S C Huang

Publications (73)63.71 Total impact

• Article: Endomyocardial biopsy in heart transplantation: schedule or event?

  N-H Chi, N-K Chou, C-I Tsao, S-C Huang, I-H Wu, H-Y Yu, Y-S Chen, S-S Wang
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  ABSTRACT: Endomyocardial biopsy is the gold standard to identify rejection after heart transplantation. Due to its invasiveness, discomfort, and difficult vascular access, some patients are not willing to accept routine scheduled biopsies years after heart transplantation. The purpose of this study was to identify whether there was a difference in outcomes among the scheduled versus event biopsy groups. We studied 411 patients who underwent heart transplantation from 1987 to 2011, reviewing biopsy results and pathology reports. There were 363 patients who followed the scheduled biopsy protocol, and 48 patients who were assigned to the event biopsy group. We extracted data on biopsy results, rejection episodes, rejection types, and survival time. The 2481 reviewed biopsies over 24 years, showed most rejection episodes (86.4%) to occur within 2 years after heart transplantation. The rejection incidence was low (2.1%) at 3 years after transplantation. The major reason for an event biopsy was poor vascular access, such as tiny central vein or congenital disease without a suitable central vein. Event biopsy group patients were younger than schedule biopsy patients (19.7 years old vs 47.6 years old; P < .05). The 10-year survival rates were 64% among the event versus 53% among the scheduled biopsy group (P = .029). The 10-year rates of freedom from rejection were similar. The rejection rate was low after 3 years; episodes occurred within 2 years. Although the long-term survival in the event group was better, they had a younger man age. The rejection and freedom from rejection rates were similar. As the rejection rate was low at 3 years after transplantation, we suggest that the event principle could be applied for biopsy at 3 years after heart transplantation.
  Transplantation Proceedings 05/2012; 44(4):894-6. · 1.00 Impact Factor
• Article: Extracorporeal membrane oxygenation and Thoratec pneumatic ventricular assist devices as double bridge to heart transplantation.

  N-K Chou, J-M Luo, N-H Chi, I-H Wu, S-C Huang, Y-S Chen, H-Y Yu, C-I Tsao, W-J Ko, S-H Chu, S-S Wang
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  ABSTRACT: Ventricular assist devices have benefited patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experiment of HTx using extracorporeal membrane oxygenation (ECMO) with Thoratec pneumatic ventricular assist device (TpVAD). From May 1996 to June 2011, among 410 patients who underwent HTx 23 required mechanical circulatory support (MCS) with implantation of the TpVAD and 15 (65%) of them received grafts. The 23 patients included 4 female and 19 male patients of age range 10 to 80 years. Eighteen (78%) of them needed ECMO before TpVAD implantation. Twelve (67%) were implanted with a TpVAD double bridge to HTx. The demand for MCS among patients with acute hemodynamic collapse has led to major improvements in the existing systems such as ECMO with double bridge to TpVAD. We used ECMO as a rescue procedure for acute hemodynamic deterioration. However, during ECMO support, left ventricular afterload increased. If prolonged support is required, TpVAD might be required: 15 (65%) of patients supported by ECMO with TpVAD needed to a wait a suitable donor. We recommend the application of ECMO for short-term support (within 1 week), and TpVAD as a bridge for medium- or long-term support.
  Transplantation Proceedings 05/2012; 44(4):878-80. · 1.00 Impact Factor
• Article: Ventricular assist device application as a bridge to pediatric heart transplantation: a single center's experience.

