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Biomedical subjects

K G Wang

Publications and source records attributed to K G Wang.

At least 37 records · Page 2Linked to original sources
PubMed1996

Central and peripheral hemodynamics in severe preeclampsia.

BACKGROUND: Doppler velocimetry, a new tool for measuring blood flow, vascular resistance, and central hemodynamics can be applied to monitor those patients at risk and provide therapeutic concepts for preeclampsia. This study was designed to use a Doppler velocimetry study to correlate the relationship between central hemodynamics, uteroplacental circulation, and the perinatal outcome in severe preeclampsia. METHODS: Thirty-one patients with severe preeclampsia, not superimposed with any medical disorder and not on antihypertensive treatment prior to admission, were enrolled in this study. On admission, laboratory determination of the maternal blood chemistry and hematogram, together with a Doppler ultrasound study of the maternal hemodynamics, and umbilical and uterine arteries, were performed. Antihypertensive agents including hydralazine, atenolol, and labetolol were given according to the state of the maternal central hemodynamics. Data were collected on the general status of the patients, the results of the Doppler ultrasound study, and the perinatal outcome. RESULTS: Patients were divided into three groups based on the systemic vascular resistance. The left ventricular function and cardiac index declined with increase in vascular resistance. The high-resistance group had a significantly high incidence of infants small for gestational age. Poor fetal growth in the high-resistance group could be attributed to the summation of underperfusion due to decreased uteroplacental blood flow and was frequently associated with maternal hemoconcentration. CONCLUSIONS: Although global vasospasm has been considered to be the basic pathophysiology of preeclampsia, the central hemodynamics varies between, and even in the same, patients. Regional vasospasm in the uteroplacental circulation occurs earlier than in the systemic circulation as a whole. A high cardiac-output in low systemic-vascular-resistance might compensate in those pregnancies with high uterine artery resistance to maintain adequate uteroplacental perfusion.

Adult↗
PubMed1996

Pelvic abscess caused by Salmonella: a case report.

We report a case of a 28-year-old woman, with no history of sexual activity, who developed a cul-de-sac abscess and bilateral salpingitis caused by Salmonella group C1. This paper documents our limited experience with such an unusual event and suggests that gastrointestinal pathogens should be considered as potential etiologic organisms in patients presenting with pelvic infection and gastroenteritis.

Abscess↗
PubMed1996

Implications of prolonged fetal heart rate deceleration during the second stage of labor.

In order to evaluate the neonatal outcomes of infants who had prolonged fetal heart rate (FHR) deceleration during the second stage of labor, the neonatal outcomes of 24 infants born after vaginal delivery at 37 to 42 weeks of gestation with prolonged FHR deceleration during the second stage of labor were compared with the outcomes of 28 infants of a similar gestational age who had normal FHR patterns. No differences in the Apgar scores, mean umbilical PaCO2, PaO2, HCO3- or base deficit values were observed between the two groups, but the mean pH values differed significantly. The occurrences of a 1-minute Apgar score < 7, umbilical arterial pH < 7.20, presence of meconium and admission to the neonatal intensive care unit were higher in the study group, but were not significantly different. None of the 24 infants with prolonged FHR deceleration experienced birth trauma, meconium aspiration, neonatal seizure or neonatal death, but three were found to have congenital heart disease. We conclude that prolonged FHR deceleration during the second stage of labor without FHR abnormalities during the first stage of labor is not always associated with an adverse neonatal outcome and does not mandate the need for surgical or immediate vaginal delivery. Their appearance on FHR tracings requires the implementation of additional methods to assess fetal well-being and also to diagnose fetal distress.

Adult↗
PubMed1996

Sonographic and clinical findings of granulosa cell tumor.

