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Kuan YC, Lin SZ, Chiu TL, Hung HY. Improved neurological function in a patient with complete spinal cord injury through bone marrow mesenchymal stem cells implantation: a case report. Regen Med 2023; 18:907-911. [PMID: 37990874 DOI: 10.2217/rme-2023-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Aim: Spinal cord injury (SCI) can cause severe disability. Several clinical trials of stem-cell based therapies are ongoing. We describe our experience of bone marrow mesenchymal stem cell (BMSC) therapy in a patient with complete SCI in the chronic stage. Case report: A 25-year-old man with complete SCI at T6 level presented with paraplegia for 5 years. We transplanted autologous BMSCs intramedullary. After 12 months follow-up, his Barthel index score was noticeably improved from severe to moderate dependency, and the sensation level improved from T7 to S5, but no improvement of motor function. Conclusion: Autologous BMSCs are potentially safe for patients with complete SCI in the chronic stage and may improve neurological function and quality of life.
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Affiliation(s)
- Ying-Chuan Kuan
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
- Bioinnovation Center, Tzu Chi Foundation, Hualien, 970, Taiwan
| | - Tsung-Lang Chiu
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Hsiang-Yi Hung
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
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Mohammed Thangameeran SI, Tsai ST, Hung HY, Hu WF, Pang CY, Chen SY, Liew HK. A Role for Endoplasmic Reticulum Stress in Intracerebral Hemorrhage. Cells 2020; 9:cells9030750. [PMID: 32204394 PMCID: PMC7140640 DOI: 10.3390/cells9030750] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022] Open
Abstract
The endoplasmic reticulum (ER) is an intracellular organelle that performs multiple functions, such as lipid biosynthesis, protein folding, and maintaining intracellular calcium homeostasis. Thus, conditions wherein the ER is unable to fold proteins is defined as ER stress, and an inbuilt quality control mechanism, called the unfolded protein response (UPR), is activated during ER stress, which serves as a recovery system that inhibits protein synthesis. Further, based on the severity of ER stress, the response could involve both proapoptotic and antiapoptotic phases. Intracerebral hemorrhage (ICH) is the second most common subtype of cerebral stroke and many lines of evidence have suggested a role for the ER in major neurological disorders. The injury mechanism during ICH includes hematoma formation, which in turn leads to inflammation, elevated intracranial pressure, and edema. A proper understanding of the injury mechanism(s) is required to effectively treat ICH and closing the gap between our current understanding of ER stress mechanisms and ICH injury can lead to valuable advances in the clinical management of ICH.
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Affiliation(s)
| | - Sheng-Tzung Tsai
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan; (S.I.M.T.); (S.-T.T.); (C.-Y.P.); (S.-Y.C.)
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Hsiang-Yi Hung
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Wei-Fen Hu
- PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien 970, Taiwan;
| | - Cheng-Yoong Pang
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan; (S.I.M.T.); (S.-T.T.); (C.-Y.P.); (S.-Y.C.)
- Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- CardioVascular Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Shin-Yuan Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan; (S.I.M.T.); (S.-T.T.); (C.-Y.P.); (S.-Y.C.)
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Hock-Kean Liew
- Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien 970, Taiwan;
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- CardioVascular Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Correspondence: or ; Tel.: +886-3-856-1825 (ext. 15911); Fax: +886-3-8560-2019
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Tsai ST, Chuang WY, Kuo CC, Chao PCP, Chen TY, Hung HY, Chen SY. Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson’s disease during deep brain stimulation with general anesthesia. J Neurosurg 2015; 123:1394-400. [DOI: 10.3171/2014.11.jns141208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Deep brain stimulation (DBS) surgery under general anesthesia is an alternative option for patients with Parkinson’s disease (PD). However, few studies are available that report whether neuronal firing can be accurately recorded during this condition. In this study the authors attempted to characterize the neuronal activity of the subthalamic nucleus (STN) and elucidate the influence of general anesthetics on neurons during DBS surgery in patients with PD. The benefit of median nerve stimulation (MNS) for localization of the dorsolateral subterritory of the STN, which is involved in sensorimotor function, was explored.
METHODS
Eight patients with PD were anesthetized with desflurane and underwent contralateral MNS at the wrist during microelectrode recording of the STN. The authors analyzed the spiking patterns and power spectral density (PSD) of the background activity along each penetration track and determined the spatial correlation to the target location, estimated mated using standard neurophysiological procedures.
RESULTS
The dorsolateral STN spiking pattern showed a more prominent bursting pattern without MNS and more oscillation with MNS. In terms of the neural oscillation of the background activity, beta-band oscillation dominated within the sensorimotor STN and showed significantly more PSD during MNS (p < 0.05).
CONCLUSIONS
Neuronal firing within the STN could be accurately identified and differentiated when patients with PD received general anesthetics. Median nerve stimulation can enhance the neural activity in beta-band oscillations, which can be used as an index to ensure optimal electrode placement via successfully tracked dorsolateral STN topography.
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Affiliation(s)
| | - Wei-Yi Chuang
- 5Department of Electrical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | | | - Paul C. P. Chao
- 5Department of Electrical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | - Tsung-Ying Chen
- 2Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien
- 3Departments of Medicine and
| | | | - Shin-Yuan Chen
- 1Departments of Neurosurgery and
- 3Departments of Medicine and
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Hung HY, Chen TY, Li MH, Chen SY, Tsai ST. A purely midline ventral schwannoma mimicking a meningioma in the thoracic spine resected via costotransversectomy. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Tsai ST, Tsai HC, Kuo CC, Hung HY, Lee CH, Chen SY. Neurosurgery in obsessive-compulsive disorder. J Neurosurg 2014; 120:1006. [PMID: 24559223 DOI: 10.3171/2013.12.jns132637] [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: 11/06/2022]
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Affiliation(s)
- Sheng-Tzung Tsai
- 1Buddhist Tzu Chi General Hospital, Hualien, Taiwan; and
- 2Tzu Chi University, Hualien, Taiwan
| | - Hsiang-Yi Hung
- 1Buddhist Tzu Chi General Hospital, Hualien, Taiwan; and
| | - Chien-Hui Lee
- 1Buddhist Tzu Chi General Hospital, Hualien, Taiwan; and
| | - Shin-Yuan Chen
- 1Buddhist Tzu Chi General Hospital, Hualien, Taiwan; and
- 2Tzu Chi University, Hualien, Taiwan
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Tsai HC, Chang CH, Pan JI, Hsieh HJ, Tsai ST, Hung HY, Chen SY. Acute stimulation effect of the ventral capsule/ventral striatum in patients with refractory obsessive-compulsive disorder - a double-blinded trial. Neuropsychiatr Dis Treat 2014; 10:63-9. [PMID: 24421642 PMCID: PMC3888347 DOI: 10.2147/ndt.s54964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Deep-brain stimulation (DBS) for treating refractory obsessive-compulsive disorder (OCD) has shown positive results in small clinical trials. Ventral capsule/ventral striatum (VC/VS) is one of the promising targets; however, whether or not acute stimulation test can provide substantial information for chronic stimulation is not yet known. We evaluated postoperative test stimulation and examined the relationship of acute simulation-induced smile/laughter and 15-month clinical outcome. METHODS Four adult patients with refractory OCD were implanted with Model 3387 leads bilaterally in an area of VC/VS. Postoperative test stimulation was performed at least 2 weeks after surgery. We performed double-blinded postoperative test stimulation with different contact and voltage. The relationship of stimulation-induced smile/laughter and chronic response was examined. RESULTS Patients presented smile, laughter, euphoria, increased heart rate, increased blood pressure, smell, chest vibration, dizziness, nausea, heat, or increased sexual drive during acute stimulation. We found that the higher the percentage of smile/laughter (34.3%, 31.3%, 56.3%, and 12.5% for four cases), the greater the reduction in the Yale-Brown Obsessive Compulsive Scale (30.6%, 38.9%, 58.8%, and 7.7% respectively at 15-month DBS). CONCLUSION This study showed that acute DBS of the VC/VS might cause mood change, cardiovascular, sensory, or motor effects. These effects were transient or habituated over six months. We suggest stimulation-induced smile/laughter may be a possible predictor for long-term DBS outcome. Larger studies, genetic studies, and imaging studies are needed to evaluate the effects of different parameters and possible predictors in the treatment of OCD.
