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Biomedical subjects

C C Yen

Publications and source records attributed to C C Yen.

At least 55 records · Page 3Linked to original sources
PubMed1997

Treatment of previously treated metastatic breast cancer by mitoxantrone and 48-hour continuous infusion of high-dose 5-FU and leucovorin (MFL): low palliative benefit and high treatment-related toxicity.

For previously treated advanced breast cancer, there is no standard second-line therapy. Combination chemotherapy with mitoxantrone, high-dose 5-fluorouracil (5-FU) and leucovorin (MFL regimen) had been reported as an effective and well tolerated regimen. From October 1993 to November 1995, we treated 13 patients with previously chemotherapy-treated metastatic breast cancer by mitoxantrone, 12 mg/m2, on day 1 and continuous infusion of 5-FU, 3000 mg/m2, together with leucovorin, 300 mg/m2, for 48 h from day 1 to 2. Each course of chemotherapy was given every 4 weeks. Most of these patients had more than two metastatic sites, with lung metastasis predominant. Seven patients had been treated with anthracycline. Seven patients had previously received radiotherapy and seven had received hormone therapy. Median number of courses of MFL regimen given was six and the median cumulative dose of mitoxantrone was 68.35 mg/m2. One patient had complete response, seven had stable disease, none had partial response and five had progressive disease. The overall objective response rate was 7.6%. The median follow-up period was 14 months. Median survival was 16 months. Median progression-free survival was 5 months. A complete responder had relapse-free survival up to 17 months. Major toxicities were cardiotoxicity and leukopenia. Eight patients were dead in the last follow-up; two of them died of treatment-related toxicity. The MFL regimen achieves little palliative benefit and induces severe toxicity at a fairly high rate. Administration of this regimen to breast cancer patients who have been treated by chemotherapy and those with impaired heart function requires careful attention.

Adult↗
PubMed1997

Orthoclone OKT3 for graft failure after allogeneic bone marrow transplantation: a case report.

Orthoclone OKT3 has been used in the prophylaxis or treatment of acute graft-versus-host disease (GVHD). No previous report of Orthoclone OKT3 in the treatment of marrow allograft failure has been found. Here a case of chronic myelocytic leukemia is presented where the patient received unrelated bone marrow transplantation and developed late graft failure. After failing all other immunosuppressive agents, marrow allograft was successfully rescued by the use of Orthoclone OKT3.

Acute Disease↗
PubMed1997

Surgical treatment of congenital convex pes valgus.

Congenital convex pes valgus is a rare, complex and heterogeneous anomaly of the foot, which is difficult to treat. From 1985 to 1994, we treated 14 patients (20 feet) with this deformity. There were six boys and eight girls. Six patients had bilateral involvement. Their ages at the time of surgery ranged from 4 to 32 months (mean, 13 mo). In eight patients (10 feet), the etiology was arthrogryposis multiplex congenita. The eitiology was unknown in six patients (10 feet). Associated problems included hip dislocation in seven patients, flexion or extension contractures of the knee in six patients, and clubfoot deformity in three patients. One patient had undergone previous surgery for release of a knee contracture. To achieve a plantigrade and balanced foot, all patients had one-stage surgical open reduction and circumferential release for the correction of deformities. At a minimum of 2 years following surgery, 11 patients (16 feet) had satisfactory results determined by a 10-point evaluation system based on both clinical and radiographic features. Satisfactory results and ambulatory prognosis were related to the etiology and severity of each patient's condition. Two patients (two feet) had scars with poor cosmetic appearance and two patients (three feet) had inadequate correction. We concluded that with adequate soft tissue release and complete talocalcaneonavicular joint reduction in one-stage surgery, proper postoperative maintenance, and physical therapy, satisfactory results in the treatment of congenital convex pes valgus can be achieved.

Arthrogryposis↗
PubMed1997

Allogeneic bone marrow transplantation for Gaucher disease--a case report.

A Chinese patient who presented painful disability of right hip was diagnosed as having type 1 Gaucher disease four years later when hepatosplenomegaly was found. Splenectomy was performed but her condition did not improve. So human leukocyte antigen (HLA)-matched sibling allogeneic bone marrow transplantation (BMT) was performed. The transplantation course was smooth. Although her bone marrow was in mixed chimeric state, symptoms disappeared and her growth caught up with normal level after BMT. Gaucher disease should be considered in cases with hepatosplenomegaly and bone disorder of unknown causes. Allogeneic BMT is an effective treatment, but the treatment-related risk should be seriously evaluated and the late complications should be closely monitored.

