C-reactive protein in childhood non-typhi Salmonella gastroenteritis with and without bacteremia.
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Adolescent↗
Biomedical subjects
Y C Huang
Publications and source records attributed to Y C Huang.
Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon.
BACKGROUND: To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. METHODS: During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39 degrees C) and marked colon dilatation with maximal diameter > 1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. RESULTS: A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. CONCLUSION: Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.
Child↗
Proinflammatory cytokines increase in sepsis after anti-adhesion molecule therapy.
Cytokine mediators and leukocyte-endothelial cell adhesion molecules are critical and interdependent components of the acute inflammatory response in sepsis. We hypothesized that the administration of monoclonal antibodies to intercellular adhesion molecule-1 (CD54) or E- and L-selectin (CD62E/L) would decrease serum levels of the proinflammatory cytokines interleukin-1beta (IL-1), IL-6, and IL-8 and tumor necrosis factor receptor (TNFR-1) in baboons during sepsis. Adult male baboons received infusions of 1 x 10(9) colony forming units (CFU)/kg heat-killed Escherichia coli (E. coli) followed 12 h later by live E. coli (1 x 10(10) CFU/kg). At the time of live bacterial infusion, six septic animals were treated with a monoclonal antibody to CD54 and six with an antibody to CD62E and L (1 mg/kg). Eight untreated septic animals served as controls. Sequentially drawn serum samples were assayed for IL-1, IL-6, IL-8, and TNFR-1 using enzyme-linked immunoassay (ELISA). Data were compared using Mann-Whitney U tests and Chi-square analyses. Median survival was decreased in both treatment groups compared to controls (P < 0.05). Peak IL-1 level was higher than controls in septic animals treated with anti-CD54 but not anti-CD62E/L (P < 0.05, P = NS, respectively). Elevations in IL-6, IL-8, and TNFR-1 were increased and prolonged in both antibody treated groups compared to controls (P < 0.05). These results provide the first in vivo evidence that leukocyte-endothelial adhesion molecules CD54 and CD62E/L regulate cytokine production in sepsis.
Animals↗
Affinity cleavage at the divalent metal site of porcine NAD-specific isocitrate dehydrogenase.
A divalent metal ion, such as Mn2+, is required for the catalytic reaction and allosteric regulation of pig heart NAD-dependent isocitrate dehydrogenase. The enzyme is irreversibly inactivated and cleaved by Fe2+ in the presence of O2 and ascorbate at pH 7.0. Mn2+ prevents both inactivation and cleavage. Nucleotide ligands, such as NAD, NADPH, and ADP, neither prevent nor promote inactivation or cleavage of the enzyme by Fe2+. The NAD-specific isocitrate dehydrogenase is composed of three distinct subunits in the ratio 2alpha:1beta:1gamma. The results indicate that the oxidative inactivation and cleavage are specific and involve the 40 kDa alpha subunit of the enzyme. A pair of major peptides is generated during Fe2+ inactivation: 29.5 + 10.5 kDa, as determined by SDS-PAGE. Amino-terminal sequencing reveals that these peptides arise by cleavage of the Val262-His263 bond of the alpha subunit. No fragments are produced when enzyme is incubated with Fe2+ and ascorbate under denaturing conditions in the presence of 6 M urea, indicating that the native structure is required for the specific cleavage. These results suggest that His263 of the alpha subunit may be a ligand of the divalent metal ion needed for the reaction catalyzed by isocitrate dehydrogenase. Isocitrate enhances the inactivation of enzyme caused by Fe2+ in the presence of oxygen, but prevents the cleavage, suggesting that inactivation occurs by a different mechanism when metal ion is bound to the enzyme in the presence of isocitrate: oxidation of cysteine may be responsible for the rapid inactivation in this case. Affinity cleavage caused by Fe2+ implicates alpha as the catalytic subunit of the multisubunit porcine NAD-dependent isocitrate dehydrogenase.
Animals↗
Sonographic evaluation of cellulitis in children.