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Affiliation(s)
- Hsin-Chi Tsai
- Institute of Medical Science, Tzu-Chi University, Hualien City, Taiwan ; Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan
| | - Chun-Hung Chang
- Department of Psychiatry, China Medical University and Hospital, Taichung, Taiwan ; China Medical University, Taichung, Taiwan
| | - Jiann-I Pan
- Department of Medical Informatics, Tzu-Chi University, Hualien, Taiwan
| | - Hung-Jen Hsieh
- Nuclear Medicine, Tzu Chi General Hospital, Hualien City, Taiwan
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Tzu-Chi General Hospital, Hualien City, Taiwan
| | - Hsiang-Yi Hung
- Department of Neurosurgery, Tzu-Chi General Hospital, Hualien City, Taiwan
| | - Shin-Yuan Chen
- Institute of Medical Science, Tzu-Chi University, Hualien City, Taiwan ; Department of Neurosurgery, Tzu-Chi General Hospital, Hualien City, Taiwan
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Hung HY, Tsai ST, Lin SH, Jiang JL, Chen SY. Uneven benefits of subthalamic nucleus deep brain stimulation in Parkinson's disease—A 7-year cross-sectional study. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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9
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Tsai ST, Hung HY, Chen SY. Deep brain stimulation modifies cognitive function. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hung HY, Tsai ST, Tsai HC, Chen SY. N-of-1 trial following deep brain stimulation in a patient with obsessive–compulsive disorder. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Tsai HC, Chang CH, Pan JI, Hsieh HJ, Tsai ST, Hung HY, Chen SY. Pilot study of deep brain stimulation in refractory obsessive-compulsive disorder ethnic Chinese patients. Psychiatry Clin Neurosci 2012; 66:303-12. [PMID: 22624735 DOI: 10.1111/j.1440-1819.2012.02352.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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: 01/20/2023]
Abstract
AIMS Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is a promising alternative to ablative surgery in treatment of refractory obsessive-compulsive disorder (OCD). A pilot study was conducted to assess 15-month outcomes of DBS in patients with refractory OCD in Taiwan. METHODS Four adult patients with a 3-year or more history of refractory OCD (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score of at least 28) met the criteria for DBS surgery. DBS electrodes were implanted bilaterally in the VC/VS. Stimulation was adjusted for therapeutic benefit and absence of adverse effects. Psychiatric evaluation was conducted preoperatively, postoperatively, and at follow up at every 3 months for 15 months. Primary outcome measure was Y-BOCS. Secondary outcomes included the Hamilton Depression Rating Scale (HAM-D), and the Global Assessment of Function Scale. RESULTS Mean severity of OCD was a Y-BOCS score of 36.3 ± 2.1. At the end of 15 months' follow up, there was a 33.06% decrease in OCD severity (P = 0.001). Similar findings were seen for HAM-D (32.51% reduction, P = 0.005), and Global Assessment of Function Scale (31.03% increase, P = 0.026). In terms of adverse effects, two patients suffered from hypomania episodes after several weeks of DBS stimulation, and one had transient hypomania-like syndrome during DBS initial programming. One patient (Case 1) had an allergic reaction to implantation of the pulse generator in the chest, and another patient (Case 3) exhibited vertigo. CONCLUSIONS We confirm that DBS of the VC/VS appears to be beneficial for improvements in function and mood among patients with treatment-resistant OCD. Compared to previous studies examining the therapeutic effects of DBS, no serious adverse effects were observed.
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Affiliation(s)
- Hsin-Chi Tsai
- Institute of Medical Science, Tzu-Chi University, Hualien, Taiwan
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12
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Tsai ST, Lin SH, Hung HY, Lin SZ, Chen SY. Long-term comparison of subthalamic nucleus stimulation between patients with young-onset and late-onset Parkinson’s disease. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Loh TW, Chiu TL, Wu SW, Hung HY, Chen KP, Su CF. Combined treatment of invasive giant prolactinoma with surgical excision, low-dose gamma knife radiosurgery, and a dopamine agonist—Report of two cases. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Chen SY, Tsai ST, Lin SH, Chen TY, Hung HY, Lee CW, Wang WH, Chen SP, Lin SZ. Subthalamic Deep Brain Stimulation in Parkinson’s Disease under Different Anesthetic Modalities: A Comparative Cohort Study. Stereotact Funct Neurosurg 2011; 89:372-80. [DOI: 10.1159/000332058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 08/15/2011] [Indexed: 11/19/2022]
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Tsai HC, Chen SY, Tsai ST, Hung HY, Chang CH. Hypomania following bilateral ventral capsule stimulation in a patient with refractory obsessive-compulsive disorder. Biol Psychiatry 2010; 68:e7-8. [PMID: 20553748 DOI: 10.1016/j.biopsych.2010.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/06/2010] [Accepted: 04/06/2010] [Indexed: 11/29/2022]
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Tsai ST, Lin SH, Chou YC, Pan YH, Hung HY, Li CW, Lin SZ, Chen SY. Prognostic Factors of Subthalamic Stimulation in Parkinson’s Disease: A Comparative Study between Short- and Long-Term Effects. Stereotact Funct Neurosurg 2009; 87:241-8. [DOI: 10.1159/000225977] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Huang CS, Lin SP, Chiu NC, Hung HY. Congenital varicella syndrome as an unusual cause of congenital malformation: report of one case. Acta Paediatr Taiwan 2001; 42:239-42. [PMID: 11550414] [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: 02/21/2023]
Abstract
Intrauterine infections with varicella-zoster virus following maternal varicella in early pregnancy and resulting in congenital malformations are rare. Herein we report a child with congenital varicella syndrome characterized by low birth weight, cicatricial scarring, hypoplasia of both lower extremities with joint contracture, congenital hip dislocation, corneal opacity, atresia of the sigmoid colon and a rarely associated cloaca anomaly. The varicella IgG remained positive after she was seven months old. Her mother developed chickenpox at the 14th week of gestation. The purpose of this article is to raise pediatricians' index of suspicion for congenital varicella syndrome when an infant is born with multiple congenital malformations with an apparent history of maternal varicella infection.
