Biomedical subjects

T M Wang

Publications and source records attributed to T M Wang.

65 records · Page 4Linked to original sources

PubMedDate not supplied

Effects of a medical expert system on differential diagnosis of renal masses: a prospective study.

A medical expert system, RMDS, was used to prospectively evaluate patients undergoing nephrectomy for suspected renal masses. The effects of a medical expert system on differential diagnosis of renal masses were investigated. After RMDS consultation, three chief residents and one junior attending physician changed their preoperative diagnosis and significantly increased their diagnostic accuracy. The results indicate that the medical expert system may have an useful role in preoperative diagnosis of renal masses.

Bayes Theorem↗

PubMedDate not supplied

Evaluation of a decision-support system for preoperative staging of prostate cancer.

The usefulness and effectiveness of a decision-support system for preoperative staging of prostate cancers (PCES) were evaluated. The study population consisted of 43 consecutive patients with the preoperative diagnosis of prostate cancer who underwent surgical operation. Results obtained using the PCES were compared with staging by four urology attending physicians and five urology residents. The effect of PCES consultation on the physicians' staging of prostate cancer was also evaluated. To confirm the usefulness of the clinical findings of prostate-specific antigen, prostate-specific antigen density, prostate volume, and abnormal Gleason score in the PCES, their receiver operating characteristic (ROC) curves for diagnosis of advanced prostate cancer were plotted. The values of the areas under the curves were 0.772, 0.800, 0.531, and 0.752. The stage of prostate cancer was correctly determined by the PCES for 38 of the 43 patients, yielding 88.4% preoperative diagnostic accuracy. The PCES was significantly more accurate than two of the attending physicians and all residents. PCES consultation improved the residents' staging accuracy to approximately that of the attending physicians. The effect of PCES consultation on the residents' staging was significantly (p < 0.001) greater than the effect on the physicians' staging. The PCES may be useful in the preoperative staging of prostate cancers, especially during residency. The system's accuracy in determining the stage of advanced prostate cancer may make it possible to avoid unneccesary surgical operations.

Aged↗

PubMedDate not supplied

Infants of twin pregnancies with one twin demise in the uterus: a retrospective study.

Many papers have reported that twin pregnancies with one twin demise in the uterus can cause complications in the surviving twin. We retrospectively reviewed charts from 1988 to 1997 at our hospital and found 17 of 302 twin deliveries with one twin intrauterine fetal death. The incidence of intrauterine death of a single twin was 5.7%. Six of the surviving twin (35.3%) had renal function impairment. One died due to acute renal failure. The other five patients recovered normal serum creatinine level. Five patients (29.4%) had abnormal brain imaging findings. One had multicystic encephalomalacia and microcephaly. Three of the five patients were complicated with cerebral palsy. After dividing the patients into complicated (n = 8, 47.1%) and non-complicated (n = 9, 52.9%) groups, we found that the patients with complication had lower Apgar score at 5 minutes and those with monochorionic diamniotic placenta had higher incidences of complication (62.5% vs 12.5%). We conclude that twin pregnancies with one fetal demise in the uterus do result in a higher incidence of complication in the surviving twin, especially if placentation type is monochorionic diamniotic. In managing the surviving twin of the monozygous twin pregnancies with one fetal demise in the uterus, we must be careful to monitor these patients. If complication was suspected, we should arrange the brain and kidney ultrasonography and manage these patients appropriately to decrease the complication risk.

Delivery, Obstetric↗

PubMedDate not supplied

Individualized developmental care in the newborn intensive care unit.

With recent advances on newborn intensive care, the survival rate of very low birth weight preterm infants has been improved. The consequently new morbidities such as learning disabilities, behavioral problems, lower mean IQ and motor clumsiness have become more frequent. Neonatal individualized developmental care seeks to read the behavior of premature infants, and pace our procedures and caregiving according to individual infant's cues. Studies have shown that with implementation of developmental care, the time spent on ventilator and hospitalization was decreased, and infants started oral feeding earlier. The short and long-term neurobehavioral outcomes were improved. Developmental care focuses not only on changing the environment to provide a calming and soothing environment for the infants and family, but also provides a chance for all the staff members to read the behavior of the infants, think and reflect before doing something to the infants.