BACKGROUND: Granulosa cell tumor (GCT) accounts for roughly 1.5% of all ovarian neoplasms and 5-10% of ovarian cancers. GCT, which may have profound end-organ effects, has attracted a significant amount of attention despite its rarity. This tumor is rare, and difficult to diagnose before operation. Until now, no specific sonographic findings have been reported. METHODS: Twelve cases of pathologically proven GCTs were diagnosed from June 1985 to March 1993. Nine of those cases had preoperative sonographic pictures taken. RESULTS: Eight out of the nine cases tested exhibited a complex multicystic sonographic pattern. For a case evaluated by a transvaginal color and pulsed Doppler assessment, the blood vessels located in the central part with diffuse dispersed vascular arrangement were found to have a resistance index of 0.38 and a pulsatility index of 0.50. The most common complaints of our patients were postmenopausal bleeding and lower abdominal pain. CONCLUSIONS: We conclude that complex multicystic sonographic features observed by high-resolution ultrasonography, in conjuction with a high preoperative estradiol level and clinical symptoms, may help to establish a preoperative diagnosis of GCT.

Adult↗
PubMed1996

Effects of severe preeclampsia with different doppler velocimetries on extra- and intrauterine environments.

We evaluated the perinatal outcome of fetuses and maternal condition of 47 patients with severe preeclampsia. Antepartum fetal surveillance (within 2 days of delivery or fetal death) included the nonstress test, Doppler velocimetry of the umbilical and uterine arteries, amniotic fluid assessment, maternal blood chemistry and hemogram. Pregnancies with abnormal Doppler velocimetry in the umbilical and uterine arteries had poor perinatal outcomes as judged by the incidence of abnormal antepartum fetal surveillance, acute fetal distress mandating immediate delivery, small for gestational age infants, perinatal morbidity and mortality and prematurity. These fetuses were at a high risk of acute and chronic hypoxia. Maternal blood chemistries and hemograms revealed a high incidence of hepatocellular dysfunction, renal insufficiency, hemoconcentration and thrombocytopenia. In cases of severe preeclampsia, those with abnormal Doppler velocimetry of both umbilical and uterine arteries, had poor extra- and intrauterine environments. Therefore, aggressive rather than expectant management was more suitable. For those with normal umbilical artery resistance and either normal or abnormal uterine artery resistance, careful management with close monitoring of both maternal and fetal status was possible in patients who were far from term.

Adult↗
PubMed1995

Laparoscopic para-aortic lymph node sampling in the staging of invasive cervical carcinoma: including a comparative study of 21 laparotomy cases.

OBJECTIVES: To assess the efficacy and risks of laparoscopic para-aortic lymph node sampling compared with standard laparotomy in staging cervical carcinoma. METHODS: From August 1993 through July 1994, 38 patients with biopsy-proven invasive cervical carcinoma (24 early and 14 advanced invasive cancers) were entered into the study. This was a prospective study of laparoscopic para-aortic lymphadenectomy in invasive cervical carcinoma, with patients serving as their own controls. Video laparoscopic lymph node sampling was performed. In patients with early invasive cancer, the nodes were sent for frozen section and, if negative, laparotomy was performed to look for any residual nodes. Radical hysterectomy was performed immediately if residual nodes were negative. Patients with either nodal metastasis on frozen section or with advanced cancer underwent para-aortic lymphadenectomy only. The operative technique was also evaluated. RESULTS: Laparoscopy required an average of 77 min (S.D. 40), with an average blood loss of 116 ml (S.D. 321). The average number of nodes was 15 (S.D. 7). At subsequent laparotomy the average number of residual nodes found was 0.4 (S.D. 0.9) and none showed metastasis. One vena cava laceration and one ureteral injury required immediate repair, and two patients were too obese to undergo laparoscopy. CONCLUSIONS: Laparoscopic para-aortic lymph node sampling is a less invasive, reliable method for staging invasive cervical carcinoma and can substitute for traditional open procedures. The incidence of risks with this method appears to be low.

Aorta↗
PubMed1995

Acute pancreatitis in pregnancy.