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Affiliation(s)
- C S Huang
- Department of Pediatrics, MacKay Memorial Hospital, 92, Sec. 2, Chung Shan North Road, Taipei 104, Taiwan
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Lin DS, Huang FY, Chiu NC, Koa HA, Hung HY, Hsu CH, Hsieh WS, Yang DI. Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants. Pediatr Infect Dis J 2000; 19:223-7. [PMID: 10749464 DOI: 10.1097/00006454-200003000-00010] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [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: 11/27/2022]
Abstract
OBJECTIVES To compare the accuracy of standard and hemocytometer white blood cell (WBC) counts and urinalyses for predicting urinary tract infection (UTI) in febrile infants. METHODS Enrolled were 230 febrile infants < 12 months of age. All urine specimens were obtained by suprapubic bladder aspiration and microscopically analyzed by the standard urinalysis (UA) and by hemocytometer WBC counts simultaneously, and quantitative urine cultures were performed. Receiver-operating characteristic (ROC) curves were constructed for each method of UA. The optimal cutoff point of the UA test in predicting UTI was determined by ROC analysis. RESULTS There were 37 positive urine cultures of at least 1,000 CFU/ml. Of these 37 patients, 9 females and 28 males, 1 had a positive blood culture (Escherichia coli). Thirty (81%) of the positive urine cultures had a bacterial colony count > or = 100,000 colony-forming units/ml, whereas the remaining had between 1,000 and 50,000 colony-forming units/ml. The area under the ROC curve for standard UA was 0.790 +/- 0.053, compared with 0.900 +/- 0.039 for hemocytometer WBC counts (P < 0.05). For hemocytometer WBC counts, the presence of < or =10 WBC/microl appeared to be the most useful cutoff point, yielding a high sensitivity (83.8%) and specificity (89.6%). Standard UA, with a cutoff point of 5 WBC/high power field, had a lower sensitivity (64.9%) and similar specificity (88.1%). The hemocytometer WBC counts showed significantly greater sensitivity and positive predictive value (83.8 and 60.8%, respectively) than the standard urinalysis (64.9 and 51.1%, respectively) (P < 0.05). The accuracy, specificity and likelihood ratio of hemocytometer WBC counts were also greater than that of standard UA (88.7, 89.6 and 8.08% vs. 84.3, 88.1 and 5.44%). CONCLUSION Hemocytometer WBC counts provide more valid and precise prediction of UTI in febrile infants than standard UA. The presence of > or =10 WBC/microl in suprapubic aspiration specimens is the optimum cutoff value for identifying febrile infants for whom urine culture is warranted.
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Affiliation(s)
- D S Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei Medical College, Taiwan
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Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC, Koa HA, Hung HY, Hsu CH, Hsieh WS, Yang DI, Huang FY. Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics 2000; 105:E20. [PMID: 10654980 DOI: 10.1542/peds.105.2.e20] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [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: 11/24/2022] Open
Abstract
OBJECTIVE To assess the usefulness of laboratory parameters, including peripheral white blood cell (WBC) count, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and microscopic urinalysis (UA), for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection (UTI), and comparison of standard UA and hemocytometer WBC counts for predicting the presence of UTI. METHODS A total of 162 febrile children <8 weeks of age were enrolled in this prospective study. All underwent clinical evaluation and laboratory investigation, including WBC count and differential; ESR; CRP; blood culture; a lumbar puncture for cell count and differential, glucose level, protein level, Gram stain, and culture; and a UA and urine culture. All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with standard UA as well as with hemocytometer WBC counts. Quantitative urine cultures were performed. Sensitivity, specificity, accuracy, likelihood ratios, and receiver operating characteristic (ROC) curves were determined for each of the screening tests. RESULTS There were 22 positive urine culture results of at least 100 colony-forming unit/mL. Eighteen of these 22 patients were males, and all were uncircumcised. There were significant differences for pyuria >/=5 WBCs/hpf, pyuria >/=10 WBC/microL, CRP >20 mg/L, and ESR >30 mm/hour between culture-positive and culture-negative groups (P <.05). The ROC area for hemocytometer WBC count, standard UA, peripheral WBC count, ESR, and CRP concentration were.909 +/-.045,.791 +/-.065,.544 +/-.074,. 787 +/-.060, and.822 +/-.036, respectively. The ROC curve analysis indicates that the CRP, ESR, and standard UA were powerful but imperfect tools with which to discriminate for UTI in potentially infected neonates. Hemocytometer WBC counts had the highest sensitivity, specificity, accuracy, and likelihood ratios for identifying very young infants with positive urine culture results. For all assessments, hemocytometer WBC counts were significantly different, compared with the standard urinalysis. ESR, CRP, and peripheral WBC counts were not helpful in identifying UTI in febrile infants. CONCLUSION UTI had a prevalence of 13.6% in febrile infants <8 weeks of age. The CRP, ESR, and standard UA were imperfect tools in discriminating for UTI, and the sensitivity of these laboratory parameters was relatively low. Hemocytometer WBC count was a significantly better predictor of UTI in febrile infants.
