the alternate method of sedation for the second procedure. There were no significant differences between the methods in patient co-operation and surgeon's satisfaction with sedation. Psychomotor tests were comparable in both groups. The patients were significantly more sedated in the group S compared to group N (P=0.004). Significantly more patients complained of an unpleasant odour group S (P<0.01) but none withdrew from the study for this reason. No adverse cardiorespiratory effects resulted from sevoflurane or nitrous oxide sedation. Both methods gave good amnesia during the procedure. There was high acceptance of both methods and the patients rated the technique as equally satisfactory. We conclude that inhalation sedation with sevoflurane is a suitable alternative method to nitrous oxide sedation.
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Affiliation(s)
- C Y Wang
- Department of Anaesthesia, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
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Chan YK, Ng KP, Chiu CL. Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur. Int J Obstet Anesth 2002; 11:176-9. [PMID: 15321544 DOI: 10.1054/ijoa.2002.0954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. There was a decline in the use of general anaesthesia for both elective and emergency caesarean sections from 41.3% and 69.4% respectively in 1995 to 21.6% and 26.9% respectively in 1999. By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.
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Affiliation(s)
- Y K Chan
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Chiu CL, Tew GP, Wang CY. The effect of prophylactic metaraminol on systemic hypotension caused by induction of anaesthesia with propofol in patients over 55 years old. Anaesthesia 2001; 56:893-7. [PMID: 11531679 DOI: 10.1046/j.1365-2044.2001.02059-4.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We conducted a double-blind, randomised, placebo-controlled study evaluating the efficacy of prophylactic metaraminol for preventing propofol-induced hypotension. Thirty patients aged 55-75 years undergoing general anaesthesia were randomly allocated to receive either metaraminol 0.5 mg or saline before administration of fentanyl 1 microg.kg(-1) and propofol 2 mg.kg(-1). Induction of anaesthesia was associated with a decrease in mean and systolic arterial pressure in both groups (p = 0.0001). However, there was no significant difference between the two groups. These results show that prophylactic use of metaraminol 0.5 mg does not prevent the decrease in blood pressure following fentanyl and propofol induction in older patients.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
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Affiliation(s)
- Y K Chan
- Department of Anesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
BACKGROUND The Internet has revolutionized the manner in which patients obtain information about health care. This technology has also allowed patients to obtain directly both prescription and nonprescription therapies. OBJECTIVE To report a case of fulminant hepatorenal failure associated with the use of hydrazine sulfate, an unregulated alternative remedy for cancer marketed on the Internet. DESIGN Case report. SETTING Academic medical center. PATIENT A 55-year-old man with maxillary sinus cancer. INTERVENTION Self-medication with hydrazine sulfate. MEASUREMENTS Serum liver and renal function tests; histologic evaluation of liver and kidney tissue. RESULTS The patient developed hepatic encephalopathy, renal failure, and profound coagulopathy. He died after severe gastrointestinal hemorrhage developed. Autopsy revealed autolysis of the kidneys and submassive bridging necrosis of the liver. CONCLUSION Fatal hepatorenal failure may occur after the use of hydrazine sulfate. This fatal complication must be considered in anyone taking or contemplating the use of hydrazine sulfate.
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Affiliation(s)
- M I Hainer
- Department of Internal Medicine, Moncrief Army Community Hospital, Fort Jackson, SC 29207, USA.
