PURPOSE: Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases. METHODS: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. RESULTS: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. CONCLUSIONS: Diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood.

Acute Disease↗

PubMedDate not supplied

Nursery neurobiologic risk score as a predictor of mortality in premature infants.

Severity-of-illness scales have been proven to be valuable in assessing clinical outcomes and several risk scores have been used to evaluate neonatal illness severity. At present, we use nursery Neurobiologic Risk Score (NBRS) to evaluate the short term outcome of preterm newborns and their correlation to length of stay and morbidity. The NBRS was determined at the neonatal intensive care unit (NICU) of Changhua Christian Hospital in 183 preterm infants with birth weight < 2500 gm, gestational age < 37 weeks and age less than 7 days between July 1991 and June 1992. The NBRS correlates significantly with the birth weight and gestational age (p < 0.0001), it is also a significant predictor of NICU mortality (r = 0.68, p < 0.0001) and morbidity (Bronchopulmonary dysplasia, BPD: r = 0.46, p < 0.0001; Retinopathy of prematurity, ROP: r = 0.20, p < 0.01), there is also a significant correlation with the length of stay (r = 0.53, p < 0.0001). We created a revised NBRS, it is also a significant predictor of NICU mortality and morbidity which are independent of birth weight. Further validation of revised NBRS in prediction of NICU mortality & morbidity is needed.

Female↗

PubMedDate not supplied

[Congenital esophageal stenosis with submucosal fibrosis: report of one case].

Esophageal stenosis due to an intrinsic congenital factor is uncommon in infancy. We report a case of a male newborn infant, who was well at birth and presented with foamy sputum from the third day of life and vomiting at 18 days of age. Esophagogram revealed a narrowed segment, about 1 cm in length, at the level of the seventh and eighth cervical vertebral bodies, with proximal dilatation. There was no sign of gastroesophageal reflux. Operative findings: There was no external compression, foreign body or fistula, but a 1 cm length of esophageal stenosis was found. The stenosed segment was hard on palpation. Segmental resection of the stenosed region, with direct anastomosis of the esophagus was performed. Pathological examination of the narrowed segment revealed fibrosis of the submucosa without any tracheobronchial remnent components.

Esophageal Stenosis↗

PubMedDate not supplied

Neonatal mortality and morbidity in a neonatal unit: impact of improved perinatal care in recent 10 years.

Analysis of the neonatal mortality record at the neonatal unit of Changhua Christian Hospital for the five-year period from 1989 to 1993 (period 2) is presented and compared with that of the period 1979-1983 (period 1). This retrospective study is to evaluate whether the mortality rate and causes of neonatal death are affected by the changing perinatal care environment in Changhua area. This study shows that the mortality rate of the all admitted babies was dramatically decreased in period 2 (18% vs 12.35%, P < 0.01) and the mortality rate of delivered babies in our hospital was significantly decreased in period 2, too. (32.74% vs 11.61%, P < 0.001). However, the mortality rate of the babies referred from other hospitals was not different between the two periods (12.30% vs 12.72%, P > 0.05). These results can be explained by the higher quality of prenatal and delivery care, higher standard of neonatal intensive care for the sick neonates in period 2 and a comprehensive transport system which was established in 1987. RDS, prematurity, sepsis, asphyxia (particularly MAS with PPHN) and congenital malformations were still the main causes of neonatal death in period 2. We suggested that prevention, early diagnosis and intervention of these disorders and regionalization of perinatal care with a more comprehensive transport system are mandatory in Changhua area.

Cause of Death↗

PubMedDate not supplied

Hypothermia and sepsis: the major causes of mortality in gastroschisis.

From 1984 to 1993, 25 neonates with gastroschisis were treated at Chianghua Christian Hospital (CCH). Twenty-one patients were outborn, and only four were inborn babies. Eighteen patients were treated by primary fascial closure of the abdominal wall defect and seven, by the silastic sac technique. One patient required creation of intestinal stomas for ileal atresia; Two patients received further operation because of pus formation and intestinal obstruction. Four patients (16%) had associated anomalies, including one ileal atresia, two malrotations and one deformity of the hand. Seven (28%) patients were small for their gestational age. Eight patients died (32%); 17 survived (68%). Nine patients (36%) were hypothermic upon arrival at the hospital, with body temperatures of 32.5 degrees C to 35.8 degrees C. Among those, three died of intractable metabolic disorders related to hypothermia and two who were hypothermal and acidotic, developed sepsis and expired. Six patients (24%) developed sepsis and only one survived. Metabolic acidosis related to hypothermia and sepsis were the major causes of death in this study (P values of 0.024 and 0.01 respectively). It is no doubt that an experienced pediatrician is essential for immediate neonatal care to prevent unnecessary insults.

Abdominal Muscles↗