Transbasal nasal polyposis masquerading as a skull base malignancy.
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Diagnosis, Differential↗
Biomedical subjects
C N Chang
Publications and source records attributed to C N Chang.
Continuous hyperthermic peritoneal perfusion for peritoneal carcinomatosis.
Continuous hyperthermic peritoneal perfusion (CHPP) with anticancer agents in warm saline was performed in 10 patients with cancer of the digestive tract and peritoneal carcinomatosis after resection of primary and metastatic lesions or both. Eight patients had colorectal cancer and one patient had recurring gastric cancer. CHPP was performed using saline containing mitomycin-C and 5-flurouracil at 42 degrees C to 43 degrees C for 60 minutes. One patient with pancreatic cancer received CHPP twice. After CHPP, the preoperative ascites of three patients disappeared. Four patients died of malignancy within 1 year of CHPP and one patient died of respiratory failure 5 months post-CHPP. The remaining five patients survived for more than 1 year after CHPP. There were no significant immediate postoperative complications, except for transient changes in liver function, white blood cell count and serum albumin level. While CHPP treatment appears to be a safe method of treatment for peritoneal carcinomatosis, its long term benefits need further investigation.
Adult↗
5-Fluoro-2-pyrimidinone, a liver aldehyde oxidase-activated prodrug of 5-fluorouracil.
5-Fluorouracil (5-FU) is an effective antitumor agent used in treating various cancers. Because of its metabolism by intestinal and other cells, 5-FU has an inconsistent bioavailability that limits its oral use. 5-Fluoro-2-pyrimidione (5-FP), a 5-FU prodrug, was synthesized and found to be converted to 5-FU by aldehyde oxidase, an enzyme present in high concentrations in the livers of mice and humans but not in the gastrointestinal tract. Using BDF1 mice, the pharmacokinetics of 5-FP were studied and compared with those of 5-FU. The bioavailability of 5-FP given orally was 100% at a dosage of 25 mg/kg and 78% at a dosage of 50 mg/kg. The half-lives of both doses of 5-FP were at least 2-fold longer than the half-lives of the same doses of 5-FU, and the clearance rates of 5-FP were 3-fold slower. 5-FP was converted rapidly to 5-FU, in vivo. The resulting 5-FU was measured at a steady-state level of 40-70 microM in plasma, at a dosage of 25 mg/kg, that was sustained for at least 4 hr. Also, when given orally, 5-FP was shown to have potent activity against Colon 38 tumor cells and P388 leukemia cells in mice. The therapeutic index of 5-FP was similar to that of 5-FU in these mouse tumor models. The potential clinical use of 5-FP as a prodrug of 5-FU should be considered.
Administration, Oral↗
Combination chemotherapy with carmustine and cisplatin before, during, and after radiotherapy for adult malignant gliomas.
Twenty-two patients, aged 16 to 67, who had malignant gliomas after surgical resection were treated with carmustine and cisplatin intravenous infusion before, during, and after radiotherapy. All patients had subtotal or total resection, or biopsy as the initial procedure. Twenty-one patients who had at least 2 cycles of chemotherapy and finished the whole course of radiotherapy were considered to be evaluable for responses. Among them, 5 had glioblastoma multiforme, 16 had anaplastic astrocytoma. The median time to tumor progression was 35 weeks (range 12-130 weeks) and median survival time was 66 weeks (range 10-156 weeks). Early progression occurred more frequently in patients with biopsy only and subtotal resection, and in patients with glioblastoma than in those with anaplastic astrocytoma. This combined modality treatment program was associated with reversible hematologic toxicity which was severe in 2 patients, and with ototoxicity in 1 patient, nephrotoxicity in 2 patients. Combination of carmustine and cisplatin with cranial irradiation for malignant gliomas is moderately toxic and appears to offer no obvious survival advantage compared with radiation therapy plus BCNU alone.
Adolescent↗
Clinical presentations and results of therapy of 63 acromegalic patients Chang Gung Memorial Hospital.
