Biomedical subjects

H S Yeh

Publications and source records attributed to H S Yeh.

At least 19 recordsLinked to original sources

PubMed2001

Six months follow-up of patients with methamphetamine psychosis.

BACKGROUND: It has been nearly 50 years since the psychotic state caused by amphetamine was first reported. However, the prognosis of methamphetamine (MAP) psychosis and its relationship with chronic schizophrenia are still vague. Some authors preferred MAP psychosis model of schizophrenia, while other studies found difference between the two groups of patients in the aspects of negative symptoms. METHODS: In this study we followed 21 psychiatric inpatients with diagnosis of MAP psychosis. Schedule for affective disorders and schizophrenia (SADS), scale for assessment of negative symptoms (SANS) and global assessment scale (GAS) were used for evaluation of these patients during admission and six months after discharge. RESULTS: Seventeen patients were interviewed and eight of them confessed reuse of MAP. The follow-up examinations found decreased total scores of delusion and hallucination in SADS and increased GAS scores. The SANS scores of the MAP psychotic patients in this study were lower than moderate level. No significant change could be found for most SANS subcategory scores except some items. CONCLUSIONS: Most MAP psychotic patients followed in this study improved much in six months. The results of the SANS evaluation and the clinical course for six months indicated that the MAP psychosis is a psychotic disorder different from chronic schizophrenia.

Adult↗

PubMed2000

Detection of epileptogenic focal cortical dysplasia by depth, not subdural electrodes.

Centers that perform presurgical epilepsy evaluations disagree on whether depth or subdural electrodes represent the optimal technique for invasive recording, especially in seizures originating outside the temporal lobe. A 13-year-old girl with a normal magnetic resonance imaging scan had unlocalized partial onset seizures, despite scalp and subdural grid ictal video/EEG recordings. Repeat video/EEG with depth electrodes showed a discrete site of continuous interictal spiking and seizure onset that was located 2-2.5 cm beneath the surface of the sensory cortex. The resected region showed focal cortical dysplasia and the patient had greater than 95% seizure frequency reduction at 3-year follow-up. We conclude that although subdural electrodes have many advantages when recording seizures outside the temporal lobes, depth electrodes may provide superior recordings when the epileptogenic region is beneath the cortical surface.

Cerebral Cortex↗

PubMed1999

Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study.

BACKGROUND AND PURPOSE: The safety and the effectiveness of the surgical treatment of spontaneous intracerebral hemorrhage (ICH) remain controversial. To investigate the feasibility of urgent surgical evacuation of ICH, we conducted a small, randomized feasibility study of early surgical treatment versus current nonoperative management in patients with spontaneous supratentorial ICH. METHODS: Patients with spontaneous supratentorial ICH who presented to 1 university and 2 community hospitals were randomized to surgical treatment or best medical treatment. Principal eligibility criteria were ICH volume >10 cm(3) on baseline CT scan with a focal neurological deficit, Glasgow Coma Scale score >4 at the time of enrollment, randomization and therapy within 24 hours of symptom onset, surgery within 3 hours of randomization, and no evidence for ruptured aneurysm or arteriovenous malformation. The primary end point was the 3-month Glasgow Outcome Scale (GOS). A good outcome was defined as a 3-month GOS score >3. RESULTS: Twenty patients were randomized over 24 months, 9 to surgical intervention and 11 to medical treatment. The median time from onset of symptoms to presentation at the treating hospitals was 3 hours and 17 minutes, the time from randomization to surgery was 1 hour and 20 minutes, and the time from onset of symptoms to surgery was 8 hours and 35 minutes. The likelihood of a good outcome (primary outcome measure: GOS score >3) for the surgical treatment group (56%) did not differ significantly from the medical treatment group (36%). There was no significant difference in mortality at 3 months. Analysis of the secondary 3-month outcome measures showed a nonsignificant trend toward a better outcome in the surgical treatment group versus the medical treatment group for the median GOS, Barthel Index, and Rankin Scale and a significant difference in the National Institutes of Health Stroke Scale score (4 versus 14; P=0.04). CONCLUSIONS: Very early surgical treatment for acute ICH is difficult to achieve but feasible at academic medical centers and community hospitals. The trend toward less 3-month morbidity with surgical intervention in patients with spontaneous supratentorial ICH warrants further investigation of very early clot removal in larger randomized clinical trials.

