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Biomedical subjects

M K Shyu

Publications and source records attributed to M K Shyu.

At least 19 recordsLinked to original sources
PubMed2001

The addition of morphine prolongs fentanyl-bupivacaine spinal analgesia for the relief of labor pain.

UNLABELLED: The combination intrathecal fentanyl (25 microg) and bupivacaine (2.5 mg) provides effective labor analgesia for approximately 90 minutes. The purpose of this prospective, randomized, double-blinded investigation was to determine if the addition of morphine (150 microg) to the intrathecal combination of fentanyl (25 microg) and bupivacaine (2.5 mg) would prolong labor analgesia. By using the combined spinal epidural technique, 95 healthy primiparous laboring women in early labor received 2 mL of one of the two intrathecal study solutions, either FB (n = 48): fentanyl (25 microg) and bupivacaine (2.5 mg); or FBM (n = 47): fentanyl (25 microg) and bupivacaine (2.5 mg) plus morphine (150 microg). The mean duration of labor analgesia was significantly longer in the FBM group than in the FB group (252 +/- 63 min vs 148 +/- 44 min, P < 0.01). There were no significant differences between the two groups regarding the sensory levels, the incidence of nausea, vomiting, pruritus, hypotension, or operative delivery. In conclusion, the addition of 150 microg of morphine to the intrathecal combination of fentanyl plus bupivacaine prolonged the duration of labor analgesia duration without increasing adverse effects. IMPLICATIONS: The addition of morphine (150 microg) to intrathecal fentanyl (25 microg) and bupivacaine (2.5 mg) prolongs the duration of labor analgesia duration without increasing adverse effects.

Analgesia, Epidural↗
PubMed2000

Prenatal depiction of angioarchitecture of an aneurysm of the vein of Galen with three-dimensional color power angiography.

A fetus with a large supratentorial cyst and cardiomegaly was encountered at 33 weeks of gestation. The cyst appeared as an aneurysmal, fluid-filled structure extending posteriorly with a finger-like appendage. Using color flow mapping, we disclosed rapid in-and-out blood flow with marked turbulence within the cyst. For evaluation of its blood supply and venous drainage of the vascular malformation, a three-dimensional reconstruction of the power Doppler image was conducted. The results revealed that the vascular malformation was supplied by a small contralateral aneurysm from the branches of Willis' circle, draining posteriorly into an abnormal falcine sinus and then into the superior sagittal sinus. No other fetal abnormality such as hydrocephalus or hydrops was discovered. The prenatal diagnosis of an aneurysm of the vein of Galen was made on the basis of the gray-scale, color Doppler findings, and also the angioarchitecture obtained by three-dimensional power Doppler imaging. The woman was admitted at 37 weeks of gestation due to labor onset and delivered the baby via the vaginal route without complication. Postnatal angiography and magnetic resonance imaging confirmed the diagnosis of an aneurysm of the vein of Galen, and the angioarchitecture depicted it before birth. We suggest that three-dimensional power Doppler ultrasonography may assist in the diagnosis of an aneurysm of the vein of Galen, and precisely delineate the complicated corresponding vasculature. This may guide postnatal management and predict the prognosis more accurately.

Adult↗
PubMed1999

Arteriovenous malformation of mesosalpinx associated with a 'vanishing' ectopic pregnancy: diagnosis with three-dimensional color power angiography.

We describe two cases of pelvic arteriovenous malformation diagnosed with the aid of three-dimensional color power angiography. In both cases, beta-human chorionic gonadotropin (beta-hCG) increased to significant levels (8413 and 1560 mIU/ml, respectively); however, neither an intrauterine nor an adnexal gestational sac could be found. In each case, we observed an adnexal mass with several tortuous areas exhibiting abundant turbulent flow. The diagnosis of arteriovenous malformation was made and further assessment by three-dimensional color power angiography and magnetic resonance imaging (MRI) was carried out. The complex vascular anatomy of arteriovenous malformation, including its feeding vessels and drainage, was clearly depicted by three-dimensional color power angiography and correlated well with magnetic resonance angiography. Levels of beta-hCG decreased in subsequent tests, and eventually became negative 2-3 months later without and intervention. We believe that an involutional ectopic pregnancy induced the rapid growth of the arteriovenous malformations within the mesosalpinx. Three-dimensional color power angiography can be performed quickly and easily, using existing ultrasound equipment. It improves our understanding of complicated vasculature, and thus is a useful adjunct to two-dimensional and color Doppler ultrasound in the diagnosis of arteriovenous malformation.