BACKGROUND: Discuss the course of acute pancreatitis in pregnant patients and demonstrate that most attacks of pancreatitis in pregnancy are mild. METHODS: This article is a retrospective case series study. Eight patients with acute pancreatitis during pregnancy were seen in referral-based obstetric practice at our department in the last 5 years. Five of them had either gallstones or hyperlipidemia. Two patients had both gallstones and hyperlipidemia. One patient was lost to follow-up at 33 weeks gestation. The others were followed at least one month post-partum. Conservative treatment was instituted for pancreatitis and a fat-restricted diet was instituted for hyperlipidemia. RESULTS: There was no maternal mortality and only one fetal death. Acute pancreatitis occurred in both primipara and multipara patients. Preterm labor or preeclampsia may occur in pregnancy complicated by acute pancreatitis. Most patients experience relief from the pancreatitis soon after delivery. Two patients underwent cesarean section, one was due to fetal distress and the other was elective. CONCLUSIONS: Early diagnosis and treatment is of utmost importance. Gallstones and/or hyperlipidemia seems to have a specific link with acute pancreatitis in pregnancy. Although acute pancreatitis is a rare complication of pregnancy, we present evidence that both maternal and fetal mortality can be minimized if appropriately treated.

Acute Disease↗
PubMed1995

Prenatal diagnosis of omphalocele associated with umbilical cord cyst.

BACKGROUND: To study the cytogenetics, ultrasound findings, biochemical screening, perinatal outcome, and associated abnormalities in cases of omphaloceles associated with umbilical cord cysts. METHODS: From 1988 to 1994, three cases of omphaloceles with umbilical cord cysts were identified at Mackay Memorial Hospital. We compared the clinical data of our three cases with six other cases in the published literature. RESULTS: Two cases of omphaloceles with umbilical cord cysts were affected with trisomy 18. One had bilateral choroid plexus cyst, intrauterine growth retardation, low levels of maternal serum alpha-fetoprotein and free beta-human chorionic gonadotropin, and the other had cleft lip and palate, single umbilical artery and intrauterine growth retardation. An elevated level of maternal serum alpha-fetoprotein was found in the case with normal karyotype. Elevated levels of amniotic fluid alpha-fetoprotein were found in two cases. Rupture of the umbilical cord cyst and disruption of the umbilical cord occurred in one case at delivery. Based on the gross and microscopic examinations, the cord cysts we observed are likely to be pseudocysts. CONCLUSION: The umbilical cord cysts most commonly associated with omphaloceles are pseudocysts and allantoic cysts. Among our three cases and the six other cases published in the literature, four out of these nine cases were trisomy 18. Prenatal diagnosis of omphaloceles or umbilical cord cysts by ultrasound warrants cytogenetic analysis and detailed sonogram to rule out the possible combination of both abnormalities and trisomy 18. If an omphalocele is associated with a large umbilical cord cyst and a normal karyotype, cesarean section is recommended to prevent the dilemma of intrauterine vascular compromise of umbilical blood flow during labor.

Abnormalities, Multiple↗
PubMed1995

Relationship between acute fetal distress and maternal-placental-fetal circulations in severe preeclampsia.

BACKGROUND: Hypoxic complications are thought to be the result of vascular lesions in the maternal-placental or fetal-placental circulation, with a resultant decrease in blood flow. This study was designed 1) to explore what kind of pathophysiological changes occur in the maternal-placental-fetal circulations associated with acute fetal distress, and 2) to determine whether umbilical velocimetry can be used as a predictor of acute hypoxia in severe preeclampsia. METHODS: Eighty-nine cases of severe preeclampsia, who had Doppler ultrasonography, maternal blood chemistry and hematogram examinations all performed within two days of delivery or fetal death, were studied. RESULTS: According to the absence or presence of acute fetal distress as determined by the fetal heart rate pattern, patients were divided into two groups: distress group and non-distress group. There was no significant difference between the two groups in maternal general status. However, patients in the distress group had a significantly shorter gestation age on admission and at delivery (p < 0.00001). In the distress group, the perinatal outcome was poor. Newborns in the distress group had, significantly, a lower birthweight, and a higher incidence of SGA, 1-min Apgar scores of less than 7, and fetal acidosis (pH < 7.2) (p < 0.001). Doppler ultrasonography also showed a significantly higher incidence of abnormal umbilical artery Doppler waveforms in the distress group (p < 0.05). However, there was no difference between the two groups in the uterine artery Doppler velocimetry. Maternal blood chemistry and hematogram examinations revealed significantly higher blood levels of hemoglobin, hematocrit, blood urea nitrogen, and creatinine but lower levels of total protein and albumin in the distress group. An abnormal umbilical artery SD ratio (> 95th centile) as a predictor of acute fetal compromise, judged by the incidence of abnormal fetal heart tracing mandating emergency delivery, 1-minute Apgar scores of less than 7, 5-minute Apgar scores of less than 7, and a pH value for the umbilical arterial blood of less than 7.2, had a sensitivity of 40.5-75%, specificity of 71.8-80%, positive predictive value of 12.5-75%, and negative predictive value of 64.5-98.4%. CONCLUSION: In severe preeclampsia, early onset of disease superimposed with maternal hemoconcentration might initiate an acute insult and predispose the fetus to acute hypoxia.

