Biomedical subjects
Publications and source records attributed to T T Hsieh.
Hepatitis B virus DNA sequences were detected in seven (12.1%) of 58 cervicovaginal cell specimens that were obtained from pregnant women by polymerase DNA amplification assay. The presence of hepatitis B virus DNA in these cells raises the possibility that infected cervicovaginal cells may be a source through which hepatitis B virus can be transmitted from infected mothers to their newborns and between heterosexual partners.
Listeria monocytogenes, an uncommon perinatal infection in human, has been reported to be correlated with abortion, premature labor, intrauterine fetal sepsis, intrauterine fetal death and neonatal infections. Reported here was the first case of perinatal listeriosis complicated with Listeria monocytogenes chorioamnionitis at 33 weeks' gestation in Taiwan. The transabdominal amniocentesis in this particular case confirmed the diagnosis. An live premature male fetus was delivered by emergency cesarean section on the next day of hospitalization due to acute fetal distress. The acute ill baby developed signs of meningitis on the following day. Blood culture of Listeriosis monocytogenes indicated early onset neonatal listeriosis. Brain sonography showed hydrocephalus after a one-month period antibiotic treatment, he was lost to follow-up one month later. A review of the literature is presented to describe the clinical, epidemiological and pathological findings and to highlight their variable presentations and procedures for management. Thus it is of great importance for obstetricians to include listeriosis as a differential diagnosis in cases of fever of unknown origin during pregnancy. Promptly obtaining proper cultures and instituting appropriate antibiotics therapy is emphasized.
Cloned Gardnerella vaginalis DNA were selected from a plasmid DNA library constructed with partially restriction endonuclease Hind III-digested genomic DNA of G. vaginalis to serve as DNA probe in detecting G. vaginalis. The level of detection was determined to be approximately 10,000 cells by slot-blot DNA hybridization. This probe DNA will not cross-hybridize with DNA of a number of non-Gardnerella micro-organisms commonly found in female genital tract. The DNA probe-based hybridization test may become a useful tool for the identification of G. vaginalis in uncultured clinical specimens.
This study was undertaken to estimate the cesarean delivery rate in Chang Gung Memorial Hospital (CGMH) and to determine whether the reasons for the rising rate have changed during the past 6 years. Since 1984, 43% of the rise in the cesarean rate was due to repeat cesareans, 29% due to dystocia, and 15% due to fetal distress. At the same time, the cesarean delivery rates due to abnormality of position and placentation dropped by 2% in either condition. The rate of cesarean delivery among those with a previous cesarean was 98%. In the future, if the number of vaginal deliveries after cesarean increases, then the overall cesarean delivery rate will decrease or stabilize.
Twenty-four pregnant women with acute appendicitis received exploratory laparotomy during an 8-year period. Abdominal pain accompanied with nausea and vomiting were the most common symptoms. Abdominal tenderness and rebounding pain were the most reliable physical signs. Leukocytosis with WBC count greater than 15,000/cu mm and granulocytes greater than 87% and prolonged symptomatic duration were indications that appendiceal perforation might have occurred. A McBurney's incision and spinal anesthesia were preferred for appendectomy during pregnancy. In cases of uncomplicated appendicitis, tocolytic agents and antibiotics were not routinely used. Premature labor occurred in 21% of patients during postoperative period.
In the retrospective study, from January 1984 to December 1987, incidental myomectomy was performed on 47 patients who received cesarean section. The control group consisted of 80 random samples who received cesarean section during the same period. The general information in both groups was similar. Postoperative infection rate was similar in both groups. Myomectomy added 11 minutes to the operation time, 112 milliliter to the operation blood loss and extended the hospital stay about one and a half day. Recovery of gastrointestinal tract function was one hour later in myomectomy group. There were no wound infection or serious morbidity in both groups. In order to estimate the value of incidental myomectomy in cesarean section, a further study of long term change of the myoma should be considered.
