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Chin-Jung Wang

Publications and source records attributed to Chin-Jung Wang.

At least 19 recordsLinked to original sources
PubMed2006

Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis.

OBJECTIVE: We report on two infertile women with localized adenomyosis who had successful pregnancies after treatment with laparoscopic cytoreductive surgery. DESIGN: Case report. SETTING: Tertiary care university hospital. PATIENT(S): Two infertile women with localized adenomyosis. INTERVENTION(S): Laparoscopic excision of adenomyotic lesion with/without subsequent hypoestrogenic agent was performed. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Hypoestrogenic agent with danazol was administered 3 months immediately after surgery in one woman. Both women conceived spontaneously at 30 and 21 months after surgery, respectively. The pregnancies were uneventful, and healthy infants were delivered via cesarean section at term. CONCLUSION(S): Laparoscopic cytoreductive surgery can be an alternative treatment to the use of hypoestrogenic agents or hysterectomy in women with localized adenomyosis, especially for those who want to maintain their fertility and achieve successful pregnancies. Patients may wait up to 21 months after surgery until a pregnancy occurs.

Adult↗
PubMed2006

Endoscopic management of cesarean scar pregnancy.

OBJECTIVE: To describe our experiences with the diagnosis and endoscopic treatment of cesarean scar pregnancy. DESIGN: Prospective clinical study. SETTING: Tertiary care university hospital. PATIENT(S): Eleven women treated in our division between 1999 and 2004 who had been diagnosed with cesarean scar pregnancy. INTERVENTION(S): Transvaginal ultrasound was used for diagnosis, and endoscopy (laparoscopy and/or hysteroscopy) was used to treat cesarean scar pregnancy and preserve fertility. MAIN OUTCOME MEASURE(S): Operative blood loss, hospital stay, and time to resolution of serum beta-hCG were recorded. RESULT(S): The gestational age at diagnosis ranged between 6 and 11 weeks. Laparoscopic treatment was used in four women, hysteroscopic treatment in six women, and one woman underwent combined treatment with laparoscopy and hysteroscopy. The average blood loss during surgery was 110.9 mL (range, 20-300 mL), and average hospital stay was 1.7 days (range, 0.25-3 days). No complications occurred, and no blood transfusion was required. All patients' uteri were successfully preserved, and serum beta-hCG levels declined to a normal limit within 4 weeks postoperatively. CONCLUSION(S): When the diagnosis of cesarean scar pregnancy is made in the first trimester, endoscopy can be an alternative surgical treatment; the prognosis is good, and fertility can be preserved.

Adult↗
PubMed2006

Prenatal diagnosis of de novo interstitial 2q14.2-2q21.3 deletion assisted by array-based comparative genomic hybridization: a case report.

BACKGROUND: During conventional karyotyping, it can be difficult to clearly identify de novo interstitial deletion of a chromosomal band when there are similar bands nearby. CASE: A 38-year-old, pregnant woman underwent genetic amniocentesis at 18 weeks of gestation due to advanced maternal age. Chromosomal studies detected an interstitial deletion at the long arm of 1 chromosome 2. Array-based comparative genomic hybridization further located the deletion in the band of interstitial 2q14.2-2q21.3. Prenatal ultrasound revealed borderline ventriculomegaly without additional abnormalities of the cardiovascular, urinary or gastrointestinal systems or the spine. Fetal magnetic resonance imaging identified mild dilatation of the posterior horns of the lateral ventricles. At 5 months after birth, the infant had febrile convulsions that were well controlled with medication. A single incisor was noted at 1 year of age. Atrophy of the left, undescended testis and developmental delay were also noted. CONCLUSION: Array-based comparative genomic hybridization is helpful in prenatal diagnosis because it can precisely locate the chromosome bands with copy number changes. Clinical manifestations in this case provide valuable information for genetic counseling pregnant women who conceive a fetus with deletion of interstitial 2q14.2-2q21.3.

Adult↗
PubMed2005

Congenital chylothorax in three siblings.

Congenital chylothorax is an uncommon condition, resulting from lymphatic accumulation in the fetal thorax; affected siblings are extremely rare. We report a woman who delivered 3 children with congenital chylothorax; each case was managed differently, including the use of ex utero intrapartum treatment (EXIT) with the third pregnancy.