Adult↗
PubMed1995

Preeclampsia in multiple pregnancy.

BACKGROUND: Preeclampsia is one of the most common pregnancy-induced complications, and results in a large number of maternal deaths. How pregnancy incites or aggravates hypertension remains unresolved; despite decades of intensive research directed to hypertensive disorders, they remain among the most important unresolved problems in obstetrics. The incidence of preeclampsia is increased in multiple pregnancies, and several preeclampsia-related fetal risks may be particularly hazardous to the babies of multiple gestations. METHODS: The records of 561 women with multiple pregnancies delivered consecutively at Mackay Memorial Hospital were reviewed retrospectively. Thirteen mild cases and 39 severe cases of preeclampsia in multiple pregnancies were compared with 52 control cases of multiple pregnancies without preeclampsia, but matched for maternal age and parity. The categories for comparison included parity, gestational age, time of onset of preeclampsia, route of delivery, mean birth weight, growth discordancy, maternal complications, neonatal morbidity and mortality. RESULTS: The incidence of preeclampsia in our consecutive series of 561 multiple pregnancies was 9.3% compared with 1.8% in singleton pregnancies (p < 0.0001). In primiparas with multiple pregnancies, the incidence of preeclampsia was 12.2% compared with 6.2% (p < 0.05) in multiparas. Breech presentation was the most common indication for Cesarean section in all groups. The preeclamptic group had a significantly higher rate of Cesarean section compared with the control group (p < 0.006), with prolonged labor and fetal distress were the two main reasons for this difference. Severe preeclamptic patients had babies with significantly lower mean birth weights (p < 0.05), higher incidence of intrauterine growth retardation (p < 0.025) and neonatal respiratory distress syndrome (p < 0.0008) compared with those of the control group. All seven cases with maternal complications were in the severe preeclamptic group. CONCLUSIONS: An unfavorable perinatal outcome was found to be associated with severe, but not with mild, preeclampsia in multiple pregnancies.

Female↗
PubMed1995

What kind of maternal factor might predict poor perinatal outcome in severe preeclampsia?: a study based on doppler velocimetry.

BACKGROUND: Umbilical artery Doppler velocimetry has been used as an important perinatal tool to identify fetal compromise. However, the fact that it is both expensive and time-consuming makes it not always available. This study was a search for any maternal serum laboratory test which might be much simpler and easier than Doppler velocimetry, and still determining the perinatal outcome in severe preeclampsia. METHODS: Forty-seven patients with severe preeclampsia were enrolled in this study. Doppler velocimetry of umbilical artery, maternal serum biochemistry and hematological tests were all performed within two days prior to delivery or fetal death. RESULTS: By choosing a maternal hematocrit (Hct) of greater than 44% as the cutoff value, a significantly higher incidence of adverse perinatal events was noted in patients with abnormal value than those with normal value. Abnormal Hct level as a predictor of adverse perinatal outcome had a sensitivity of 50.0%, a specificity of 84.2%, a positive predictive value of 53.3% and a negative predictive value of 63.8%. CONCLUSIONS: This study found that elevated maternal Hct (> 44%) levels might indicate a condition of hemoconcentration with reduced placental perfusion in severely preeclamptic patients. Hct level can serve as a clinically useful predictor of adverse perinatal outcome.