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Chiu CL, Chan YK, Ong GS, Delilkan AE. A comparison of the maintenance and recovery charcateristic of sevoflurane-nitrous oxide against isoflurane-nitrous oxide anaesthesia. Singapore Med J 2000; 41:530-3. [PMID: 11284610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND To compare the maintenance and recovery characteristics of sevoflurane and isoflurane anaesthesia in Malaysian patients. METHOD This is a prospective, open labelled, randomized, controlled study. Sixty unpremedicated ASA I or II patients (aged 18-50 years), scheduled for elective breast lump excision were randomly allocated to receive either isoflurane or sevoflurane for the maintenance of anaesthesia following fentanyl and propofol intravenous induction. The systolic, diastolic, mean arterial blood pressure and heart rate were measured. The speed of recovery was measured by time to eye opening, time to following simple command, and time to correctly giving own names and address. The incidence of postoperative complication was also recorded. RESULTS The trend of systolic blood pressure was significantly higher in the isoflurane group as compared to the sevoflurane group for the duration of anaesthesia (p < 0.001, by ANOVA for repeated measurement) but the trend of heart rate was similar for both groups. The recovery time was faster in the isoflurane group. [mean time of eye opening (SD) = 6.8 (2.2) vs 10.7 (4.4) min, p < 0.001; mean time of sticking tongue out (SD) = 7.9 (2.9) vs 11.5 (4.7) min, p < 0.01; mean time of giving own name (SD) = 7.8 (2.7) vs 11.8 (4.8) min, p < 0.001, mean time of giving own address (SD) = 8.4 (2.9) vs 12.0 (4.7) min, p < 0.01]. No major adverse effects were encountered postoperatively and the incidences of minor adverse effects were low in both groups. CONCLUSION We concluded that sevoflurane is a safe alternative to isoflurane but in these short procedures, awakening time was surprisingly slower than after isoflurane.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Abstract
We present a case of headache following epidural anaesthesia for caesarean section. The patient did not exhibit the classical features of post dural puncture headache and the cause was uncertain. The headache was complicated by post partum seizure and a history of pregnancy-induced hypertension. A diagnostic lumbar puncture had to be done to exclude meningitis as she had a raised white blood count. An epidural blood patch performed 12 days post partum resolved the headache immediately.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Wang CY, Chiu CL, Tan YM, Liau CH, Goh KL. Inhalation sedation with sevoflurane for upper gastrointestinal endoscopy. Br J Anaesth 2000; 85:668-70. [PMID: 11064642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Huang HM, Pan LC, Lee SY, Chiu CL, Fan KH, Ho KN. Assessing the implant/bone interface by using natural frequency analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:285-91. [PMID: 10982948 DOI: 10.1067/moe.2000.108918] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A number of techniques have been proposed for detecting the stability of dental implants. However, the clinical applicability of those methods is still limited. The purpose of this study was to evaluate a new innovative, noninvasive, minimum-contact method for the stability assessment of dental implants. STUDY DESIGN Natural frequency is a physical property of a structure, which is strongly related to its boundary conditions. In this study, a modal testing technique was carried out to measure the natural frequency of dental implants. The implants were fixed by a metal clamp stand and were excited to vibrate by an impulse hammer. A noncontact piezoelectric microphone then acoustically acquired the vibration responses of the implants. Natural frequencies of the tested implants were recorded under various clamping forces and clamping levels. RESULTS Natural frequencies of the tested implants were concentrated from 8 to 19 kHz under different boundary conditions. On the other hand, the natural frequency values decreased when boundary levels and boundary force were reduced. Linear relationships (P <.005) were found between response frequencies and the degree of implant stability. CONCLUSIONS Our results show that the boundary status of an implant can be monitored by detecting its natural frequency. A noncontact transducer used in this study can also serve as a useful tool for future clinical investigations.
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Koh CK, Hew FL, Chiu CL. Treatment of chronic urticaria with thyroxine in an euthyroid patient with thyroglobulin and microsomal antibodies. Ann Acad Med Singap 2000; 29:528-30. [PMID: 11056786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The association of chronic urticaria and thyroid autoimmunity is not well recognised and the potential use of thyroxine in the treatment of chronic urticaria in patients with thyroid autoimmunity is even less well known. CLINICAL PICTURE We report a case of chronic urticaria in an euthyroid patient with evidence of significantly elevated levels of thyroglobulin and microsomal antibodies. TREATMENT AND OUTCOME Treatment with thyroxine has brought about clinical remission of the chronic urticaria but no change in the thyroid antibody levels could be demonstrated. CONCLUSION Patients with chronic urticaria should be screened for evidence of thyroid autoimmunity. A closely monitored trial of thyroxine therapy for those who have thyroid autoimmunity can be rewarding.