Adult↗
PubMed1999

Doppler waveform analysis of the intertwin blood flow in acardiac pregnancy: implications for pathogenesis.

OBJECTIVE: To investigate interfetal hemodynamics in acardiac twins and the implications for pathogenesis. DESIGN: A retrospective study. SUBJECTS: All acardiac twins involved in this study were identified by B-mode ultrasound at a teaching hospital in Taiwan. METHODS: Color Doppler imaging and, in one case, color power angiography were used to assess umbilical blood flow between acardiac twins and their normal co-twins. Placental anastomoses were examined by pathologists after delivery. RESULTS: In total five sets of acardiac twins and their normal co-twins were enrolled. Autonomous cardiac activity in the form of a contractile pocket was detected in two cases. Analysis of the pattern of the Doppler waveforms in each case enabled us to classify the type of hemodynamics into one of three categories: 'collision-summation', typified by a pattern of cyclic alternations of bidirectional flow; 'twin-pulse', which described the simultaneous recordings of two opposite constant flows with different pulsating rates; and the 'pump in' pattern, which indicated pulsatile flow in the reversed direction towards the acardiac mass. In two cases we detected, we believe for the first time, an artery-to-vein placental anastomosis between the acardiac twin and its co-twin. The nature of the vascular connections were confirmed on pathological follow-up. CONCLUSIONS: Our observations suggest that acardiac twins may be not only the result of but also the cause of placental vascular anastomoses, which may involve either artery-to-artery or artery-to-vein anastomoses.

Angiography↗
PubMed1998

Prenatal diagnosis of monosomy 10q25 associated with single umbilical artery and sex reversal: report of a case.

The association of rare chromosomal rearrangements involving a specific 10q breakpoint with a single umbilical artery (SUA) and sex reversal has never been reported. This report describes the case of a fetus with prenatal ultrasound features of severe intrauterine growth retardation (IUGR), congenital heart disease, and SUA. Fetal blood study revealed de novo deletion of 10q25 and a 46,XY karyotype, while ultrasound demonstrated female genitalia. Based on these findings, sex reversal was diagnosed. Polymerase chain reaction (PCR) amplification revealed the presence of the sex-determining region of the Y (SRY) gene. The pregnancy was terminated at 36 weeks and the newborn weighed 1908 g with marked facial dysmorphism and abnormal genitalia. Because the parents refused autopsy for this case, histopathological examination of gonads was not performed. Breakpoint of the long arm of chromosome 10 may be responsible for sex reversal in the present case and it could thus confirm the concept of autosomal sex reversal proposed in previous reports.

Abortion, Induced↗
PubMed1998

Application of the surface rendering technique of three-dimensional ultrasound in prenatal diagnosis and counselling of Klippel-Trenaunay-Weber syndrome.

Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks' gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.

Adult↗
PubMed1998

Antenatal depiction of the fetal ear with three-dimensional ultrasonography.

OBJECTIVE: To evaluate the feasibility of examining the fetal ear with three-dimensional ultrasound. METHODS: In 125 pregnancies between 19 and 38 weeks of gestation, fetal ears were evaluated by three-dimensional ultrasound. The volume images with surface rendering were analyzed to depict the morphology, lying axis, orientation, and cranial location of the fetal ears. RESULTS: Three-dimensional images of one or both ears were successfully reconstructed in 105 fetuses. Among them, 18 fetuses had anomalous ears. The anomalous ears, including microtia, low-set ear with slope axis, abnormal ear orientation, and edematous ear, were confirmed after delivery. Three-dimensional ultrasound consistently displayed fetal ear abnormalities with greater accuracy and clarity. CONCLUSION: Because anomalous ears may be a part of complex fetal malformations, it is important to recognize ear abnormalities. Due to the complexity of the fetal ear, three-dimensional ultrasound offers more important information than two-dimensional ultrasound, which simply gives auricular geometry. We suggest that three-dimensional ultrasound can be used better to examine the fetal ear and may prove to be useful for prenatal diagnosis and genetic counseling.