Adult↗
PubMed1994

Perinatal characteristics of low birthweight infants in postdate pregnancies.

BACKGROUND: Early literature discussed postdate pregnancy in relation to difficult delivery of mothers with an excessively large fetus; more recent reports imply that the risk of perinatal death exists especially for the small, growth-retarded fetus. However there is little in the literature concerning low birthweight infants in postdate pregnancies. METHODS: A 6-year retrospective review of 135 low birthweight infants with 40 or more weeks' gestation was conducted. Among the subjects, 19 cases had a gestational age greater than 42 weeks (Group 1), 26 cases, between 41 and 42 weeks (Group 2), and 90 cases, between 40 and 41 weeks (Group 3). Assess was made of the outcomes of low birthweight infants in postdate pregnancies, comparing Group 1 with Group 2 and Group 3. RESULTS: Group 1 infants had significantly higher rates of chromosomal (21.1%) and congenital (31.6%) abnormalities and perinatal mortality (21.1%) than either Group 2 or Group 3 infants. Also, in Group 1 there were two cases of polyhydramnios and they both had abnormal karyotypes. CONCLUSIONS: The outcome of low birthweight infants in postdate pregnancies appears to be worse than predicted. This finding could offer for managing the cases which have a high frequency of abnormal karyotype (21.1%), especially when combined with polyhydramnios.

Adult↗
PubMed1994

Transvaginal color flow imaging in the follow-up of invasive gestational trophoblastic disease: a case report.

A case of invasive gestational trophoblastic disease after partial hydatidiform mole was presented in this study in which the diagnosis was made along with the treatment being monitored by means of transvaginal color Doppler ultrasound. In this case, the appearance or disappearance of vascular changes induced by invasive mole corresponded with serum beta human chorionic gonadotropin (beta-hCG) titer. Vascular changes displayed on color Doppler scanning may thus complement the application of hCG in postmolar pregnancy surveillance.

Adult↗
PubMed1993

Doppler velocimetry study of maternal hemodynamics and fetal vascular pattern in a case of chronic hypertension with superimposed severe preeclampsia and impending fetal death.

A case is presented of chronic hypertension with superimposed severe preeclampsia; absence of end-diastolic velocity in the umbilical artery had been noted at gestational age of 20 weeks. Because the fetus was previable, the mother was treated with pharmacotherapy according to the maternal hemodynamics; uteroplacental circulation and fetal vascular blood flow were monitored by Doppler velocimetry. Deterioration of the fetal condition occurred during crossover of maternal hemodynamics from a low-resistance to a high-resistance state. Serial Doppler velocimetry studies done within 40 minutes of fetal death are described. There were two types of absent end-diastolic velocity in the umbilical artery, and the pathophysiology and clinical management may be quite a different in these two situations.

Adult↗
PubMed1992

Prenatal diagnosis of meconium peritonitis--a case report with literature review.

A case of meconium peritonitis that was diagnosed ultrasonographically in the second trimester is presented. Fetal ascites, intraabdominal calcification and polyhydramnios were detected on antenatal ultrasonography. Specks of calcification were also demonstrated on abdominal radiography postnatally. The obstetric and neonatal implications of meconium peritonitis are discussed with literature review.

Adult↗
PubMed1992

Decreased amniotic fluid index in term pregnancy. Clinical significance.

In a study of 331 term pregnancies a four-quadrant technique was used to obtain amniotic fluid index measurements, and the results were compared with the current widely used single-pocket measurement. In contrast to the "2-cm rule," the amniotic fluid index measurements consistently demonstrated higher sensitivity in predicting poor fetal outcome with no decrease in specificity. It was noted that pregnancies with an index of < or = 8 cm showed higher incidences of meconium staining, cesarean delivery for fetal distress, abnormal fetal heart rate monitoring and Apgar scores of < or = 7 or less at one minute.

Amniotic Fluid↗