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Affiliation(s)
- D S Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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20
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Liu HC, Lee KS, Hsu CH, Hung HY. Neonatal vallecular cyst: report of eleven cases. Changgeng Yi Xue Za Zhi 1999; 22:615-20. [PMID: 10695210] [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: 02/15/2023]
Abstract
BACKGROUND Vallecular cyst is fairly uncommon in neonates and infants. Although benign in nature, it may cause severe airway obstruction and even death. This study retrospectively analyzed the clinical manifestations of vallecular cyst in neonates and discussed its management. METHODS From June 1993 through January 1997, 11 cases of vallecular cyst were collected and reviewed retrospectively. There were 8 male infants and 3 female infants. Their clinical manifestations, age at the onset of symptoms, age at diagnosis, and surgical management were analyzed. Fibrolaryngoscopy was used for preoperative diagnosis and postoperative follow-up. RESULTS The infants' initial presentations were inspiratory stridor, respiratory distress, noisy breathing, feeding difficulty, and failure to thrive. There was a high incidence of patients with coexisting signs of laryngomalacia (10/11). Ten patients received laryngomicrosurgery with CO2 laser for deroofing the cyst. Additional supraglottoplasty was performed at the same time in 4 patients with laryngomalacia type A + C and in one patient with severe laryngomalacia type C. Their symptoms all resolved soon after surgery. The phenomenon of laryngomalacia also disappeared. There has been no recurrence up to the present. CONCLUSION Although fairly uncommon, vallecular cyst should be included in the differential diagnosis of congenital laryngeal stridor in neonates. The use of fibroendoscopy can promptly diagnose vallecular cyst and any synchronous airway lesions. Although most of the synchronous laryngomalacia (type C) in this study was secondary to vallecular cyst, we suggest that supraglottoplasty be taken into consideration during cyst deroofing when the signs and symptoms of laryngomalacia type A are also present.
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Affiliation(s)
- H C Liu
- Department of Pediatrics, Chang Gung Children's Hospital, Kaohsiung, Taiwan, R.O.C
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Hsu CH, Chang JH, Lee YJ, Hung HY, Kao HA, Huang FY. Thyroid function in the sick very low-birth-weight infants. Acta Paediatr Taiwan 1999; 40:237-42. [PMID: 10910620] [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: 04/14/2023]
Abstract
This study was undertaken to determine postnatal changes in thyroid function in very low-birth-weight (VLBW) infants. A total of one-hundred VLBW infants participated. Serial examination of serum levels of thyroxine (T4), free T4, triiodothyronine (T3), and thyroid-stimulating hormone (TSH) was performed in the neonatal period. A total of eighty-nine infants survived to discharge, while eleven died during hospitalization. Transient hypothyroxinemia was found in forty-one (46.1 percent) of the survivors. One of the surviving infants had primary hypothyroidism. His data was excluded from the analysis. In the other eighty-eight surviving infants, TSH levels were within normal limits throughout the six-week study period. T4 and free T4 values decreased after the first day of life, reaching a nadir at one week of age, followed by progressive increases. The mean cord blood T3 level was very low; the serum T3 value increased progressively in the postnatal period. We found a correlation between low T4 and free T4 values and mortality and neonatal illness. Hypothyroxinemia was associated with critical illness. In conclusion, the postnatal changes in thyroid function in VLBW infants were characteristic, with transient hypothyroxinemia being common in these infants. Further investigation of the relationship between thyroid function, death, neonatal illness, and developmental outcome is warranted.
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Affiliation(s)
- C H Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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22
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Lo FS, Lee KS, Chen LS, Hung HY, Hsu CH, Lin SP, Lee YJ. Congenital nasal pyriform aperture stenosis: a diagnostic clue to solitary maxillary central incisor prior to eruption in three infants. J Otolaryngol 1999; 28:51-3. [PMID: 10077785] [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: 02/11/2023]
Affiliation(s)
- F S Lo
- Department of Medicine, Chang Gung Children's Hospital, Tao-Yuan, Taiwan
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23
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Chang JH, Hsu CH, Kao HA, Hung HY, Huang FY. Home oxygen therapy for chronic lung disease in very low-birth-weight infants. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1998; 39:237-41. [PMID: 9775493] [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: 02/09/2023]
Abstract
Prolonged hospitalization in infants suffering from chronic lung disease who require continuous oxygen therapy can be avoided by oxygen administration at home. In the period from August 1995 to September 1996, 155 very low-birth-weight (VLBW) infants were consecutively admitted to the neonatal intensive care unit of Mackay Memorial Hospital. Of the 155 infants, 72% (111/155) survived to discharge. However, 34% (38/111) of the survivors developed chronic lung disease. Twenty-three infants with chronic lung disease underwent home oxygen therapy after 107.0 +/- 43.6 days of hospitalization. The mean duration of home oxygen therapy was 4.3 +/- 3.4 months. In the first year after discharge, 91% of the patients required rehospitalization. One patient died during the fourth hospitalization. Follow-up information on growth and development at one year of corrected age was available for 19 patients. Five of the 19 patients had a body weight below the 5th percentile. Five of the 19 infants were mentally retarded and 12 of the 19 patients had significantly delayed motor development. In conclusion, carefully supervised home oxygen therapy permits safe early discharge of selected VLBW infants with chronic lung disease. Their somatic and psychomotor development should be carefully followed up.
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Affiliation(s)
- J H Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Abstract
Atrial flutter is a rare arrhythmia in the neonate and early infancy. We retrospectively reviewed the clinical presentations, treatment and outcome of seven patients who presented clinically with atrial flutter. The age of onset ranged from 1 day to 3 months. Atrial flutter was diagnosed in the first 3 days of life in 4. Three cases presented as atrial flutter with 2:1 atrioventricular conduction and the remaining 4 with variable AV block. Heart failure was present in 3 patients and 6 patients showed normal intracardiac structure on echocardiography. Electrical cardioversion was attempted as the first treatment in 4 cases, followed by digoxin in three of the four. Digoxin was given as an initial therapy in 2 patients. One patient recovered spontaneously without treatment. In the 6 patients who received therapy, 5 converted to normal sinus rhythm within 2 days. The remaining patient had ventricular ectopic beats for about 4 months. Only 2 cases were maintained on oral digoxin for at least 4 months after discharge. No patient had a recurrence of atrial flutter during the follow-up period which ranged from 6 months to 7 years. We conclude that there is a good long-term prognosis for atrial flutter in the neonate. Digoxin and DC cardioversion may be effective as initial therapy. Long-term digoxin prophylaxis after conversion to sinus rhythm may be not necessary.
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Affiliation(s)
- C C Peng
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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25
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Abstract
Intussusception found in the 1st month of life is rare and usually discussed as one entity, neonatal intussusception, but in fact, includes the intussusceptions occurring both prenatally and neonatally, of which the clinical presentations and results are different. Four full-term babies with prenatal intussusception presenting as intestinal atresia (IA) and three premature babies with neonatal intussusception mimicking necrotizing enterocolitis (NEC) are presented. Prenatal intussusception, as one of the causes of IA produces prominent signs of intestinal obstruction immediately after birth. Preoperative evaluation usually fails to yield a definitive diagnosis, but surgery is usually performed in time and is successful. In neonatal intussusception, full-term infants usually have a pathological lead point and the colon is almost always involved. A barium enema is thus useful in diagnosis. Premature babies, on the other hand, rarely have a colonic component, and the clinical features are insidious and similar to NEC. This results in diagnostic confusion that may lead to a dangerous delay in appropriate surgical correction. A high level of suspicion about this condition in cases diagnosed presumptively with NEC is important. Serial abdominal sonograms may be helpful in the early diagnosis of neonatal intussusception.