Within a 3 year period from July 1996 to July 1999, a total of 105 children with clinical diagnosis of cellulitis were evaluated by ultrasonography. Eighty-six children (age range, 17 days to 15 years) fulfilling the sonographic criteria for diagnosis of cellulitis were enrolled into the study. The sonographic features were used to correlate with clinical symptoms and their duration, the peripheral leukocyte count, and the serum C-reactive protein level. Pus aspiration for immediate microscopic and later bacteriologic studies was carried out under sonographic guidance. Ultrasonographic features of cellulitis included subcutaneous tissue thickening without distortion and pus (25 cases, 29%), distortion of subcutaneous tissue without pus accumulation (26 cases, 30%), distortion of subcutaneous tissue with pus accumulation (19 cases, 23%), and distortion of tissue with abscess formation (16 cases, 18%). The presence of sonographic features of tissue distortion with or without pus accumulation, including abscess formation in children with cellulitis, correlated with a longer duration of symptoms (greater than 4 days), the presence of high-grade fever, higher peripheral leukocyte count, and higher serum C-reactive protein levels. Those patients who underwent sonographically guided aspiration or surgical intervention showed a shorter hospital stay and fever duration than those without such aspiration. Our results indicated that ultrasonography is of great value in managing cellulitis by providing information regarding the progression of inflammation. Sonographically guided aspiration of pus may be a treatment of choice, as it may decrease the need for operation.
Adolescent↗
Foot complications in people with diabetes: a community-based study in Taiwan.
BACKGROUND AND PURPOSE: This comparative cross-sectional and community-based study was aimed at defining foot complications in diabetic patients. These data have not yet been reported for Asian societies. METHODS: Of a population of 3,602 subjects aged 35 years or more in Chin-Shan, Taipei, 309 diabetic patients were identified. Two hundred and nineteen (71%) of those patients were compared to 100 individuals randomly selected for the nondiabetic control group in the same community. RESULTS: Three diabetic patients underwent lower extremity amputation and four had skin ulcerations. Diabetic patients had a significantly higher prevalence of peripheral neuropathy (32.4% vs 16%), arterial insufficiency (12.6% vs 3.0%), and medial arterial calcification (13.6% vs 5.0%), when compared to the nondiabetic controls. The age and sex-adjusted rates of hallux valgus, loss of skin hair on the dorsum of the foot, tinea unguium, arterial insufficiency, medial artery calcification, and peripheral neuropathy were significantly higher in diabetic than nondiabetic subjects. Aging and hyperglycemia (> 140 mg/dL) increased the prevalence of foot complications in both groups. Foot complications were also remarkably associated with the duration of diabetes (p = 0.003). CONCLUSIONS: This study shows that diabetes mellitus is associated with an increased likelihood of foot complications in this geographically defined Taiwanese population. Patient age and diabetic duration are associated with the significantly higher prevalence of foot complications.
Adult↗
The interference of uptake of thallium-201 in cultured rat myocardial cells with existence of potassium related pharmaceuticals--a preliminary report.
Thallium-201 myocardial perfusion imaging is wildly used to detect and assess the extent of jeopardized myocardial ischemia in the coronary artery disease and the viability of myocardium post infarction. In recent years, there has been a great deal of pharmacological development of blockers and openers of potassium channel. In this study, we will discuss the interference of uptake of thallium-201 ion in cultured neonatal rat myocytes with existence of a variety of pharmacological agents. The cultures of neonatal rat myocardial cells were incubated with different agents such as potassium chloride, sodium-potassium ATPase pump inhibitor (ouabain), cesium compound, variable potassium channel blockers (4 AP, TEA and glibenclamide) and their openers (minoxidil, and cromakalim). The radioactivity of intracellular thallium-201 that could enter rat myocardial cells was detected by gamma counter sixty minutes after thallium-201 was added. In this study we found that thallium and potassium ions behave in an analogous manner in cultured rat myocardial cells. Both 2.5 mM and 5 mM concentration of extracellular potassium ion significantly result in reduction of thallium-201 ion influx in rat myocardial cells. 0.5 mM ouabain, an inhibitor of sodium-potassium ATPase pump, reduced about 40% of influx of thallium-201 ion in cultured rat myocardial cells via active transport. Combination of both potassium ion and ouabain inhibit most of thallium-201 ions influx in myocardial cells, but it is not completely inhibited. Cesium, a potassium antagonist, also interferes with the uptake of thallium-201 in cultured rat myocytes in our study. The most interesting finding in our investigation is that potassium channel blockers such as TEA and glibenclamide, inhibit the influx of thallium-201 in myocytes. However, potassium channel openers have no overt effect on influx of thallium-201 in cultured rat myocytes. We indirectly observe about 60% of influx of thallium-201 ion into cultured rat myocardial cells via active sodium-potassium ATPase pump. Potassium, cesium and potassium channel blockers, such as TEA and glibenclamide, inhibited the different percentage of influx of thallium-201 in cultured rat myocardial cells in this study.
