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Biomedical subjects

G J Lin

Publications and source records attributed to G J Lin.

At least 19 recordsLinked to original sources
PubMed1999

Prenatally detected tumor mass in the adrenal gland.

BACKGROUND/PURPOSE: Screening programs using urinary vanillylmandelic acid have detected neuroblastomas in early infancy with some success. With the widespread use of ultrasonography in modern obstetric practice, use of ultrasonography to screen for fetal neuroblastoma seems to be reasonable and practical. METHODS: Seven fetuses had suprarenal masses detected by maternal ultrasound scan at 32 to 37 weeks' gestation between 1993 and 1998. They were delivered normally if the pregnancy was uncomplicated, especially if it was without maternal preeclampsia or fetal hydrops. Each mass was further confirmed by ultrasound scan, computed tomography, or magnetic resonance imaging in the neonatal period. Tumor excision was performed at the age of 6 to 38 days of life. RESULTS: The size of the masses measured ranged from 2.0x2.0 cm to 4.5x4.5 cm. The diagnosis was adrenal hemorrhage in 1 neonate, Evan's stage I neuroblastoma in 3, and stage IV-S neuroblastoma in 3. All of the specimens with a diagnosis of neuroblastoma showed a favorable histology by the Shimada classification system. Infants with stage I disease were treated with tumor excision only, and they had survived without disease by 14, 18, and 25 months of follow-up. One infant with stage IV-S neuroblastoma was treated further with minimal chemotherapy and has survived without disease at the 66-month follow-up examination. Another child with stage IV-S neuroblastoma has survived with local recurrence and increasing liver metastasis and was still on chemotherapy at the 2-month follow-up examination. The third child with stage IV-S disease presented with massive hepatomegaly and bone marrow involvement, and disseminated intravascular coagulopathy had developed. The patient died on the 5th day of life without surgical intervention. CONCLUSIONS: The increasing use of obstetric ultrasonography has made the prenatal screening of neuroblastomas possible. The prognosis of infants with a suprarenal mass may be improved with this early detection and early surgical intervention.

Adrenal Gland Neoplasms↗
PubMed1998

Application of the surface rendering technique of three-dimensional ultrasound in prenatal diagnosis and counselling of Klippel-Trenaunay-Weber syndrome.

Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks' gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.

Adult↗
PubMed1998

Antenatal depiction of the fetal ear with three-dimensional ultrasonography.

OBJECTIVE: To evaluate the feasibility of examining the fetal ear with three-dimensional ultrasound. METHODS: In 125 pregnancies between 19 and 38 weeks of gestation, fetal ears were evaluated by three-dimensional ultrasound. The volume images with surface rendering were analyzed to depict the morphology, lying axis, orientation, and cranial location of the fetal ears. RESULTS: Three-dimensional images of one or both ears were successfully reconstructed in 105 fetuses. Among them, 18 fetuses had anomalous ears. The anomalous ears, including microtia, low-set ear with slope axis, abnormal ear orientation, and edematous ear, were confirmed after delivery. Three-dimensional ultrasound consistently displayed fetal ear abnormalities with greater accuracy and clarity. CONCLUSION: Because anomalous ears may be a part of complex fetal malformations, it is important to recognize ear abnormalities. Due to the complexity of the fetal ear, three-dimensional ultrasound offers more important information than two-dimensional ultrasound, which simply gives auricular geometry. We suggest that three-dimensional ultrasound can be used better to examine the fetal ear and may prove to be useful for prenatal diagnosis and genetic counseling.

Ear, External↗
PubMed1997

Renal vascular resistance in normal children--a color Doppler study.

To investigate the relationship between age and renal vascular resistance and to establish normative data of the systolic/diastolic ratio (S/D ratio), pulsatility index (PI), and resistant index (RI) of the renal artery in the normal pediatric population, we studied 252 normal children aged newborn to 13 years (a total of 449 kidneys) with a color Doppler unit. After the normality of the kidney was established, color flow mapping was performed to localize the segmental portion of the renal artery. Flow velocity waveforms were then obtained by pulsed Doppler, and S/D ratio, PI, and RI were calculated. Multiple regression analysis confirmed the age dependence of the S/D ratio, PI, and RI of the renal artery in normal children. Renal vascular resistance continuously declines after birth and stabilizes at the age of 102-130 months. Normative data for S/D ratio, PI, and RI of the renal artery in normal children were established for each age group. Since renal vascular resistance decreases with age and stabilizes at 8-10 years, we suggest using different normal ranges for each age group when studying renal vascular resistance in pediatric patients.

Adolescent↗
PubMed1996

Agenesis of the ductus venosus in a case of monochorionic twins which mimics twin-twin transfusion syndrome.