Bone Marrow Transplantation↗
PubMed1997

Acute myelomonocytic leukemia preceded by secondary amenorrhea and presenting with central diabetes insipidus: a case report.

The patient, a 28 year-old female, received treatment for secondary amenorrhea two months before her first admission to our hospital. She was later found to have central type diabetes insipidus and acute myelomonocytic leukemia. A diagnosis of panhypopituitarism was established but there was no laboratory or radiological evidence of neuroleukemia. Complete remission was obtained after one course of induction chemotherapy. She received four more courses of chemotherapy including one course of high-dose cytosine arabinoside (Ara-C) and 14-day granulocytic colony-stimulating factor (G-CSF) for peripheral blood stem cell (PBSC) mobilization. Then she received autologous PBSC transplantation (Auto-PBSCT). Unfortunately leukemia relapsed 4 months after transplantation. The patient expired soon due to severe electrolyte imbalance and sepsis. Throughout the whole course, her pituitary function was only partially recovered after treatment and there was no laboratory or radiological evidence of CNS leukemia.

Adult↗
PubMed1997

Lethal acute pulmonary edema following intravenous naloxone in a patient received unrelated bone marrow transplantation.

A 39-year-old man was diagnosed as having acute myeloid leukemia and received 6 courses of chemotherapy. The bone marrow revealed complete remission. He had no prior history of cardiac or pulmonary disease. HLA-matched unrelated bone marrow transplantation (BMT) was performed in September 1995. Pre-transplant studies including chest X-ray, electrocardiogram and pulmonary function test were normal. The procedure of BMT was smooth and serial bone marrow examination showed successful engraftment. Serial chest X-rays done every week after BMT were normal. There were no evidence of fluid overload but severe mucositis was noted. On the 38th day after BMT, intravenous injection of 10 mg morphine was prescribed to relief severe oral pain. Respiratory depression developed right after, and naloxone 0.4 mg was given by an intravenous route. One hour later, severe shortness of breath was noted and the emergent chest X-ray revealed acute pulmonary edema. He became unconscious 2 hours later and expired 24 hours after naloxone injection in spite of intensive medical treatment. Naloxone-induced acute pulmonary edema is an extremely rare but lethal complication. Only a few cases have been reported in English literature. We report a case of acute myeloid leukemia receiving unrelated BMT to develop acute pulmonary edema rapidly after intravenous injection of naloxone. The clinical features and pathogenesis are discussed.

Acute Disease↗
PubMed1996

Hypercapnic respiratory acidosis precipitated by hypercaloric carbohydrate infusion in resolving septic acute respiratory distress syndrome: a case report.

Complications may occur when nutritional support is administered either parenterally or enterally. Inappropriate nutritional formulas with high carbohydrate loads can precipitate respiratory failure in patients with compromised lung function, induce respiratory distress which manifests as dyspnea and tachypnea in an originally normal lung condition, produce hypercapnic acidosis in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) as well as patients recovering from acute respiratory distress syndrome (ARDS) without chronic lung disease, or result in difficult weaning. Hypercaloric mixed substrates administered either parenterally or enterally can also have profound impacts on gas exchange and energy expenditure. This report describes a patient who experienced exacerbation of respiratory distress and hypercapnic acidosis during recovery from septic ARDS as the result of a nutritionally-related increase in CO2 production. As carbohydrate calories were decreased, CO2 production diminished and the hypercapnia was resolved. The importance of indirect calorimetry cannot be overemphasized during tailoring of nutritional support for the critically ill patients.

Acidosis, Respiratory↗
PubMed1996

Bone marrow transplantation with HLA partially matched related donors.