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Affiliation(s)
- N L Wang
- Department of Pediatric Surgery, Mackay Memorial Hospital, Taiwan, Republic of China
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26
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Lin DS, Huang FY, Lin SP, Chen MR, Kao HA, Hung HY, Hsu CH. Frequency of associated anomalies in congenital hypoplasia of depressor anguli oris muscle: a study of 50 patients. Am J Med Genet 1997; 71:215-8. [PMID: 9217225] [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: 02/04/2023]
Abstract
Aside from congenital heart disease, anomalies associated with unilateral hypoplasia of the depressor anguli oris muscle have not been well-documented in large series. We evaluated the associated anomalies in 50 infants or children with this disorder (male:female = 2:1) and found accompanying anomalies in 35 (70%) of 50 cases. They included anomalies of the head and neck (48%), heart (44%), skeleton (22%), genitourinary tract (24%), central nervous system (10%), gastrointestinal tract (6%), and miscellaneous minor anomalies (8%). Nearly half of our cases (22/50) had at least 2 associated systemic anomalies. Failure to thrive and psychomotor retardation were found in 5 (10%) and 3 (6%) patients, respectively, on follow-up. Three infants died neonatally of severe heart disorders, and the other one died of central nervous system anomalies. The above findings indicate that a thorough search for associated anomalies, particularly in the cardiovascular system, should be performed in all newborns with asymmetric crying face.
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Affiliation(s)
- D S Lin
- Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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27
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Abstract
We present a premature newborn with congenital rickets, born to a mother with untreated chronic renal insufficiency. X-ray films showed blurred metaphyseal ends and decreased bone density in the femurs and ribs. With treatment including calcium, phosphate, and vitamin D, her rickets healed and she grew normally.
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Affiliation(s)
- L Y Wang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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28
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Wang LY, Hung HY, Hsu CH, Kao HA, Huang FY. Clinical experience with early enteral feeding in very-low-birth-weight infants. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1997; 38:282-7. [PMID: 9297929] [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: 02/05/2023]
Abstract
The primary objective of this study was to evaluate the safety and benefit of early enteral feeding in very-low-birth-weight (VLBW) infants without parenteral nutrition. Weight gain, feeding intolerance, nosocomial infection rate and a postnatal growth curve were recorded for 61 VLBW premature infants who were admitted to the Neonatal Intensive Care Unit of Mackay Memorial Hospital from September 1, 1995 to February 28, 1997. Nine infants were unable to complete the study and three were excluded because of severe bronchopulmonary dysplasia; therefore only 49 infants could be evaluated. They were divided into two groups based on birth weight: 1001 gm to 1250 gm (Group A, mean birth weight 1153 +/- 64 gm, mean gestational age 29.0 +/- 2.2 weeks), and less than or equal to 1000 gm (Group B, mean birth weight 911 +/- 82 gm, mean gestational age 27.1 +/- 1.5 weeks). They received breast milk or premature formula by intermittent nasogastric or continuous nasogastric feeding. Growth was followed over the first 30 postnatal days. Group A reached 100 kcal/kg/day of enteral feeding at a mean age of 17 days as compared with a mean age of 20 days for group B. Infants regained their birth weight at 20 and 25 days in Groups A and B, respectively. By the 30th postnatal day, weight gain exceeded birth weight by 218.2 +/- 143.1 gm and 95.3 +/- 81.5 gm in groups A and B respectively. No definite episodes of necrotizing enterocolitis (NEC) developed. Two cases of Escherichia coli sepsis and one of Klebsiella sepsis occurred. The conclusion was that early enteral feeding in very-low-birth-weight infants does not increase the risk of NEC. It was also demonstrated that enteral feeding alone can produce biphasic postnatal growth curves in very-low-birth-weight infants. Although early enteral feeding was well tolerated in the study infants, the occurrence of feeding intolerance in some (36%) would suggest that additional parenteral nutrition may benefit some infants until full enteral feeding can be achieved.
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Affiliation(s)
- L Y Wang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Chen CP, Chen HC, Liu FF, Jan SW, Chern SR, Wang TY, Hung HY. Cutis marmorata telangiectatica congenita associated with an elevated maternal serum human chorionic gonadotrophin level and transitory isolated fetal ascites. Br J Dermatol 1997; 136:267-71. [PMID: 9068748] [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: 02/03/2023]
Abstract
A 34-year-old woman with an abnormal maternal serum screening result and a Down syndrome risk of 1:60 calculated from a maternal serum alpha-fetoprotein (AFP) value of 1.4 multiples of the median (MoM) and a human chorionic gonadotrophin (hCG) level of 4.32 MoM at 18 weeks' gestation was found to have isolated fetal ascites at 23 weeks' gestation. Spontaneous resolution occurred 10 weeks after the initial presentation. After birth, the neonate had generalized cutis marmorata telangiectatica congenita (CMTC), large vascular plaques on the scalp with superficial ulceration and crusts, a small atrial septal defect, a patent ductus arteriosus, hepatomegaly, micrognathia, seizures, an abnormal electroencephalogram, congenital retinal detachment, glaucoma and widely spaced toes. Our patient illustrates that CMTC in utero may be associated with a markedly elevated maternal serum hCG level as well as transitory isolated fetal ascites. However, such associations can be coincidental and further collaborative studies and cases will be necessary before it can be determined that a disproportionately elevated hCG level and transitory isolated fetal ascites are predictive of CMTC in utero.
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Affiliation(s)
- C P Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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30
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Mu SC, Hung HY, Chiu NC, Chen HH, Chen LJ. Cutis marmorata telangiectatica congenita with cerebral and ophthalmic anomalies: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1997; 38:65-8. [PMID: 9066194] [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: 02/03/2023]
Abstract
A term male neonate had an uncommon congenital vascular disorder of the skin covering the whole body and extremities. These skin lesions were characterized by mottling and persistent telangiectasia. A skin biopsy showed nevus vascularis reticularis which was recognized as cutis marmorata telangiectatica congenita. In addition to the cutaneous involvement, the patient also had fetal ascites, pleural effusion, patent ductus arteriosus, glaucoma, retinal detachment in the left eye, and telangiectasia in the right eye. Neonatal focal seizure developed and expired on the 34th day of life. The cerebral image studies suggested vascular anomalies with secondary cerebral parenchymal damage. Cutis marmorata telangiectatica congenita may be solitary but is frequently associated with other developmental defects. However, the specific findings of cerebral and ophthalmic lesions in our case were rather unusual.
