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Biomedical subjects

K L Hung

Publications and source records attributed to K L Hung.

At least 37 records · Page 2Linked to original sources
PubMed1986

Cranial ultrasound in the detection of postmeningitic complications in the neonates.

Serial cranial ultrasound examinations were performed through the anterior fontanel to detect and follow the complications of bacterial meningitis in 16 neonates. The final results included normal findings in 9 patients, and abnormal in the other 7 cases. Among the latter, 5 patients with hydrocephalus were sequentially found after the second week of the disease and the earlier the onset, the larger the ventricular dilation. One ventriculitis showed polycystic loculi with abnormal septa in the advanced stage. Cystic low attenuation lesion with mass effect at a later stage of meningitis specified one patient with brain abscess. Progressive dilatation of ventricular systems without associated growth of head girth disclosed a process of brain atrophy. They had neither obvious neurological signs nor specific CSF findings clinically, but their sonograms showed the abnormal changes which were finally proved by CT scans. The potential value of cranial ultrasound in the detection of post-meningitic complication besides CT scan is stressed.

Brain↗
PubMedDate not supplied

Guillain-Barré syndrome in children: a cooperative study in Taiwan.

Seventy-two children with Guillain-Barré syndrome (GBS), diagnosed at 11 major teaching hospitals in Taiwan during the period 1986-1990, were studied retrospectively. There were 44 males and 28 females ranging in age from 7 months to 15 years. Preceding events could be traced in 61 patients (85%), including antecedent infection in 59 patients and previous vaccination in 2. As well as the consistent pictures of progressive weakness and generalized hyporeflexia, there were sensory complaints (26%), cranial nerve lesions (46%), respiratory failure (14%) and autonomic dysfunction (25%). Motor symptoms reached a maximum within 20 days in 88% of the patients, with the plateau lasting less than 2 weeks in 75%, and became stable within 3 months in 76%. Overall outcome showed complete recovery in 73% of the patients within 6 months after onset. Four (5.6%) had recurrence, and there was no mortality. The present study revealed that the annual incidence of GBS in Taiwan can be estimated roughly as 0.66 per 100,000 and that the course of childhood GBS is relatively benign.

Adolescent↗
PubMedDate not supplied

Multiphasic disseminated encephalomyelitis mimicking multiple sclerosis.

We report a case of multiphasic disseminated encephalomyelitis (MDEM) following viral illness presenting as multiple sclerosis (MS) in a 7-year-old boy. The patients had two episodes of alternating hemiparesis and other neurologic symptoms following viral infection, which were separated by 3 years. Neuroimaging studies demonstrated multiple, discrete, small nodules and large globular lesions in the cerebral white matter, basal ganglia, brainstem and cerebellar areas. Based on typical appearance of magnetic resonance imaging (MRI) and clinical manifestations including systemic symptoms such as fever, nausea, vomiting, headache and seizures followed by consciousness disturbance and other multifocal neurologic signs, the diagnosis of MDEM rather than that of MS was made. Because it is difficult to differentiate between MDEM and MS on the basis of the clinical history, the cerebrospinal fluid examination and evoked potential studies, this report emphasizes that the MRI study of the brain may provide an important clue for the diagnosis.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Epstein-Barr virus encephalitis in children.

Fourteen children with Epstein-Barr virus (EBV) encephalitis admitted to our pediatric department during the period 1988 to 1998 were collected and reviewed to characterize the clinical, laboratory and neuroradiological findings. There were 7 boys and 7 girls. The age of onset ranged from 10 months to 14 years. Among them, 5 patients belonged to Alice in Wonderland syndrome, 5 were diagnosed as acute viral encephalitis, 1 presented with acute meningoencephalitis followed by cerebellitis, the remaining 3 cases attributed to acute disseminated encephalomyelitis. The main symptoms were fever (43%), seizure (36%), bizarre behavior (31%), headache (21%) and metamorphopsia (36%). The presenting signs included altered consciousness (50%), meningeal sign (14%), bulbar sign (14%), cerebellar sign (7%), and cranial nerve palsy (7%). Classic findings of infectious mononucleosis were obscure. The laboratory data showed the existence of atypical lymphocyte in only one case but positive serology for EBV infection in all patients. Pleocytosis was found in 3 (30%) of 10 patients examined. Eight (67%) of 12 patients had nonspecific electroencephalographic changes in the acute stage. Computed tomography (CT) scans were abnormal in 2 (40%) of 5 patients tested; while magnetic resonance image (MRI) disclosed lesions in 5 (56%) of 9 patients, with abnormal signals in various parts of the brain. Single photon emission computed tomography (SPECT) brain scan showed abnormal perfusion lesions in 3 (75%) of 4 patients studied. The results demonstrate the diversity of neurological manifestations of EBV encephalitis. EBV should be considered in any acute neurological illness of uncertain etiology in the pediatric population. While MRI remains the image of choice in EBV encephalitis, SPECT detects the abnormal perfusion more precisely in a substantial number of patients.

