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Biomedical subjects

C R Wang

Publications and source records attributed to C R Wang.

138 records · Page 8Linked to original sources

Budd-Chiari syndrome caused by obstruction of the hepatic inferior vena cava: immediate and 2-year treatment results of transluminal angioplasty and metallic stent placement.

PURPOSE: To assess the usefulness of percutaneous transluminal angioplasty (PTA) and expandable metallic stent (EMS) placement for treatment of Budd-Chiari syndrome (BCS). METHODS: Thirty-two patients with BCS were treated by PTA alone or by PTA and EMS placement. Among the 32 patients, a membranous obstruction was found in 24 and a segmental stenosis or occlusion in 8 patients. The follow-up period for PTA was 38-68 months (mean 52.2 months); for EMS it was 20-36 months (mean 24.3 months). RESULTS: Twenty-one patients underwent PTA as the primary treatment. Of these, one patient died of disseminated intravascular coagulation shortly after the procedure; 20 had good to excellent initial angiographic and clinical results. Of the 20, restenosis or reocclusion developed in 10 patients (48%), all before 27 months; 8 patients (38%) became symptomatic, and 2 remained symptom-free for a total recurrent obstruction rate of 50%. The EMS group of 17 patients included 11 patients who underwent primary stenting and 6 patients with secondary stenting after recurrence following primary PTA; restenosis was demonstrated in only 2 patients (12%). CONCLUSIONS: We conclude that PTA alone produces excellent short-term results and about 50% sustained patency after 2 years in patients with BCS; therefore it should remain the procedure of first choice. Stents should be reserved for primary or secondary PTA failures.

Adult↗

Diagnosis of anomalous innominate artery syndrome by spiral CT with 3D reconstruction of the airway: report of one case.

Stridor in infants is a symptom that indicates partial obstruction of the large airways. Vascular rings are an unusual cause of tracheal compression which can induce stridor in infants and children. We report a 4-month-old boy with recurrent wheezing and stridor for 2 months. Spiral computed tomography (CT) and three-dimensional (3D) reconstruction aided in the diagnosis of external compression on the trachea by an innominate artery. Successful relief of the airway's obstruction was achieved by aortopexy. Three months after surgery, he was symptom free without any medication.

Aorta, Thoracic↗

Diagnosis of the congenital urethral anomalies of male child by voiding cystourethrography.

Congenital urethral anomalies in boys are rare. This report concerns seven children with congenital urethral anomalies other than hypospadias from March 1995 to February 1998. Seven cases of congenital urethral anomalies were diagnosed by voiding cystourethrography (VCUG) from 1246 examinations of boys over a period of three years. There were four posterior urethral values, one anterior urethral valve, one anterior urethral diverticulum, and one megalourethra. Five of them had vesicoureteral reflux (VUR). Two cases of posterior urethral valve had renal failure in spite of surgery. Three cases exhibited renal cystic dysplasia. The clinical presentation and imaging findings are presented. Conventional fluoroscopically monitored VCUG is the principal examination used for bladder and urethra study in children. Therefore, in boys presenting the signs and symptoms related to voiding disturbance, VCUG is used to detect not only VUR but also anomalies in the bladder and urethra. In conclusion, VCUG is safe and essential for diagnosis of congenital urethral anomalies.

Child↗

Sonographic and color Doppler sonographic diagnosis of acute osteomyelitis: report of one case.

Acute osteomyelitis in childhood is uncommon. Early diagnosis is often difficult. We present a 7-year-old boy with clinical manifestation of fever and progressive left thigh swelling for one week. Sonography of the left thigh showed periosteal thickening with subperiosteal abscess around the metaphysis of the left distal femur. Tc-99m bone scintigraphy showed increased uptakes at the left distal femur. Osteomyelitis was suspected from the examination of ultrasound and bone scan examinations. His symptoms were not relieved following systemic antibiotic therapy and a follow-up color Doppler sonography showed vascular flows within and around the periosteum indicating active inflammation. He finally received surgical drainage and the operative findings confirmed the diagnosis of osteomyelitis. In conclusion, ultrasound may be a helpful and convenient tool for establishing the early diagnosis of pediatric osteomyelitis. Ultrasound and color Doppler sonography can be used as clinical parameters to evaluate the disease severity and the progression of osteomyelitis in children.

Acute Disease↗

Hirschsprung's disease presenting with diffuse intestinal pneumatosis in a neonate.

In the neonate, pneumatosis intestinalis is almost always associated with necrotizing enterocolitis. The manifestation of diffuse intestinal pneumatosis in Hirschsprung's disease has been reported rarely. It may occur as a result of Hirschsprung's disease complicated with enterocolitis. We report a two-day-old female baby born at term with the problems of failure to pass meconium, progressive abdominal distension and bile stained vomiting. There was an early roentgenographic presentation of pneumatosis intestinalis which might have led to a diagnosis of necrotizing enterocolitis. However, the intestinal pneumatosis resolved within 48 hours. After anorectal manometry and contrast enema examination, an ileostomy was performed at the age of 23 days, and multiple biopsies of intestine showed aganglionosis up to the ileum at the level of 85 cm above the ileocecal valve. Unfortunately, the patient developed short bowel syndrome after operation and died suddenly after an accidental choking at the age of three months. This case suggests that Hirschsprung's disease may have an unusual early roentgenographic presentation with diffuse intestinal pneumatosis in the first few days of life. Anorectal manometries and suction biopsies are crucial for further diagnosis.