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Affiliation(s)
- S C Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C
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31
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Abstract
UNLABELLED Pancreatitis in children is not common and can be associated with severe morbidity and mortality. We encountered 43 children, ranging in age from 2 to 18 years, with pancreatitis over the past 10 years. The diagnosis of pancreatitis was made in those patients who showed: (1) significant intra-operative pathology or; (2) clinical findings of pancreatic inflammation and laboratory confirmation. More than one third (16 cases) of the cases were due to trauma, other causes included systemic disease (10), structural disease (8), and toxins or drugs (4). Five cases were classified as idiopathic. Most of the patients presented with abdominal pain (95%) and vomiting (56%). Jaundice was found in 7 patients and an abdominal mass in 2. Morbidity included pseudocyst (10), relapse (4), hyperglycaemia (4) and miscellaneous problems. Eight (50%) of the patients with trauma and 6 (86%) of the patients with structural diseases required surgery. Other patients were managed conservatively with bowel rest, gastric decompression, intravenous fluid and total parenteral nutrition. One case had a fatal outcome. All the survivors did well in long term follow up. Relevant literature has been reviewed and the sensitivity of various diagnostic modalities compared and discussed. A lesser known association between pancreatitis and structural anomalies such as choledochal cyst is discussed. To our knowledge, the present review is the first on pancreatitis in Chinese children. CONCLUSION Pancreatitis can occur from a wide variety of causes and may result in severe complications. Early diagnosis, close monitoring and aggressive intervention are mandatory to reduce morbidity and mortality.
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Affiliation(s)
- C Y Yeung
- Department of Paediatrics, Mackay Memorial Hospital, Taipei Taiwan, ROC
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32
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Huang LW, Chen MR, Lin SP, Huang FY, Ho MY, Kao HA, Hsu CH, Hung HY, Tsai TC. The VATER association: analysis of forty six cases without karyotyping. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1995; 36:30-4. [PMID: 7778443] [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: 01/27/2023]
Abstract
Forty-six patients with two or more features of the VATER association admitted to the Mackay Memorial Hospital from May, 1983 to Mar, 1992 were retrospectively enrolled in this study. We compared the incidence of major features with that reported in the literature. Imperforate anus, congenital heart disease, and renal anomalies were the three most common major features in our study. Thirteen patients died. Heart failure was the major cause of mortality. We noted many patients associated minor features, and among them there was a relatively high ratio of cleft lip, cleft palate, and hypospadius. The overall outcome and development were good among the survivals. We suggest that children who have any congenital anomaly included in the VATER association should get a careful examination and evaluation of their heart, genitourinary tract, limbs and vertebrae. Early correction if possible is indicated in such patients.
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Affiliation(s)
- L W Huang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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33
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Wang SF, Huang FY, Chiu NC, Tsai TC, Ho UY, Kao HA, Hsu CH, Hung HY. Urinary tract infection in infants less than 2 months of age. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1994; 35:294-300. [PMID: 8085450] [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: 05/22/2023]
Abstract
Ninety-five infants, less than 2 months of age, diagnosed as urinary tract infections, from July 1984 to June 1991, were reviewed. Their urinary cultures, obtained either by suprapubic puncture or via catheterization, all had bacterial colony counts of over 10(5)/ml. In this survey, males predominated (91.6%). Fever and gastrointestinal problems were the two most prevalent signs. E. coli was the most common causative organism, and gentamicin was the most effective antibiotic. Vesicoureteral reflux (VUR), the most common anomaly, was found in one-third (25/76) of patients on voiding cystourethrography, with 20% being high grade (Gr. IV or Gr. V). Eleven cases (11%) had bacteremia, and one case had bacterial meningitis. Sixty-seven cases were followed up in our hospital and seven of them had second infections within a year of their first UTI. The mean period between episodes was less than two months. All these patients had urinary tract anomalies and received oral chemoprophylactic drugs for variable lengths of time. Five of the seven recurrences were caused by resistant bacilli. Continuous oral antibiotic prophylaxis and regular follow-up examinations were the rules of prevention for further infection and future renal impairment. These preventive methods are especially important in young infants with UTI.
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Affiliation(s)
- S F Wang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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34
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Hung HY, Huang FY, Ho MY, Kao HA. Adult respiratory distress syndrome in full term neonates. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1994; 35:36-44. [PMID: 8178641] [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: 01/29/2023]
Abstract
From July 1987 to October 1991, we experienced 10 full-term newborn infants with severe adult respiratory distress syndrome (ARDS). The triggering events were intrauterine/perinatal asphyxia in 6 and sepsis in 4. All had severe respiratory distress/failure and were mechanically ventilated with high concentration of inspired oxygen and positive end-expiratory pressure. Radiography of the chest all showed bilateral dense consolidation (white out lungs) and reduced lung volume. Persistent pulmonary hypertension (PPHN) was documented in 9 cases (90%). The concomittent occurrence of ARDS and PPHN rendered respiratory management extremely difficult. High-rate ventilation and tolazoline infusion were used in all these 9 PPHN cases. Acute complication of respiratory therapy (pneumothorax) was encountered in 5 patients. Only 3 cases survived, all belonging to the asphyxia group. Of these 3 survivors, 1 developed bronchopulmonary dysplasia, 1 had cerebral palsy on follow up and the other one was lost on follow up. The outcome of neonatal ARDS was generally poor.
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Affiliation(s)
- H Y Hung
- Department of Pediatrics, Mackay Memorial Hospital Taipei, Taiwan, R.O.C
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35
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Sun W, Huang FY, Hung HY. Fatal enteroviral infection in a neonate. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1993; 34:492-5. [PMID: 8296563] [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: 01/29/2023]
Abstract
Enterovirus infection has been recognized as one of the most common viral infections in the perinatal and neonatal periods. It frequently leads to significant mortality. One fatal case of neonatal enteroviral infection was experienced in last year. The patient was a one-day-old male, presenting with neonatal sepsis. He has a biphasic illness, first with a mild febrile prodrome then followed by severe systemic involvement, with meningitis, myocarditis, hepatosplenomegaly and disseminated intravascular coagulation. All bacterial cultures were negative, but the rectal swab isolated enterovirus. The echocardiogram revealed depressed cardiac function, and he finally expired at the age of 10 days. The autopsy findings supported the diagnosis of perinatal enteroviral infection (coxsackievirus B infection was highly suspected). Clinically, if a neonate presents as sepsis, but has the following conditions, enteroviral infection should be considered: (1) negative bacterial cultures; (2) multiple organ involvement; (3) proven enteroviral infection in the same nursery or ward; (4) a mild febrile illness in the mother within the last antepartum 10 days or the first postpartum 5 days; (5) any family members with fever or signs of upper respiratory infection within 15 days before delivery.