Cerebellar Diseases↗

PubMed1999

Cerebral metabolism of the remote area after epilepsy surgery.

To clarify whether epilepsy surgery improves cerebral metabolism, pre- and postoperative positron emission tomography (PET) scans were performed, with special reference to hypometabolism outside the resected epileptogenic zones in nine patients (8 males, 1 female) with medically intractable complex partial seizures and multiple hypometabolic zones. Seven patients underwent unilateral anterior temporal lobectomy, one patient underwent selective amygdalohippocampectomy, and one patient underwent parieto-occipital cortical resection and anterior temporal lobectomy. PET scans were obtained at least 6 months after surgery. Eight patients became seizure-free, and one patient had fewer than three seizures per year. Four patients showed improved glucose metabolism in the formerly hypometabolic zones, which were remote to the surgical site and ipsilateral to the epileptogenic foci. Five patients, who showed bilateral temporal hypometabolism preoperatively, had contralateral temporal hypometabolism after surgery. The relative glucose uptake in four of these patients showed increased metabolism of the adjacent lobes ipsilateral to the surgical site. The lobes that showed increased glucose metabolism after surgery were mostly frontal. Hypometabolism is reversible in the ipsilateral remote area, and may be caused by inhibition via the intercortical pathway. Contralateral temporal hypometabolic zones that persist after surgery may be caused by a different mechanism, and neither indicate the presence of seizure foci nor affect the seizure outcome.

Adolescent↗

PubMed1998

Substance use disorders among inpatients with bipolar disorder and major depressive disorder in a general hospital.

The prevalence and type of substance abuse and dependence were determined for 49 patients with mood disorders on a general hospital psychiatric unit. A standardized diagnostic interview was conducted with a high value of inter-rater reliability. This study found that 18.4% of mood disorder inpatients met the diagnostic criteria for psychoactive substance use disorders by DSM-III-R. Sedatives-hypnotics-anxiolytics was the most common substance use disorder (10.2%), followed by alcohol (6.1%). Patients with major depression had a higher rate of comorbidity with substance use disorders than did the bipolar disorder patients (p = 0.011). The prevalence of sedatives-hypnotics-anxiolytics use disorder among major depression patients was 35.7%, which was higher than that among bipolar disorder patients (0%). Male patients had a significantly higher percentage of substance use disorders than did female patients (p = 0.054). Seventy-seven percent of the patients with a dual diagnosis of mood and substance use disorder were not diagnosed as having substance use disorders by psychiatrists in charge.

Adolescent↗

PubMed1998

Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese.

An assessment of potential risk factors for substance use disorders was performed in 49 patients with major affective disorders in a general hospital acute care unit in Taiwan. The major depression patients were noted to have a higher prevalence of substance use disorder than bipolar disorder patients (p = 0.011). Those patients with substance use disorders were noted to be significantly male-predominated (p = 0.043), to have a later onset age of affective disorder (p = 0.009), and to have more visits to the emergency room in the recent one year (p = 0.009). The sedatives-hypnotics-anxiolytics was the most frequently used forms of drug abuse. The major depression patients had a significantly higher sedative-hypnotics-anxiolytics use disorder rate than the bipolar disorder patients (p = 0.001). All patients with alcohol use disorder were noted to have other substance use disorders as well. Fifty six percent of those patients with substance use disorder were polysubstance users. Eighty three percent of the male patients with substance use disorder had poly-substance use disorder.

Adolescent↗

PubMed1997

Vasopressin-induced amber-like skin necrosis.

Case reports about vasopressin-induced cutaneous necrosis are not frequent. Here we report a further case, of which skin manifestations included not only mottling, cyanosis, ecchymosis, bullae and gangrene, but also amber-like change in focal areas. Besides, intermittent paling of the skin with or without deep pain sensation of the limbs over non-injection sites was observed that might be a warning sign of impending skin necrosis. Based on the literature about vasopressin-induced skin necrosis we discuss the possible role of coagulation enhancement of this molecule.

Esophageal and Gastric Varices↗

PubMed1997

Cervical myelopathy associated with intracranial dural arteriovenous fistula: MR findings before and after treatment.

