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Biomedical subjects

Ching-Shiang Chi

Publications and source records attributed to Ching-Shiang Chi.

51 records · Page 3Linked to original sources
PubMedDate not supplied

Bacterial meningitis of an infant with Currarino triad.

Currarino triad is a rarely hereditary condition including: (1) an anorectal malformation, (2) an anterior sacral defect, and (3) a presacral mass. Autosomal dominant transmission is suggested. We reported one case of Currarino triad, who was a 3-month-old male with sacral dysgenesis, imperforated anus and enteric cyst. This case presented with acute lower limbs paralysis due to bacterial meningitis complicated with acute arachnoiditis. The diagnosis of this condition led to a work-up of his sibling, who was found to have an incomplete type. The purpose of this case is to emphasize that a high index of suspicion for timely diagnosis and treatment of Currarino triad could prevent devastating complications.

Abnormalities, Multiple↗
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Clinical evaluation of short children referred by school screening: an analysis of 655 children.

A national screening and referral program of short school children was launched in Taiwan in 2000. We analyzed 655 referrals (boys 303, girls 352) from this program whose heights were below--2 standard deviation score (SDS) for age and gender. Evaluation included: detailed medical history, physical examination and laboratory tests such as blood count, thyroid function, growth hormone screening, bone age and chromosome tests. The results were compared with worldwide data. Normal variations accounted for 64.9% of all etiologies for reasons such as constitutional delay 37.4%, familial short stature 16.5%, and a combination of above two 11.0%. The rest were of pathological short stature for reasons such as: idiopathic short stature 7.9%, growth hormone deficiency 7.9%, precocity 3.2%, skeletal dysplasia 2.3%, intrauterine growth retardation 1.4%, Turner syndrome 1.4%, other chromosomal anomaly 0.8%, and others 5.0%. We conclude that the majority of short stature in Taiwanese children is due to normal variation although potentially treatable causes account for at least 12.8% of cases, such as GHD, Turner syndrome, hypothyroidism and precocity. The inexpensive screening program therefore seems to be beneficial in identifying children with short stature of potentially treatable etiology.

Adolescent↗
PubMedDate not supplied

Characteristics of hospitalizations among adolescents in Taiwan: population-based data.

To understand the adolescent health status in Taiwan, we collected hospitalization data of Taiwanese adolescents in 1997 under the execution of National Health Insurance (NHI). Then 5% of the data was selected with systematic sampling method by National Health Research Institute (NHRI) and was categorized according to age, gender, disease pattern and specialty. The results showed there were totally 160, 120 adolescent admissions in 1997, about 6.81% of total population admissions. There were more female than male admissions and more late adolescent than early adolescent admissions. In clinical disorders, injury was the leading cause of hospitalization for male adolescent and female early adolescent admissions. Delivery was the leading cause of hospitalization for female late adolescent admissions. The most common specialty admissions among early adolescents were for pediatrics, followed by surgery, and then general medicine. Among late adolescents, the most common specialty admissions were for surgery, followed by obstetrics and gynecology, and then general medicine. In conclusion, the most common reasons of adolescence hospitalization were related to behavioral factors rather than disease processes, and adolescent admissions by specialty were mostly non-professional.

Adolescent↗
PubMedDate not supplied

Peritoneal dialysis in children with acute renal failure after open heart surgery.

Acute renal failure is a frequently reported complication after open heart surgery in children and carries a high mortality. Conservative treatment often makes post-operative care difficult and ambiguous. Peritoneal dialysis (PD) or hemofiltration is another therapeutic choice. Hemofiltration has some limitations in pediatric patients. Many aspects of PD are currently under discussion. We retrospectively reviewed 184 children who underwent open heart surgery with cardiopulmonary bypass. Four patients fulfilled the criteria of acute renal failure. PD was performed after conservative treatment failed. All patients successfully survived through the post-operative period. No electrolyte imbalance, fluid overload or acute hemodynamic changes was observed after the initiation of PD. In our limited experience, PD is a safe and effective method for managing patients with acute renal failure after open heart surgery.

Acute Kidney Injury↗
PubMedDate not supplied

Maternal intention and actual behavior in infant feeding at one month postpartum.