Adult↗
PubMed2005

Laparoscopic-assisted vaginal subtotal hysterectomy.

BACKGROUND: A novel approach in combined laparoscopic and vaginal procedures through the posterior cul-de-sac for subtotal hysterectomy is introduced. PATIENTS AND METHODS: Twenty-one women with menometrorrhagia, symptomatic adenomyosis, or uterine myomas were enrolled in this study. After laparoscopic dissection of bilateral round ligaments and adnexa, a guiding suture brought the uterine fundus down through the posterior cul-desac into the vagina via a posterior colpotomy. Subtotal hysterectomy and hemostasis of the cervical stump were then performed transvaginally by conventional techniques and equipment. RESULTS: Mean operative time, blood loss, and length of hospital stay were 111.2 +/- 28.8 minutes, 252.4 +/- 147.9 mL, and 3.2 +/- 0.9 days, respectively. No patients developed serious complications, but 1 patient had a postoperative stump infection and was treated with 2 combined antibiotics, uneventfully. CONCLUSION: A combined laparoscopic and vaginal approach in performing subtotal hysterectomy through the posterior cul-de-sac is an alternative to a purely laparoscopic approach.

Anti-Bacterial Agents↗
PubMed2005

Comparison of the efficacy of the pulsed bipolar system and conventional bipolar electrosurgery in laparoscopically assisted vaginal hysterectomy.

BACKGROUND: We compared the safety and effectiveness of the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopically assisted vaginal hysterectomy (LAVH). PATIENTS AND METHODS: In this prospective, nonrandomized study, 62 women with benign gynecologic diseases scheduled for LAVH were divided into two groups: one group underwent LAVH with the pulsed bipolar system and the second group underwent LAVH with conventional electrosurgery. Outcome measures for both groups were compared in terms of length of operative time, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULTS: The mean operative time (87.6+/-28.1 minutes vs. 93.4+/-20.2 minutes, P=0.368), blood loss (196.8+/-143.7 mL vs. 253.2+/-125.8 mL, P=0.105), and blood transfusion rate (3.2% vs. 6.5%, P=1.0) were slightly greater in the conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. The mean length of hospital stay was similar in both groups (3 days). No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. CONCLUSION: Our findings indicate that the pulsed bipolar system is as safe and effective as conventional electrosurgery, and may offer an alternative option for patients undergoing LAVH.

Adult↗
PubMed2004

A simplified method to decrease operative blood loss in laparoscopic-assisted vaginal hysterectomy for the large uterus.

UNLABELLED: STUDY OBJECTIVE. To evaluate the role of oxytocin in decreasing operative blood loss in laparoscopic-assisted vaginal hysterectomy (LAVH) for the large uterus (weight > or = 500 g). DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: Eighty-eight women scheduled for a hysterectomy for large benign uterine tumors. INTERVENTION: Two ampules of oxytocin (10 u/mL/amp) were added to 1000 mL of saline solution running at the rate of 40 mU/min during the course of LAVH. MEASUREMENTS AND MAIN RESULTS: Blood loss and blood transfusion rate were significantly greater in the group without oxytocin infusion (group B) than in the group with oxytocin infusion (group A), with 485.7 +/- 321.6 mL versus 364.1 +/- 173.2 mL (p <.05) and 26.7% versus 6. 1% (p <.05), respectively. There was no significant difference in average age, body weight, and number of vaginal deliveries and cesarean sections between the two groups. There also was no significant difference in mean uterine weight, postoperative stay, and complications between the two groups. CONCLUSION: Oxytocin infusion can cause uterine contractions that decrease uterine perfusion. It is a safe and inexpensive method to help decrease operative blood loss during LAVH for the large uterus.

Adult↗
PubMed2004

Trocar-assisted sling suspension for stress urinary incontinence: three-year follow-up.