  K H Hsu, S C Huang, N H Chou, N H Chi, C I Tsao, W J Ko, Y S Chen, C I Chang, I S Chiu, S S Wang
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  ABSTRACT: There are limited options for mechanical circulatory support to treat end-stage heart failure in pediatric patients. Although extracorporeal membrane oxygenation is commonly used in infants and children, ventricular assist devices (VAD) provide a longer duration of support with fewer complications before recovery or as a bridge to heart transplantation (HTx), as described herein. This retrospective chart review of eight patients transplanted from April 2008 to December 2011, after left ventricular assist device (LVAD) implantation due to end-stage heart failure. Their mean age was 12 years (9-15 y) and mean body weight, 48 kg (20-78). All were New York Heart Association functional class IV with mean left ventricular ejection fractions less than 15%. The six patients (75%) received HTx after a mean LVAD support duration of 43.2 days; 2 (25%) died before a suitable heart became available. Their mean duration of LVAD support was 30 days. There were 4 (50%) who experienced clinically evident thromboembolic events: 3 (37.5%) cerebrovascular with 1 mortality and 1 (12.5%) as acute limb ischemia. Transient hemodialysis was performed in 4 (50%). Bloodstream infection identified in 6 (75%) was controlled with intravenous antibiotics. Driveline infection identified in 4 (50%) was treated successfully with local wound dressing changes and intravenous antibiotics. One 9-year-old boy died of rejection at 16 months after transplantation. Because of the organ shortage, pediatric patients have a low chance to undergo HTx. VAD provides long-term support for children with end-stage heart failure before a suitable heart becomes available. A thromboembolic event remains a major complication influencing their survival.
  Transplantation Proceedings 05/2012; 44(4):883-5. · 1.00 Impact Factor
• Article: The outcome of heart transplantation in hepatitis C-positive recipients.

  M-H Lin, N-K Chou, N-H Chi, Y-S Chen, H-Y Yu, S-C Huang, W-J Ko, H-W Chou, S-S Wang
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  ABSTRACT: Clinical outcomes of heart transplantation (HTx) among recipients with chronic hepatitis C virus (HCV) infection are poorly understood especially in Asia. Therefore, this study evaluated these clinical outcomes. Using retrospective chart review we collected data on 385 patients including 20 HCV-positive recipients at the time of transplantation. We obtained information on demographics features, serial transaminases, graft function, patient survival as well as the incidences of acute hepatitis and transplant coronary artery disease. Between 1987 and 2010, the 20 HCV-positive patients had a median age at transplantation of 52 years (range, 30-63). Seventeen were men and three women. All the patients were classified as Child-Pugh class A; two had cirrhosis prior to HTx. Over a mean follow-up of 63 months (range, 2 days to 187 months), there were 11 deaths, including two hospital mortalities and nine subsequent deaths. Only one mortality (5%) was related to Child-Pugh class C cirrhosis, despite liver transplantation. Among the other 19 deceased or surviving recipients, there was no evidence of hepatic dysfunction or hepatocellular carcinoma. Transplant coronary artery disease was detected in six patients (30%). There was no significant difference in Kaplan-Meier actuarial survival between the HCV-positive and HCV-negative recipients (P = .59). There was no significant difference in patient survival or graft function between HCV-positive and HCV-negative HTx recipients. Additionally, HCV-positive recipients were not at an increased risk of hepatic failure or accelerated transplant coronary artery disease.
  Transplantation Proceedings 05/2012; 44(4):890-3. · 1.00 Impact Factor
• Article: Cardiac allograft vasculopathy compared by intravascular ultrasound sonography: everolimus to mycophenolate mofetil--one single-center experience.

  N-K Chou, C-F Jan, N-H Chi, C-M Lee, I-H Wu, S-C Huang, Y-S Chen, H-Y Yu, C-I Tsao, W-J Ko, S-H Chu, S-S Wang
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  ABSTRACT: Cardiac allograft vasculopathy (CAV) remains one of the leading causes of late graft failure and death. Cyclosporine microemulsion Neoral (CsA) had been used in heart transplantation (HTx) recipients. Meanwhile, Everolimus (EVL; Certican, Norvatis Pharmaceuticals; Basel, Switzerland) or mycophenolate mofetil (MMF) have been combined with CsA for maintenance treatment. We compared atherosclerosis in HTx patients showing CAV by intravascular ultrasound (IVUS) in two groups: the CE who received CsA, EVL, and steroid versus the CM group, who received CsA, MMF, and steroid. We explored IVUS parameters such as plaque thickness (PT), lumen circumference (LC), media adventitial circumference, lumen diameter (LD), and media adventitial diameter to characterize the atherosclerosis among CE versus CM groups. In this study, both the CE and CM groups showed increased plaque thickening in the first year posttransplantation (P < .05). However, MMF significantly reduced LC and LD (P < .05) Upon multivariate linear regression analysis, the CE group seemed to show less effect on the maximal difference in PT between 2 and 12 months after adjusting for age at transplantation and gender (P < .05). There was no acute clinical adverse event of CAV reported in either both group during the follow-up. The atherosclerosis of CAV revealed by LC, LDmax, and LDmin was significantly less among patients treated with CE than CM. These results suggested that everolimus-treated patients showed benefits compared with MMF-treated subjects as extrapolated from these IVUS data.
  Transplantation Proceedings 05/2012; 44(4):897-9. · 1.00 Impact Factor
• Article: Clinical experience of tacrolimus with everolimus in heart transplantation.