Ear, External↗
PubMed1998

Ultrasound measurement of the fetal cavum septi pellucidi.

OBJECTIVES: To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. SUBJECTS AND METHODS: A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. RESULTS: The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. CONCLUSIONS: The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.

Anthropometry↗
PubMed1998

Maternal age-specific risk of Down syndrome in an Asian population: a report of the Taiwan Down Syndrome Screening Group.

This study is a novel approach in establishing the maternal age-specific risk for Down syndrome screening in an Asian population. The relative frequency by one-year maternal age interval in women who had live births in the Taiwan area between 1975 and 1995 was used as the age-specific distribution of women who had unaffected pregnancies. Data about Down syndrome live births were obtained from the Taiwan Down Syndrome Association to establish the age distribution of women who had Down syndrome live births. The relative frequencies and the likelihood ratio by one-year maternal age interval was calculated and smoothed by running median and moving average smoothing methods. The age-specific risk was established by multiplying the total population risk by the likelihood ratio of the specific maternal age. The total live births in the Taiwan area between 1975 and 1995 were 7,232,689. A total of 527 cases of Down syndrome live births were registered in the Taiwan Down Syndrome Association. A total of 466 cases (88.43 per cent) of Down syndrome live births occurred before age 35, which was higher than occidental reports. This study established the first sizeable database of maternal age-specific risk for Down syndrome in an Asian population.

Adolescent↗
PubMed1996

Agenesis of the ductus venosus in a case of monochorionic twins which mimics twin-twin transfusion syndrome.

We describe a pair of monochorionic twins with clinical manifestation of twin-twin transfusion syndrome, including discordant fetal growth, hydrops of the larger twin, and the 'stuck twin' phenomenon of the smaller twin. In the hydropic twin, we found agenesis of the ductus venosus and an abnormal umbilical vein draining directly into the inferior vena cava. There was also marked enlargement of the right atrium, representing the volume overload on it. We believe that the agenesis of the ductus venosus in the larger twin may have contributed to the 'unbalanced shunting' between the monochorionic twins. This then led to a clinical picture mimicking that seen in the authentic twin-twin transfusion syndrome.

Adult↗
PubMed1996

Concordant body stalk anomaly in monozygotic twinning--early embryo cleavage disorder.

We describe a case of concordant body stalk anomaly in monozygotic twins that manifested with umbilical cord agenesis, evisceration of abdominal contents, and multiple gastrointestinal, genitourinary, and skeletal anomalies. Body stalk anomaly in twin gestation is extremely rare and poses an embryological interest. We suggest that the hypothesis of 'incomplete twinning' might contribute to the pathogenesis of this syndrome complex.

Abdominal Muscles↗
PubMed1995

Prenatal detection of limb defects after chorionic villus sampling.

Prenatal sonographic diagnoses of two cases of severe limb defects after first-trimester chorionic villus sampling (CVS) are presented. Pathological examination after elective termination correlated well with the prenatal sonographic findings. Although the relationship between CVS and limb defects remains controversial, careful ultrasound examination for possible limb defects in cases receiving CVS is recommended.

Adult↗
PubMed1995

Limb defects after chorionic villus sampling.

