Hawaii Medical Journal Articles For 1994

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Blood transfusion: the risks and benefits.
(1994-01) Frohlich, J A
As greater attention is focused on medical and legal risks of the transfusion process, physicians ordering a blood transfusion must advise their patients thoroughly and clearly of the potential risks involved. Physicians must explain clearly to patients that a zero-risk blood supply is impossible to achieve; patients must understand that all necessary steps practicable have been taken to ensure the safest possible supply.
Ethnic differences in the recurrence of adenomatous polyps after colonoscopic polypectomy.
(1994-01) Phillips, D L; Okamura, D; Tokumine, T
A retrospective study was done of polyp recurrence rates following an initial clearing colonoscopy for adenomatous polyps. The intent of the study was to identify risk factors that would predict a greater risk for recurrence in Hawaii's ethnically diverse population. When the initial exam detected multiple polyps, a higher recurrence rate was found in Caucasian patients.
Retinopathy of prematurity: incidence and severity in Hawaii.
(1994-01) Drouilhet, J H; Pelke, S; Sroat, D; Ing, M; Wong, B; Kokame, G; Easa, D
Because survival of low birth-weight infants requiring intensive care has improved recently, particularly since the advent of exogenous surfactant therapy, we reviewed our experience at Kapiolani Medical Center for Women and Children (KMCWC) from 1989 to 1991 to determine if the incidence of retinopathy of prematurity (ROP), a serious long-term complication, had also increased. During this 3-year period, threshold disease, the ROP stage in which cryosurgery is recommended, occurred only in infants < or = 1000 grams. Seventy-four infants < or = 1000 grams were diagnosed with ROP of any stage. Sixteen eyes (9 infants) reached threshold; 14 were treated with cryosurgery. Six of these eyes have useful vision on follow up; 8 do not. Exogenous surfactant therapy had no significant effect on ROP incidence or severity in our series. Although ROP incidence did not increase during this review period, it remains a serious problem in high-risk premature infants in our Newborn Intensive Care Unit.
Persistent postoperative ventricular tachycardia treatment by using external cardiopulmonary support.
(1994-01) Hamid, B A; Azuma, S S; Hong, R A; Lau, J M
Drug-resistant incessant ventricular tachycardia (DRIVT) after cardiac surgery is a rare but almost always fatal event. Antiarrhythmic therapy seems to be ineffective and electrical cardioversion is of limited value when these patients present themselves with recurrent, sustained ventricular tachycardia. A patient with DRIVT in whom external cardiopulmonary support finally succeeded in bringing about resuscitation will be described in this article. The use of external cardiopulmonary support (CPS) should be considered in patients with this kind of malignant arrhythmia.
The immunologic staging of chronic active hepatitis B patients in Hawaii.
(1994-02) Ching, N; Lumeng, J; Pon, E; Ching, C Y
The hepatitis B antigen/antibody levels and natural killer cell activity status of chronic hepatitis B patients identified by the Hawaii State Department of Health were evaluated to select chronically infected hepatitis B patients for interferon therapy and to determine possible immunodeficiencies. The presence of hepatitis Be antigen denotes active replication of the virus. Ninety-five patients were studied: 17/95 (18%) had chronic active hepatitis B, 71/95 (75%) were hepatitis B carriers and 7/95 (7%) had seroconverted. NK activity to the erythroleukemia K562 cell and virus-infected HSV-1 cell of the chronic active and carrier population (P < .05) were lower than that of the control population and those who had spontaneously seroconverted. Of this population 18% were identified with active viral infection and would be candidates for interferon therapy.
A review of the radiographic manifestations of gout.
(1994-02) Gagliardi, J A; Lengyel, R J
Hyperuricemia and gout are found in high percentages of the Pacific Island population. As local clinicians and radiologists are more likely to have patients with either the diagnosis or suspicion of gout, a pictorial review of the common radiographic manifestations is presented especially for their information.
Encouraging more physicians to recommend smoking cessation programs to their patients.
(1994-02) Joshi, M
The need for organ donation in Hawaii.
