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Biomedical subjects

C C Chen

Publications and source records attributed to C C Chen.

At least 811 records · Page 45Linked to original sources
PubMedDate not supplied

Hirschsprung's disease: an analysis of 104 cases.

One hundred and four cases of Hirschsprung's disease in infants and children diagnosed at the National Taiwan University Hospital during the period of 1984 to 1989 were analysed for demographic patterns, clinical manifestations, accuracy of various diagnostic procedures, especially the reliability of suction biopsy, and postoperative course. The important symptom constellation included abdominal distention, delayed meconium passage, and tight anus in the biopsy-positive group. Complementary diagnostic procedures were mandatory for accurate diagnosis, since 26% of the patients (7 of them with ultrashort segment) were diagnosed over a period of more than two months. The first biopsy in 25% of the patients aged less than 1 month could not be interpreted, and in 27.6% of this subgroup the radiological pictures were inconclusive. Further scrutiny of clinical manifestations together with other elaborate study including repeated rectal biopsies may be required for establishing a definite diagnosis of the disease. The surgical mortality is low, but surgical morbidity remains high and needs further improvement.

Adolescent↗
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Congenital diaphragmatic hernia: analysis on factors affecting survival.

Thirty cases of early-onset congenital diaphragmatic hernia were admitted to National Taiwan University Hospital from 1976 to 1990. The mortality rate has increased in recent years, with an overall mortality rate of 26.7%. Low PH value of initial blood gas, early onset of symptoms at birth and total absence of hemidiaphragm were the three most poor prognostic factors (P less than 0.01). Preoperative stabilization of those patients with an initial PH value less than 7.2 may be helpful (P less than 0.04).

Blood Gas Analysis↗
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[Achalasia: report of two cases].

The first case, a two-month-old female infant, had frequent vomiting since 5 days of age. Dilated esophagus with narrowed distal end was noted on barium meal study. Panendoscopic examination revealed dilated esophagus and a pin-head sized, stenotic lumen at 15 cm from the incisor. Under the impression of esophageal stenosis, gastrostomy was performed for feeding. Esophagogram made at 6 months of age demonstrated good patency of the esophagus without stenosis and gastrostomy was subsequently closed at the age of 1 year. Unfortunately, swallowing disturbance had bothered her intermittently since. Barium esophagogram and panendoscopy made 8 years later again revealed distal esophageal obstruction with dilated proximal esophagus. The second case was a two and half year old boy who suffered from frequent regurgitation of undigested food for 6 months. Dilated esophagus with narrowing of the lower end of esophagus was noted on barium meal study. After admission, panendoscopic examination revealed the esophagus was very narrow at 25 cm from incisor and the proximal esophagus was dilated. The esophageal dilatation with mercury-weighted bougies was performed intermittently. At present he is doing well, and a barium meal study showed adequate esophageal emptying.

Barium Sulfate↗
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Spontaneous focal intestinal perforation in prematurity: report of three cases.

Three premature neonates with a localized perforation of the intestine, but not associated with necrotizing enterocolitis (NEC) or gastrointestinal anomaly are reported. The birth weight of these babies was around 1500 g and they exhibited striking similarities in the clinical course. Before laparotomy, NEC was firstly impressed. Abdominal distension, refusal of feedings, poor activity and respiratory distress were the major manifestations. Pneumoperitoneum was all detected before operation. The perforate site was terminal ileum in one and anterior cecum in the other two babies. The gastrointestinal tract was otherwise normal. The first case received segmental resection of the perforation with end to end anastomosis and the other two underwent ileostomy. Bacteria was discovered from the peritoneal fluid in the second and third cases, including E. coli, Enterobacter cloacae and Klebsiella pneumoniae respectively. The postoperative course was complicated with wound infection and adhesion ileus in two patients. Rectal suction biopsy in the second and third cases showed normal histology. Until present all three patients were uneventful. We concluded that premature or very low birth weight infants with spontaneous, localized gastrointestinal perforation and peritonitis had milder course than NEC, and if promptly diagnosed and treated, the prognosis is excellent.

Cecal Diseases↗
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[Congenital megacolon presented as fecaloma and urinary tract infection. Report of one case].