Retrospective analysis of 63 acromegalic patients who received regular follow-up in Chang Gung Memorial Hospital is presented. Our purpose was to examine clinical characteristics of acromegalic patients and the results of combination therapy in this medical center. Fifty-one cases received operative treatment. Among them, 43 cases presented with extrasella involvement of the pituitary tumor. Postoperative external radiotherapy was performed in 20 cases. Thirteen cases received medical treatment with bromocriptine or octreotide. After surgery, growth hormone (GH) levels in 23 out of 51 cases (45.1%) were reduced to less than 5 ng/mL. In cases which received postoperative radiotherapy, mean GH level could be reduced gradually after the treatment. In the group treated with bromocriptine, the GH level was controlled in three of nine patients. In five of the six cases who received octreotide therapy. GH levels were maintained at less than 5 ng/mL. Although GH levels were reduced after octreotide treatment, the paradoxical response to the thyrotropin-releasing hormone (TRH) stimulation test still persisted. The data presented in this study suggest that after combination therapy for acromegalic patients (most cases with pituitary macroadenoma), the serum GH levels in 90% cases could be maintained at less than 5 ng/mL.
Acromegaly↗
Intraoperative somatosensory evoked potentials for localization in excision of recurrent parasagittal meningioma--a case report.
Removal of tumors that are located in the motor area is a challenge to neurosurgeons because of the possibility of injuring the motor cortex. We present our experience in excision of a recurrent parasagittal meningioma located in the central area. With the help of somatosensory evoked potentials (SSEP) monitoring, the tumor was removed totally without any neurologic sequela.
Aged↗
Characterization of a hydroxyurea-resistant human KB cell line with supersensitivity to 6-thioguanine.
Hydroxyurea (HU) is currently used in the clinic for the treatment of chronic myelogenous leukemia, head and neck carcinoma, and sarcoma. One of its drawbacks, however, is the development of HU resistance. To study this problem, we developed a HU-resistant human KB cell line which exhibits a 15-fold resistance to HU. The characterization of this HU-resistant phenotype revealed a gene amplification of the M2 subunit of ribonucleotide reductase (RR), increased levels of M2 mRNA and protein, and a 3-fold increase of RR activity. This HU-resistant cell line also expressed a "collateral sensitivity" to 6-thioguanine (6-TG), with a 10-fold decrease in the dose inhibiting cell growth by 50% as compared to the KB parental line. The mechanism responsible for this supersensitivity to 6-TG is believed to be related to an increasingly efficient conversion of 6-TG to its triphosphate form, which is subsequently incorporated into DNA. After passage of the resistant cells in the absence of HU, the cell line reverts. The revertant cells lose their resistance to HU and concomitantly their sensitivity to 6-TG. This phenomenon is due to the return of RR to levels comparable to that of the KB parental cell line. These observations and their relevance to cancer chemotherapy will be discussed in this paper. Our results suggest that a clinical protocol could be designed which would allow for a lower dose of 6-TG to be used by taking advantage of the increased RR activity in HU-refractory cancer patients. Two drugs which display collateral sensitivity are known as a "Ying-Yang" pair. Alternate treatment with two different Ying-Yang pairs is the rationale for the "Ying-Yang Ping-Pong" theory in cancer treatment. This rationale allows for effective cancer chemotherapy with reduced toxicity.
Animals↗
Anti-Tac(Fab)-PE40, a recombinant double-chain immunotoxin which kills interleukin-2-receptor-bearing cells and induces complete remission in an in vivo tumor model.