The MR findings in three patients with intracranial dural arteriovenous fistula associated with cervical myelopathy are described. The MR appearance of an enlarged cord with associated abnormal signal and enhancement is nonspecific and can simulate tumor, demyelination, and inflammation. Enlarged perimedullary vessels may not always be identifiable, but if present, should suggest the presence of an arteriovenous fistula.

Aged↗

PubMed1996

Postictal language dysfunction in patients with right or bilateral hemispheric language localization.

PURPOSE: As shown previously, when temporal lobe complex partial seizures (TLCPS) originate from the language dominant hemisphere, patients cannot read a test phrase correctly within 60 s of the end of the ictal discharge. We wished to assess whether postictal language testing results discordant with this pattern identified patients with non-left (right hemisphere or mixed) language dominance. METHODS: Since 1988, all patients undergoing video/EEG monitoring at our institution have been given a test phrase to read aloud as soon as a seizure is detected. Inclusion criteria for this study were (a) postictal language testing within 60 s of seizure end for at least one TLCPS, (b) > 90% seizure reduction after anterior temporal lobectomy with 2-year minimum follow-up, and (c) language localization by either intracarotid amobarbital test (IAT) or direct electrical stimulation of left hemisphere cortex. RESULTS: Two hundred twenty-four seizures in 64 patients were analyzed. Discordant postictal language patterns were noted in 10 of 11 patients with IAT documented non-left language dominance and in 15 of 53 with left dominance (p = 0.006; sensitivity 90.9%, specificity 71.7%). CONCLUSIONS: Postictal language testing accurately identifies patients with non-left language dominance and may be useful in selecting appropriate patients for IAT.

Adult↗

PubMed1995

Repetition and the arcuate fasciculus.

According to the traditional model of language organization, repetition deficits arise following damage to the arcuate fasciculus of the dominant hemisphere (conduction aphasia). Conduction aphasia may result from lesions that spare the arcuate fasciculus. However, these patients have atypical language organization. We describe a man with normal language architecture who underwent a resection of the anterior portion of his arcuate fasciculus and retained his ability to repeat words and sentences. We propose that the arcuate fasciculus is not necessary for speech repetition by the lexical route.

Adult↗

PubMed1995

Seizure control and extent of mesial temporal resection.

Controversy exists about the extent of mesial temporal lobe resection that improves seizure control in patients with temporal lobe epilepsy. In this retrospective study, 70 patients with mesial temporal seizure activity (without evidence of tumor or vascular malformation) were surgically treated and followed for at least 2 years. The extent of mesial temporal resection was based on the findings of interictal and ictal discharges using depth electrodes, which were inserted preoperatively or intraoperatively by the orthogonal approach to the amygdaloid and hippocampal regions. Only the amygdala was resected along with the limited lateral neocortex if no epileptiform activity involved the hippocampus. The amount of hippocampal excision was determined by the extent of interictal seizure activity. The following groups became seizure free: all 8 patients with only amygdalar resection; 6 of 10 patients with amygdalar and < or = 1 cm hippocampal resection; 23 of 38 with 1-2 cm hippocampal removal, and 11 of 14 with > 2 cm hippocampal excision. In cases where there was no hippocampal resection, neuropsychological outcome compared favorably with controls. Our results suggest that although most patients with temporal lobe epilepsy require hippocampal resection of varying degrees, there is a subset in whom the amygdala may be the crucial element of a mesial temporal epileptogenic network. These patients can undergo a surgical resection sparing the hippocampus without compromising seizure outcome.

Adult↗

PubMed1995

Surgical management of epilepsy associated with developmental anomalies of the brain.