  S-S Wang, N-K Chou, N-H Chi, S-C Huang, I-H Wu, C-H Wang, H-Y Yu, Y-S Chen, C-I Tsao, W-J Ko, C-T Shun
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  ABSTRACT: Tacrolimus (Tac) in combination with mycophenolate mofetil is widely used after heart transplantation (HT). Everolimus (EVR), a new potent proliferation signal inhibitor can be used with a carcineurin inhibitor to reduce the occurrence of rejection. The purpose of this study was to evaluate the efficacy and safety of Tac combined with EVR in de novo HT. From January 2009 to April 2011, 33/62 patients who underwent HT were prescribed Tac and EVR as de novo immunosuppression. The main exclusion criteria were poor kidney function (serum creatinine > 2.8 mg/dL), panel-reactive antibodies > 25%, donors > 60 years old, or cold ischemia time > 6 hours. All patients received Tac (C0 blood level 5-10 ng/mL during the first 6 months, then 3-5 ng/mL), EVR (C0 target 3-8 ng/mL), and corticosteroids. After transplantation, routine examinations included echocardiogram and protocol endomyocardial biopsy. There was no operative mortality. The 1- and 3-year actuarial survivals were 95.74% ± 3.49%. One patient who had undergone coronary artery bypass grafting previously and received intra-aortic balloon pumping and extracorporeal membrane oxygenator-assisted cardiopulmonary resuscitation before HT died of Aspergillus septicemia 58 days after HT. No biopsy-proven acute rejection > grade 2R or acute rejection associated with hemodynamic compromise was observed. Hyperlipemia was noted in 16 cases (48.5%), hypertension in 11 (33.3% 5%), and diabetes mellitus in 12 (36.4%). No other severe adverse events were noted. Concentration-controlled EVR (C0 target 3-8 ng/mL) in combination with Tac achieved good efficacy and safety. The 1- and 3-year actuarial survivals were 95.74% ± 3.49%.
  Transplantation Proceedings 05/2012; 44(4):907-9. · 1.00 Impact Factor
• Article: Heart retransplantation for pediatric primary allograft failure.

  J M Luo, N K Chou, Y S Chen, S C Huang, N H Chi, H Y Yu, W J Ko, S S Wang
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  ABSTRACT: Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. When the transplanted heart fails, retransplantation is suggested and herein we have presented the prognosis of these pediatric cases. From March 1987 to March 2011, we performed 404 heart transplantations including 45 pediatric patients, 6 (13.3%) of whom experienced graft failure requiring retransplantation. Only four of the six patients (66.7%) had a chance for retransplantation. Six of 45 pediatric heart transplant patients (13.3%) experienced graft failure requiring retransplantation. Four of them (66.7%) underwent retransplantation. Only one of the four died due to severe postoperative sepsis with acute respiratory distress. The other three patients recovered well and remain alive with no neurological sequelae; all are in New York Heart Association functional classification I at present. Pediatric post-heart graft failure require expectations retransplantation, which shows a good prognosis.
  Transplantation Proceedings 05/2012; 44(4):913-4. · 1.00 Impact Factor
• Article: Twenty-four year single-center experience of hepatitis B virus infection in heart transplantation.