The diagnosis of ventral abdominal wall defect can now be made prior to birth. With this diagnosis, the family can make decisions and a planned optimal management can lead to a successful outcome. There were 31 cases of ventral wall defect identified at Chang Gung Memorial Hospital (CGMH) from January 1979 through March 1988. Twenty of them were classified as gastroschisis; among them, 17 (85%) were born in outside clinics and none of them had associated anomalies. In contrast, among 11 cases of omphalocele, there was a lower frequency of transferred cases (27% vs 85%), and 4 cases had additional defects, including two multiple anomalies and two bladder exstrophies. There were no significant differences between gastroschisis and omphalocele in the mortality rate (30% vs 36%), in the incidence of intrauterine growth retardation (IUGR) (30% vs 27%) and in the Cesarean section rate (15% vs 18%). All 4 cases of prematurity (less than 36 weeks of gestational age) expired after delivery and 2 of these had body weights of less than 1500 g. Three out of 5 cases delivered by Cesarean section expired; the mortality (60%) was higher than that of vaginal delivery (28%). All 3 cases were gastroschisis, 2 of them were transferred from outside clinics and all expired due to sepsis. The diagnosis of ventral wall defect should be made prenatally, with obstetric ultrasonography, maternal serum alpha-fetoprotein screening and fetal karyotyping. Therefore, fetal transport in utero to a referral center and optimal perinatal care for those fetuses with potentially correctable lesions can be well planned.
Four cases of severe preeclamptic patients with the findings of hemolysis (H), elevated liver enzymes (EL) and a low platelet count (LP) were presented. Maternal mortality occurred in two of the four cases with one experiencing liver rupture. Intrauterine fetal death occurred in 3 cases. The entity has been termed the HELLP syndrome. The high maternal and perinatal mortality of our cases was mainly due to the severe coagulopathy associated with the HELLP syndrome. The practicing obstetrician must be knowledgeable about this severe consequence of toxemia in pregnancy and aggressive management is essential to improve maternal and perinatal outcome.
This study assesses the relative risks of first trimester transcervical chorionic villus sampling (CVS) versus midtrimester amniocentesis performed between April 1986 and March 1988. The most common indication for prenatal diagnosis was advanced maternal age. We discovered 5.1% chromosomal aberrations in CVS compared to 1.0% in amniocentesis. Bleeding was the most frequent early complication, and only 1 case had major hemorrhage with subsequent spontaneous abortion. The fetal loss rate (gestational age less than 28 weeks) was 4.5% in CVS versus 1.2% in amniocentesis, which was not significantly different from the background fetal loss rate reported in normal pregnancies after an 8-week gestational age. Three cases of fetal loss after CVS were probably procedure-related; 1 case had spontaneous abortion and 2 cases had chorioamnionitis. Therefore, we considered that the causal relationship between CVS and the infection was highly probable. The clinical pregnancy outcome indicated that there were no differences in overall perinatal mortality, Apgar score, body weight, body length, gestational age at delivery, intrauterine growth retardation, placenta weight and placental disorders between the CVS group and the amniocentesis group. The pregnancies did not reveal any specific effects of the prenatal diagnostic procedure, but a long-term pediatric follow-up is needed.
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OBJECTIVES: To investigate the second trimester maternal urine free beta-human chorionic gonadotropin (hCG) levels of chromosomally abnormal pregnancies in Asians. METHODS: Free beta-hCG levels were analyzed from the urine samples of 110 control and 17 chromosomally abnormal pregnancies, including 11 cases of Down syndrome, 1 case of trisomy 18, and other chromosomal abnormalities (one mosaic deletion and 4 translocations) from the second trimester of pregnancy. Results were normalized to urine creatinine (Cr) concentration and converted to the multiple of the median (MOM) level for the appropriate gestation. Gestational age of all cases was determined by ultrasound parameters. RESULTS: The median free beta-hCG MOM levels of Down syndrome (4.02 MOM) and other chromosomally abnormal pregnancies (2.03 MOM) are significantly higher than that of normal pregnancies (0.99 MOM) (p = 0.002 and p = 0.024, respectively). Nine of 11 (81.8%) Down syndrome cases, one trisomy 18 case, and 2 of 5 (40%) other chromosomally abnormal cases would be expected to be above the 95th centile of the control values (2.95 MOM cut-off). CONCLUSION: Urine free beta-hCG could be a potential and useful marker in the detection of fetal Down syndrome and other chromosomal abnormalities in Asians.