Biomedical subjects

Chung-I Chang

Publications and source records attributed to Chung-I Chang.

26 records · Page 2Linked to original sources

PubMed2002

Revisit on congenital bronchopulmonary vascular malformations: a haphazard branching theory of malinosculations and its clinical classification and implication.

We propose a haphazard branching theory to support the concept of bronchopulmonary malinosculations, and we apply this theory to classify congenital bronchopulmonary vascular malformation (BPVM) based on the anatomical results we have found. Between January 1990 and December 1997, a total of 22 pediatric patients (10 male and 12 female), aged 2 days to 14 years (median, 19.6 months), with congenital BPVM were enrolled in this retrospective study. Study modalities include the clinical features and plain chest films (n = 22) plus at least two of the following: echocardiography (n = 13), barium esophagraphy (n = 2), bronchoscopy (n = 4), contrast bronchography (n = 8), high-resolution direct coronal CT (n = 1) and electron beam or ultrafast CT (n = 1) of the chest, MRI (n = 10), MRA (n = 1), contrast cineangiocardiography (n = 9), surgery (n = 11), or autopsy (n = 2). The salient clinical features were recurrent lung infections in 14 patients, acute respiratory distress in 13, associated cardiovascular malformations in 8, dextroversion in 7, congestive heart failure in 7, dextrocardia in 4, and complex congenital heart diseases in 4. There were abnormal openings (malinosculations) of the pulmonary airway in 20 patients: to an artery in 12, to a vein in 8, and to the lung parenchyma in 9. These 22 patients with congenital BPVM can be classified into bronchial malinosculation (10 cases), arterial malinosculation (2 cases), and bronchoarterial malinosculation (10 cases). Congenital BPVM can be classified in terms of bronchopulmonary malinosculation based upon a haphazard branching theory, in which abnormal communications between two independent systems (primitive foregut system and aortic-pulmonary arch system) occurred coincidentally rather than causally.

Adolescent↗

PubMed2002

Another twist in helix C and a missing pocket.

PKB/Akt reveals a major role for helix C in the regulation of activity in the first structure of an AGC family protein kinase in its low-activity form.

Cyclic AMP-Dependent Protein Kinases↗

PubMed2002

Conservative treatment in an infant with superior vena cava syndrome after cardiac surgery.

Superior vena cava (SVC) syndrome rarely responds to conservative treatment. We report the case of a 2-month-old boy with SVC syndrome and bilateral chylothorax after surgical repair of the hemitruncus. Medical management with low-dose heparin, dipyridamole, and aspirin resulted in improvements of head swelling and chylothorax. The chyle had disappeared 46 days postoperatively. Compensatory growth of collateral vessels was also found. Although surgical repair is sometimes advocated in patients with SVC syndrome, medical treatment is an important alternative if the risk of surgery is too high.

Cardiac Surgical Procedures↗

PubMedDate not supplied

Experience with extracorporeal life support in pediatric patients after cardiac surgery.

Extracorporeal life support (ECLS) had been successfully used in neonatal respiratory failure, but cardiac ECLS has been used increasingly in recent years. The purpose of this study was to review our experience in pediatric patients supported by ECLS for postoperative circulatory failure and to analyze the factors associated with mortality. Between January 1999 and December 2004, 68 pediatric patients (< 18 years old) who received ECLS within 7 days after cardiac surgery at the National Taiwan University Hospital were included in this study. The overall survival rate of this cohort was 32.4%. Age and gender did not affect survival. Patients with separate biventricular physiology had a higher probability of survival than those with systemic-pulmonary shunt or cavopulmonary anastomosis (41.3% vs. 13.6%, p < 0.05). Acute renal failure during ECLS was significantly associated with mortality (83% vs. 33.5%, p < 0.001). After ECLS initiation, the lowest lactate levels on the second to fourth days were lower in survivors than in nonsurvivors (2.4 vs. 3.3 mmol/L, p < 0.05). There was a trend toward a better survival in the most recent 2 years in comparison with the previous 4 years (47.6% vs. 25.5%, p = 0.07), although this trend did not reach statistical significance. In conclusion, nonbiventricular physiology, acute renal failure, and high blood lactate levels after ECLS increased the risk of mortality for pediatric patients requiring ECLS for postoperative cardiac support.