  Y C Chen, M K Chuang, N K Chou, N H Chi, I H Wu, Y S Chen, H Y Yu, S C Huang, C H Wang, C I Tsao, W J Ko, S S Wang
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  ABSTRACT: Hepatitis B virus (HBV) infection is hyperendemic in Taiwan. We have reported the outcome of (1) recipients with hepatitis B surface antigen (HBsAg)-positive; HBsAg-negative recipients who receive donor hearts from HBsAg-positive donors; and treatment with lamivudine of hepatitis B flare-ups after heart transplantation, using case numbers that range from 100 to 200. From July 1987 to May 2011, all 412 orthotopic heart transplant recipients and donors underwent routine preoperative screening for hepatitis B virus markers and liver function parameters. Lamivudine was prescribed prophylactically for recipients with elevated serum enzyme levels or an HBV DNA virus load before transplantation, or when there was evidence of hepatitis B flare-up after transplantation. Postoperative HBV markers and liver function parameters were collected over a mean follow-up time of 7.8 years. Thirty-four recipients were HBsAg-positive before heart transplantation, and 23 experiencing HBV reactivation upon follow-up requiring lamivudine treatment. Clinical responses were achieved in all of them: 15 were complete and two, slow partial responses. Twenty-six recipients with an HBV naïve status at the time of heart transplantation, and three patients received donor hearts from an HBsAg-positive donor under perioperative hepatitis B immunoglobulin prophylaxis. HBV infection was successfully prevented in two patients, but the other one contracted HBV hepatitis, which was successfully treated with lamivudine. HBV reactivation after the heart transplantation was common but usually well controlled with lamivudine treatment. Although posttransplantation liver function deteriorated for a period, there was no HBV infection-related morbidity or mortality. Perioperative hepatitis B immunoglobulin prophylaxis can successfully prevent HBV naïve recipients from infection in some cases, but HBsAg-positive donors should only be considered in high risk situations.
  Transplantation Proceedings 05/2012; 44(4):910-2. · 1.00 Impact Factor
• Article: Molecular phylogeny of Phalaenopsis Blume (Orchidaceae) on the basis of plastid and nuclear DNA

  C. C. Tsai, Y. C. Chiang, S. C. Huang, C. H. Chen, C. H. Chou
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  ABSTRACT: The internal transcribed spacers (ITS) of nuclear ribosomal DNA (nrDNA) and plastid DNA, including the trnL intron, the trnL-F spacer, and the atpB-rbcL spacer, from most of the living species in the genus Phalaenopsis were sequenced. The monophyly of the genus described by Christenson (Christenson EA (2001) Phalaenopsis. Timber Press, Portland, p 330), that Doritis and Kingidium are synonyms of Phalaenopsis, was supported by these molecular data. Within the genus, subgenus Polychilos was monophyletic, and the species were divided into two subclades. The subgenus Phalaenopsis was shown to be non-monophyletic, because the sections Esmeralda and Deliciosae appeared separated the from sections Phalaenopsis and Stauroglottis. Meanwhile, subgenera Aphyllae and Parishianae were also shown to be non-monophyletic on the basis of the molecular data. Furthermore, the monotypic species of subgenus Proboscidioides, P. lowii, formed a clade with subgenus Aphyllae. In accordance with geographical distribution, the historical geography of Southeast Asia due to the periodic glacial epochs, and molecular phylogeny, two evolutionary trends of Phalaenopsis from the original center in South China to the Philippines, Indonesia, and Malaysia were suggested. First, using Indochina and some older parts of the Philippines (e.g., Mindoro and Palawan) as stepping stones, Phalaenopsis species dispersed from South China to the Philippines, where the sections Phalaenopsis and Stauroglottis of subgenus Phalaenopsis developed. Second, using the Malay Peninsula as a stepping stone, Phalaenopsis species dispersed from South China to Indonesia and Malaysia, where the subgenus Polychilos developed. Keywords Phalaenopsis -Phylogeny-Biogeography-Plastid DNA
  Plant Systematics and Evolution 04/2012; 288(1):77-98. · 1.34 Impact Factor
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  Available from: endocrine.org.tw

  Article: Treatment of osteoporosis with TheraCyte-encapsulated parathyroid cells: a study in a rat model.