A 5-month old boy was admitted with urinary tract infection. While doing the voiding cystogram, the bladder was found to be pushed to the right side by a soft tissue mass. Through CT scan examination, the mass revealed to be a fecaloma. Through rectal suction biopsy and barium enema study for megacolon, it was proved to be a case of congenital megacolon. A pull-through operation for megacolon was carried out. He recovered quickly, and was discharged 10 days later. We make this report in order to discuss this rare presentation which may occur in congenital megacolon.

Fecal Impaction↗
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Treatment of esophageal atresia with distal tracheoesophageal fistula: are gastrostomy and prophylactic esophageal dilatation necessary?

Fourteen cases of esophageal atresia with distal tracheoesophageal fistula were treated by primary anastomosis (11 cases) or delayed primary anastomosis (3 cases) between August 1980 and September 1985. Postoperative esophageal dilatation was not used in the 13 survivors and none developed esophageal stricture. In the 11 cases of primary anastomosis, gastrostomy was performed simultaneously only in the first 2 cases. The omission of gastrostomy did not aggravate the preexisting pulmonary condition. Rather it shortened the operation time. It is considered that prophylactic esophageal dilatation is not necessary and gastrostomy is required only when primary anastomosis is not possible.

Dilatation↗
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Retrograde intussusception as a complication of Roux-en-Y anastomosis for choledochal cyst--report of one case.

A 19 month-old girl with choledochal cyst received complete cyst excision and biliary reconstruction by Roux-en-Y hepaticojejunostomy. Three months later, intestinal obstruction developed and small bowel intussusception was diagnosed preoperatively by ultrasonography. Laparotomy revealed retrograde jejunojejunal intussusception, involving the distal end of the Roux limb. To best knowledge, this is the first case in a child and the third case having such complication after Roux-en-Y anastomosis, reported in the literature. It should be noted that, if intestinal obstruction develops in a patient who had received this procedure for choledochal cyst, retrograde intussusception, although very rare, should be considered in addition to adhesion ileus.

Anastomosis, Roux-en-Y↗
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Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: preliminary findings.

Although the small intestine contains 75% of the mucosal surface of the gastrointestinal tract, it is the site of only 2% as many malignancies as the large bowel. The association of Crohn's disease with small intestine adenocarcinoma is well known, but the analytic epidemiology of small intestine malignancies has not received much attention. We reviewed the medical records of 19 patients with adenocarcinoma and 17 with malignant carcinoids identified from the Columbia-Presbyterian Medical Center Tumor Registry in the years 1980-1987. These were compared with 52 controls with nonmalignant conditions from the same time period. Three adenocarcinoma patients but no carcinoid patients or controls had previous Crohn's disease (P < 0.004). Three adenocarcinomas and three carcinoids, but no controls, had previous cholecystectomy (P < 0.004). Previous peptic ulcer disease was recorded for two patients with adenocarcinoma and three with carcinoid but no controls (P < 0.02, P < 0.0002). The age and sex adjusted odds ratio for cigarette smoking was 4.6 (95% confidence interval, 1.0-20.7) for adenocarcinomas and 4.2 (0.8-22.4) for carcinoids. The adjusted odds ratio for alcohol consumption was 4.0 (1.0-15.9) for adenocarcinomas and 3.1 (0.7-13.9) for carcinoids. Further studies are warranted to confirm these associations and to identify potential protective factors in the small intestine.

Adenocarcinoma↗
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Sydenham chorea.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

[Fetus in fetu: report of a single case].

A five-year-old girl had been noted, since birth to have abdominal distension. There was no history of twinning or teratoma in the family. Physical examination discovered a 15 x 10 cm mass in the abdomen. Roentgenologic examination demonstrated the presence of an axial skeleton and long bones within the mass. MRI showed a retroperitoneal mass with components of cystic, bony and fatty tissues. When the mass was surgically removed from the retroperitoneal cavity, pathologic examination disclosed a parasitic fetus measuring 15.3 x 6.3 x 6.0 cm in size and suspended by a peduncle within a capsule. The fetus was covered with skin, sebaceous materials and black hair. There were bilateral and symmetric upper extremities with a flapper-like, deformed hand. No obvious genital organ was noted. Dissection of the midline, revealed a vertebral column with spinal cord. An atrophic skull bone containing cephalized glial tissue was noted. A thoracic cavity and scapular bone were found in the thoracic cage; however, no heart was noted. Gastrointestinal tract and kidney-like organs were seen within the abdominal cavity. Microscopically, there were glial tissues within the skull bone, spinal cord and vertebra. The upper extremities revealed two long bones surrounded by myxomatous and fibrous tissue. A well developed intestine and an ovary containing follicles with nearby lympy nodes were seen. The capsule showed fibrous tissue with calcification and hairs. It was distinguished from the teratoma by the presence of a vertebral axis and by an appropriate arrangement of other organs or limbs with respect to the axis, and corresponding to the generally recognized diagnostic criteria of fetus in fetu.