Five-hundred and ninety-one mothers completed a follow-up questionnaire at one month postpartum. The total breastfeeding rate declined from 83.4% before discharge to 50.8% at one month. One-hundred and fifty-three (25.9%) mothers exclusively breastfed, 147 (24.9%) mothers mixed fed, and 291 (49.2%) mothers formula fed their babies at that time. Among the mothers who initially intended to exclusively breastfeed, 39.3% changed to formula feeding, while 7.1% of the mothers who intended to mix feeding and 4.8% of the mothers who intended to formula feed changed to exclusive breastfeeding at one month postpartum. Nine percent of the breastfeeding mothers weaned within the 1st week, 9.2% weaned between the 1st and 2nd week, 8.4% weaned between the 2nd and 3rd week, while another 14.8% weaned between the 3rd and 4th week. Milk insufficiency, maternal tiredness, not knowing whether the infant had enough to eat and breast problems were the four major reasons for changing feeding method from breastfeeding to formula feeding. Positive breastfeeding attitude, non-employment and husband's approval of breastfeeding was negatively associated with changing feeding behavior from breastfeeding to formula feeding within one month postpartum. In conclusion, successful breastfeeding not only depends on factors related to the mother, but also on her environment. Education regarding breastfeeding should be provided to the entire family including the mother and father. The workplace needs to be more accommodating to breastfeeding mothers, so that they can continue breastfeeding after returning to work.

Breast Feeding↗
PubMedDate not supplied

Vascular ring due to double aortic arch with atretic left arch and left ligamentum arteriosum: report of one case.

A 1-day-old female infant presented with vomiting immediately after feeding and shortness of breath after birth. Esophagography revealed external compression of the esophagus. Echocardiography showed a right aortic arch with mirror image branching of brachiocephalic vessels without intracardiac anomalies. Left ventriculography confirmed the echocardiography findings and revealed a tenting of the proximal part of the left subclavian artery and a blind pouch of Kommerell diverticulum at the descending aorta. The patient underwent surgery, which revealed a complete vascular ring compressing the trachea and the esophagus. The ring was formed by a right aortic arch, atretic left arch and left ligamentum arteriosum. Following surgical division of the ligamentum arteriosum and the atretic left arch, the symptoms subsequently improved.

Aorta, Thoracic↗
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Clinical spectrum of acute respiratory distress syndrome in a tertiary pediatric intensive care unit.

Acute respiratory distress syndrome (ARDS) has been a great challenge in the field of pediatric critical care medicine. The clinical picture of children with ARDS in Taiwan has seldom been reported. The purpose of this study was to investigate the incidence, predisposing factors, clinical manifestations, strategies of ventilator support, adjuvant therapies, and prognosis of children with ARDS in a tertiary pediatric intensive care unit (PICU). A retrospective review of admissions to our PICU in the past 3 years showed that 16 cases met the criteria of pediatric ARDS. The incidence was 0.2% of all PICU admissions. The predisposing factors were varied, and pneumonia was the most common. The mean values of acute lung injury scores, ventilation indices and PaO2/FiO2 on admission were 3.6 +/- 0.5, 68.0 +/- 32.8 and 71.6 +/- 25.2, respectively. The averages of maximal peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) were 40.3 +/- 9.8 and 14.0 +/- 4.6 cmH2O, respectively. Only three patients (19%) expired due to overwhelming systemic infection. Compared with our previous high mortality rate report, we emphasized gentle mechanical ventilation care, early employment of high PEEP and adjuvant therapy with sodium nitroprusside (SNP) nebulization and/or inhaled nitric oxide (iNO) to achieve an improved survival rate.

Administration, Inhalation↗
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Outcome of antithyroid medication and radioiodine therapy in pediatric Graves' disease.