  F-F Chou, S-C Huang, S-S Chen, P-W Wang, P-H Huang, K-Y Lu
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  ABSTRACT: The purpose of this study was to evaluate parathyroid function at monthly intervals following the implantation of TheraCyte-encapsulated live human parathyroid cells into ovariectomized rats and to determine the effect on bone mineral density (BMD) 4 months after ovariectomy ( 3 months after implantation). Parathyroid tissues were obtained from patients undergoing surgery for secondary hyperparathyroidism. In total, 21 Sprague-Dawley rats divided randomly into three groups were subjected to one of three treatments: (1) implanted with TheraCyte A-encapsulated 4x10(6) live parathyroid cells; (2) implanted with TheraCyte B-encapsulated 4x10(5) live parathyroid cells; (3) a sham operation; the control group. Rats were ovariectomized 1 month prior to the implantation of the TheraCyte. Blood was drawn at the time of implantation and at monthly intervals thereafter for 3 months to check the levels of calcium, phosphorus and intact parathyroid hormone (iPTH). The BMD of the lumbar spine (L1-L5) and of the left femoral bone was measured with dual-energy-X-ray absorptiometry (DEXA) 1 month after ovariectomy and 3 months after implantation of the TheraCyte (4 months after ovariectomy). We found that the viability ratio of cryopreserved tissues was between 55 and 79% after thawing. In the control group, the BMD of the lumbar spine (L1-L5) had not decreased significantly (p=0.237) nor had the BMD of the left femoral bone increased significantly (p=0.063) 3 months after implantation. In the TheraCyte A group, the BMD of both the lumbar spine (p=0.018) and left femoral bone (p=0.018) had increased significantly 3 months after implantation. In the TheraCyte B group, the BMD of both the lumbar spine (p=0.017) and the left femoral bone (p=0.025) had also increased significantly 3 months after implantation. Serum iPTH levels were higher in the TheraCyte A group than in the TheraCyte B group (p=0.006), and higher in the TheraCyte B group than in the control group (p=0.040). Serum calcium levels were not significantly higher in the TheraCyte group A than in the TheraCyte B group or in the control group. Serum phosphorus levels were not significantly different between the TheraCyte A and TheraCyte B groups. Implantation of TheraCyte A-encapsulated 4x10(5) live parathyroid cells and TheraCyte B-encapsulated 4x10(6) cells can increase the BMD of ovariectomized rats within 3 months of implantation. Neither cause high serum calcium and low phosphorus concentrations.
  Osteoporosis International 02/2006; 17(6):936-41. · 4.58 Impact Factor
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  Available from: images3.wikia.nocookie.net

  Article: Molecular phylogeny of Phalaenopsis Blume (Orchidaceae) based on the internal transcribed spacer of the nuclear ribosomal DNA

  C C Tsai, S C Huang, C H Chou
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  ABSTRACT: The internal transcribed spacer (ITS1, 5.8S rDNA, and ITS2) region of nuclear ribosomal DNA (nrDNA) was sequenced from 53 species, which represent most of the living species diversity in the genus Phalaenopsis (Orchidaceae). A phylogeny was developed for the genus based on the neighbor-joining and maximum parsimony analyses of molecular data. Results of these analyses provided support for the monophyly of the genus Phalaenopsis and concurred in that the genera Doritis and Kingidium should be treated as being parts of the genus Phalaenopsis as suggested by Christenson (2001). Within the genus Phalaenopsis, neither subgenera Aphyllae nor Parishianae were monophyletic, and they were highly clustered with subgenus Proboscidioides plus sections Esmeralda and Deliciosae of subgenus Phalaenopsis based on ITS data. Those species also have the same characters of morphology of four pollinia and similar biogeographies. Furthermore, neither subgenus Phalaenopsis nor Polychilos was monophyletic. Within the subgenus Phalaenopsis, only section Phalaenopsis was highly supported as being monophyletic. As for the subgenus Polychilos, only section Polychilos was moderately supported as being monophyletic. In conclusion, the present molecular data obtained from the ITS sequence of nrDNA of the genus Phalaenopsis provide valuable information for elucidating the phylogeny of this genus.
  Plant Systematics and Evolution 10/2005; 256(1):1-16. · 1.34 Impact Factor
• Article: Cerebral infarction in perinatal and childhood bacterial meningitis.

