Biomedical subjects

S L Hwang

Publications and source records attributed to S L Hwang.

At least 55 records · Page 3Linked to original sources

PubMed1997

Delays in thrombolytic therapy in acute myocardial infarction: an audit from the east coast of peninsular Malaysia.

The objectives of this study were to evaluate the time delays between the onset of symptoms and admission to hospital and provision of thrombolytic therapy in patients with suspected acute myocardial infarction; and to examine the accuracy of the clinical diagnosis and the therapeutic decision on thrombolysis in these patients. An observational study of 96 patients with suspected myocardial infarction was undertaken over a period of 15 months in the Coronary Care Unit of Hospital Kuala Terengganu. Seventy per cent of the patients arrived in the hospital within 6 hours of the onset of symptoms. After arrival in the emergency room, it took a median time of 85 minutes before the administration of thrombolytic therapy. Of the 67 patients who were given thrombolysis, 46 were treated within 6 hours of the onset of symptoms. About a quarter of patients said that they had delayed seeking treatment at the hospital. Treatment delays occurring in the hospital were mainly due to admission procedures as well as late diagnosis. Eighty-one patients had confirmed myocardial infarction of whom 59 received thrombolytic therapy. Eight patients receiving thrombolytic therapy had no confirmation of myocardial infarctions. Improvements in diagnostic accuracy and reduction of delays in the provision of thrombolytic therapy could be achieved by better training of health care staff as well as by further streamlining of admission procedures.

Clinical Protocols↗

PubMed1997

Allergical fungal sinusitis with intracranial abscess--a case report and literature review.

Fungus infection of the sinunasal tract usually follows a slow, nonaggressive course. With massive bone destruction or along the foramen of skullbase, the disease may extend outside the confines of the sinunasal tract even into intracranum, causing cerebral epidural, subdural and intracerebral abscess. Recently, allergic fungal sinusitis (AFS) has been a described disease entity, usually occurring in immunocomponent individuals. Early reports cited Aspergillus as the causative organism. It is now recognized that the dematiaceous fungi, including Bipolaris, Culvularia, Exserohilum, and Alternaria are associated with AFS. The disease typically follows a slow, mild course and dose not invade tissue, although pressure in the sinus can eventually cause expansion and erosion of the sinus walls. We report a case who was presented with right facial swelling and numbness, right vision loss, right hearing loss as well as deficit in cranial nerve III, IV, V, VI. A gangrene was found in right upper concha. A biopsy was done and fungal hyphae was noted. The brain MRI revealed right temperal tip abscess; he was then transfered to our ward for further surgeical treatment. The pathological findings revealed Aspergillus. A new diagnostic entity, "skull base allergical fungal sinusitis" (SBAFS) as issued, could corporate the histological diagnostic criteria and the computed tomography of bone erosion in this case. Biopsy in the sinus and the brain is necessary to rule out fungus or tumor invasion. The awareness and corporation between otolaryngologists, ophthalmologists, and neurosurgeone with the disease can avoid delayed diagnosis and promote early treatment.

Adult↗

PubMed1997

[Cognition, needs, satisfaction, and emotional responses for home care in bone marrow transplantation patients].

Bone marrow transplantation (BMT) is an aggressive treatment which can induce considerable physical and psychological stresses. Patients face various problems in self care and psychological adjustment after discharge from the hospital. The purpose of this study was to explore the cognition, needs, satisfaction, and emotional responses toward home care in BMT patients and the factors influencing them. Forth BMT patients were enrolled from the outpatient clinic of BMT in a medical center. A descriptive research design was adopted. Cognition, needs, satisfaction, anxiety and depression for home care in these patients were collected by questionaires. The results showed that BMT patients had inadequate knowledge about how to care for themselves at home. High need and low satisfaction on disease adjustment and home care were found in these patients. All patients experienced anxiety and depression. Occupation, education, and socioeconomic status were found to affect patient's cognition. Religious belief influenced needs and satisfaction for home care in these patients. Sex and social-economic status emotional reaction of patients. This study will help health personnel understand the cognition, needs and satisfaction for home care in BMT patients. It can be used as a reference for organizing discharge plan and extending the continuity of care for BMT patients.

