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Biomedical subjects

C Y Chou

Publications and source records attributed to C Y Chou.

At least 55 records · Page 3Linked to original sources
PubMed1995

Sinusoidal fetal heart rate pattern during chemotherapy in a pregnant woman with acute myelogenous leukemia.

A 22-year-old woman was referred to our hospital because of severe anemia in the 20th week of gestation. Acute myelogenous leukemia was diagnosed and she was treated with multiple-agent chemotherapy in the second and third trimesters. Although the patient tolerated the intensive treatment, an intermittent sinusoidal fetal heart rate pattern was detected during chemotherapy. Complete remission was achieved at the 35th week of gestation. An underweight baby boy, suffering from pancytopenia, was delivered by cesarean section at 36 weeks' gestation. The baby recovered well and had adequate growth. No abnormalities where found at examination two months after birth. The fetal sinusoidal heart rate pattern may have been induced by severe anemia due to myelosuppression caused by the transplacental receipt of chemotherapeutic agents.

Anemia↗
PubMed1994

Serum level of squamous cell carcinoma antigen and tumor size are useful to identify preoperatively patients at high risk of cervical cancer.

BACKGROUND: The benefit of postoperative adjuvant therapy for patients with cervical cancer is uncertain, and moreover, may increase morbidity. In this study, patient age, clinical stage of the cancer, tumor size, and levels of serum squamous cell carcinoma cell antigen and carcinoembryonic antigen were studied in patients with Stage Ib and IIa squamous cell carcinoma of the uterine cervix to determine if these parameters can be used, before the surgical intervention, to distinguish patients who require postoperative adjuvant therapy from those who do not. METHODS: Ninety-nine patients were studied. After surgery, patients were classified either as high risk or low risk according to the results of histopathologic findings. The age of the patient was noted, and FIGO stage, squamous cell carcinoma antigen, carcinoembryonic antigen, and clinical tumor size were determined. A univariate analysis and then a stepwise logistic regression procedure were performed to select significant clinical predictors from among the five variables mentioned above. Any selected predictors were further analyzed by the receiver operator characteristic curve. RESULTS: Serum squamous cell carcinoma antigen and clinical tumor size measured by colposcopic examination were significant clinical predictors of the treatment strategy postoperatively. From the receiver operator characteristic curve, a sensitivity of 84.2%, a specificity of 91.8%, a positive predictive value of 84.5% were attained. CONCLUSIONS: Serum squamous cell carcinoma antigen assays and clinical tumor size estimated by colposcopic examination are helpful in identifying patients who require postoperative adjunctive therapy.

Adult↗
PubMed1994

Color Doppler ultrasonography and serum CA 125 in the differentiation of benign and malignant ovarian tumors.

Color Doppler ultrasonography and serum CA 125 were used to evaluate 114 adnexal tumors prior to surgery. Six patients were excluded from this study because of ovarian cancer, borderline ovarian malignancy, and tubal gestation. A total of 108 patients were eligible: 83 patients with benign and 25 patients with malignant ovarian tumors. Resistance index (RI) was used to determine the peripheral resistance of intratumoral vessels. The cutoff point for the RI was defined as 0.5. The blood flow was considered to be normal when the RI was greater than 0.5 and abnormal when it was less than 0.5. The blood flow was detected in 100% of malignant tumors and 59% of benign tumors. The initial cutoff value for CA 125 was 35 U/mL. Sensitivity, specificity, positive predictive value, and negative predictive value were compared in terms of RI, serum CA 125, and a combination of the two. Our conclusion is that the combination of RI and CA 125 gives a sensitivity of 100% and negative predictive value of 100%. If the cutoff point of CA 125 was raised from 35 to 65 U/mL, then a specificity of 100% and positive predictive value of 100% were also attained with the use of RI and CA 125 without changes in sensitivity or negative predictive value. We conclude that the combination of color Doppler ultrasonography and serum CA 125 is an effective method to differentiate benign from malignant ovarian tumors.