STUDY OBJECTIVE: To evaluate 3-year outcomes of trocar-assisted sling suspension (TASS) for genuine stress incontinence. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-based, tertiary-level center for endoscopic surgery. PATIENTS: One hundred forty women with genuine stress incontinence with bladder neck hypermobility. INTERVENTION: After standard surgery preparation and general endotracheal anesthesia, TASS was performed. The periurethral space and thicker parts of the pubocervical fascia were opened from the vagina. A 0.5-cm incision was made on both sides of the lower abdomen and was measured 4-cm lateral to the linea album and 2-3-cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A 2-cm x 30-cm folded polypropylene mesh was placed inside the vagina and was then pulled out of the trocar sheath by a laparoscopic forceps. MEASUREMENTS AND MAIN RESULTS: All patients completed the procedures without exception. The average blood loss was less than 50 mL (range 10-200 mL). The operative time ranged from 20 to 90 minutes with a mean time of 32 +/- 12 minutes. Eleven patients had voiding difficulty. Six of them voided well after intermittent self-catheterization performed 28 days postoperatively. Seven patients had poor healing of the anterior vaginal wall; therefore, removal of mesh and wound repair were performed. One patient suffered from a retroperitoneal hematoma, and one patient had an intraoperative bladder injury. The overall complication rate was 14.3%. During 12-36 months of follow-up, 134 of 140 patients (95.7%) were satisfied with the surgery. CONCLUSIONS: Based on the results of our pilot study, TASS is quite feasible as a method of treatment for stress urinary incontinence. The surgery is not difficult to perform when compared with Burch colposuspension. Moreover, it encompasses the simplicity and effectiveness of tension-free vaginal tape surgery. In addition, TASS also can correct lateral wall defects such as cystocele.

Adult↗
PubMed2004

Laparoscopic-assisted vaginal myomectomy through an anterior approach.

BACKGROUND: To evaluate the safety and efficacy of a combined laparoscopic and vaginal approach through the anterior cul-de-sac in dealing with fundal and/or anterior wall uterine myomata. PATIENTS AND METHODS: Seven women with symptomatic fundal and/or anterior wall uterine myomata were enrolled in this study. After laparoscopic identification of the location of the myomata, a guiding suture brought the dominant myoma down through the anterior cul-de-sac into the vagina via an anterior colpotomy. Resection and suturing were then performed transvaginally. RESULTS: Mean +/- standard deviation (SD) operative time, blood loss, and the length of hospital stay were 88.1 +/- 27.8 minutes, 278.6 +/- 131.8 mL, and 2.9 +/- 0.7 days, respectively. No patients developed serious complications, and only four transient macroscopic hematuria occurred intra- and postoperatively. CONCLUSION: Although transient hematuria may occur, a combined laparoscopy and vaginal approach in dealing with fundal and/or anterior wall uterine fibroids through the anterior cul-de-sac is an alternative to pure laparoscopic myomectomy.

Adult↗
PubMed2004

Three-dimensional power Doppler ultrasound diagnosis and laparoscopic management of a pregancy in a previous cesarean scar.

An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

Adult↗
PubMed2003

Huge maternal hydronephrosis: a rare complication in pregnancy.

A huge maternal hydronephrosis is uncommon in pregnancy and might be mistaken as a pelvic mass. A 21-year-old primigravida was noted at 25th week of gestation to have a visible bulging mass on her left flank. The mass was originally mistaken as a large ovarian cyst but later proved to be a huge hydronephrosis. Retrograde insertion of ureteroscope and a ureteric stent failed, so we performed repeated ultrasound-guided needle aspiration to decompress the huge hydronephrosis, which enabled the patient to proceed to a successful term vaginal delivery. Nephrectomy was performed after delivery and proved the diagnosis of congenital ureteropelvic junction obstruction.

Adult↗
PubMed2003

Laparoscopic radical trachelectomy for stage Ib1 cervical cancer.

Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.

Adult↗
PubMed2003

Postlaparoscopic vulvar edema, a rare complication.

Two cases of unilateral labial edema occurred after laparoscopic presacral neurectomy and were associated with massive chylous ascites. One woman was cured by a second laparoscopy to repair the chylous leakage. In the other, vulvar edema subsided in 2 days and chyloperitoneum subsided spontaneously in 3 weeks. The mechanism of postlaparoscopic vulvar edema is believed to be similar to that of Conn's postparacentesis labial edema, in which the unhealed puncture tract permits ascites to travel through and accumulate in the labia majora.