Adolescent↗

PubMed1996

Immunohistochemical pattern of P53 protein in human astrocytic tumors.

P53 immunohistochemistry in astrocytic tumors has usually been evaluated by the percentage of positive cells. However, in this study we analyzed the P53 immunopositive cells by their patterns of distribution. Formalin-fixed and paraffin-embedded sections from 38 patients with astrocytic tumors were examined. The distribution pattern of P53 immunostaining cells was divided into 3 types: negative, locally scattered, and diffuse clustering. There were 2 positive stains in 5 astrocytomas (40%), 12 positive in 24 anaplastic astrocytomas (50%), and 7 positive in 9 glioblastoma multiformes (78%). In astrocytomas, the positive cells were locally scattered. In anaplastic astrocytoma and GBM, the positive cells appeared locally scattered or as diffuse clustering. For the variant immunoreactive expression, the mean ages for patients with negative, locally scattered and diffusely clustered P53 immunostaining were as follows: 51.4, 52.6, and 28.4 years (P < 0.01), respectively. In anaplastic astrocytoma and GBM, the diffusely clustered pattern was more common in younger patients, whereas elderly patients in same groups tended to have few or no P53 immunopositive cells. Thus, our results implicate that clonal expansion of P53 immunopositive cells is associated with brain tumor progression.

Adolescent↗

PubMed1996

Brain metastasis from pericardial angiosarcoma.

A case of metastatic intracranial angiosarcoma in a 17-year-old female is presented. The patient underwent a sternotomy for treatment of a primary angiosarcoma arising from the pericardium. The postoperative course was uneventful but the patient died as a result of multiple metastases. The metastatic intracranial tumor had features characteristic of angiosarcoma as revealed by light microscopy with positive immunohistochemical staining of factor VIII-related antigen. Only a few cases of intracranial metastasis from cardiac angiosarcoma have been reported in the literature.

Adolescent↗

PubMed1996

Pituitary abscess: CT and MRI findings.

We report a patient with a pituitary abscess which was incidentally found after he had sustained a head injury. This 61-year-old man had no clinical or laboratory evidence suggestive of a pituitary lesion. A precontrast-enhanced brain computed tomograph (CT) showed a slightly hyperdense tumor. Magnetic resonance imaging (MRI) showed hyperintensity on T1-weighted images, but central hypointensity with peripheral ring-form hyperintensity on proton density-weighted and T2-weighted images. These CT and MRI characteristics may have been attributable to the abundant proteinaceous content of the abscess. Therefore, the appearance of a pituitary abscess in image studies may be variable depending on the abscess composition.

Abscess↗

PubMed1994

The design of an emergency operating procedure in process control systems: a case study of a refrigeration system in an ammonia plant.

The purpose of this study was to develop a method to aid and support human operators in emergency operations. A conceptual model of system performance was constructed in order to observe the constraints of human capabilities under emergency conditions. Then the influence of emergent events and the applicable condition of procedural design principles were discussed. In order to help operators in handling the emergent event, a decision table support and a computer support were developed according to historical data and principles of procedural design. In order to verify the effects of above methods, a simulated experiment of handling the emergent event in the refrigeration system of an ammonia plant was performed. As shown by the experimental results, the support methods successfully improved the response speed of the subject, but did not improve accuracy. The results also revealed that the decision table support had a better effect on simple error type, whereas the 16-breadth computer support had a better effect on both the simple error type and complex error type.

Adult↗

PubMed1994

[Contralateral epidural hematoma following the craniotomy for intracerebral tumor--one case report and review of literature].

A 40-year old female patient suffered from headaches for 2 months. Two days before admission, the headache got worse and vomiting and seizures followed. Brain CT scans revealed a right frontal intracerebral tumor. So she received a craniotomy to remove the tumor, which was verified as glioblastoma multiforme. The postoperative course was uneventful. However, headaches attacked again two weeks later. An epidural hematoma on the left parietooccipital region was found on brain CT scans. The craniotomy was done to remove the hematoma and no abnormal vessels or inflammation was seen in the operative field. This was the first such case we had encountered. We review the literature and discuss possible factors related to this case.

Adult↗

PubMed1992

[Neurogenic pulmonary edema: five cases report].