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Affiliation(s)
- C K Koh
- Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
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Chiu CL, Ong GS. Subcutaneous emphysema and pneumomediastinum after endotracheal anaesthesia. Ann Acad Med Singap 2000; 29:256-8. [PMID: 10895351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION We report a case of subcutaneous emphysema and pneumomediastinum that presented postoperatively after tracheal extubation. CLINICAL PICTURE A 51-year-old man had an uneventful anaesthesia lasting about 6.5 hours. Intubation was performed by a very junior medical officer and was considered difficult. He developed sore throat, chest pain, numbness of both hands and palpable crepitus around the neck postoperatively. Chest X-ray revealed diffuse subcutaneous emphysema, pneumomediastinum and possible pneumopericardium. TREATMENT He was treated conservatively with bed rest, oxygen, analgesia, antibiotic prophylaxis, reassurance and close monitoring. OUTCOME The patient made an uneventful recovery. CONCLUSIONS We discussed the possible causes.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CL, Chan YK, Ong G, Delilkan AE. A comparison of the induction and emergence characteristics of sevoflurane and halothane in children. Med J Malaysia 1999; 54:346-51. [PMID: 11045061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
This open labelled, randomised, controlled study was designed to compare the induction and recovery characteristics of sevoflurane and halothane anaesthesia in children. Forty American Society of Anaesthesiologist (ASA) physical status class 1 or 2 children (aged 1-10 year, weighed less than 25 kg) scheduled for elective urological procedure lasting less than one hour were allocated randomly to receive either sevoflurane (group S, n = 20) or halothane (group H, n = 20). The induction time in children receiving sevoflurane was significantly shorter than in those receiving halothane (mean (SD) 46 (13.6) second vs 69 (19.4) seconds, p < 0.005). The emergence from anaesthesia was also faster in children receiving sevoflurane than in those receiving halothane (mean (SD) 9 min (4.3 min) vs 21 min (8.9 min), p < 0.001). No major adverse effects were encountered in each group. We concluded that sevoflurane is comparable to halothane in Malaysian children.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur
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Chiu CL, Wang CY. Sevoflurane for dental extraction in children with Tetralogy of Fallot. Paediatr Anaesth 1999; 9:268-70. [PMID: 10320610 DOI: 10.1046/j.1460-9592.1999.00330.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two children with Tetralogy of Fallot presented for dental extraction. Anaesthesia was induced rapidly and smoothly by inhalation of sevoflurane. We discussed the advantages of sevoflurane as an induction agent as compared to halothane in these children.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CL, Jaais F, Wang CY. Effect of rocuronium compared with succinylcholine on intraocular pressure during rapid sequence induction of anaesthesia. Br J Anaesth 1999; 82:757-60. [PMID: 10536557 DOI: 10.1093/bja/82.5.757] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We have compared the effect of rocuronium and succinylcholine on intraocular pressure (IOP) during rapid sequence induction of anaesthesia using propofol and fentanyl, in a randomized double-blind study. We studied 30 adult patients, allocated to one of two groups. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol until loss of verbal response. This was followed by succinylcholine 1.5 mg kg-1 (group S; n = 15) or rocuronium 0.9 mg kg-1 (group R; n = 15). Laryngoscopy was performed 60 s later. IOP, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, immediately before intubation and every minute after intubation for 5 min. A Keeler Pulsair air impulse tonometer was used to measure IOP and the mean of two readings obtained in the right eye at each measurement time was recorded. Intubating conditions were evaluated according to a simple scoring system. IOP in the succinylcholine group was significantly greater than that in the rocuronium group (mean 21.6 (SEM 1.4) mm Hg vs 13.3 (1.4) mm Hg; P < 0.001). Intubating conditions were equally good in both groups. We conclude that with rapid sequence induction of anaesthesia using propofol and fentanyl, rocuronium did not cause as great an increase in IOP as succinylcholine and may be an alternative in open eye injury cases.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CL, Delilkan AE. Sevoflurane induction in acute airway obstruction. Hosp Med 1998; 59:828. [PMID: 9850310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- C L Chiu
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Abstract
Forty patients without eye disease, undergoing elective nonophthalmic surgery, were studied in a double-blind, randomised, placebo-controlled study evaluating the efficacy of mivacurium pretreatment in attenuating the rise in intra-ocular pressure in response to suxamethonium administration, laryngoscopy and intubation. The patients were randomly allocated to receive either mivacurium 0.02 mg.kg-1 or normal saline as pretreatment 3 min before a rapid sequence induction technique using alfentanil, propofol and suxamethonium. Suxamethonium induced a significant increase in intra-ocular pressure in the control group but not in the mivacurium pretreatment group (mean (SEM) increase = 3.5 (1.2) mmHg vs. 0.4 (0.8) mmHg, p < 0.05). There was a decrease in intra-ocular pressure in both groups after laryngoscopy and intubation with no significant difference between the two groups. These results show that mivacurium pretreatment is effective in preventing the increase in intra-ocular pressure after suxamethonium administration.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Chiu CL, Khanijow V, Ong G, Delilkan AE. Endotracheal tube ignition during CO2 laser surgery of the larynx. Med J Malaysia 1997; 52:82-3. [PMID: 10968058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We report a case of endotracheal tube fire occurring during CO2 laser surgery of the larynx. The ignition of an endotracheal tube was thought to be caused by laser penetration of an unprotected portion of the tube during resection of vocal cord tumour. Fire hazard is inevitable when a laser is used in the path of combustible gases and in the presence of flammable objects. We discuss the methods of prevention that were used.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur
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Lock JA, Chiu CL. Correlated light scattering by a dense distribution of condensation droplets on a window pane. Appl Opt 1994; 33:4663-4671. [PMID: 20935836 DOI: 10.1364/ao.33.004663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An analytical model of the scattering structure factor for an assembly of noninteracting hard disks has recently appeared in the literature [Phys. Rev. A 42, 5978-5989 (1990)]. We employ this model to calculate correlated light scattering by monodispersions and binary mixtures of condensation droplets on a window pane. We find that an area fraction of ƒ ≥ 0.6 is required for producing the near-forward direction scattering suppression and that a moderately wide polydispersion of droplet sizes is capable of producing the experimentally observed bright ring of colored light.