We have produced a single plasmid encoding both the heavy chain Fd domain (VH + CH1) of the anti-interleukin-2 receptor (IL2R) monoclonal antibody anti-Tac, and the anti-Tac light chain fused to PE40, a truncated derivative of Pseudomonas exotoxin. The active immunotoxin anti-Tac(Fab)-PE40 could be recovered from E. coli from either periplasm or renatured inclusion bodies. The double-chain immunotoxin was very cytotoxic toward IL2R-bearing cell lines, human activated T cells and fresh adult-T-cell-leukemia cells. The cytotoxicity was similar to that of anti-Tac(Fv)-PE40, the single-chain recombinant toxin containing only the variable domains of anti-Tac. IL2R-binding affinity was also equivalent to that of anti-Tac(Fv)-PE40, which is one-third that of anti-Tac. The serum half-life in mice was significantly prolonged as compared with anti-Tac(Fv)-PE40, with a beta phase of 430 vs. 57 minutes, but the LD50s were equivalent when the immunotoxins were administered in 3 daily doses. Anti-Tac(Fab)-PE40 was very cytotoxic in vitro toward transfected ATAC-4 carcinoma cells which express IL2Rs. In mice bearing ATAC-4 tumors, anti-Tac(Fab)-PE40 showed significant anti-tumor activity, inducing complete remissions in 80 and 100% of treated animals at approximately 7 and 14% respectively of the LD50. Anti-Tac(Fab)-PE40 was much more effective in vitro and in vivo than chemical conjugates between anti-Tac and truncated PE molecules. The recombinant Fab toxin should be studied further as potential treatment for IL2R-related malignancies, particularly if smaller recombinant immunotoxins have insufficient half-life in humans.
ADP Ribose Transferases↗
Cytotoxicity of recombinant Fab and Fv immunotoxins on adult T-cell leukemia lymph node and blood cells in the presence of soluble interleukin-2 receptor.
Single-chain immunotoxins anti-Tac(Fv)-PE40 and anti-Tac(Fv)-PE40KDEL, composed of variable domains of the anti-Tac monoclonal antibody and truncated forms of Pseudomonas exotoxin, have shown potent cytotoxic activity against malignant peripheral blood mononuclear cells (PBMCs) from adult T-cell leukemia (ATL) patients originating from the Caribbean. However, several clinically important issues have not previously been addressed. These include the potential of soluble interleukin 2 receptor in ATL patients to block immunotoxin effectiveness, the relative sensitivity of malignant lymph node cells (LNCs) versus PBMCs, the effect of an immunotoxin with a prolonged half-life, and finally whether ATL cells from patients in Japan have toxin sensitivity equal to those of the Caribbean patients. To resolve these questions, we studied 32 malignant PBMC and LNC samples from 30 ATL patients from Japan. PBMCs from 27 of 27 patients were very sensitive with 50% inhibition of protein synthesis achieved with 0.02-0.85 ng/ml (0.3-13 pM) of anti-Tac(Fv)-PE40KDEL or anti-Tac(Fv)-PE40. LNCs had sensitivity very similar to that of PBMCs in the five patients tested. The fully recombinant immunotoxin, anti-Tac(Fab)-PE40, which has 8-10 times the t1/2 alpha and beta compared to the Fv-immunotoxins, was also very cytotoxic toward cells from 27 of 27 patients tested with 50% inhibition of protein synthesis of 0.08-25 ng/ml. It was found that purified soluble interleukin 2 receptor added to the cytotoxicity assay decreased the cytotoxic activity of anti-Tac(Fv)-PE40KDEL or anti-Tac(Fab)-PE40, but that 1 x 10(4) units/ml or less had minimal competitive effects. It was found that ATL patients who have responded even incompletely to conventional chemotherapy have soluble interleukin 2 receptor levels lower than this at posttreatment. We conclude that recombinant immunotoxins containing anti-Tac(Fv) are effective against Japanese ATL PBMCs or LNCs and might be most effective if used in vivo after conventional chemotherapy. If it is found in humans that the effectiveness of single-chain recombinant toxins is limited by short half-life, anti-Tac(Fab)-PE40 should be considered as an alternative agent.
ADP Ribose Transferases↗
Surgical treatment for ossification of the posterior longitudinal ligament of the cervical spine.
Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. Most symptomatic patients present with a myelopathy or myeloradiculopathy. Surgical decompression is the preferred treatment. The choice of operative approach, anterior or posterior, is still controversial. From January 1986 to June 1992, 20 patients with this condition received operations at Chang Gung Memorial Hospital. The clinical manifestations and the results of treatment are analysed. The ideal surgery seems to be the anterior approach with bone fusion. If, however, the OPLL involves more than three segments, the posterior approach with an expansive laminoplasty would be the better alternative technique.