Adolescent↗
PubMed1994

Uterine leiomyosarcomas coexistent with cellular and atypical leiomyomata in a young woman during the treatment with luteinizing hormone-releasing hormone agonist.

We report a case of a 28-year-old woman who had received 2 months of intranasal buserelin (a luteinizing hormone-releasing hormone agonist; LH-RH agonist) therapy for presumed uterine leiomyomata. In addition to no reduction of the tumor size evaluated by sonography, heavy vaginal bleeding and abdominal pain recurred and worsened during the therapy. Pathological examination of the myomectomy and hysterectomy specimens revealed leiomyosarcomas coexistent with cellular, atypical, and classical leiomyomata. We suggest that this is a case of leiomyosarcomas arising in preexisting leiomyomata rather than de novo from the smooth muscle fibers of the myometrium. Furthermore, the potential of LH-RH, agonist therapy to delay the surgical treatment of an unsuspected leiomyosarcoma is high-lighted. Close monitoring of the treatment response by improvement of clinical symptoms and sonographic assessment of tumor size may be helpful in early diagnosis of an underlying malignant tumor.

Adult↗
PubMed1994

Primary malignant lymphoma of the uterine cervix shows favorable response to neoadjuvant chemotherapy.

Primary malignant lymphoma localized in the uterine cervix is a rare condition for which radiation therapy, surgery, or chemotherapy either alone or in combination have been the mainstay of treatment. The effectiveness of neoadjuvant chemotherapy for this condition, however, has not been evaluated. We experienced one case of primary malignant lymphoma of the uterine cervix, stage IIa according to FIGO, and IEA according to the Ann Arbor staging system for extranodal lymphomas, which was treated with neoadjuvant chemotherapy and surgery. The patient first underwent neoadjuvant chemotherapy consisting of cyclophosphamide, vinblastine, epirubicin, bleomycin, procarbazin, and oncovin (COP-BLAM) to reduce the size of the tumor. This was followed by an extended total hysterectomy, left salpingo-oophorectomy, and bilateral pelvic lymph node dissection. Neoadjuvant chemotherapy given before surgery resulted in a remarkable reduction in the tumor size which made the subsequent surgery technically easy. In addition, it is possible that intraoperative micrometastasis of the tumor cells could be better prevented. The patient received additional chemotherapy with COP-BLAM schedules postoperatively. No evidence of recurrent lymphoma has been observed in 2 years after the treatment. Neoadjuvant chemotherapy may be an effective treatment modality for primary malignant lymphoma of the uterine cervix.

Adult↗
PubMed1994

Cardiovascular collapse during gynecologic laparoscopy complicated by pulmonary edema: report of a case.

Although gynecologic laparoscopic surgery has recently become a routine and widespread operative procedure in Taiwan, the potential risks and complications in the clinical practice of laparoscopy should not be overlooked. Whilst the incidence of complications are rare, they can sometimes be serious, even life-threatening. This case report presents a woman with ruptured endometrioma, who developed sudden-onset cardiovascular collapse during laparoscopic procedure, in which carbon dioxide was used for insufflation. After resuscitation including cardioversion, her vital functions were restored; pulmonary edema developed soon afterwards but was resolved with conservative treatment. We discuss the possible causes of cardiovascular collapse during laparoscopic procedure and the management of resulting complications.

Adult↗
PubMed1994

The hemodynamic effects of continuous intravenous infusion of propofol at higher rates.