(1994-03) Limm, W M; Wheeler, M S; Ishimoto, S; O'Friel, M; Cheung, A H
Donor organ availability is the primary limiting factor in organ transplantation. The number of patients on the national organ waitlist has increased to more than 32,000, while the number of donors has remained fairly constant at approximately 4,500 per year. In Hawaii, there are 98 patients awaiting organ transplants, and for the past 5 years, the average number of donors per year was 15. The criteria for organ donation, brain death, approaches to donation request, and the management of the multiple organ donor are discussed.
Pancreas transplantation for diabetic patients in Hawaii.
(1994-03) Cheung, A H; Limm, W M; Wong, L L
Diabetes mellitus is a common disease affecting a large population in Hawaii. Over the past 20 years, pancreas transplantation has evolved into a viable therapeutic option for selected patients with diabetes mellitus. This report describes the first combined pancreas-kidney transplant performed in Hawaii on June 28, 1993 on a patient with juvenile-onset diabetes mellitus and diabetic nephropathy. The patient has remained off insulin and off dialysis since the transplant. The history, indications, techniques, and potential complications related to this procedure are discussed.
Liver transplantation in Hawaii.
(1994-03) Wong, L L; Cheung, A H; Limm, W M; Tsai, N C
The first liver transplant performed in Hawaii was on May 17, 1993 in a patient with end-stage liver disease caused by autoimmune hepatitis. Liver transplantation is a well-accepted treatment for end-stage liver disease with a 1-year patient survival of 80% to 85%. Early recognition of the appropriate candidate by primary care physicians and prompt referral to a liver transplant center are essential for optimal results. The indications, contraindications, organ procurement and allocation, complications, and results of liver transplantation are described. Finally, several controversial areas will be introduced, including liver transplant for alcoholic cirrhosis and hepatitis B, and use of transjugular intrahepatic portosystemic shunts (TIPS).
Cardiac transplantation in Hawaii.
(1994-03) Moreno-Cabral, C E; Nakaahiki, J H
Clinical cardiac transplantation was successfully introduced 26 years ago, and from an initial experimental status, it has moved forward to become an accepted and well-established treatment modality for end-stage cardiac disease. The first cardiac transplant operation in Hawaii was performed in March 1987; the patient lived for 1 year. A total of 20 heart transplant operations have been performed in 19 patients at St. Francis Medical Center in Honolulu. There has been only one hospital death, and our current one-year survival is 77%, which is similar to national statistics. Our longest survivor is now more than 6 years following transplantation. The incidence of rejection episodes and infectious complications is comparable to other studies.
Allogeneic and autologous bone marrow transplant experiences in Hawaii.
(1994-03) Wong, L M; Jim, R T; Loh, K K; Wilkinson, R W; Chong, C D
Allogeneic bone marrow transplant (BMT) was first performed successfully at St. Francis Medical Center in 1978. Since that time, 91 BMTs have been performed for aplastic anemia, leukemia, lymphoma, and Stage II, III and IV breast cancers. This article will explain the methods, complications and results of BMT in Hawaii.
25 years of kidney transplantation in Hawaii.
(1994-03) Cheung, A H; Wheeler, M S; Fan, F L; Limm, W M; Wong, L L; Pang, R K; Chinn, H Y; Wong, L M
The first kidney transplant in Hawaii was performed in August 1969. In the following 25 years, more than 433 kidney transplants were performed. The most common etiology leading to transplantation was chronic glomerulonephritis. Patient and graft survivals after a kidney transplant have progressively improved, particularly after the introduction of cyclosporine in 1984. The overall one-year patient and graft survival rates now are 96% and 85%, respectively; these results exceed the national averages.
Organ transplantation overview.
(1994-03) Wong, L M; Cheung, A H
Helicobacter pylori infection and chronic active gastritis.
(1994-04) Ro, M S; Yang, H Y; Pang, R J; Pang, G M
Helicobacter pylori (H. pylori) is an S-Shaped, gram-negative bacillus that recently has been implicated in the pathogenesis of chronic active gastritis and other peptic ulcer disease. These findings have encouraged gastroenterologists to provide a new rationale for patient management, with hope of providing more successful treatment of peptic ulcer disease, particularly gastritis. Therefore, a cooperative diagnostic effort was made at the pathology laboratory of St Francis Medical Center to adopt a simple and reliable method for the identification of H. pylori in tissue sections of endoscopic biopsies of stomach and duodenum. We attempted to estimate the prevalence of H. pylori infection in patients biopsied for upper Gl disorders who were refractory to medication. A prevalence of H. pylori infection among different ethnic groups also was studied.