  C-J Chang, W-N Chang, L-T Huang, Y-C Chang, S-C Huang, P-L Hung, H-H Ho, C-S Chang, K-W Wang, B-C Cheng, C-C Lui, H-W Chang, C-H Lu
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  ABSTRACT: Cerebral infarction is an important neurological complication of childhood bacterial meningitis, but little is known about its epidemiology and outcomes. To determine the predictive factors, clinical features, causative pathogens, and outcomes of cerebral infarction secondary to perinatal and childhood bacterial meningitis. Retrospective analysis Over the period 1986-2001, 166 perinatal and childhood patients were identified as having culture-proven bacterial meningitis, of whom 14 had cerebral infarction at admission. The clinical and CSF data of patients with and without cerebral infarctions on admission were compared. Cerebral infarction patients accounted for 10% (14/166) of bacterial meningitis cases, mostly in the first year of life (11/14, 79%). Salmonella species (n = 4) and Streptococcus pneumoniae (n = 4) were the most frequent causative pathogens, accounting for 57% (8/14) of episodes. Single infarctions were found in four patients and multiple infarctions in 10. At 1 year follow-up, outcome was good in three, but poor in 11. Significant differences between the two patient groups at admission included age bands, presence of seizures, hydrocephalus, disturbed consciousness on admission, and CSF lactate concentration. There was a high prevalence of cerebral infarctions when the disease was caused by S. pneumoniae and Salmonella species. Occurrence was highest in the first year of life, and the prognosis in this patient group is poor. Risk factors associated with cerebral infarction in our patients included age 28-365 days, seizures, hydrocephalus, disturbed consciousness on admission, and high CSF lactate concentrations.
  QJM: monthly journal of the Association of Physicians 11/2003; 96(10):755-62. · 2.33 Impact Factor
• Article: Different management options for anaphylactoid purpura with intussusception: a case report.

  W C Li, S F Ko, H W Kuo, S C Huang, C D Liang, M M Tiao
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  ABSTRACT: Intussusception is the most common surgical indication of anaphylactoid purpura. About 50% of cases are of the ileo-ileal type. Surgical intervention, rather than radiologic reduction, is preferable for older children suffering from anaphylactoid purpura with intussusception, where a lead point lesion is often found. The authors report a case of anaphylactoid purpura with intussusception with spontaneous reduction, and postulate that subsequent to relieving bowel-wall edema using antihistamine and steroid therapy, the ileo-ileal intussusception may spontaneously reduce.
  Academic Emergency Medicine 11/2001; 8(10):1005-7. · 1.86 Impact Factor
• Article: Hepatic focal nodular hyperplasia in children: report of three cases.

  P L Hung, S C Huang, H W Kuo, C S Shieh, M M Tiao
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  ABSTRACT: Hepatic focal nodular hyperplasia is very rare in children. We present 3 cases aged from 8 to 17 years. All of them are girls, none of whom used oral contraceptives. Case 1 was a hepatitis B carrier and was incidentally found to have focal nodular hyperplasia (FNH). The other 2 cases presented with abdominal pain. Abdominal computed tomography revealed a solitary liver tumor in cases 2 and 3, but no abnormalities in case 1. A 7-cm tumor was located in the left lobe of the liver with compression of the stomach in the 2nd case. Abdominal magnetic resonance imaging (MRI) showed a mass with isointense density to liver parenchyma on T1WI and hyperdensity on T2WI in the 1st and the 3rd cases. The inferior vena cava was compressed and displaced anteriorly in the 1st case. Because of differences in the clinical presentation and imaging studies, the 1st and 2nd cases received resection while the 3rd case was treated conservatively. Pathologic findings confirmed the diagnosis of focal nodular hyperplasia in all 3 cases. We emphasize the importance of an MRI scan in the diagnosis of hepatic focal nodular hyperplasia, and different clinical manifestations and imaging studies may lead to different management.
  Chang Gung medical journal 11/2001; 24(10):657-62.
• Article: Pulmonary valvular stenosis complicated by cerebrovascular accident and congestive heart failure in a young child.