Acute Disease↗

PubMedDate not supplied

Constrictive pericarditis presenting as massive ascites in children: report of one case.

Abdominal distension has been described as the most common presenting symptom in children with constrictive pericarditis. This report describes a 13-year-old boy who had abdominal distension with massive ascite and hepatosplenomegaly as an initial presentation. The physical signs of jugular vein engorgement and gallop rhythm as well as the pericardial calcification on the chest roentgenogram lead to the diagnosis of constrictive pericarditis. After ultrafast computed tomography and cardiac catheterization confirmation, the patient received a pericardiectomy with excellent relief of symptoms. Pathology of the pericardium reveals fibrocalcified change, but no acid fast stained bacillus nor granulomatous lesion was observed. The incidence of constrictive pericarditis with evident pericardial calcification in children is extremely low. The diagnostic value of the chest roentgenogram and physical findings for the constrictive pericarditis are addressed.

Adolescent↗

PubMedDate not supplied

Arterial switch operation for transposition of the great arteries: experience from 2000-2002 in Taiwan.

Arterial switch operation (ASO) is considered the procedure of choice for transposition of great arteries (TGA). The results and long-term prognosis improved with recent advances in perioperative management. We herein analyze the clinical outcome of patients undergoing ASO at our institution during the past 3 years. From 2000 to 2002, 44 patients (30 male and 14 female) of TGA received ASO. Age at operation varied from 4 days to 6.6 years (median 14 days) with body weight ranged from 2.25 kg to 18.1 kg (median 3.3 kg). Palliative procedure prior to ASO was performed in 8 patients (18.8%). Normal coronary artery pattern was found in 28 patients (63.6%). The early mortality was 11% (5/44). Only associated ventricular septal defect (VSD) was a significant predictor for operative mortality (p=0.012). With a follow-up ranged from 11 to 44 months, the gradient of neo-pulmonary artery stenosis was 16.5 +/- 18.2 mmHg. Four patients (10%) received balloon dilatation and the other three (7.7%) underwent reoperation. The gradient of neo-aortic stenosis was 16.5 +/- 18.2 mmHg that needed to be dilated in three patients (7.7%). The probability free from reintervention was 73% at the 3rd postoperative year. One patient had moderate degree of pulmonary valve regurgitation and six had moderate neo-aortic valve regurgitation. In conclusion, the ASO can be performed in infants with satisfactory results, even in those with a body weight less than 2.5 kg. Only associated VSD was shown to be a risk factor.

Cardiovascular Surgical Procedures↗

PubMedDate not supplied

Persistent truncus arteriosus: twenty years experience in a tertiary care center in Taiwan.

BACKGROUND: Persistent truncus arteriosus (PTA) is a rare congenital heart disease. The disease spectrum and outcome in the Oriental are still unclear. METHODS AND RESULTS: A total of 35 patients with PTA were identified from the Pediatric Cardiology Database of this institution, giving an incidence of 0.47%. According to the Van Praagh classification, we found type A1 in 16, A2 in 10, A3 in 4 and A4 in 5 patients. The most common truncal valves were still tricuspid (57.1%) and quadricuspid (28.5%), with the latter being associated with moderate to severe truncal regurgutation. Eleven patients had not received surgery and all died. We classified the era of operation as early (between 1980 and 1995) or late (1996-2001), and further classified the type of PTA as simple (type A1 or A2) or complex (interrupted aortic arch-A4, absent orifice of one PA from truncal root-A3 or moderate truncal valve insufficiency). The overall surgical mortality was 67%. Statistical analysis revealed that age at operation (older than 6 months), early operation era and complex PTA were risk factors for survival. CONCLUSIONS: PTA is a rare form of congenital heart disease in Taiwan and probably also in the Oriental. The surgical reparation seems to improve with experience. Early operation may prevent pulmonary vasculopathy. However, the results in complex PTA remain poor.

Age Factors↗

PubMedDate not supplied

Ring-sling complex: report of one case.

The ring-sling complex is a rare developmental anomaly combining pulmonary artery sling and complete tracheal ring. The abnormal left pulmonary artery is a sling-like structure that surrounds the trachea and produces upper airway obstruction. Complete tracheal ring is associated with tracheal stenosis which often leads to respiratory distress. This article presents a case of this anomaly and emphasizes the importance of detecting the complex combination when evaluating related disease spectrum.

Humans↗