Diagnosis, Differential↗

Anticardiolipin antibodies and interleukin-6 in cerebrospinal fluid and blood of Chinese patients with neuro-Behçet's syndrome.

Anticardiolipin antibodies of the IgG, IgM and IgA isotypes and soluble IL-6 were measured in paired serum and cerebrospinal fluid samples from five patients with neuro-Behçet's syndrome. Another five patients with non-inflammatory neurological diseases were also studied as a control group. Anticardiolipin antibodies, especially the IgM isotype, and IL-6 were highly elevated in the cerebrospinal fluid of patients with neuro-Behçet's. Levels of both IgM isotype anticardiolipin antibodies and IL-6 in the cerebrospinal fluid dropped after disease activity subsided. These results suggest that the increase in IgM isotype anticardiolipin antibodies and IL-6 in cerebrospinal fluid may be involved in the immune response of neuro-Behçet's within the central nervous system. Serial measurements of IgM isotype anticardiolipin antibodies and IL-6 in the cerebrospinal fluid may be useful in evaluating disease activity in neuro-Behçet's.

Adult↗

Phenotypic and functional analysis of natural killer cells in systemic lupus erythematosus patients.

Systemic lupus erythematosus (SLE) manifested with multiple autoantibodies production and glomerulonephritis, is the best example of systemic autoimmune diseases. To further elucidate the role of cytokines and the potential involvement of natural killer cells (NK cells) in the pathogenesis of lupus, phenotypic analysis of peripheral blood mononuclear cells (PBMC), NK cells cytotoxicity and cytokines production pattern of SLE patients and normal controls were examined. In addition, the effect of a variety of cytokines on anti-dsDNA antibodies production was also investigated. Our results showed that: (a) there was an increased percentage of memory T cells and decreased percentage of NK cells in SLE patients when compared to normal controls (p < 0.05); (b) a decreased production of cytokines like gamma-IFN in mitogen-stimulated PBMCs was also noted in SLE patients; (c) cytolytic activity of NK cells was markedly reduced in SLE patients (p < 0.05); (d) spontaneous secretion of IgG anti-dsDNA antibodies by B cells isolated from SLE patients could be inhibited by gamma-IFN, but not by IL-2, IL-4 and IL-5. These data suggested that decreased functions of NK cells and related type 1 T helper cells be closely related to the immune dysregulation and autoantibodies production in SLE.

Adolescent↗

Cerebral arteriovenous malformations in children: neuroimaging findings.

Cerebral arteriovenous malformations (CAVMs) are uncommon in children. CAVMs represent the most frequent intracranial vascular pathology at pediatric ages. This report concerns 13 children below the age of 16; all were identified between September 1995 and December 1996 with 14 CAVMs among them. All were proved by conventional cerebral angiography (CCA). Thirteen computed tomography (CT), 7 magnetic resonance images (MRI), 2 magnetic resonance angiography (MRA) and 13 conventional cerebral angiography (CCA) were analyzed. Most CAVMs nidus were located in cerebral hemispheres. Four in the temporal lobe, two in the parietal lobe, three in the frontal lobe, two in the occipital lobe, and three in the corpus callosum. One of them was of a mixed type with two nidi. The major clinical features of CAVMs were intracranial hemorrhage and seizures. Experience here was that MRI is superior to CT in showing the exact anatomic relationships of the nidus and in demonstrating the extent of CAVMs nidus obliteration after treatment. MRA provided a noninvasive means of studying blood vessels and vascular pathology in relationship to the CAVMs nidus. Standard angiography is still necessary to characterize in-flow and out-flow of vessels in CAVMs when definitive treatment is considered.

Adolescent↗

Pneumonia with pneumatocele formation caused by Mycobacterium tuberculosis: report of one case.

Pneumatoceles are usually characteristic of staphylococcal pneumonia. They are rarely formed as one of the complications of Mycobacterium tuberculosis pneumonia. We report a 1-year-and-5-month old male child with pneumonia who was confirmed to have the rare complication, pneumatocele formation, by chest radiography and computed tomography. Since the patient did not respond to empiric antibiotic therapy, gastric larvage through a nasogastric tube was performed on three consecutive mornings and, as a result, acid fast rods were found on the three specimens. The cultures subsequently yielded M. tuberculosis. He was finally cured with a 6-month course of antituberculous chemotherapy. We conclude that tuberculosis should be considered in infants or young children with pneumonia that presents radiologically as pneumatocele formation, especially in whom there has been no response to empiric antibiotic therapy.

Humans↗