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Affiliation(s)
- W Sun
- Department of Pediatrics, Mackary Memorial Hospital, Taitung Branch, Taiwan, R.O.C
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Abstract
Aspergillus sp. are the most common contaminants of the paranasal sinuses with the maxillary sinus as the site most frequently involved. Fungal sphenoid sinusitis can be a life-threatening situation, thus aggressive therapy is indicated. The treatment is primarily surgical. The transnasal endoscopic technique offers excellent visualization and an atraumatic approach to the sphenoid sinus. Surgical exteriorization and aeration of the involved sinus, without using antifungal chemotherapeutic agents is curative. A rare case of sphenoid sinus aspergillosis which was successfully treated by transnasal endoscopic sphenoidotomy is reported.
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Affiliation(s)
- W S Lin
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan, R.O.C
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37
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Abstract
In order to delineate the efficacy of plasmin-treated intravenous gamma-globulin (IVGG) in the treatment of Kawasaki syndrome, we compared the frequency of coronary artery abnormalities in children treated or not with IVGG for Kawasaki syndrome. Among 291 cases of Kawasaki syndrome diagnosed during the period of 1987 to 1991 without coronary abnormalities within 10 days of the onset of illness, 128 were treated with IVGG and aspirin and were compared with 163 treated with aspirin alone. IVGG was given in a dosage of 400 mg/kg/day for 4 consecutive days. The detection of coronary abnormalities was monitored by two dimensional echocardiography. Two weeks after enrollment coronary artery abnormalities were present in 37 (22.7%) of 163 children in the aspirin group and in 9 (9%) of 128 in the gamma-globulin group (P < 0.05). Seven weeks after enrollment, abnormalities were present in 20 (12.3%) of 163 children in the aspirin group and in 6 (4.6%) of 128 in the IVGG group (P < 0.05). We conclude that plasmin-treated IVGG is effective in reducing the prevalence of coronary artery abnormalities in Kawasaki syndrome and suggest a predominant role of the Fc gamma fragment of IgG in the therapeutic effect.
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Affiliation(s)
- C H Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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38
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Lee JH, Hung HY, Chen MR. Transient hypertrophic cardiomyopathy with first degree atrioventricular block and QT prolongation. Report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1993; 34:38-44. [PMID: 8333286] [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: 01/29/2023]
Abstract
Transient asymmetric hypertrophy of the interventricular septum was found by echocardiography in a 20-day-old infant whose mother was not diabetic. The electrocardiogram showed first-degree atrioventricular block and QT prolongation. Electrocardiograms on all first degree relatives were within normal limits. With the medication of propranolol, the infant did well. Both echocardiographic and electrocardiographic findings returned to normal two months later (Acta Paed Sin 1993; 34:38-44).
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Affiliation(s)
- J H Lee
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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39
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Lee JH, Hung HY, Huang FY. Kawasaki disease with Reye syndrome: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1992; 33:67-71. [PMID: 1626454] [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: 12/27/2022]
Abstract
A seven-month-old girl was admitted to the Pediatrics Department of Mackay Memorial Hospital with the following symptoms and signs: (1) high fever for more than five days; (2) injection of bilateral conjunctiva; (3) bright red lips with strawberry tongue; (4) edematous change of palms and soles, followed by digit desquamation; (5) an ill-defined, erythematous plaque on the scar of the BCG. Kawasaki disease was diagnosed, and high dose aspirin (100 mg/kg/day) and intravenous gamma-globulin (IVIG) (400 mg/kg/day) were given for four days. The patient was afebrile on the second day after IVIG infusion, and was discharged six days after admission. A small single daily dose of aspirin (10 mg/kg/day) was given after the afebrile days. Unfortunately, vomiting and consciousness disturbance were noted one day after discharge. Laboratory data showed elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) and ammonia. Hypoglycemia and prolonged PT and PTT were also noted. Reye syndrome was suspected, and the patient was admitted to the intensive care unit for further management. A liver biopsy gave findings consistent with Reye syndrome. In spite of intensive treatment, the infant expired on the second day after admission. In a review of the literature, no correlation between these two syndromes was found. This rare case is presented to warn that Reye syndrome may follow Kawasaki disease when aspirin has been prescribed at a high dose.
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Affiliation(s)
- J H Lee
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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40
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Huang SE, Hung HY, Wang JH, Jou WB, Lin WS. [An epidemiological study of otolaryngologic emergency diseases]. Zhonghua Yi Xue Za Zhi (Taipei) 1991; 48:456-61. [PMID: 1664285] [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: 12/28/2022]
Abstract
We studied 2561 cases of otolaryngologic emergencies in the Far Eastern Memorial Hospital from January 1, 1985, to December 31, 1989, looking for the distribution and epidemiology of these emergency diseases. Our conclusions were as follows: 1. Total emergency otolaryngologic cases [otologic cases and pharyngolaryngologic cases] demonstrated a tendency to increase from year to year. 2. Acute otitis media and foreign bodies of the nose also showed an increase from year to year. 3. The "top five" emergency otolaryngologic diseases in order of frequency were: epistaxis (22.7%), foreign bodies of the throat (18.7%), acute tonsillitis (11.4%), acute otitis media (7.7%), and foreign bodies of the ear (6.4%). 4. Patients admitted to the emergency department (7.2%) ranked in order of frequency were: epistaxis (29%), acute tonsillitis (24.5%) and esophageal foreign bodies (14.1%). 5. Emergency visits occurred most frequently between 20-24 o'clock (26.5%) daily; the least from 4-8 o'clock (9.3%).
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Affiliation(s)
- S E Huang
- Department of Otolaryngology, Far Eastern Memorial Hospital
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41
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Wang GC, Kao HA, Hwang FY, Ho MY, Hsu CH, Hung HY. [Complications in the use of mechanical ventilator in newborns: one year's experience]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1991; 32:227-32. [PMID: 1776449] [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: 12/28/2022]
Abstract
A retrospective study was undertaken of 175 patients (119 males, 56 females) admitted to the neonatal intensive care unit of Mackay Memorial Hospital during the period of July 1, 1985 to June 30, 1986 who received mechanical ventilation during their stay at the hospital. Upon reviewing the clinical histories of these patients, the complication rate of mechanical ventilation was 31.9%. The percentages of each complication were: pneumothorax 50.0%, pneumomediastinum 5.2%, pulmonary interstitial emphysema 1.7%, atelectasia 13.8%, pneumonia 13.8%, chronic lung disease 13.8%, nasopharyngeal infection 1.7%. Survival rate of these ventilated patients with or without complication was not significant statistically (69.2% vs 65.6%). However, with regard to the hospital course, cases with complication had a significantly longer duration of ventilator usage, hospital stay and oxygen usage than uncomplicated cases. In conclusion, experienced personnel are needed to supervise the use of mechanical ventilation in neonates, and a team of well-trained nurses working in the neonatal intensive care unit are essential to minimize complications.