BACKGROUND: Approximately one-fourth of patients who could benefit from bone marrow transplantation (BMT) are served by a genotypically identical sibling donor. When patients do not have an HLA-matched donor, alternative marrow sources should be explored. The way to allow survival in some patients is to perform two- or three loci HLA mismatched BMT. Preliminary results with BMT in partially-matched, related donors performed at Veterans General Hospital-Taipei are reported. METHODS: Between 1985 and 1994, a total of 121 patients were enrolled in this study. Ten patients received BMT with HLA partially-matched, related donor, including 2 acute nonlymphocytic leukemia (ANLL), 5 chronic myelocytic leukemia (CML) and 3 severe aplastic anemia (SAA). Three and four hematologically malignant patients received cyclophosphamide (Cy) + radiotherapy (RT) and Cy + Busulfan(Bu) preconditioning regimens, respectively; three SAA patients received standard Cy + RT regimen. Additional prophylaxis against graft-versus-host disease (GVHD) consisted of methotrexate (MTX) and cyclosporin-A (CSA). The median follow up was 36 months. Seven were 2-loci disparate and 3 were 3-loci. RESULTS: Engraftment developed with a mean of 20.9 days after transplant. Nonengraftment rate was 1/10 (10%), delayed graft failure 2/10(20%) and venoocculsive disease (VOD) 1/10(10%). The percentage of patients who developed grade II to IV acute GVHD was low (13.6% of those mismatched at 0 locus, 31.6% mismatched at 1 loci and 14.3% at > or = 2 loci. p = 0.181). Extensive chronic GVHD occurred in 16.7% (34.1% of those mismatched at 0 locus, 41.2% mismatched at 1 loci and 16.7% at 2 loci. p = 0.492). There were five deaths. The other 5 still survived at 36 months of follow-up. Log-rank analysis revealed no statistical significance between those mismatched at > or = 2 vs at 1 (p = 0.146) but the difference between those mismatched at > or = 2 and at 0 (p = 0.0359) was statistically significant. CONCLUSIONS: When patients requiring BMT without an HLA identical sibling donor, an alternative transplant from haploidentical family members remains a viable option, especially when a patient has CML, SAA or other refractory hematologic malignancies.

Adolescent↗
PubMed1991

[Computerized cephalometric analysis in clinical use].

In making a computerized cephalometric analysis, first the film should be traced, and the landmarks pricked and manually digitalized into an X-Y coordinate system. The computer's analysis program registers for the landmarks, automatically calculates the angles and line distances, and then compares these values to the norms. The computer can also print out the measurements and draw a computer-produced graph on request. Such a procedure is convenient and yields more accurate results. The most common mistake, picking in the wrong sequence, can be controlled by carefully inspecting the computer-produced graph.

Cephalometry↗
PubMed1986

Cycloheximide analogues as potential anticonvulsants.

A series of 22 cycloheximide analogues in which the substituents on the cycloheximide ring and imide nitrogen were varied, the glutarimide ring was changed to a succinimide ring, and the ring and/or side-chain oxygens were present as ketone and/or alcohol groups were prepared and sent to the Anticonvulsant Drug Development program of the National Institute of Neurological and Communicative Disorders and Strokes for evaluation as anticonvulsants. Three compounds, namely cycloheximide (1a), 2-methyl dione 2c, and dihydrocycloheximide (4a), were further evaluated in Phase II testing for quantification of maximum activity with the latter eventually progressing to Phase IV and Phase VI screens.

Animals↗
PubMed1976

Evaluation of heterogeneity in hemoglobins of Gallus domesticus and coturnix quail using disc-gel electrophoresis.

The heterogeneity in the hemoglobins of Gallus domesticus and Coturnix quail (Japonicum) was studied. Comparisons between a mutant hemoglobin type, the normal hemoglobin type and a heterozygous type were made in both species using disc-gel electrophoresis. The same heterogeneity of the primary hemoglobins as had previously been observed in these populations of chickens and quail by cellulose acetate electrophoresis was also observed using disc-gel electrophoresis. The same major hemoglobin component was observed in all the hemoglobin types, but the electrophoretic mibility of the minor component was different. In addition to the major and minor components which accounted for 93% of the total hemoglobin, four trace components were observed. One of these trace components (T) had previously been shown by cellulose acetate electrophoresis to be associated with the mutant minor hemoglobin. The other three trace components were in close proximity, but migrated anodally to the major, normal minor and mutant minor components. Their presence was not consistent and their concentration was usually at the lower limit of resolution. No differences could be detected between the electrophoretic mobility of the mutant hemoglobin of chickens and quails, suggesting that parallel mutations have occurred in the two species.