The new formula of propofol was introduced in 1985. Because of its characteristics of rapid onset and elimination, it was often used as a drug of induction and maintenance of total intravenous anesthesia. However, the hemodynamic effects of propofol was still controversial. The present study was to observe its hemodynamic reactions at higher infusion rate. Hemodynamic studies were performed in 11 female patients, 17 to 54 years old, ASA class I-II, presenting for major lower abdominal operation. Patients with heart, lung, liver, or endocrine disease were excluded. No premedication was given before anesthesia. A radial arterial line and a swan-ganz catheter were inserted under local anesthesia. Cardiac output (CO), arterial blood pressure (ABP), central venous pressure (CVP), pulmonary arterial pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were obtained before induction to foster systemic vascular resistance index (SVRI), left ventricular systolic work index (LVSWI), right ventricular systolic work index (RVSWI), and pulmonary vascular resistance index (PVRI), cardiac index (CI) by an H/p computer analyzer. Propofol (2 mg/kg) was combined with succinylcholine (1.5 mg/kg) for induction. Anesthesia was maintained with propofol and norcuron. The infusion rates of propofol were 10 mg/kg/hr during the first 30 minutes and 8 mg/kg/hr during the following 30 minutes, norcuron, 0.1 mg/kg initially and 1 mg for maintenance after 30 minutes. Normal saline was infused 1000 to 1500 ml in study period to maintain higher preload. Post induction hemodynamic data were collected at the 5th, 15th, 30th, 60th min after induction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Prediction of fetal macrosomia by single ultrasonic fetal biometry.

A total of 1,056 fetuses underwent single ultrasonographic measurement of fetal biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), and estimated body weight within five days of delivery. The accuracy of these parameters and estimated body weight equations in the prediction of macrosomia (birth weight > or = 4,000 g) was evaluated. With the use of receiver operator characteristic curves, the optimal cutoff value for each parameter with the best sensitivity, specificity and accuracy was selected. BPDs > or = 9.4 cm had the best sensitivity (68.8%), specificity (74.3%), and accuracy (74.1%). ACs > or = 35 cm had the best sensitivity (81.3%), specificity (81.5%), and accuracy (81.5%). FLs > or = 7.0 cm had the best sensitivity (68.8%), specificity (74.5%), and accuracy (74.3%). The estimated body weight equations did not increase the prediction values whether or not FL was included. Both had the same prediction values at > or = 3,700 g, ie, sensitivity (71.9% vs 71.9%), specificity (92.1% vs 93.8%), and accuracy (91.5% vs 93.2%). The results showed AC to be the best single parameter for predicting macrosomia. Combinations of these parameters were better than a single parameter in the prediction of macrosomia.

Anthropometry↗
PubMed1993

Clinical case-controlled study of small-for-gestational-age babies.

In this series, we compared the prenatal risk factors and perinatal complications of small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) babies systemically through a case-controlled study. A total of 115 SGA babies were retrospectively compared with 115 AGA matched pairs at the National Cheng Kung University Hospital. We analyzed the prenatal risk factors, signs of fetal distress and perinatal outcome between these two groups. Univariate analysis showed significant differences for the following items: 1) maternal risk factors, 2) fetal risk factors, 3) presence of prenatal risk factors, 4) abnormal fetal heart rate tracings, 5) low one-minute Apgar scores, 6) low five-minute Apgar scores, 7) thick meconium staining, 8) presence of fetal distress, 9) pediatric ICU care, and 10) presence of perinatal complications. Multivariate logistic regression showed that maternal hypertension and fetal anomaly were statistically significant risk factors associated with SGA in this series. In conclusion, SGA babies demonstrate higher frequencies of maternal and fetal risk factors, signs of fetal distress and perinatal complications than AGA babies.

Case-Control Studies↗
PubMed1993

Medical treatment of uterine myoma with long-acting gonadotropin-releasing hormone agonist prior to myomectomy.