Adolescent↗
PubMedDate not supplied

Neurologic involvement in an outbreak of enterovirus 71 infection: a hospital-based study.

Enterovirus (EV) can cause varied clinical manifestations. Involvement of the central nervous system (CNS) with the nonpolio EVs are common and important causes of morbidity in children. To investigate the manifestations of nonpolio enteroviral infections with CNS involvement during the EV outbreak, from February 1998 to January 1999, we collected 153 hospitalized patients in our pediatric ward caused by nonpolio EV infections which were diagnosed by history, clinical features, or detected from viral cultures. Fourteen patients (9.2%) had CNS presentations, 13 males and one female. The ages ranged from one month to 10.3 years. The spectrum of CNS presentations included aseptic meningitis (4 cases, 28.6%), encephalitis (5 case, 35.7%), encephalomyelitis (3 cases, 21.4%), and poliomyelitis-like syndrome (2 cases, 14.3%). Among these patients, 8 cases (57.1%) were isolated with EV71 from at least one site of rectal or throat swab sampling. Two fatal cases were presented as encephalitis and complicated with pulmonary edema. Generally, enteroviral infections are considered as a benign infectious disease in children. However, pediatricians should keep in mind that EV71 has caused several endemic outbreaks and continues to be an occasional cause of severe CNS disease. Early evaluation and appropriate treatment of CNS enteroviral infections may minimize the neurologic sequelae.

Central Nervous System Viral Diseases↗
PubMedDate not supplied

Oral bacterial therapy promotes recovery from acute diarrhea in children.

Lactobacilli in the intestines play an important role in developing natural defenses against both intestinal bacterial and viral infections. So a prospective clinical study was carried out at Cathay General Hospital to determine the effect of Lactobacillus acidophilus and Bifidobacterium infantis on the course of acute diarrhea in hospitalized children. Altogether 100 children between 6 and 60 months of age were collected and randomly allocated into 2 groups. Study group (n = 50) was given Infloran Berna, which contains 10(9) viable Lactobacillus acidophilus and 10(9) Bifidobacterium infantis, one capsule tid for 4 days and control group (n = 50) received parenteral rehydration only without any medication. Only 20 stool cultures in study group had positive culture results for Lactobacillus or Bifidobacterium. All children were evaluated for the degree of dehydration before rehydration. The clinical course of diarrhea was followed during the treatment period. Features on admission were similar between the study group and control group in age, duration of diarrhea at home, serum sodium & potassium and dehydration degree. The duration of diarrhea was defined as the time until the last appearance of watery stool. There was no difference between the study group and control group in the frequency of diarrhea stools on the day before admission (p > 0.05). However, the frequency of diarrhea for study group improved on the first and second day of hospitalization with statistical difference (p < 0.01). The duration of diarrhea during hospitalization in study group also decreased (3.1 vs. 3.6 days, p < 0.01). Oral bacterial therapy is an effective adjuvant therapy in rotavirus positive and negative children with diarrhea and can safely be administered during an episode of acute diarrhea.

Acute Disease↗
PubMedDate not supplied

Cardiotoxicity in imipramine intoxication: report of one case.

Imipramine is the most commonly prescribed tricyclic antidepressant of acute life threatening self-poisoning. We report a 15-month-old boy of accidental poisoning with imipramine, who developed generalized tonic-clonic convulsions and drug-related cardiac conduction abnormalities with PR prolongation, QRS widening, and QTc lengthening. The patient's imipramine level was 1389 ng/ml. The rapid resolution of intraventricular conduction delay and normalization of the QRS-T complexes after gastric lavage, installation of activated charcoal and alkalinization of the blood strongly implicates imipramine intoxication in the etiology of the cardiotoxicity. The patient made a full recovery without neurological sequelae.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

Study on the concentrations of cerebrospinal fluid immunoglobulin G and albumin in children.

Concentrations of immunoglobulin G (IgG) and albumin in cerebrospinal fluid (CSF) and serum were measured in 118 "normal" Chinese children from birth to 15 years old to obtain the reference values for the evaluation of the blood-brain barrier (BBB) function. The values of the CSF/serum IgG ratio, CSF/serum albumin ratio and IgG index (IgG ratio/albumin ratio) were then calculated for each subject. A relation was found between the content of IgG in CSF and serum depending on age. The gradual decrease of CSF IgG and IgG ratio during the first 6 months indicated a postnatal impediment of the diffusion of IgG from the blood to the CSF. In the meanwhile the CSF/serum albumin ratio continued to drop until the age of one year. The slower slope of the decrement of the latter ratio further demonstrated the differential permeability of the BBB in favor of the shift of small molecular protein. The change of the protein permeability within the first year of life shows a characteristic of the maturational process of the BBB. Nevertheless, IgG index has no age-dependent variation throughout the childhood period. It remains constant in the absence of inflammation within the central nervous system.

Adolescent↗
PubMedDate not supplied

Familial Bartter's syndrome--a study of free water clearance.