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Cornell SH, Musallam JJ, Chiu CL, Christie JH. Individualized computer tomography of the skull with the EMI scanner using the 160 X 160 matrix. AJR Am J Roentgenol 1976; 126:779-85. [PMID: 179346 DOI: 10.2214/ajr.126.4.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The individualized approach to the performance of computerized tomography of the skull is described. With the use of the 160X160 matrix it is possible to look at the initial scans almost immediately after their completion. If necessary, unsatisfactory scans can be repeated, the position of the head can be changed and artifacts due to motion can be minimized or eliminated. Lesions can be revealed or enhanced with intravenously injected contrast material if desired. The individualized approach has eliminated the need to recall patients and has improved the diagnostic capability of the method.
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Chiu CL, Sickels W. Common bony densities simulating disease in the chest. JAMA 1975; 234:1171-4. [PMID: 1242441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chiu CL, Roelofs JD, Go RT, Doty DB, Rose EF, Christie JH. Coronary angiographic and scintigraphic findings in experimental cardiac contusion. Radiology 1975; 116:679-83. [PMID: 1153780 DOI: 10.1148/116.3.679] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Clinical, angiographic, scintigraphic and pathologic observations in myocardial contusion were correlated. Radionuclide imaging of the injured heart with 99mTc-Sn-polyphosphate provides an accurate diagnosis in acute, even mild, myocardial contusion. The study can be carried out without danger to the critically ill patient. The coronary angiographic findings in this study explain what is occurring pathologically in the heart. Since arteriography is a more invasive technique than radionuclide imaging, its use is recommended only when the image is negative if it is neccessary to establish the clinical diagnosis for treatment or when more than one week has elapsed since the injury.
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Abstract
A new method of diagnosing myocardial contusion was studied in 8 patients in whom the injured mycardium was visualized as an abnormal area of increased activity in the region of the heart one hour after intravenous injection of 10 mCi of 99m-Tc-Sn-polyphosphate or pyrophosphate. Serum enzymes in these patients were elevated, but electrocardiograms were nonspecific for myocardial injury. It is hoped that this new technique of imaging the injured myocardium will provide specific and confirmatory diagnosis of myocardial contusion associated with closed chest injuries.
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Cornell SH, Christie JH, Chiu CL, Lyon LW. Computerized axial tomography of the cerebral ventricles and subarachnoid spaces. Am J Roentgenol Radium Ther Nucl Med 1975; 124:186-94. [PMID: 1094844 DOI: 10.2214/ajr.124.2.186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Go RT, Chiu CL, Doty DB, Cheng HF, Christie JH. Radionuclide imaging of experimental myocardial contusion. J Nucl Med 1974; 15:1174-5. [PMID: 4427146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Chiu CL, Weber DL. Prostatic carcinoma in young adults. JAMA 1974; 230:724-6. [PMID: 4479267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Chiu CL, Roelofs JD. Acute bacterial endocarditis with septic emboli. J Iowa Med Soc 1974; 64:434, 436-7. [PMID: 4613764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Clinical and experimental observations in myocardial contusion have been correlated. Cardiac arrhythmia is always an important consequence and may be fatal. Reduction in cardiac output often accompanies significant cardiac injury. The coronary arterial circulation is not interrupted and is generally enhanced to the area of injury. Healing of the injury under these circulatory conditions may result in patchy scarring and peculiar adynamic areas of myocardium. Early diagnosis of myocardial contusion may be aided using radionuclide imaging with (99m)Tc-Sn-polyphosphate.
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Go RT, Chiu CL, Neumann LA. Diagnosis of superior sagittal sinus thrombosis by dynamic and sequential brain scanning. Report of one case. Neurology 1973; 23:1199-204. [PMID: 4583517 DOI: 10.1212/wnl.23.11.1199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Chiu CL, Gambach RR. Spontaneous perforation of the esophagus (Boerhaave's syndrome). J Iowa Med Soc 1973; 63:436-8. [PMID: 4742132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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