Abdominal Neoplasms↗
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Surgical management of complicated gastrointestinal salmonellosis in children.

From January 1984 to October 1991, 11 consecutive patients with complication of Salmonella infection received surgical intervention at our hospital. The age at operation ranged from 4 days to 8 years old, with a mean of 1 year and 8 months. Most of them (64%) were under the age of one year. Eight cases were male, 3 cases were female. The most common pathogen was Salmonella paratyphi Gr. B (73%); the most common presenting symptoms and signs were abdominal pain (82%), pyrexia (82%) and muscle guarding (82%). The indications for surgery included pneumoperitoneum (55%), peritonitis (36%) and intestinal obstruction (9%); 6 cases received one stage operation, 5 cases received staged operations (enterostomy). The most commonly involved organ was ileum (54%). Ceftriazone (rocephin) was the drug of choice for the first 2 weeks postoperatively. Total parenteral nutrition (TPN) was used for at least 2 weeks. The postoperative complications included adhesion ileus (9%), high output enterostomy (9%), reperforation (9%), and wound infection (18%); there was no surgical mortality. Prompt diagnosis, early resuscitation and operative management are mandatory to avoid mortality.

Child↗
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Torticollis: a long-term follow-up study.

To achieve better guidelines for the future management of torticollis, this study analyzed surgical and nonsurgical management of 253 torticollis patients who were treated in this hospital from 1971 to 1993. Of those, 37 cases received operation only, 78 cases were operated after failed physical therapy, and 138 cases were treated only at the Rehabilitation Department. If free neck movement was considered to be the primary goal of treatment, most parents were satisfied with the results. However, if facial and skull deformities were the serious sequelae of torticollis, then only less than half of the surgical and nonsurgical groups of patients were graded as normal. Further, 10.9% of physical therapy group and 7% of the surgical patients need further operation to release the fibrotic bundle which limited their neck movement. Therefore, it is suggested that torticollis treatment should include early interventions such as adjusting sleep position, careful planning of physical therapy and/or operation and a long term follow-up period as essential for better management of torticollis.

Child↗
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Spontaneous resolution of neonatal ovarian cyst: report of one case.

The treatment of large, asymptomatic, neonatal ovarian cysts is controversial. Some authors recommend surgical intervention if the cyst diameter is greater than 5 cm. We report a case of an antenatally diagnosed ovarian cyst with a diameter of 6.6 cm. It involuted spontaneously within 8 months after birth without complications. We propose a conservative management of large, uncomplicated neonatal ovarian cysts. Close observation with serial ultrasound examinations may help avoid unnecessary operations.

Adult↗
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Dyskinesia from manganism in a hepatic dysfunction patient.

A 14-year-old boy came to the neurological clinic because of involuntary movement. He represented a case of common variable hypogammaglobulinemia, with hepatosplenomegaly noted for 5 years and jaundice for 1 month. Neurological and laboratory examinations revealed choreoathetosis and hyperbilirubinemia, hypoalbuminemia, increased hepatic aminotransferase, and decreased indocyanine green clearance; as well as increased signal change over the globus pallidus, subthalamic area, internal capsule, tegmentum, brain stem and pituitary gland revealed by a brain magnetic resonance (T1-weighted) imaging study. A manganese study confirmed high body manganese loading. Trihexyphenidyl administration ameliorated the dyskinesia; however, the patient died from hepatic failure later. Though rare in incidence, manganese intoxication should be considered in cases with dyskinesia and the characteristic brain MRI findings. Even if no environmental exposure is involved, total parenteral nutrition, porto-systemic shunt and chronic hepatic dysfunction could lead to a heavy manganese load resulting in symptomatic manifestation.

Adolescent↗