  Y T Chu, C D Liang, S F Ko, S C Huang, M M Tiao
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  ABSTRACT: Pulmonary valvular stenosis (PS) with intact ventricular septum is a common congenital heart disease. In general, mild PS has a benign clinical course. However, in severe PS and some cases of moderate stenosis, increasing severity of the lesion may occur. The manifestations of either cerebrovascular accident (CVA) or congestive heart failure (CHF) are rarely reported in pediatric patients with PS. In this report, we describe a girl with severe PS complicated by seizures and sudden onset of hemiparesis at 13 months of age who developed CHF when 16 months old. CHF was cured after successful balloon valvuloplasty. She remained well without residual hemiparesis or recurrent seizures during the 1-year follow-up. Early balloon valvuloplasty should be emphasized in patients with severe PS, even if there are no significant clinical symptoms. With prompt balloon valvuloplasty, these complications can be effectively prevented.
  Chang Gung medical journal 09/2001; 24(8):517-21.
• Article: Pancreatitis with gallbladder ascariasis in a child: case report.

  M M Tiao, C D Liang, S C Huang, C B Huang, H H Shih
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  ABSTRACT: A 10-year-old girl was admitted for abdominal pain for 1 week. Morning vomiting with 5 Ascaris and diarrhea with Ascaris were found. Radiograph of the abdomen disclosed no significant abnormality. Abdominal sonogram revealed a normal biliary tree; but mildly enlarged pancreatic thickness, and thickened gallbladder wall. Within the thickened gallbladder wall a linear echogenic structure with worm-like movement suspected of being Ascaris was found. We report this case because pediatric pancreatitis and a gallbladder wall thickened with worm-movement have rarely been reported. Urgent treatment and surgery are required for the very ill child with a tensely distended abdomen or signs of peritoneal irritation. Early diagnosis is very important to prevent further complications. We emphasize the role of sonography in the diagnosis of this case and the prevention of progressive deterioration.
  Chang Gung medical journal 02/2001; 24(1):68-71.
• Article: Acute necrotizing encephalopathy of childhood.

  H S Wang, S C Huang
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  ABSTRACT: Symmetric change of the entire area of the bilateral thalami, as with panthalamic lesions, plus involvement of other regions in the brain rarely occurs to previously healthy children. The term, acute necrotizing encephalopathy of childhood, has recently been proposed. Its clinical, radiological, and pathological features are described. This disease predominantly affects infants and young children living in Taiwan and Japan, and manifests itself as acute encephalopathy following 2 to 4 days of fever and minor symptoms of the respiratory and/or gastrointestinal systems. The hallmark of this encephalopathy consists of multifocal, symmetric brain lesions affecting the bilateral thalami, and/or cerebral periventricular white matter, brainstem tegmentum, or cerebellar medulla, which can be documented by ultrasonography, computed tomography, and magnetic resonance imaging of the brain. The prognosis is usually poor. Less than 10% of patients recover completely. Cases with good outcome were reported to have reversible imaging changes. Focal neurologic deficits are common sequelae. The pathogenesis of acute necrotizing encephalopathy of childhood is still not known. Some diseases, such as Reye's syndrome, vascular occlusion, tumor, hemorrhage of the thalamus, Sandhoff disease, or Leigh and Wernicke encephalopathies must be differentiated clinically, radiologically, or pathologically. By excluding other disease entities, acute necrotizing encephalopathy of childhood can be diagnosed.
  Chang Gung medical journal 02/2001; 24(1):1-10.
• Article: Pancreatic pseudocysts in children.