Five patients with neurogenic pulmonary edema (NPE) were reported. The edemas were caused by head injuries in four patients and by a craniotomy in the fifth. The onset of NPE was either acute (3 hours after injury) or was slow to develop (4 days later). Clinical symptoms included the sudden onset of coughing, tachypnea, tachycardia, and pink bubbly sputum. Moreover, the patients also suffered cyanosis, confusion, or respiratory failure. The distribution of the resulting pulmonary edema was diffuse in 4 cases and localized within a single lobe of the lung in 1 case. Treatment of the NPE included reducing intracranial pressure (glycerol), diuresis (furosemide and mannitol), narcotics (morphine, phenobarbital), and blocking the peripheral effect of sympathetic reflex activity (hydralazine, sodium nitroprusside). Mechanical ventilation support (CPU-1) in combination with controlled hyperventilation may also be necessary. The inability to correct hypoxemia without toxic levels of oxygen necessitates the use of PEEP (positive end-expiratory pressure, +5-10 cmH2O). Resolution of symptoms was noted 24 to 48 hours after treatment in 4 patients. Early diagnosis and intensive care of the pulmonary edema may have a significant bearing on the recovery of lung functions. Unfortunately, 4 of the patients failed to survive because of central nervous system failure. We therefore want to emphasize that NPE can cause secondary deterioration of neurological functions. In conclusion, when dealing with respiratory distress patients with CNS injuries, the possibility of additional damage from a NPE must be taken into consideration.

Adolescent↗

PubMed1992

Cystic intracranial meningioma.

Between April 1983 and April 1991, we studied nine cases of intracranial meningioma with cystic change out of 100 intracranial meningioma patients. The incidence was 9%. The patient's ages ranged from 40 years to 75 years old. There were five men and four women, of them, three had intratumoral cysts, and six had peritumoral cysts. Histologically, 7 cases were diagnosed as meningothelimatous type, one as psammomatous and the other one as angioblastic type. All the tumors with cystic change in this series were greater than two centimeters in diameter. Because the morphology was indistinct, Nauta's type II cystic meningioma was easily misdiagnosed as glioma or metastatic tumors preoperatively. Microsurgery is the best way for complete removal of the cyst wall to prevent recurrence.

Adult↗

PubMed1992

An analysis of brain tumors in south Taiwan.

A series of 544 pathologically verified brain tumors were analyzed for the relative incidence and location of tumors as well as the distribution of age and sex. These data were compared to series from north Taiwan, mainland China, America, Germany, and Japan. The incidence of gliomas among brain tumors in south Taiwan (25.4%) was lower than other reports (31-44%). It is interesting to note that the incidence of gliomas in Asian reports is lower than those in America and Germany. A much higher percentage of meningiomas and pituitary adenomas were seen in Taiwan's reports than in those from other countries. Aggressive surgical decompression of brain metastases in selected cases is advised and they comprised 15.1% of total brain tumors operated on. The incidence of brain tumors in the older age group in south Taiwan (22.1%) was much higher than those reported from mainland China (1.65%). Our series revealed a preponderance of tumors in females over males, which may be affected by the greater number of female-predominate meningiomas and pituitary adenomas.

Adolescent↗

PubMed1990

Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation.

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.

Adult↗

PubMed1990

Static anthropometry of civilian Chinese in Taiwan using computer-analyzed photography.

The purpose of this study was to establish a static anthropometric data bank for Chinese civilians in Taiwan using a computer-analyzed photographic method. Stratified random sampling was applied to decide the sampling site; sample size was established by considering standard errors in a pilot study. Then a photographic method was employed in addition to direct measurement of selected body dimensions. In all, 933 subjects were measured. The data were entered via a digitizer into a microcomputer for processing. The resulting anthropometric data bank was organized by age, sex, and occupational groupings. Comparisons with data from previous studies were made, and recommendations for further research presented.

Adolescent↗

PubMed1990

Contributing factors to formation of left atrial spontaneous echo contrast in mitral valvular disease.