Three siblings in one family were found to have Bartter's syndrome. All of them had persistent hypokalemia, metabolic alkalosis, hyperreninemia and normal blood pressure. Patient 1 also had hyponatremia and hyperaldosteronism. Free water clearance studies during a maximal water diuresis showed that all of them had mild decrease in distal fractional chloride reabsorption. Patient 1 had normal proximal sodium reabsorption, however, patient 2 and patient 3 had enhanced proximal sodium reabsorption. These data suggest that the defect in chloride reabsorption at the Henle's loop may contribute to the pathogenesis of Bartter's syndrome, and compensatory proximal sodium reabsorption is very important in maintaining normal plasma sodium in Bartter's syndrome.

Absorption↗
PubMedDate not supplied

[Measurements of anterior fontanels in Chinese].

Assessment of the size of the anterior fontanel is used as an index of cranial development from birth to the second year of life. From January to May, 1988, measurements of anterior fontanel size were collected for all available newborns and infants from the nursery and well-baby clinics. The size of anterior fontanel was measured as the average value of the length (anterior-posterior dimension) and the width (transverse dimension), as proposed by Popich in 1972. Any fontanel too small to be measured was judged to be closed. Totally 704 subjects, divided into 10 groups by age (3 days, 1, 2, 4, 6, 9, 12, 15, 18, and 24 months) were measured. Results showed that the mean size of anterior fontanel in these 10 groups was 26.7 mm, 25.8 mm, 24.9 mm, 25.7 mm, 20.2 mm, 14.9 mm, 11.5 mm, 10.2 mm, 13.0 mm, and 12.1 mm, respectively. Results also showed a variation of fontanel size in all groups. There was a tendency toward decrease in fontanel size after six months of age. There were no significant differences in size and age of closure of the anterior fontanel between two sexes. Closure of the fontanel was first noted in about 5% of the babies 6 months after term, but in about 8% of the babies at 24 months of age, the fontanel had not closed. The median age of fontanel closure was 14.5 months in males and 14.3 months in females.

Cephalometry↗
PubMedDate not supplied

The evaluation of cerebral blood flow velocities in normal newborns and infants.

The cerebral blood flow velocities of 80 normal newborn babies and 117 normal infants were evaluated by pulsed-Doppler investigation of anterior cerebral arteries through the open anterior fontanel. Peak systolic blood flow velocity (PSFV), end-diastolic blood flow velocity (EDFV), mean blood flow velocity (MFV), and the pulsatility index (PI) values were measured for all subjects. In the neonate group, all flow velocities increased in the first 20 days after birth, with rapid increase from one to two months of age. After that, velocities increased steadily within the first year of age. The increasing flow velocities probably reflect the changes in cerebral blood flow and arterial blood pressure during the first year of life. On the contrary, the pulsatility indices (PI) slightly decreased during this first year. The result supports the hypothesis of a decrease in cerebrovascular resistance during infancy. This study may have value as reference for normal cerebral blood flow velocities and pulsatility indices as determined during infancy for different age groups.

Age Factors↗
PubMedDate not supplied

Development of auditory brainstem evoked response in normal Chinese children.

The average brainstem evoked potentials elicited by auditory click stimuli were recorded from 144 normal Chinese children including the age groups of newborns, 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 to 5 years, 5 to 10 years and 10 to 15 years. The auditory brainstem responses (ABRs) were analyzed for peak latencies, interpeak latencies and wave configuration in each group. The latencies of the wave components decreased with age. The auditory function related to peripheral transmission (PT) and central (brainstem) transmission (CT) was shown to mature at different rates. PT reached the adult pattern around the age of 3 months; whereas CT matched that of adult until or soon after 1 year of age. In addition, the waveforms of ABR display an independent course for development. By 6 months of age, the adult configuration replaces the infantile response. Longitudinal follow-ups on several subjects paralleled the transverse data. It is estimated that the first one year of life is the critical period for the development of auditory function postnatally, both peripheral and central pathways. ABR is a very reliable test to show the maturational changes of auditory and brainstem function.

Adolescent↗
PubMedDate not supplied

Pulsatile flow changes in the anterior cerebral arteries in infants with patent ductus arteriosus: measured with Doppler technique.

Cerebral hemodynamics were measured, using the Doppler ultrasound technique (directed toward anterior cerebral artery through the anterior fontanel), in 6 patent ductus arteriosus (PDA) patients with large left to right shunt and in 32 neonates before and just following functional closure of ductus arteriosus. PDA was confirmed by color echocardiogram and Doppler flow study. All 6 sick babies had prominent retrograde flow in the descending aorta during diastole. The value of pulsatility index (PI) derived from the components of peak systolic and end--diastolic frequency, was calculated. An obvious higher PI with simultaneous decrease in diastolic Doppler frequency in sick babies (PI = 0.89 +/- 0.05) were detected. On the contrary, the PI valves in the presence of opening of the ductus (PI = 0.65 +/- 0.07) in normal newborn infants didn't differ significantly with those just following functional closure (PI = 0.63 +/- 0.05). These data suggested that PDA might result in the physiologic consequence of ischemic cerebral injury if large left to right shunt occurred.

Cerebral Arteries↗