A less bulky uterine myoma is technically easier to deal with during surgery. Recently gonadotropin-releasing hormone agonists (GnRH-a) have been used for the purpose of medical hypophysectomy, thereby reducing the size of uterine myomas. Ten premenopausal women with infertility and intramural-submucous myoma manifesting with menorrhagia and obstruction of the tubal ostia were recruited for this study. A long-acting depot GnRH-a, Decapeptyl, was given intramuscularly every four weeks for three months as an adjunct prior to myomectomy. Luteinizing hormone, follicular stimulating hormone and estradiol declined to the menopausal range following treatment. The size of the myoma decreased to a mean of 32.3 +/- 13.3% of the original volume. Myomectomy was performed in eight patients at the end of the study. Remarkably little blood loss was observed during the surgery. All of the patients had their uteri preserved, and six out of eight patients achieved pregnancy within 12 months after surgery. Our results indicate that monthly administration of long-acting GnRH-a significantly reduces the myoma volume and makes myomectomy technically easier to perform with the possibility of reduced complication rates and better preservation of future fertility.

Adult↗
PubMed1992

Pelvic actinomycosis with colo-ileo-vesical fistula formation: report of a case.

Pelvic actinomycosis with multiple fistular formation is rarely reported in the literature. We herein present a case of pelvic actinomycosis with sigmoid colo-ileovesical fistulae in a 36-year-old intrauterine device (IUD) user. She was admitted to the hospital because of general malaise, weight loss and bilateral palpable adnexal masses. Sonography showed bilateral adnexal masses which contained many echolucent spots. A barium enema examination revealed sigmoid colo-ileo-vesical fistulae. A computed tomographic scan showed bilateral cystic adnexal masses, bilateral hydronephrosis and hydroureter. Preoperatively, pelvic malignancy was suspected. An exploratory laparotomy was performed. Bilateral tubo-ovarian abscesses with extensive adhesions were found. Pathologic examination of the operative specimen revealed pelvic actinomycosis. The patient was treated with penicillin for 14 weeks and had a stable clinical course.

Actinomycosis↗
PubMed1991

Arterial hemodynamics in human hypertension. Effects of adrenergic blockade.

BACKGROUND: Resistance, pulse wave velocity, and wave reflections have been shown to be increased in patients with essential hypertension compared with normotensive controls. These alterations are completely normalized by nitroprusside infusion but exacerbated during beta-adrenergic blockade, suggesting an enhanced smooth muscle tone that is in part modulated by adrenergically mediated vasodilation. The present study was performed to examine the extent to which this apparently enhanced smooth muscle tone is a result of alpha-adrenergically mediated vasoconstriction. METHODS AND RESULTS: Age-matched normotensive and hypertensive Chinese subjects were instrumented with catheter-tipped micromanometers and an electromagnetic flow velocity sensor positioned in the ascending aorta. Aortic impedance and wave reflection properties were obtained from Fourier analysis of the pressure and flow signals during baseline conditions, after beta-blockade with propranolol (0.15 mg/kg i.v.), and after alpha-blockade with intravenous phentolamine (range, 15-80 mg) that was sufficient to either normalize blood pressure or produce a pressure that could not be further lowered. Compared with normotensives, in the baseline state, hypertensives had elevated resistance (1,962 versus 1,268 dyne.sec/cm5, p less than 0.001), total power (1,893 versus 1,568 mW, p less than 0.08), reflected pressure wave component (25.6 versus 13.5 mm Hg, p less than 0.001), ratio of reflected to forward wave (0.65 versus 0.42, p less than 0.001), and pulse wave velocity as determined from the frequency of the first zero-crossing of impedance phase angle (4.6 versus 3.5 Hz, p less than 0.03). During combined alpha- and beta-adrenergic blockade, blood pressure decreased into the normal range (from 162/103 to 131/87 mm Hg) but was still somewhat higher than that in the normotensive subjects. Resistance (1,914 dyne.sec/cm5, p less than 0.03), reflected wave (19.5 mm Hg, p less than 0.01), and ratio of reflected to forward wave (0.61, p less than 0.001) were, however, persistently elevated above normal values. CONCLUSIONS: alpha-Adrenergically mediated vasoconstriction cannot account for all of the hemodynamic alterations seen in essential hypertension.