Animals↗
PubMedDate not supplied

Factors predictive of survival in patients with node-positive colorectal cancer in Taiwan.

BACKGROUND/AIMS: Preoperative CEA levels, depth of tumor penetration, and the number of positive lymph nodes were reported as independent factors prognostic of survival in colorectal cancer patients. This study was carried out in an effort to evaluate the prognostic significance of these three factors in patients with Dukes' C colorectal cancer in Taiwan. METHODOLOGY: Between 1992 and 1994, a total of 112 patients with node-positive colorectal cancer were evaluated retrospectively at the Veteran General Hospital-Taipei. All patients underwent potentially curative surgery and received 5-fluorouracil based adjuvant chemotherapy. Reference to the Dukes' classification was according to the classical criteria described in 1932 for carcinoma of the rectum and adapted for use in colonic tumors. Data on the location of the tumor, depth of penetration, number of positive lymph nodes, degree of tumor differentiation, and preoperative CEA levels were analyzed to understand their association with survival. Blood samples for CEA measurement were taken a few days before operation. A multivariate analysis using the Cox's proportional hazards regression model was then performed to determine the most important independent predictors of survival among all the possible variables. RESULTS: Using univariate analysis the number of positive lymph nodes (P < 0.001), penetration of the bowel wall (P < 0.001), and preoperative CEA levels (P < 0.001) were found as significant prognostic factors, while the degree of tumor differentiation, location of the tumor, age and sex were not significant. Using multivariate Cox analysis the number of positive lymph nodes, penetration of the bowel wall, and preoperative CEA levels were still found as independent prognostic factors in node-positive colorectal cancer patients. CONCLUSIONS: Data obtained from our study indicates that preoperative CEA levels, depth of tumor penetration, and the number of positive lymph nodes were independent prognostic factors in Dukes' C colorectal cancer patients. They could serve as appropriate modifications of the initial Dukes scheme in node-positive diseases.

Carcinoembryonic Antigen↗
PubMedDate not supplied

Randomized trial comparing weekly bolus 5-fluorouracil plus leucovorin versus monthly 5-day 5-fluorouracil plus leucovorin in metastatic colorectal cancer.

BACKGROUND/AIMS: The purpose of this study was to compare the efficacy and toxicity profiles of weekly intravenous (i.v.) bolus injection of 5-fluorouracil plus low-dose leucovorin with the Mayo Clinics' monthly 5-day schedule of 5-fluorouracil and leucovorin in the treatment of metastatic colorectal cancer. METHODOLOGY: A total of 96 patients with previously untreated metastatic colorectal cancer were randomized to receive either a weekly i.v. bolus injection of 5-fluorouracil 400 mg/m2 plus leucovorin 20 mg/m2 (weekly arm), or i.v. bolus injection of 5-fluorouracil 425 mg/m2 plus leucovorin 20 mg/m2 for 5 consecutive days every 4 or 5 weeks (monthly arm). Therapy was continued until disease progression or unacceptable toxicity appeared. In the presence of disease progression, the study regimen was stopped and second-line treatment was instituted after the patient was discontinued from this study. RESULTS: There was no significant difference of response rates between both regimens. The response rate were 14.3% in the weekly arm (2 CR and 5 PR, 95% CI: 2.6-25.2%) and 10.6% in the monthly arm (1 CR and 4 PR; 95% CI: 6.5-32.3%), respectively (P = 0.8957). The survival times were also similar between the two (P = 0.4207, log-rank test). The median survival were 15.8 months in the monthly arm and 18.4 months in the weekly arm. Hematologic toxicity was minimal in both arms. However, the monthly arm produced a higher toxicity in severe (grade 3-4) diarrhea (14.9% vs. 2%; P = 0.029) and stomatitis (8.5% vs. 0; P = 0.054). CONCLUSIONS: Weekly bolus injection of 5-fluorouracil and low-dose leucovorin achieved a similar response rate and survival as compared with the Mayo Clinics' monthly 5-day schedule, but severe toxicity was less commonly seen using the weekly regimen. As current chemotherapeutic treatment for metastatic colorectal cancer is largely palliative rather than curative, the weekly bolus regimen may be a more favorable approach in managing metastatic colorectal cancer.

Aged↗