Adenosine Triphosphate↗
Influenza A virus infection in infants.
Influenza A virus causes a variety of respiratory and nonrespiratory illness in children. The symptomatology varies with different age groups. The purpose of this retrospective study was to define the clinical characteristics of influenza A infection in Taiwanese infants. During the period from December 1997 to February 1998, 37 febrile patients younger than 1 year of age, including five newborns, were admitted to our hospital due to suspicion of sepsis or meningitis. The medical records of these patients were retrospectively evaluated. Influenza A virus was isolated from the specimens of the throat swabs in all patients, whereas no bacterial pathogen was detected. The most common clinical manifestations of these infants were lower respiratory tract infections, including pneumonia, bronchiolitis, and croup. There was no significant difference between the clinical characteristics of infants younger than 3 months and those aged from 3 months to 1 year. The mean duration of fever, peak of body temperature, and duration of hospitalization were 3.41 (+/-1.86) versus 4.4 (+/-2.02) days, 39.0 (+/-0.57) versus 39.9 (+/-0.63) oC, 4.9(+/-1.49) versus 6.3 (+/-3.7) days in infants younger than 3 months and infants aged from 3 months to 1 year, respectively. The older infants aged from 3 months to 1 year had a significantly higher peak body temperature than the infants younger than 3 months (p < 0.05). Two patients with croup had a more severe clinical course, however, the outcomes were good in all patients. During an influenza A virus outbreak, influenza A infection should be included in the differential diagnosis of infants with lower respiratory tract infection.
Age Factors↗
Effects of glucose-free maintenance solution on plasma glucose during anesthesia in patients undergoing long neurologic surgery.
BACKGROUND: Using glucose-free solution as fluid maintenance is widely advocated during neurosurgery because of concerns about hyperglycemia aggravating cerebral ischemia. This study evaluated the alterations in plasma glucose concentrations in both adult and pediatric patients undergoing lengthy neurologic surgery, during which they were given glucose-free solutions. METHODS: This study included 154 patients (ASA class II, aged 3 months-75 years) undergoing elective neurosurgical procedures. They were divided into two groups: group A (15-75 years-of-age) and group P (3 months-14 years-of-age). Groups A (n = 126) and P (n = 28) were further divided into five subgroups, respectively, based on the duration of surgery: 5, 6, 7, 8 and 9 hours. Anesthesia was maintained with isoflurane, fentanyl and vecuronium. Blood sampling was undertaken every hour throughout surgery. RESULTS: Adult patients differed significantly in body weight (61.5 +/- 10.9 vs 25.6 +/- 14.9 kg), age (58.9 +/- 15.7 vs 7.5 +/- 4.3 years), use of preoperative beta-blocking agents (33/126 vs 1/28) and the need for blood transfusion (58/126 vs 24/28). Neither group had elevated glucose levels. Compared with pediatric patients, the incidence of intraoperative hypoglycemia was statistically higher in adult patients, with a rate that peaked in the eighth (25.9%, group A vs 0% group P) and ninth hours (27.3%, group A vs 0% group P) of surgery. There were no differences in glucose concentrations at other points in time. CONCLUSIONS: In contrast to pediatric patients, intraoperative hypoglycemia occurred more often in adult patients during prolonged neurosurgical procedures when glucose-free solution was used for fluid maintenance. Therefore, frequent determination of plasma glucose concentrations is mandatory, especially in patients undergoing long-lasting neurosurgical anesthesia.
Adolescent↗
Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate.