Graves' disease is a significant medical condition in children. The optimal therapy is controversial. We reviewed 40 pediatric patients with Graves' disease, 5.0-17.7 yrs of age (mean 10.2 yrs), treated for at least one yr from 1990 to 2002 to assess the outcome of antithyroid medication and radioiodine therapy. The follow-up duration was 1.1-11.8 yrs (mean 5.1 yrs). Clinical variables were also analyzed to identify the prognostic factors. The 40 patients were divided into 3 groups according to their therapeutic options to analyze outcome. To identify predictors, patients who achieved remission after antithyroid drugs within 2 yrs (n = 7) were compared with those who received more than 2 yrs of medication but did not enter remission (n = 25). In group 1, 28 patients received antithyroid drugs for 0.7-10 yrs (mean 3.4 yrs). Fourteen (50%) achieved remission after 0.7-6.6 yrs (mean 2.6 yrs). In group 2, 9 patients received subsequent radioiodine therapy (10-15 mCi) after antithyroid drugs for 1.1-9.2 yrs (mean 4.4 yrs). Remission was achieved after 1-11 months (mean 3.1 months) in 8 (89%). In group 3, initial 131I (12-15 mCi) was used in 3 patients. All of them (100%) attained remission within 2 months. The overall remission rate of patients receiving medical therapy (group 1 and 2) was 38% (14/37). Of the 11 patients who achieved remission after radioiodine, 10 had hypothyroid status and required thyroxine replacement. There were no significant differences with any of the clinical variables that might predict remission after medication within 2 yrs, possibly because of the small number of patients. Our data demonstrate that radioiodine is an efficient and effective therapy for pediatric Graves' disease as first-line treatment or subsequent therapy for those with relapsed disease after medical therapy, although most patients develop hypothyroidism after treatment.

Adolescent↗
PubMedDate not supplied

Balloon valvuloplasty for critical aortic stenosis in two infants.

Critical aortic valve stenosis (AS) is a difficult clinical condition. Besides supportive medical care, relief of the stenosis is most important to the patients' survival. We present two cases using transcatheter balloon valvuloplasty in managing critical AS in young infants. Case 1 was a 2 month-old female infant. She presented with cardiopulmonary failure. Aortic annulus was 8 mm and the aortic valve was dilated with a 6 mm and then an 8 mm diameter balloon. The pressure gradient was reduced from 83 to 13 mmHg. Case 2 was a 7 day-old male infant. Aortic annulus was 6.7 mm and the aortic valve was dilated with a 6 mm diameter balloon. The pressure gradient was reduced from 87 to 44 mmHg. Both patients tolerated the procedure well. No major complications developed except that a transient weak femoral pulse was noted in case 1. In our limited experience, balloon valvuloplasty is a safe and effective therapeutic choice for managing critical AS in young infants. The advantages include no need of bypass or general anesthesia, shortened hospital course, reduced exposure to blood product, and no scar.

Aortic Valve Stenosis↗
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PHACE syndrome: report of one case.

PHACE syndrome indicates a neurocutaneous syndrome including Posterior fossa malformation, large facial Hemangioma, Arterial malformation, Coarctation of the aorta and/or other Cardiac anomalies, and Eye abnormalities. We here report a female infant who presented a giant facial hemangioma. Dandy-Walker malformations with hydrocephalus was found subsequently. We treated the hemangioma with prednisolone, methylprednisolone, interferon-alpha, and local injections of corticosteroid. Encephalomalacia was found later and it was attributed to carotid artery anomalies. Brain image studies, thorough ophthalmologic and cardiac examinations are strongly recommended in infants with large, plaquelike facial hemangiomas. Carotid angiography should also be considered if carotid artery anomalies are suspected.

Abnormalities, Multiple↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defect using the Amplatzer Septal Occluder: initial results of a single medical center in Taiwan.

The Amplatzer Septal Occluder (ASO) is the first and only device to receive full approval for clinical use in patients with secundum atrial septal defect (ASD) from the United States Food and Drug Administration. This study reports the device's initial results in Taichung Veterans General Hospital, a tertiary medical center in central Taiwan. Between October 2001 and December 2004, 39 consecutive patients (31 females, 8 males) with secundum ASD underwent attempt at transcatheter closure using the ASO under general anesthesia and transesophageal echocardiographic guidance. Six patients were excluded due to deficient rims (2 patients), multiple ASDs (1 patient), too large a defect (1 patient), too small a defect (1 patient) and 1 patient with associated atrial flutter. A total of 33 patients (26 females, 7 males) underwent the device closure procedure. The median age was 10.6 years (range 3.1-57.5 years) and median weight was 42 kg (range 13.5-73 kg). The median Qp/Qs ratio was 2.12 (range 1.02-5.52). The median balloon stretched diameter of the defect by sizing plate was 16 mm (range 5-37 mm). A total of 33 devices (median size 17 mm, range 7-38 mm) were implanted in 33 patients. The median fluoroscopy time was 10.1 minutes (range 5.9-29 minutes) and the median procedure time was 55 minutes (range 30-105 minutes). Complications included asymptomatic device embolization to the right ventricle in 1 patient (surgical removal) and transient complete atrioventricular block in 1 patient. Follow-up echocardiography at 10 minutes, 24 hours, 1 month, 6 months, 1 year and 2 years after the procedure showed complete closure rates of 76% (25/33), 91% (30/33), 100% (32/32), 100% (22/22), 100% (22/22), and 100% (9/9), respectively. In conclusion, transcatheter closure of secundum ASD using the Amplatzer Septal Occluder is safe and effective, with a very low complication rate.