Developing Countries↗

PubMedDate not supplied

Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance.

In order to survey both the epidemiology of nosocomial infection in our neonatal intensive care unit (NICU) and the changing face of nosocomial infection after the introduction of National Health Insurance (NHI) in Taiwan, we retrospectively reviewed the nosocomial infections which occurred in our NICU from March 1, 1991, to February 28, 1999. We also compared the nosocomial infections from the viewpoint of NHI. The mean rate of nosocomial infections in our NICU during these 8 years was 13.6%, and it had significantly increased after the NHI plan was implemented (from 7.9% to 19.0%). The most common type of nosocomial infection was blood stream infection (53.8%, 120 of 223 infections). Coagulase-negative Staphylococci and fungi were the two most common pathogens of nosocomial blood stream infection in our NICU, accounting for 28.1% and 24.2% of the infections, respectively. The survival rate of very low birth weight (VLBW) infants increased from 76.3% to 78.4% after the implementation of NHI. However, the nosocomial infection rate of the VLBW infants had markedly increased from 22.6% to 41.9%. The total number of hospitalization days of the patients with nosocomial infection was significantly greater than that of those without nosocomial infections (p < 0.05), and the patients with the lower birth weights had longer hospital stays. The risk factors for nosocomial infection including invasive procedures, multiple and empirical antibiotics, and extremely low birth weight premature infants, remained the same, but the prevalence of nosocomial infection in the neonatal intensive care unit has changed markedly since the NHI plan began. Further investigation to determine strategies for preventing nosocomial infection in very low birth weight infants is warranted.

Cross Infection↗

PubMedDate not supplied

The follow-up on the training course of pediatric advanced life support.

Two parts are included in this article. First, to improve the training course in pediatric advanced life support (PALS), we held a 2-day PALS training course on March 28 and 29, 1999. A pretest, posttest, and survey questionnaire were given to each participant. Of the 143 participating in the 2-day PALS course, 137 completed the study. The mean pretest score was 70.2 (SD = 11.5) and the mean posttest score was 86.9 (SD = 9.1). There was significant improvement noted after the 2-day PALS training course (p < 0.001). The 2-day PALS training course resulted in greater improvement in scores compared with the previous 1-day PALS training course in some certain groups of participants. The number of participants complaining that they were too rushed to get the best learning result declined from 71 of 106 (66.3%) taking the 1-day training course to 43 of 137 (31.4%) taking the 2-day training course. Second, a same written test was given to the 129 participants who had finished a 1-day PALS training course one year previously to evaluate the participants' retention of knowledge after 1 year. Of 82 responders who took the 1-year follow up test, 75 were from the medical center. The score of the follow-up test for these 75 participants showed a significant decline when compared with the posttest, except for those receiving another training course of advanced life support during the follow-up year. We conclude that the 2-day PALS training course is better than the 1-day PALS training course. Those who participate in the pediatric critical or emergent care had better receive the 2-day PALS training course. The participants receiving the 1-day PALS training showed a significant decline in their knowledge after 1 year, and they should reinforce their knowledge in the following years.

Child↗

PubMedDate not supplied

Cerebral magnetic resonance imaging of preterm infants after corrected age of one year.

A total of 17 very-low-birth-weight (range from 625-1500 grams) preterm infants received brain magnetic resonance imaging (MRI) study at a mean corrected age of 23 months (range from 15-33 months). They were classified into two groups. In Group 1 (12 cases) the cranial ultrasound study was normal during infancy. There were two cases with typical change of periventricular leukomalacia (PVL) detected by MRI study; both showed spastic diplegia. In Group 2 (five cases) ultrasound study was abnormal during infancy while the MRI confirmed the change of PVL in these cases whose ultrasound study showed typical change of PVL. In two cases of intraventricular hemorrhage (IVH) Grade I and III separately, the MRI also revealed the change of PVL, but only the case of IVH grade III had spastic diplegia. The myelination process of all cases were completed as normal term infants. In conclusion, brain MRI confirmed the PVL change discovered by cranial ultrasound and the results were strongly correlated with spastic type cerebral palsy. For those infants with an abnormal neurological examination, MRI may be useful for diagnosis of PVL in spite of normal ultrasound findings during the newborn period.