PURPOSE: To determine the safety and effectiveness of arteriovenous malformation (AVM) embolization using liquid adhesives in a series of 103 patients with cerebral AVMs who underwent embolization with n-butyl-2-cyanoacrylate (NBCA). METHODS: All embolization procedures were performed using NBCA and a lipiodol mixture delivered by a flow-directed and/or guide-wire directed microcatheter. RESULTS: Using the Spetzler-Martin grading system, there were two cases of grade I AVM, 23 of grade II AVM, 31 of grade III AVM, 37 of grade IV AVM, and 10 of grade V AVM. Eleven patients underwent embolization only; these patients either had evidence of morphologic cure on follow-up angiogram, or showed evidence of a stable condition at 2-years follow-up. Seven patients were not treated owing to technical problems or a positive functional test. All other patients underwent preoperative embolization; 75%-99% obliteration was noted in 39 of these patients, 50%-74% obliteration in 33, and less than 50% obliteration in 13. Embolization-related complications occurred in nine patients, and two patients died as a result of the procedure. Severe neurologic complications occurred in two patients and five patients developed mild or transient neurologic deficit. CONCLUSIONS: Endovascular treatment of brain AVMs with an NBCA mixture has a lower complication rate than shown in previous studies using other materials. The percentage of obliteration of the nidus is increased because NBCA penetrates AVMs better than polyvinyl alcohol particles. NBCA can be used at a lower concentration than other acrylates, and therefore causes almost no catheter gluing. The embolic mass formed by NBCA is more biocompatable than that formed by other acrylates.
Adolescent↗
[Clinical analysis on 238 cases of longitudinal fracture of posterior teeth]
OBJECTIVE:To investigate the characteristics and clinical features of the longitudinal fractures of posterior teeth and evaluate the therapeutic methods.METHODS:The records of 238 cases with the longitudinal fractures of posterior teeth were analyzed retrospectively. The clinical features were sum med up. Eextractions of teeth were performed in 108 patients, and the conservative therapies in 130.RESULTS:The incidence of longitudinal fractures of posterior teeth was highest in the 30-59 years. The rate between male and female was 4:3. The longitudinal fractures of posterior teeth most occurred in the first molar of the maxilla with endodontic treatment. The follow up peroid was more than 2 years in 83 cases. The success rate was 75/83. CONCLUSION:The longitudinal fractures of posterior teeth can be cured by early fixation, and prevented by avoiding dysfunctional bite, treating subclinical fracture, and using proper methods of treatment of endodontics.
Journal Article↗
Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease.
BACKGROUND: In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. METHODS: We studied 154 children with virus-culture confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. FINDINGS: Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95% CI 2.6-60.1], p=0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p=0.003). INTERPRETATION: EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.
Adolescent↗
Diagnosis of respiratory tract viruses in 24 h by immunofluorescent staining of shell vial cultures containing Madin-Darby Canine Kidney (MDCK) cells.
Nine hundred and seventy-eight clinical specimens were examined taken from patients with respiratory tract viruses (RV)-like syndrome between November 1996 and July 1998. The study was undertaken to evaluate the effectiveness of centrifuge-enhanced shell vial cultures (SVC) containing Madin-Darby Canine Kidney (MDCK) cells, combined with immunofluorescent (IF) staining in 24 h. This technique rapidly detects and identifies respiratory tract viruses. The conventional tube culture system with multiple cell lines would ordinarily detect RV within 3-30 days. The SVC/IF method using single cell line (MDCK cells) allowed detection of 81.5% of influenza A virus, 72% of parainfluenza virus, 82.6% of respiratory syncytial virus (RSV) and 79.6% of adenovirus in 24 h.
Adenoviridae↗
Stability of blood pressure: is a sequential blood pressure reading protocol efficient for a large-scale community screening programme.
The purpose of this study is to assess the relative stability of the systolic and diastolic blood pressure (BP) measures obtained in a state-wide screening programme. A state-wide hypertension survey was conducted in California in 1983 in which a total of 6381 adults were interviewed in their homes. Three BP measurements were taken, with a 5-min interval between each measure. The BP screening protocol used by The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure recommended a total of three measures, in which the second and the third measures are averaged. Results of the household survey indicated significant differences between the three subsequent BP measurements (P < 0.001), with much smaller differences between the second and third measure. This result implies that BP of an individual is approaching stability after the second measure and, consequently, two subsequent BP measurements may be sufficient to identify subjects with elevated BP. We compare the three-measure screening protocol with a two-measure screening protocol in which only the first two BP readings are taken and the second reading is used to indicate BP levels of subjects. The percentage of agreement between the three-measure and the two-measure screening protocols is 97.57%. Using the three-measure screening protocol as a standard, the sensitivity and false-negative rate are 98.73% and 0.43%, respectively. The two-measurement screening protocol is recommended as an equally sensitive and a more efficient procedure for a large-scale community-screening programme.