OBJECTIVE: To clarify the association between limb defects and chorionic villus sampling (CVS). METHODS: Questionnaires were sent to 165 major obstetric units in Taiwan to survey the incidence of limb defects with and without CVS exposure during 1991. Limb defects with CVS exposure from September 1990 to June 1992 were also surveyed. The spectrum of limb defects in CVS-exposed and general populations were compared by the Poisson test. RESULTS: The incidence of limb defects in the surveyed general population in 1991 was 0.032% and that with CVS exposure was 0.294%, a statistically significant difference (P < .001). The incidence of severe limb defects in the general population was 0.0026% and that with CVS exposure was 0.22%, also statistically significant (P < .001). Twenty-nine cases of limb defects after CVS were reported from September 1990 until June 1992: 19 cases with transverse limb reduction, two with mid-palm reduction, seven with adactyly or hypodactyly, and one with syndactyly. Four cases also had oromandibular-limb hypogenesis syndrome. CONCLUSIONS: The incidence of limb defects, especially the severe types, was increased after CVS. The spectrum of limb defects with CVS exposure was more severe than the limb defects seen in the general population and showed a specific pattern ranging from hypodactyly, adactyly, and transverse limb reduction, to oromandibular-limb hypogenesis. A correlation between the severity of limb defects and the timing of CVS was suggested.

Abnormalities, Multiple↗
PubMed1995

Extrauterine twin-twin transfusion syndrome after birth in conjoined twins.

Cross-circulation of conjoined twins in utero has been demonstrated and the extent of its severity has varied. Significant 'extrauterine' twin-twin transfusion syndrome after birth, however, caused by an unbalanced shunting within the circulation has not been reported. In a case of omphalopagus conjoined twins complicated by hypovolemia in one twin and hypervolemia in the other, we demonstrated by color Doppler imaging an aberrant vessel from the hepatic artery of one twin to the hepatic vein of the other. Unbalanced shunting through this aberrant vessel was suspected and urgent separation of the conjoined twins was undertaken. Circulatory changes after birth leading to 'extrauterine twin-twin transfusion syndrome' are discussed. A possible explanation of the pathophysiology of intrauterine twin-twin transfusion syndrome is also given.

Adult↗
PubMed1994

Incremental angiogenesis assessed by color Doppler ultrasound in the tumorigenesis of ovarian neoplasms.

BACKGROUND: The crucial role of angiogenesis in tumor behaviour has been studied extensively in vitro. The authors assessed the in vivo angiogenesis in ovarian neoplasms by color Doppler ultrasound and waveform analysis. METHODS: The intratumor artery resistance index (RI) of 222 ovarian neoplasms referred for color Doppler ultrasound evaluation was measured, and the corresponding histopathologic diagnosis was recorded. RESULTS: Satisfactory intratumor artery waveforms were obtained at an average of 1.12 sites in 44.7% (68 of 152) of benign tumors and at 6.28 sites in 97.1% (68 of 70) of the malignant group. Great heterogeneity in RI values existed. The RI of the intratumor artery in the benign group during the follicular phase (mean, 0.678) was significantly higher (P < 0.001) than that of the luteal phase (mean, 0.414), epithelial ovarian carcinoma (n = 34; mean, 0.402), malignant germ cell tumor (n = 6; mean, 0.413), malignancy metastasized to the ovary (n = 18; mean, 0.357), and other rare malignancies (n = 4; mean, 0.435). The RI of primary ovarian malignancy (n = 41; mean, 0.411) was significantly higher than that of malignancy metastasized to the ovary (P < 0.05). The RI values of epithelium-originated neoplasms showed a significant incremental decrease from benign tumors (n = 48; mean, 0.695) toward borderline malignancy (n = 6; mean, 0.535; P < 0.01), early-stage ovarian carcinoma (n = 10; mean, 0.485; P < 0.01), and, finally, to advanced-stage ovarian malignancies (n = 29; mean, 0.398; P < 0.05). CONCLUSIONS: Angiogenesis is a common phenomenon in malignant ovarian neoplasms, but the intensity of neovascularization may depend on individual tumor characteristics. The authors documented the incremental decrease of the resistance index in ovarian neoplasms, which may reflect the increase in angiogenesis intensity as an indication of malignant potential.

Adolescent↗
PubMed1994

Intrauterine intervention in a case of recurrent meconium peritonitis.

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.

Adult↗