Adult↗
Maxillary involvement in central craniofacial fractures with associated head injuries.
From January 1983 through December 1990, we treated 703 patients with central craniofacial fractures. Among them 177 had maxillary fractures, with or without frontonasoethmoidal involvement. Of the 177, 151 patients were diagnosed in the acute stage. Using the Glasgow Coma Scale, these 151 patients were divided into three groups: group I (GCS score 13-15), 100 patients; group II (GCS score 9-12), 33 patients; group III (GCS score 3-8), 18 patients. The patterns of facial fractures were analyzed and surgically corrected after the following average postadmission lags: group I, 7.1 days; group II, 11.5 days; group III, 13.3 days. The average hospital stay for each group was: group I, 15.6 days; group II, 19.5 days; and group III, 27.2 days. The mean follow-up period was 12 months. The physiologic, functional and esthetic outcomes were assessed. Regardless of initial head injury severity, the outcomes in each group showed almost no statistically significant differences, and unnecessary extended hospital stays may be avoided by early surgical management.
Adolescent↗
Two-dimensional left ventricular deformation during systole using magnetic resonance imaging with spatial modulation of magnetization.
BACKGROUND: Myocardial tissue tagging with the use of magnetic resonance imaging allows noninvasive regional analysis of heart wall motion and deformation. However, any evaluation of the effect of disease or treatment requires a baseline reference of normal values and variation. We studied the two-dimensional motion of material points imaged within the left ventricular wall using spatial modulation of magnetization (SPAMM) in 12 normal human volunteers. METHODS AND RESULTS: Five parallel short-axis and five parallel long-axis slices were acquired at five times during systole. SPAMM tags were generated at end diastole using a 7-mm grid. Intersection point data were analyzed for displacement, rotation, and torsion, and triangles of points were analyzed for local rotation and principal strains. Short-axis displacement was the least in the septum for all longitudinal levels (P < .001). Torsion about the long axis was uniform circumferentially because of the motion of the centroids used to reference the rotation. In the long-axis images, the base displaced longitudinally toward the apex, with the posterior wall moving farther than the anterior wall (13.4 +/- 2.2 versus 9.7 +/- 1.8 mm, P < .001) in this direction. The largest principal strain (maximum lengthening) was approximately radially oriented in both views. In the short-axis images, the minimum principal strain (maximum shortening) increased in magnitude toward the apex (P < .001) with little circumferential variation, except at midventricle, where the anterior wall showed greater contraction than the posterior wall (-0.21 +/- 0.03 versus -0.19 +/- 0.02, P < .02). CONCLUSIONS: Consistent regional variations in deformation are seen in the normal human heart. Displacement and maximum shortening strains are well characterized with two-dimensional magnetic resonance tagging; however, higher-resolution images will be required to study transmural variations.
Adult↗
Chylothorax after endoscopic sympathectomy: case report.
Endoscopic sympathectomy is a new trend for the treatment of hyperhidrosis palmaris. It is a simple and effective technique; however, it carries some recognized risks such as Horner's syndrome and pneumohemothorax. We recently encountered a case complicated by the development of a chylothorax. The patient was a 23-year-old healthy women with profuse palmar sweating. She developed an intractable dry cough after a transthoracic endoscopic sympathectomy. A chest x-ray revealed a left pleural effusion. A chylous effusion was found after thoracentesis and fluid analysis. The pleural effusion resolved after chest tube drainage and diet control. Although endoscopic sympathectomy is a simple and quick procedure, unusual complications, such as chylothorax, may occur. Appropriate early recognition and treatment can prevent a disastrous result.
Adult↗
[Unspecified subarachnoid hemorrhage in Taiwan].