BACKGROUND: Disorders as the central nervous system forms during the pre-, peri-, or postnatal periods may cause developmental anomalies of the brain. Such maldevelopment, ranging from slight to severe disturbances, appears to be the mechanism for causing childhood seizure disorders. However, the surgical treatment of these lesions responsible for intractable partial seizures remains undefined. METHOD: Twenty-two patients (8 males, 14 females) with chronic seizure disorders associated with structural lesions of the brain related to developmental anomalies were surgically treated (1983 to 1990). Imaging studies, intraoperative findings, and histology showed 12 lesions in the temporal lobe, 1 in the frontal lobe, and 9 of multilobular involvement. All patients had preoperative prolonged electroencephalography with sphenoidal electrodes. Sixteen patients had intraoperative electrocorticography. All underwent craniotomy and total excision of the epileptogenic zone unless the speech or motor cortex was involved. RESULTS: Results of postoperative seizure control during the follow-up period (mean 5.5 years) were excellent (seizure-free) in 12 patients (including four with complete and eight with incomplete excision of the structural lesion), good in seven, fair in two, and poor in one. CONCLUSION: Seizure control is possible for patients with total excision of the epileptogenic zone, even including those with incomplete excision of a structural lesion caused by developmental brain anomalies.

Adolescent↗

PubMed1995

Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures.

Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985-1992), the authors divided them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizures with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Group B patients with 13 (92.8%) seizure free at follow up (mean 52 months). Only three (18.8%) of the Group A patients became seizure free after lesionectomy at follow up (mean 33 months). In eight Group A patients, who underwent temporal lobectomy as a second procedure after lesionectomy failed to control seizures, five (62.5%) became seizure free. Group B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis of covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Based on this study, the authors found that the probable relief from seizures caused by a temporal lobe lesion is greater if the region of epileptogenicity, usually the amygdalohippocampal complex, is resected along with the tumor in a temporal lobectomy.

Adolescent↗

PubMed1995

Analysis of drug abuse among adolescent psychiatric inpatients at Veterans General Hospital-Taipei.

BACKGROUND: The problems of drug abuse has been growing rapidly in Taiwan area recently. Adolescents hospitalized due to drugs related problems were a special population and research of this population may contribute to the whole view of the drug abuse problems in our society. METHODS: Psychiatric inpatient records of Veterans General Hospital-Taipei from January, 1991 to June, 1993 were reviewed. Among totally 296 admissions of 260 adolescents, 38 admissions of 27 adolescents were related to drug abuse. The discharge diagnosis, urine drug screen test during admission, hospitalization course, follow-up condition of the 38 admissions as well as the demographic data, pattern of drug abuse, family and personal problems of the 27 adolescents were collected and analyzed. RESULTS: Among the 27 patients, 21 (78%) abused amphetamine only or mainly, and 14 (52%) of them also drank alcohol daily. As a whole, they began to drink at age 15.6 +/- 1.5 years, to abuse amphetamine at 16.8 +/- 1.2 years. Those who sniff glue started at the age of 15.4 +/- 1.8 years and those who abuse heroin started at the age of 18 years. 14 patients (51%) had previous abstinence history, and the most common reason of failure were craving, peer pressure and boredom. Personal and family factors were the major difficulties encountered in the process of abstinence, according to the evaluation of their incharge doctors. 16 (59%) of them had definite family problems, including loss of parent(s), marital discord or inconsistent attitude of parents, and psychotic history of mother. Interestingly, 15 (56%) of the patients were the youngest, 5 (18%) were the only sons and only 3 (11%) were the eldest in their family. Among the 38 admissions, 34 (89%) were diagnosed as "organic delusional disorder", or "organic hallucinosis" by DSM-III-R criteria. CONCLUSIONS: Amphetamine has become one of the most popular drugs of abuse in Taiwan area in recent years. Many drugs of abuse in Taiwan area 10 years ago were not found in this study. Because of the psychidelic effect of amphetamine, many amphetamine abusers were hospitalized and the drug abusers among adolescent psychiatric inpatients have increased almost 5 times in the past 10 years. Family problems played a significant role. Family approach would thus be very important in prevention, treatment and rehabilitation of the adolescent drug abusers.

Adolescent↗

PubMed1994

Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability.

37 outpatients with at least one prospectively observed manic or hypomanic episode comprised a sample for comparison of five definitions of dysphoric (hypo)mania. Dysphoric symptoms were continuously rather than bimodally distributed. Prevalence of dysphoria varied from 5 to 73% depending on the definition used. Female gender was associated with dysphoria under two of the five definitions. Inter-episode stability in patients with at least two prospectively observed episodes (n = 15) was not significantly different from chance. These data do not indicate that (hypo)mania can be dichotomized on the basis of dysphoria. Advantages and disadvantages of dimensional and categorical approaches to specifying mood in mania or hypomania are discussed.