We describe a pair of monochorionic twins with clinical manifestation of twin-twin transfusion syndrome, including discordant fetal growth, hydrops of the larger twin, and the 'stuck twin' phenomenon of the smaller twin. In the hydropic twin, we found agenesis of the ductus venosus and an abnormal umbilical vein draining directly into the inferior vena cava. There was also marked enlargement of the right atrium, representing the volume overload on it. We believe that the agenesis of the ductus venosus in the larger twin may have contributed to the 'unbalanced shunting' between the monochorionic twins. This then led to a clinical picture mimicking that seen in the authentic twin-twin transfusion syndrome.

Adult↗
PubMed1996

Concordant body stalk anomaly in monozygotic twinning--early embryo cleavage disorder.

We describe a case of concordant body stalk anomaly in monozygotic twins that manifested with umbilical cord agenesis, evisceration of abdominal contents, and multiple gastrointestinal, genitourinary, and skeletal anomalies. Body stalk anomaly in twin gestation is extremely rare and poses an embryological interest. We suggest that the hypothesis of 'incomplete twinning' might contribute to the pathogenesis of this syndrome complex.

Abdominal Muscles↗
PubMed1996

Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports.

Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low-resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible.

Adenofibroma↗
PubMed1995

Extrauterine twin-twin transfusion syndrome after birth in conjoined twins.

Cross-circulation of conjoined twins in utero has been demonstrated and the extent of its severity has varied. Significant 'extrauterine' twin-twin transfusion syndrome after birth, however, caused by an unbalanced shunting within the circulation has not been reported. In a case of omphalopagus conjoined twins complicated by hypovolemia in one twin and hypervolemia in the other, we demonstrated by color Doppler imaging an aberrant vessel from the hepatic artery of one twin to the hepatic vein of the other. Unbalanced shunting through this aberrant vessel was suspected and urgent separation of the conjoined twins was undertaken. Circulatory changes after birth leading to 'extrauterine twin-twin transfusion syndrome' are discussed. A possible explanation of the pathophysiology of intrauterine twin-twin transfusion syndrome is also given.

Adult↗
PubMed1995

Successful medical treatment for staphylococcal vertebral osteomyelitis complicated by spinal epidural abscess, psoas abscess and meningitis: a case report.

A 42 year-old farmer was transferred to our hospital for recently exaggerated lower back pain. Neurological examination revealed an L4 radiculopathy on the right side. Meningitis developed after admission. MRI showed L4-5 osteomyelitis and discitis with contiguous spinal epidural abscess and right psoas abscess. Blood culture and CSF culture both grew Staphylococcus aureus. Because the patient refused to receive a drainage procedure, we gave him antibiotics which resulted in a favorable outcome.

Abscess↗
PubMed1994

Intrauterine intervention in a case of recurrent meconium peritonitis.

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.

Adult↗
PubMed1994

Neonatal renal venous thrombosis--a case report describing serial sonographic changes.

Neonatal renal venous thrombosis (NRVT) is a serious complication of newborns. Ultrasound is most useful in detecting NRVT. However, there is no detailed description of the evolution of ultrasound finding in NRVT. Here we report a patient with NRVT with complete ultrasound follow-up. Perivascular streaks were first seen at 3 days of age with a diffusely enlarged and echogenic right kidney. Echolucency then gradually appeared over the medulla area with shrinking renal size. Concomitant loss of renal function was evidenced by dimercaptosuccinic acid scan. The kidney became contracted at the age of 1 year. Since the pathognomonic perivascular streaks were present for only a few days, early ultrasound scanning should be performed for every newborn suspected of having NRVT.

Humans↗
PubMed1994

Clinical experience of posterior urethral valves.

Nine patients with posterior urethral valves were seen at Chang Gung Memorial Hospital from 1985 to 1992. The age at presentation ranged from five days old to 28 years old. The presenting symptoms and signs included abdominal distension, urinary tract infection, respiratory distress, urinary ascites, and weak stream. Patients were examined by voiding cystourethrography and ultrasonography. Surgical management of these patients included primary valve ablation (three cases), cutaneous vesicostomy plus delayed valve ablation (five cases) and primary valve ablation with delayed ureteral reimplantation (one case). For small infants with posterior urethral valves (five cases), temporary vesicostomy and delayed valve ablation offers excellent results in preventing iatrogenic urethral stricture. However, for older children and young adults, the recommended treatment is primary valve ablation. For seven patients with nadir serum creatinine < 1.0 mg/dL, the renal function remained within the normal range, yet during follow-up, one case had renal insufficiency. Vesicoureteral reflux was found in five cases. Spontaneous resolution was noted in two cases after valve ablation, and three cases were controlled with prophylactic antibiotics. The experience of our series suggests that primary valve ablation may be traumatic to the neonatal urethra and temporary diversion would allow greater renal recovery during the neonatal period. With newer delicate instruments, valve ablation may be performed earlier and as a one-stage operation in the future.