Adolescent↗
PubMedDate not supplied

Comparison of right atrial pressure and central venous pressures measured at various anatomical locations in children.

PURPOSE: To compare the right atrial pressure to the central venous pressures measured at different points in spontaneously breathing children and try to find a formula to estimate right atrial pressure by central venous pressure measurement. METHODS: Fifty-one children, aged 5 +/- 4.7 years, who underwent right heart catheterization were studied. All patients were sedated and breathed naturally. The mean pressure was the electronic mean of nine heart beats calculated by Philips BC4000 digital angiographic system. Mean pressure of the right atrium was compared to those measured at the high superior vena cava (SVC), low SVC, high inferior vena cava (IVC) (T10-11), middle IVC (L1-2), low IVC (L3-4), and iliac vein (L5-S1). RESULTS: Mean pressures of central veins were significantly higher than that of the right atrium (all p<0.01). Adjusted central venous pressures of SVC-0.5, high IVC-1.5, middle IVC-2, low IVC-2.5, and iliac vein-3 (mmHg) had a good agreement with the right atrial pressure. CONCLUSIONS: Central venous pressures are significantly higher than the right atrial pressure in spontaneously breathing children. Adjusted pressures of SVC-0.5, high IVC-1.5, middle IVC-2, low IVC-2.5, and iliac vein-3 (mmHg) can accurately reflect the right atrial pressure.

Atrial Function, Right↗
PubMedDate not supplied

Pseudohypoparathyroidism: report of seven cases.

Pseudohypoparathyroidism (PHP) is a rare inherited syndrome with several types. We reviewed the cases of 7 PHP patients seen between 1990 and 2003, and analyzed their clinical, biochemical data and long-term medical outcomes. Six boys and one girl were included. Two siblings showed Albright's hereditary osteodystrophy (AHO) and PHP Ia was impressed. The rest were suspected of PHP Ib. Their mean diagnosed age was 10.8 years and most had symptoms onset for several years before diagnosis. The most frequent initial presentations were seizure, followed by extremity muscle spasm, short stature, learning disability and psychomotor retardation. Mild thyrotropin elevation was noted in two patients of PHPIa. Early puberty onset, combined with bone age advancement was noted in the boy with PHP Ia, who had the shortest predicted adult height (PAH) (139.5 cm). The other 5 boys had normal PAH, mean 171.42 cm, and 4 male patients reached final height with a mean of 163.25 cm, close to their target heights. During treatment, 2 patients developed nephrocalcinosis. In conclusion, subtypes of PHP present heterogeneous phenotypes. Non-Ia subtypes might not be rare in Taiwan. Therefore, in hypocalcemic patients with mild high or normal parathyroid hormone (PTH), even in the absence of AHO, PHP should be ruled out. Regular renal sonography follow-up is recommended during therapy.

Adolescent↗
PubMedDate not supplied

Combined transcatheter closure of atrial septal defect and patent ductus arteriosus: report of two cases.

Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are common congenital heart defects and usually isolate. The combination of these two defects is infrequent. Nowadays, both defects are amenable to transcatheter closure, without surgery. However, both defects by transcather closure was rarely reported. Here we report that two children with ASD and PDA benefited from combined interventional therapy using the Amplatzer septal occluder for the ASD and Gianturco coils for the PDA. Based on our limited experience, closing the PDA before the ASD may be a better option.

Cardiac Catheterization↗