Baromedicine today--rational uses of hyperbaric oxygen therapy.
(1994-04) Tabrah, F L; Tanner, R; Vega, R; Batkin, S
Compressed air, and more recently hyperbaric oxygen, have been used and misused in medical treatment for more than 300 years. Advances in physiology have led to rational protocols for hyperbaric oxygen use. Hyperbaric oxygen will enhance wound healing by fibroblast and capillary proliferation, suppress infection, reduce edema, reverse CNS damage from carbon monoxide and cyanide poisoning, and reduce clostridial alpha toxins. Monoplace and multiplace chambers are used for treatment during which EKG and oxygen tissue monitoring, as well as hemodynamic and respiratory support, can be continued, iatrogenic air embolism and diving decompression sickness demand immediate treatment. Investigative uses of adjunct therapy for several other clinical problems include treatment of MS, acute spinal cord injuries, and acute MI. Specific indications agreed on by the Undersea and Hyperbaric Medicine Society are recognized by most third-party payers including Medicare, Champus, and HMSA. Hyperbaric medicine remains a fertile area for basic physiologic investigation and outcomes research.
Helicobacter pylori infection--gastritis, ulcers and gastric cancer.
(1994-04) Goldstein, N
Omega-3 fatty acids in Hawaii seafood.
(1994-05) Ako, H; Ota, E; Ogasawara, A
Omega-3 fatty acids, the most potent of which are found in seafood, are of interest because of their effects on cardiovascular and inflammatory diseases and their possible effects on cancer. However, consumers in Hawaii wishing to increase their dietary omega-3 to omega-6 fatty acid ratio are faced with the difficulty that several types of seafood popular in Hawaii and aquacultured seafood new in the marketplace have unknown omega-3 fatty acid levels. The purpose of this work is to determine omega-3 fatty acid levels of selected seafood and fish oil capsules. Several seafoods and some over-the-counter fish oil capsules were sampled and analyzed. Aku eggs, aquacultured hamachi (yellowtail jack from Japan), one sample of turbot, and EPA Plus, Promega, and Omega-3 Super EPA capsules were found to contain high levels of omega-3 fatty acids. Levels were comparable to those in the fatty fishes such as salmon and mackerel. Butterfish, mahimahi eggs; other fish oil capsules (ProEPA and Omega 3) contained moderate levels of omega-3 fatty acids. Fish cakes, seaweed, several lean fishes, and cod liver oil capsules had small quantities of omega-3 fatty acids. It appeared that the omega-3 fatty acid content of aquacultured species studied was significantly higher than in wild caught species. There was a substantial difference between claimed and actual omega-3 fatty acid levels in commercially available fish oil capsules. These findings can help consumers when selecting types of seafood for their diet that are good sources of omega-3 fatty acids.
The Waianae Diet Program: a culturally sensitive, community-based obesity and clinical intervention program for the Native Hawaiian population.
(1994-05) Shintani, T; Beckham, S; O'Connor, H K; Hughes, C; Sato, A
The Waianae Diet Program (WDP) is a community-based program designed at the Waianae Coast Comprehensive Health Center in response to the high rates of obesity and chronic disease among Native Hawaiians. Its foundation is a 3-week program of traditional Hawaiian diet and cultural teachings. It employs 8 innovations in clinical nutrition and health promotion theory: 1. Non-calorie restricted weight loss protocol, 2. Dietary clinical intervention, 3. Cultural sensitivity, 4. Transition diet, 5. Whole-person approach, 6. Group ohana (family) support, 7. Community intervention, and 8. Role modeling. It has demonstrated significant weight loss with no calorie restriction, improvement in blood pressure, serum glucose, and serum lipids. It appears to have wide acceptance in the Hawaiian community. More studies are warranted to determine the long-term effect of this program.
Health care, Hawaiian style.
(1994-05) Goldstein, N

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