Adult↗

PubMed1994

Dural cavernous angiomas outside the middle cranial fossa: a report of two cases.

Cavernous angiomas of the dura mater are clinically and radiographically distinct from parenchymal cavernous angiomas. In this report, we present two cases of dural cavernous angiomas located outside the middle cranial fossa. The first patient is a 36-year-old woman with two dural cavernous angiomas, including one that enlarged during a 2-year period of observation. The second patient is a 33-year-old man with medically intractable seizures from a dural cavernous angioma of the convexity, which was discovered at autopsy. From our experience and a review of the literature, we have identified two groups of dural cavernous angiomas that differ in incidence, natural history, and surgical management. Most dural cavernous angiomas arise from the middle fossa; in contrast, only 15 cases of dural cavernous angiomas outside the middle fossa have been reported. Those in the middle fossa are more clinically aggressive and more difficult to resect surgically, because they grow toward the cavernous sinus and the parasellar region. Most patients with dural cavernous angiomas outside the middle fossa present with headaches, whereas those patients with dural cavernous angiomas in the middle fossa present with ocular signs, visual field defects, endocrinopathy, and trigeminal symptoms. Radiographically, both of the angiomas resemble meningiomas. Because of their intimate association with the cavernous sinus, surgical resection of middle fossa cavernous angiomas often is incomplete and may require postoperative radiosurgery to control growth. In contrast, angiomas in other locations are easily and successfully resected with little blood loss. The location of dural cavernous angiomas is an important factor in making the surgical decision and in predicting the outcome.

Adult↗

PubMed1994

Surgical resection of third ventricle colloid cysts. Preliminary results comparing transcallosal microsurgery with endoscopy.

It is still not determined which is the best surgical option for third ventricle colloid cysts. Since 1990, the authors have used a steerable fiberscope to remove colloid cysts in seven patients and have performed microsurgery via a transcallosal approach in eight patients. The two techniques were compared for operating time, length of hospital stay, incidence of complications, recurrence, and hydrocephalus, and days spent recuperating before return to work to determine if endoscopic removal of colloid cysts is a safe and effective alternative to microsurgery. Statistical analysis was adjusted for age, sex, and presenting symptoms. Microsurgical cases averaged 206 minutes of operating time whereas endoscopic cases averaged 127 minutes (p = 0.01). For combined days spent in the intensive care unit and on the ward, the patients averaged 9.5 days after microsurgery and 4 days after endoscopy (p = 0.05). Postoperative complications occurred in five of eight patients after microsurgery and in one of seven patients after endoscopy (p = 0.09); complications were transient and primarily related to short-term memory loss. In all patients, preoperative symptoms resolved and the cysts have not recurred. Postoperatively, one patient required a ventriculoperitoneal shunt after microsurgery but all patients were shunt-independent after endoscopy. Patients returned to work an average of 59 days after discharge following microsurgery compared with an average of 26 days after endoscopy (p = 0.05). Compared with transcallosal microsurgery for the removal of colloid cysts, these preliminary results show that a steerable endoscope reduced operating time and that patients spent fewer days in the hospital and returned to work sooner after endoscopy.

Adolescent↗

PubMed1994

Treatment of clozapine-induced agranulocytosis with recombinant granulocyte colony-stimulating factor.

BACKGROUND: Is clozapine-induced agranulocytosis amenable to treatment with recombinant granulocyte colony-stimulating factor (rG-CSF)? Will this treatment provide benefits in terms of morbidity, mortality, and costs compared with current treatment? METHOD: Five patients with clozapine-induced agranulocytosis (granulocytes < 500/cu mm) were treated with the rG-CSF filgrastim, in addition to standard agranulocytosis therapy protocol. RESULTS: Time from onset until resolution of agranulocytosis was 8.2 +/- 2.1 days compared with a historical study of seven cases where filgrastim was not used and 15.7 +/- 3.7 days were required for resolution. CONCLUSION: rG-CSF (filgrastim) may be an effective and cost-reducing way to provide improved treatment for clozapine-induced agranulocytosis. More research is required.

Adult↗