We report the epidemiological and clinical features of unspecified subarachnoid hemorrhage by reviewing the literature published in Taiwan. Data from stroke registry from January 1988 to June 1992 showed that 4.9% of 23910 acute strokes were diagnosed as subarachnoid hemorrhage; in about half of them the cause of hemorrhage was not specified due to lack of confirmatory diagnostic examinations or to rapid deterioration of consciousness subsequent to bleeding that made angiography unapplicable during hospitalization. The age distribution, sex ratio, clinical profiles and associated risk factors in this group of patients were similar to those in the group of aneurysmal rupture. Therefore, the majority of patients categorized in the group of unspecified subarachnoid hemorrhage very likely had aneurysmal ruptures. The causes of subarachnoid hemorrhage were more frequently undetermined in hospitals where neuroradiological as well as neurosurgical facilities and staff were not immediately available, and also in patients whose clinical condition was poor on arrival at the hospital or who deteriorated rapidly after the onset. These two facts may partly explain the higher case-fatality rate and poorer prognosis in patients whose causes of subarachnoid hemorrhage were undetermined and effective surgical treatment could not be done.
Adult↗
An intracranial aneurysm associated with a recurrent meningioma--a case report.
A patient presented with late onset seizure due to sphenoid ridge meningioma excision, during a craniotomy. Nine years after craniotomy, sphenoid ridge meningioma recurred in this patient along with middle cerebral artery (MCA) aneurysm. Peripheral intracranial aneurysm has been shown to be caused by many etiologies. But a direct relationship to an intracranial neoplasm is extremely rare. A causal relationship between the growth of the tumor and the development of the aneurysm is postulated.
Adult↗
Prolonged nonoliguric acute renal failure associated with high-dose vitamin K administration in a renal transplant recipient.
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Acute Kidney Injury↗
Benign osteoblastoma of the spine--report of two cases.
Benign osteoblastoma is a rare spinal tumor, with the posterior element mainly involved. Symptoms do vary and there is a long diagnostic delay, especially in young people. We present two cases of benign osteoblastoma. One occurred in the atlas and presented with a painless neck mass. The other occurred in the lumbar spine with symptoms of long-term spinal pain and radicular pain. Preoperative Technetium bone scan and computed tomography (CT) resulted in exact localization and better operative planning. En bloc excision of tumor is indicated for complete pain relief and full return of spinal mobility.
Adult↗
The biochemical basis for the differential anti-human immunodeficiency virus activity of two cis enantiomers of 2',3'-dideoxy-3'-thiacytidine.
Two cis stereoisomers of 2',3'-dideoxy-3'-thiacytidine (SddC) were investigated for their activity against human immunodeficiency virus type 1 (HIV-1) in human acute lymphoblastic leukemia H-9 cells. (-)-SddC is six times more potent against HIV-1 and at least 1.7-fold less cytotoxic than (+)-SddC. Metabolism studies showed that the intracellular accumulation of the active triphosphate form of (-)-SddC is more than 2-fold greater than that of (+)-SddCTP in H-9 cells. In contrast, (+)-SddCTP is approximately 1.5 times more potent than (-)-SddCTP as an inhibitor of HIV-1 reverse transcriptase using a rRNA template (Ki = 0.22 and 0.034 microM, respectively) and gapped DNA (Ki = 0.53 and 1.02 microM, respectively). The enantiomers are comparable as substrates for incorporation into DNA by the RNA-dependent HIV-1 reverse transcriptase; however, neither analog is incorporated as readily as dCTP. The above observations do not explain the difference in the anti-HIV potency between the enantiomers. A novel 3'-5' exonuclease was partially purified from the cytosol of H-9 cells and assayed for the removal of (+)- and (-)-SddCMP-terminated DNA. Removal of (+)-SddCMP was approximately two to three times faster from 3'-terminals of single-stranded and double-stranded DNA, whereas on DNA/RNA substrates, the exonucleolytic cleavage of (+)-SddCMP proceeded approximately six times faster than that of (-)-SddCMP. This result correlates with the observed difference in the anti-HIV effect between the two compounds and suggests that this novel enzyme may be an important determinant of their antiviral activities.
Antiviral Agents↗