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Affiliation(s)
- G C Wang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Chiou CB, Huang FY, Hsu CH, Hung HY, Chen SC. [Congenital cutaneous candidiasis: report of two cases]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1990; 31:396-401. [PMID: 2284948] [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: 12/31/2022]
Abstract
Congenital cutaneous candidiasis is a very rare disease. We reported two newborn infants in whom generalized skin eruption was noted at birth, characteristics of erythematous papules and pustules. The eruption involved head, face, neck, trunk and extremities. Candida albicans was demonstrated on direct KOH smear, by surface fungal cultures and skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis which manifests as thrush, diaper dermatitis. The route of infection is ascending in congenital cutaneous candidiasis. The skin eruption is usually noted at birth or within 12 hours after delivery as a diffuse erythematous maculopapula, with pustules or vesicles distributed over head, face, neck, trunk and extremities. There is no fever; other constitutional signs are lacking. No evidence of impaired immunological responsiveness has been noted in previous study. Clinical features, direct smear examination of specimen and appropriate cultures are useful in differentiating the lesions from other more common dermatoses of the neonatal period. Topical antifungal therapy is sufficient unless systemic candidiasis is present. Prognosis for congenital cutaneous candidiasis is good.
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Affiliation(s)
- C B Chiou
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Hsu WC, Hung HY, Huang FY, Kao HA, Lee HC, Shih CC, Chen PF. Pulmonary hypoplasia associated with oligohydramnios: report of five cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1990; 31:388-95. [PMID: 2284947] [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: 12/31/2022]
Abstract
From January 1986 to December 1988, 5 cases of oligohydramnios with pulmonary hypoplasia were experienced. Clinically, all of the newborn infants had unique faces and evidence of respiratory distress with tachypnea, cyanosis, intercostal retractions, nasal flaring and grunting respiration presented within minutes after birth. Usually, they had no response to respiratory therapy. Most of them showed small lung volume by chest roentgenogram and were prone to develop pneumothorax. All 5 cases did not survive more than a few hours. Autopsy findings disclosed pulmonary hypoplasia. Four of them had urinary tract malformation, and the other one had the history of prolonged leakage of amniotic fluid.
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Affiliation(s)
- W C Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Subramanian MV, Hung HY, Dias JM, Miner VW, Butler JH, Jachetta JJ. Properties of mutant acetolactate synthases resistant to triazolopyrimidine sulfonanilide. Plant Physiol 1990; 94:239-44. [PMID: 16667692 PMCID: PMC1077216 DOI: 10.1104/pp.94.1.239] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Triazolopyrimidine sulfanilides are a class of highly active herbicides whose primary target is acetolactate synthase. Spontaneous mutants of tobacco (Nicotiana tabacum) (KS-43) and cotton (Gossypium hirsutum) (PS-3 and DO-2) resistant to triazolopyrimidine sulfonanilide were selected in tissue culture. Acetolactate synthase partially purified from the three mutants were 80- to 1000-fold less sensitive to inhibition by the compound compared with the corresponding wild-type enzyme. The mutants also varied in the cross-resistance pattern to other acetolactate synthase inhibiting herbicides in the sulfonylurea, imidazolinone, and pyrimidyl-oxy-benzoate chemical families. Thus, acetolactate synthase from KS-43, PS-3, and DO-2 cultures have different mutations. The affinities for pyruvate, thiamine pyrophosphate, as well as the activity of the mutant enzymes were found to be comparable to the corresponding wild-type enzymes. However, the enzyme from PS-3 was highly resistant to feedback inhibition by valine and leucine. In contrast, acetolactate synthase from KS-43 and DO-2 were inhibited by valine and leucine to nearly the same extent as the wild-type enzymes. Also, PS-3 cultures accumulated much higher levels of the branched chain amino acids compared to the wild-type cotton culture. The mutation in the PS-3 enzyme has therefore rendered it insensitive to feedback regulation by valine and leucine.
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Wang PA, Lee HC, Hung HY, Yeh MR, Cheng BF, Wang CH. [Duplication of the alimentary tract: report of three cases]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1989; 30:349-55. [PMID: 2637618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three cases of duplications of the alimentary tract are presented. Case 1 was a 5-month-old male baby. He was admitted due to copiously painless rectal bleeding. Tc-99m pertechnetate scanning revealed unusual tubular and spherical lesions. Laparotomy findings were that a tubular ileal duplication m assured 100cm or so in length and communicated with ileal lumen by its distal orifice. Moreover, there were 2 spherical duplications like ping-pong ball in morphology located in neighboring mesentery. Case 2 was a 2-day-old male newborn. He was admitted because of persistent bilious vomiting on his second day of life. Plain film x-ray revealed dilated stomach and scanty bowel gas. Laparotomy finding was that a cystic duplication measured 1.5cm in length which located in and obstructed the lumen of proximal jejunum. Also there was a distal orifice of duplication in communication with jejunal lumen. Case 3 was a 4-year-and-4-month-old boy who admitted after intermittently non-projectile vomiting for a period of 1 1/2 year. Sonography showed a calcification lesion at right upper quadrant of abdomen. Panendoscopy saw a refraction at second part of duodenum. The findings of laparotomy were that 2 tumor masses laid upon gastrocolic ligament. One was ossified soft tissue (gastrocolic ligament) with 1.5 x 1 x 0.8cm3 in size, and the other was cystic duplication of transverse colon in contact with beneath mesocolon. All duplications of 3 cases were lined with ectopic gastric and small intestinal mucosa, and ulcerative lesion was found in case 3 only. All lesions were resected and removed with good results.
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Shen EY, Hung HY, Hsu CH, Kao HA, Huang FY. Choroid plexus hemorrhage: clinical and sonografic findings of nine cases. Zhonghua Yi Xue Za Zhi (Taipei) 1988; 42:47-52. [PMID: 3064896] [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: 01/04/2023]
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Wu WH, Chyou SC, Huang FY, Liang DC, Shen EY, Hsu CH, Hung HY, Ho MY, Kao HA, Tsou YO. Clinical observation of primary Epstein-Barr virus infection in children. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1988; 29:145-51. [PMID: 2856176] [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: 01/03/2023]
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Chen KH, Kao HA, Hung HY, Huang FY, Ho MY, Chyou SC, Yeh ML. [Clinical observation of lung bud anomalies in children]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1988; 29:110-5. [PMID: 3272517] [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: 01/05/2023]
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Lee CT, Huang FY, Hung HY, Hsu CH, Lee HC, Shih SL, Yeh ML. [Intussusception: analysis of 167 cases]. Zhonghua Yi Xue Za Zhi (Taipei) 1988; 41:153-8. [PMID: 3167661] [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: 01/04/2023]
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50
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Shyur SD, Shih CC, Hung HY, Lin-Chu M, Liang DC, Lan CC. Non-hydropic cases in homozygous alpha thalassemia: report of 3 cases. Taiwan Yi Xue Hui Za Zhi 1987; 86:438-41. [PMID: 3598553] [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: 01/06/2023]
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