Adult↗
PubMed1990

Enhanced natural killer cell activity in patients with cervical carcinoma by postoperative PS-K immunotherapy.

The cell-mediated immunity in 19 patients with stage I and II cervical carcinoma was evaluated before and after postoperative PS-K immunotherapy. Lymphocyte subpopulations were enumerated using specific monoclonal antibodies (moAbs) of the Leu series (Leu2, Leullb, Leu15, and Leu19) and the OKT series (OKT3, and OKT4). A 4-hour 51Cr-release assay was used to measure natural killer (NK) cell activity. Serum levels of interleukin-2 (IL-2), soluble interleukin-2 receptor (IL-2R), and tumor necrosis factor (TNF) were also determined before and after postoperative PS-K immunotherapy. The results showed that the number of cells carrying the marker of a non-major histocompatibility complex (MHC), restricted cytotoxic lymphocytes in the peripheral blood and NK activity at three different effector/target ratios increased significantly after postoperative PS-K immunotherapy. It is therefore concluded that postoperative PS-K immunotherapy enhanced the NK activity in patients with cervical carcinoma, in which NK activity tended to be lower. Further clinical investigation to assess the effectiveness of PS-K immunotherapy in improving the overall survival is in progress.

Adjuvants, Immunologic↗
PubMed1989

The efficacy and safety of recombinant tissue plasminogen activator infusion in acute myocardial infarction.

UNLABELLED: Recombinant tissue plasminogen activator (rt-PA) is the most promising agent use for salvaging ischemic myocardium in acute infarction. To assess the safety and efficacy of rt-PA thrombolytic therapy, an open label clinical trial was conducted. Patients of acute myocardial infarction with angina, occurring within the five previous hours, was treated with rt-PA 100 mg infusion within three hours; followed with coronary arteriography to assess the patency rate of infarct vessels. Twenty-five cases of acute myocardial infarction were studied over a 10-month period. The patients, 24 male and one female, were aged 58.1 +/- 7.7 years. Rt-PA was given at 3.17 +/- 1.0 hour. Infarct-related vessels had opened in 21/24 cases when examined with coronary arteriogram three hours after infusion. Good antegrade flow of grade 2 to 3 was gained in 20/24 cases, representing an 83% success rate. One patient expired from cardiogenic shock during the infusion; another was expired from noncardiac accident after coronary bypass graft. The total inhospital mortality rate was about 8%. There was no major bleeding complication except in one case with gastrointestinal bleeding requiring transfusion. IN CONCLUSION: rt-PA is safe and effective in the treatment of acute myocardial infarction in the early stage. Coronary arteriography can be safely delayed until three hours postinfusion, and the achieved reperfusion rate is up to 83%.

Adult↗
PubMed1989

Decreased natural killer cell activity in patients with invasive cervical carcinoma.

The cell-mediated immunity in 21,12,14 and 12 patients with preinvasive, stage I and II invasive cervical carcinoma, and in controls respectively, was studied. Lymphocyte subpopulations were enumerated using specific monoclonal antibodies (moAbs) of the Leu series (Leu2, Leu3, Leu4, Leu11b, and Leu15). Double stain using fluorescein-isothiocyanate (FITC) conjugated Leu2 moAb and phycoerythrin (PE) conjugated Leu15 moAb was applied to distinguish cytotoxic T-cells from suppressor T-cells. A 4-hour 51Cr-release assay was used to measure natural killer (NK) cell activity. The results showed that there was no significant difference in lymphocyte subpopulations among these 4 studied groups. However, the NK activity tended to be lower in patients with invasive cervical carcinoma (stage I and II) especially at a high effector/target ratio of 100. It is therefore concluded that functional cytotoxicity assay is more informative in evaluating the status of cell-mediated immunity against tumors than the enumeration of lymphocyte subsets.

Adult↗