The formation of left atrial spontaneous echo contrast may relate to blood stasis. This study analyzed the factors contributing to the formation of that contrast. Transesophageal echocardiography, transthoracic echocardiography, cardiac catheterization, and left ventricular angiography were performed in 139 patients, divided into five groups. Predominant mitral stenosis with atrial fibrillation was found in 36 patients (group I); normal porcine valve in the mitral valvular area with atrial fibrillation in 31 (group II); predominant mitral stenosis with normal sinus rhythm in 26 (group III); moderate to severe mitral regurgitation with atrial fibrillation in 25 (group IV); atrial fibrillation with normal mitral valve in 21 (group V). The results showed left atrial spontaneous contrast echo was found in only 1 of 139 patients by transthoracic echocardiography and 62 of 139 cases were detected by transesophageal echocardiography. There was a high incidence of left atrial spontaneous echo contrast in cases of mitral obstruction with atrial fibrillation and enlarged left atrium (group I, 88%; group II, 74%), but a lower incidence in cases with normal sinus rhythm (group III, 4%), atrial fibrillation alone (group V, 16%), and increased left atrial flow velocity (group IV, 9.5%). The diameter of the left atrium was significantly different between presence and absence of left atrial spontaneous contrast echo (54.3 +/- 9.2 mm vs. 48.3 +/- 8.6 mm, p less than 0.01). The mean pressure gradient was similar in groups I and III (14.6 +/- 0.6 mHg and 14.4 +/- 2.8 mHg, respectively) but different in group II (10.9 +/- 3.2 mHg, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Peritumoral brain edema in intracranial meningiomas.

We analyzed 38 patients with 39 meningiomas verified pathologically. The study included 27 females and 11 males. The ages of the patients on admission ranged from 11 to 77 years (averaged 47.6 years). The incidence of brain edema associated with meningiomas was 69%. The extent of peritumoral edema on the CT scans positively related to the duration of preoperative symptoms, the location and size of tumors, and breaching of the cortex by meningiomas. The meningotheliomatous meningiomas were frequently associated with significant brain edema. The ultrastructural features showed some relationship between increased secretory activity and the extent of peritumoral edema.

Adolescent↗

PubMed1990

Intracranial epidermoid cysts.

Intracranial epidermoid cysts are rare and constitute only 0%-8% of all intracranial tumors. Ten cases with verified pathology were observed during a 3-year period, comprising 4% of our brain tumors. There were two rare intracerebral cysts and one hourglass-shaped lesion involving the middle and posterior fossa. One patient presented with suprasellar retrochiasmative lesion, the remaining patients had C-P angle epidermoid cysts. Patients were aged between 18 and 58 years (averaging 41 years) with a long history of progressive neurological deficit (average 4.3 years). There were 6 women and 4 men. The clinical symptoms differed according to the location of the lesions. High-resolution computerized tomography was the main diagnostic procedure for these lesions. Typically, they revealed a hypodense and non-enhanced mass lesion. Calcification was seen in three of our patients. Total gross resection of cysts should be attempted whenever the cystic wall allows, especially for patients with unbearable trigeminal neuralgia. The post-operative results for this benign tumor were excellent in most patients.

Adolescent↗

PubMed1989

Maintenance error reduction strategies in nuclear power plants, using root cause analysis.

This study proposes a conceptual model of maintenance tasks to facilitate the identification of root causes of human errors in carrying out such tasks in nuclear power plants. Based on this model, an external/internal classification scheme was developed to discover the root causes of human errors. As a consequence, certain policies pertaining to human error prevention or correction were proposed.

Journal Article↗

PubMed1989

Nonparasitic hepatic cysts detected in ultrasonographic examination: analysis of 95 cases.

Ultrasonography has gained wide use in the diagnosis of hepatic cystic diseases. Ninety cases with nonparasitic hepatic cysts were detected in 4,615 patients who underwent routine abdominal ultrasonography. In this series, hepatic cysts were mostly discovered in men (62.1%), in the age range of 51-70 years (63.1%) and located in the right lobe of the liver (62.1%). Hepatomegaly, abdominal mass, abdominal pain, and jaundice were the common clinical manifestations in patients with symptomatic hepatic cysts (13.7%), especially in cases with larger or multiple cysts. Only 4 patients received invasive management; 2 with ultrasonographic guide aspiration alone, 1 with external drainage, and 1 with alcohol instillation. Complications in this series of liver cysts were noted in 3 patients (3.16%) including infection, portal hypertension and jaundice.

Adult↗