  M M Tiao, J H Chuang, S F Ko, C S Shieh, S C Huang, C D Liang, H W Kuo
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  ABSTRACT: Pancreatic pseudocysts in children are uncommon. The purpose of this study was to investigate the clinical course, image findings (with emphasis on sonograms), and outcome of 12 patients with pancreatic pseudocysts. From January 1986 to May 2000, 12 patients with a diagnosis of pancreatic pseudocysts were encountered in our hospital. There were 8 males and 4 females with ages ranging from 3 to 18 years. The etiology was blunt abdominal trauma in all 12 cases. The cysts were detected from 3 to 57 days after injury, and the sizes ranged from 0.6 to 16 cm. Six patients received surgical treatment. External drainage was performed in 3 cases, subtotal pancreatectomy in 1, cystogastrostomy in 2. Initial serum amylase level correlated with neither the time to normalization (r = 0.354, p = 0.268), cystic appearance after trauma (r = 0.029, p = 0.933), nor resolution (r = 0.322, p = 0.309). Sonographic follow-up revealed that the disappearance of cysts was noted from 11 days to 10 months following injury. The size of the pseudocysts correlated with neither the time of detection (r = 0.284, p = 0.371) nor disappearance (r = -0.175, p = 0.586). Serial sonogram examinations play an important role in monitoring the progress of pancreatic pseudocysts, which may develop even 57 days after injury. The size of pseudocysts correlated with neither the times of detection nor disappearance, and the initial serum amylase level correlated with neither the time to normalization nor cystic appearance after trauma.
  Chang Gung medical journal 01/2001; 23(12):761-7.
• Article: Clinical features and outcome of appendicitis in children younger than three years of age.

  C B Huang, H R Yu, G C Hung, S C Huang, J H Chuang
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  ABSTRACT: Acute appendicitis is the most common surgically amenable cause of acute abdominal pain in children. We analyzed our past experience of appendectomies in children and present the clinical characteristics of appendicitis in children younger than 3 years of age. A better understanding of appendicitis in early childhood would allow us to achieve an earlier diagnosis. A group of 475 children from 4 months to 15 years of age who underwent appendectomy for appendicitis was studied over a 5-year period from July 1994 to June 1999. Excluding cases with negative pathological findings (n = 34), they were divided into 2 age groups: group I (< or = 3 years old) and group II (> 3 years old). Medical records were reviewed and comparisons between clinical findings, laboratory data, pathology findings, and complications were made. Of 441 cases enrolled in our study, 24 (5.4%) were 3 years of age or younger. Of all children older than 3 years of age, 32 (7.1%) had negative pathological findings compared to children younger than 3 years of age (7.7%). The duration of symptoms prior to diagnosis in group I was 3.6 days compared to group II at 2.0 days. Children from group I frequently showed a higher incidence of fever (90% vs. 53.4%), abdominal distention (50% vs. 9.8%), perforation (50% vs. 40.1%), and missed first impression (29% vs. 2.4%) than those from group II. Children of group I also had a higher complication rate (41.7% vs. 11.5%). In early childhood the symptoms and signs of appendicitis usually are nonspecific. There is a longer duration before diagnosis, more instances of fever and abdominal distention, less right lower quadrant pain, less local tenderness and rebounding pain, and no obturator sign. Close observation and on-going evaluation of patients are essential.
  Chang Gung medical journal 01/2001; 24(1):27-33.
• Article: Genetic heterogeneity in three Chinese children with Fukuyama congenital muscular dystrophy.

  Y J Jong, K Kobayashi, T Toda, E Kondo, S C Huang, Y Z Shen, I Nonaka, Y Fukuyama
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  ABSTRACT: Three Chinese patients, two boys and one girl, were afflicted with the typical clinical, myopathological and neuroradiological findings of Fukuyama congenital muscular dystrophy (FCMD). Polymorphism analysis of our patients did not reveal the founder haplotype (138-192-147-183 in D9S2105-D9S2170-D9S2171-D9S2107) of Japanese FCMD, even though one patient was descended from Japanese ancestry. Full mutational analysis of the fukutin gene revealed that there is neither 3 kb insertion nor point mutation. These findings suggest genetic heterogeneity between Chinese and Japanese FCMD patients.
  Neuromuscular Disorders 03/2000; 10(2):108-12. · 2.80 Impact Factor