Adolescent↗
PubMed1990

[Penile revascularization: report of 4 cases].

From February to June in 1989, 4 patients consulted our ward with the complaint of impotence. After each patient's history and physical examination were taken, a series of tests were administered which included hepatic and renal function, blood sugar, cholesterol, triglyceride, testosterone, prolactin level, nocturnal penile tumescence (NPT), duplex sonography, cavernosography, and internal pudendal arteriography. The results of these tests suggested vasculogenic impotence and penile revascularization was attempted. In 2 patients the Michal-II method was used. The second patient was treated with the Virag-V method. In the fourth patient, the Michal-II method was combined with the administration of the Virag-V method. After 6 months of follow-up, objective tests such as NPT and a Duplex scanning examination showed moderate improvement in the patients who received the Virag-V method, alone or in combination with the Michal-II method. Subjectively, all the patients except the one who received just the Virag-V method, felt improvement in erection angle, penetration, and satisfaction. We conclude that penile revascularization may be a more noninvasive, physiological alternative to penile prosthesis for some cases of vasculogenic impotence.

Adult↗
PubMed1990

Intrathecal morphine's effect on somatosensory impulses transmission-studied with posterior tibial nerve SSEP.

In order to investigate neurotoxic potential of spinally injected morphine solution, somatosensory evoked potential (SSEP) was utilized to detect the change of electrophysiologic activity of spinal neurons after long term application of intrathecal morphine. Eight patients received intrathecal morphine injection regularly after CHEMO-PORT implantation were studied with posterior tibial nerve SSEP. Patients received SSEP examination just before and right after first episode of morphine injection and were followed up at 30 minutes, 60 minutes, 2 hours, 8 hours, and the 7th day and the third month of regularly injection. The results showed that there were no definite change of latencies and amplitudes of impulses generated by lumbar spinal cord (N22) and cortex (P40). We therefore suggest that electrophysiologic activities of spinal cord and cortex are not affected by chronic intrathecal morphine injection. Possible mechanism and proposed pathway of morphine's action were also discussed.

Evoked Potentials, Somatosensory↗
PubMed1989

Membranous nephropathy in 52 hepatitis B surface antigen (HBsAg) carrier children in Taiwan.

To elucidate the prognosis and the causative viral antigens of hepatitis B virus (HBV)-associated childhood membranous nephropathy (MN), the clinical course and glomerular HBV antigens were studied in 52 HBsAg carrier children with MN (40 boys, 12 girls). With Fab fragments of monoclonal antibodies, hepatitis Be antigen (HBeAg) was detected in the glomerular deposits in 41 (95%) of 43 cases but HBsAg and hepatitis B core antigen (HBcAg) in none. HBeAg was detected in sera from 43 (93%) of 46 children examined. These results suggest that HBeAg plays an important role in the development of MN in HBsAg carrier children. During the follow-up period (mean, 4 years), complete remission was found in 64% and 92% of the patients followed for one and seven years, respectively; only one child had mild renal function impairment. These findings suggest a favorable outcome of HBsAg-associated childhood MN. The patient's age, disease duration, amount of glomerular deposit, focal sclerosis and disease stage appeared to affect the clinical course. HBsAg seroconversion to HBsAg-negative occurred in seven cases, and all (100%) had quick remission in two years. In patients with persistent HBsAg carriage, serum HBeAg status alone did not correlate with remission rate and remission occurred usually before the HBeAg seroconversion to anti-HBe. These findings, together with the predominant horizontal infection in these children in contrast to the frequent vertical (perinatal) transmission from HBsAg carrier mothers in HBsAg carriers in Taiwan, suggest that factors other than HBeAg per se may also play important roles.

Carrier State↗
PubMed1986

Rheumatic fever recurrences: controlled study of 3-week versus 4-week benzathine penicillin prevention programs.

To compare the merits of 3-week versus 4-week injections of benzathine penicillin G in preventing recurrence of rheumatic fever, 179 patients aged 4 to 19 years were assigned to one of the two programs. Age, weight, cardiac status, and streptococcal infections among the patients and their family members studied in each program were comparable. Eight-two patients and their family members were monitored for streptococcal infections. Compliance in the two programs was comparable. Of the 63 patients who stayed in the 4-week program, RF recurred in six, as a result of prophylaxis failure in five and associated with partial compliance in one. Of the 90 patients in the 3-week program, RF recurred in one, associated with partial compliance; no failures occurred (P = 0.01). We recommended that for RF chemoprophylaxis in individuals at great risk, regardless of age, benzathine penicillin injections should be administered every 3 rather than every 4 weeks.

Adolescent↗