Brain↗

PubMedDate not supplied

Intraventricular hemorrhage in preterm neonates--a two year experience.

A prospective brain sonograph study was performed on 134 preterm neonates with birth weight of less than 2500 gm. Ten (7.5%) infants had intraventricular hemorrhage (IVH). The incidence of IVH in preterm neonates weighing less than 1500 gm was 13% and in neonates of less than 32 weeks gestation was 11.27%. Ninety percent of the IVH occurred within the first 72 hours of life. Prematurity, and hypoxia were considered as significant contributing factors for neonatal IVH. Six of the 7 infants with IVH grade I have a favorable neurological outcome. One of the 3 infants with IVH grade III has psychomotor delay. Routine brain sonograph study is considered practical and invaluable for diagnosis of IVH in preterm neonates.

Cerebral Hemorrhage↗

PubMedDate not supplied

Candidemia in the neonatal intensive care unit.

The hospital records of 18 infants (9 males & 9 females) with one or more positive cultures for Candida species were studied retrospectively in an attempt to define the characteristics, associated factors and treatment for candidemia in the neonatal intensive care unit. The number of patients have increased recently and the mortality rate is 56% (10/18). The Candida species isolated from blood were Candida albicans in 16 cases and Candida parapsilosis in 2 cases. Fever, not-doing-well, and abdominal distention were the most common presentations, prompting us to the initial impression of bacterial sepsis and/or necrotizing enterocolitis. Eleven associated factors for candidemia were relating to the measures and therapy in the neonatal intensive care unit, such as prolonged use of broad-spectrum antibiotics, parenteral hyperalimentation etc. All of these 18 patients were treated with intravenous amphotericin B. Six patients were given adequate total dose (> 25 mg/Kg), while 12 patients underwent inadequate treatment (3.7 +/- 2.9 mg/Kg). The 10 fatal patients belonged to the inadequate treatment group. As there is continual progress in neonatal intensive care units, candidemia is becoming an increasing common problem and which deserves attention.

Amphotericin B↗

PubMedDate not supplied

Neonatal Candida albicans meningitis: report of one case.

Candida meningitis is a growing problem today. We report a 21-day-old male baby who was a victim of Candida albicans meningitis with the initial presentations of fever, mild stiff neck, poor feeding and activity. He had been treated with intravenous antibiotics and ventilator therapy prior to admission Initially, he was treated as a case of bacterial sepsis after admission with intravenous antibiotics. Due to positive cultures of cerebrospinal fluid for Candida albicans twice, intravenous amphotericin B was started from the 13th hospital day and was continued for 38 days. The successive three sets of CSF fungus culture yielded negative results and the patient was doing well without fever. Meanwhile, the brain sonogram revealed normal findings and he was discharged in a stable condition. We report this case and review some literature in an attempt to know more about this unusual disease, which is becoming more frequent as progress in intensive care grows.

Candidiasis↗

PubMedDate not supplied

Congenital syphilis: report of twelve cases.

Between 1983 and 1992 at the Taichung Veterans General Hospital, twelve congenital syphilis patients were diagnosed, according to the Centers for Disease Control (CDC) criteria. For the five boys and seven girls, ages at diagnosis ranged from 1 day to 8 months, with an average of 23 days. Among these 12 patients, four (33%) were premature. Seven patients (58%) were diagnosed in the past three years. These 12 patients were divided into inborn and outborn patient groups. Serological tests for syphilis were done in all inborn patients, but none in the outborns. All five outborn patients were symptomatic. In comparison, only one of seven inborn infants showed clinical evidence of congenital syphilis. The mean age at diagnosis was obviously older in the outborn patient group (53 days vs. 1 day). Six of ten patients (60%) had cerebrospinal fluid (CSF) abnormalities, while four of nine (44%) showed radiological abnormalities of bones. The hematologic and biochemical abnormalities compatible with congenital syphilis were also described. Penicillin was the drug of choice in ten patients. Despite adequate treatment, one patient died of respiratory failure. There has been no evidence of any signs of late congenital syphilis in those patients who survive. Congenital syphilis, a serious but preventable disease, is best treated adequately and early for minimal sequelae.

Female↗