Adolescent↗
Catatonic features: differential diagnosis and treatments at an emergency unit.
During a 2-year period, 34 patients of catatonic features in Chinese ethnic background Taiwanese were brought to the emergency unit of Chang Gung Memorial Hospital at Linkou. The ratios of the causes of catatonic features by schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions were 26, 9, 24 and 41%, respectively. After the treatments of antipsychotics, benzodiazepam, or electroconvulsive therapy (ECT), 24 patients (70.6%) showed complete remission, seven patients (20.6%) showed partial remission, and three patients (8.8%) showed no response (two died). Additionally, a suggestive period is proposed in order to distinguish acute and insidious onset catatonic conditions to help clinicians in deciding on probability immediately. The patients were grouped into four diagnostic categories; namely, schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions for comparison. One-way ANOVA and Duncan's multiple-range test were used for continuous variables, and the Chi-squared test was used for categorical variables. The mean duration of 'insidious onset catatonic condition' (including schizophrenic disorders and general medical conditions) before seeking medical help was longer than 3.33 weeks, while the mean duration of 'acute catatonic condition' (including mood disorders and neuroleptic-induced disorders) was shorter than 1.83 weeks. These findings suggest that 2-3 weeks would be a cut-off point for acute or insidious onsets of catatonic conditions.
Acute Disease↗
Thumb reconstruction in a bilateral upper extremity amputee: an alternative to the Krukenburg procedure.
A 23-year-old man sustained traumatic loss of both hands. His left defective forearm underwent lengthening with a 3-cm segment of the ipsilateral radius; this was immediately followed by an ipsilateral second toe microvascular transfer to the stump of the radius to provide pinch. Two years after the procedure the reconstructed hand had recovery of both motion and sensibility.
Adult↗
Infected cephalohematoma associated with sepsis and skull osteomyelitis: report of one case.
Osteomyelitis is rarely complicated by an infected cephalohematoma. We report a case of an infected cephalohematoma associated with Escherichia coli sepsis and osteomyelitis of the skull. This 37-day-old boy had E. coli sepsis, which had a poor response to antibiotic treatment. An infected cephalohematoma was found when he was 43 days old. Cranial computed tomography (CT) scanning showed cephalohematoma with abscess formation and underlying bony destruction over the left parietal region. Antibiotics alone could not eradicate the infection. Extensive incision, drainage, and debridement of the necrotic bone resulted in prompt improvement. Three weeks of ceftizoxime administered intravenously, followed by 3 weeks of cefixime given orally completed the treatment course.
Anti-Bacterial Agents↗
Obesity concerns, weight satisfaction and characteristics of female dieters: a study on female Taiwanese college students.
OBJECTIVE: This study was designed to obtain baseline data regarding desired body weight, weight satisfaction, self-perceived weight categories, approaches to weight loss of female college students in Taiwan. The characteristics of subjects who are dieting were also assessed. METHODS: One thousand, fifty-seven female college students participated in this study. Written questionnaires were used for data collection. Students' height and weight were also measured. Simple frequency and one-way analysis of variance (ANOVA) were used to analyze data. Post hoc analyses were performed with the LSD test when the F ratio for the ANOVA was significant at p<0.05. RESULTS: In general, subjects perceived themselves as being heavier than their actual weight categories. The percentage of subjects who perceived they were overweight or obese was much higher than the percentage of subjects who were actually in these categories (51.4% vs. 16.2%). Above 20% of subjects in both severely underweight and underweight categories use some methods to lose weight. More than 60% of subjects in acceptable weight categories still want to lose weight. A higher percentage of subjects chose exercise than dieting as the major weight-loss method. Subjects in the DS/D (dissatisfied/dieting) group did not score higher points for knowledge and attitude in nutrition, and they tended to measure their body weight more frequently (p<0.05), spent more time for exercise (p<0.05) and for reading nutrition information (p<0.05); they also skipped lunch (p<0.05) more frequently than others. CONCLUSIONS: The results indicate that risk factors leading to eating disorders are common among Taiwanese college females. Dietitians, physicians and other health professionals should be on the alert to identify patients with eating disorders.
Adolescent↗