Adult↗
PubMed2003

Management of port-site metastasis after laparoscopic surgery for ovarian cancer.

OBJECTIVE: The purpose of this study was to define the clinical features and long-term prognosis of port-site metastasis after primary laparoscopic surgery for ovarian cancer. STUDY DESIGN: All the patients with epithelial ovarian cancer or borderline malignancy who had undergone primary laparoscopic surgery at our institution were reviewed. The clinicopathologic parameters, flow cytometric parameters, p53, p27, bax, HER-2/neu, and bcl-2 by immunostaining, presentation of port-site implants, management of the individual patient, and long-term outcome were analyzed. CANCERLINE and MEDLINE (1960-2002) were searched for related papers. RESULTS: Between 1993 and 2001, of the 31 patients with epithelial ovarian cancer or borderline malignancy who underwent primary laparoscopic surgery at Chang Gung Memorial Hospital, 6 (19.4%) had port-site metastasis. The other 2 patients were referred after port-site metastasis. Tumors with port-site recurrences had higher S-fraction than those without (median: 18.2% vs 9.9%, P =.003; relative risk ratio: >15.5% vs <or=15.5% = 38.33; 95% CI, 3.3-449.2). Those patients who have port-site metastasis develop during chemotherapy (n = 2) or after adequate chemotherapy had been given (n = 2) all died of cancer. Two patients have been currently alive without disease, the tumors of whom were p27-positive and p53-, HER-2/neu -, bcl-2-negative. CONCLUSION: Port-site metastasis after laparoscopic surgery, during chemotherapy or when adequate chemotherapy has been given, is usually associated with poor outcome. Further investigations are necessary to define the mechanisms and effective management to prevent and treat this serious complication.

Adult↗
PubMed2002

Fertility-preserving treatment in young patients with endometrial adenocarcinoma.

BACKGROUND: Hormone therapy alone for early-stage, low-grade endometrial carcinoma arising in young women has been reported occasionally in case reports or small series. However, a comprehensive guideline for selection, treatment, and follow-up is not available as yet. METHODS: In the current study, the authors' evaluated the outcome of a cohort of young women with clinically diagnosed endometrial adenocarcinoma Stage IA, Grade 1 who were selected for fertility-preserving treatment by stringent staging procedures and treated in a standard protocol using combinations of megestrol acetate, tamoxifen, and gonadotropin-releasing hormone analog (GnRHa). RESULTS: Nine eligible patients were treated between 1991 and 1999. The median age of the patients was 32 years (range, 30-39 years). Of the 9 patients, 8 (88.9%) achieved complete remission after hormone therapy. Four patients had ever conceived (two patients had three term pregnancies and underwent consolidation hysterectomy after completion of family planning). Only one patient underwent hysterectomy for failure to respond, whose tumor was estrogen receptor (ER)/progesterone receptor (PgR) positive by immunostaining but negative by ligand-binding method. Another patient, whose tumor was ER negative/PgR positive, had residual carcinoma on the first assessment and achieved complete remission after replacement of tamoxifen with a GnRHa. Four responders later developed recurrent endometrial carcinoma. One underwent immediate hysterectomy. Two were successfully re-treated with hormone therapy, but the other did not respond and underwent hysterectomy. All nine patients have been alive without evidence of disease 25-113 (median, 69) months from initial diagnosis. CONCLUSIONS: The treatment strategy described in the current study is feasible. A larger multicenter trial of fertility-preserving treatment is warranted for nulliparous young patients with well selected Stage I, Grade 1, endometrial adenocarcinoma.

Adenocarcinoma↗
PubMed2002

Laparoscopic uterine artery ligation for treatment of symptomatic adenomyosis.

STUDY OBJECTIVE: To investigate the effect of laparoscopic uterine artery ligation on symptomatic adenomyosis. DESIGN: Prospective pilot study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Twenty women with symptomatic adenomyosis. INTERVENTION: Laparoscopic ligation of bilateral uterine arteries with hemoclips and electrocoagulation of bilateral uterine ovarian vessels. MEASUREMENTS AND MAIN RESULTS: Patients underwent sonographic measurement of uterine size, and recorded amount of menstruation and dysmenorrhea preoperatively and postoperatively. Six months postoperatively, mean uterine size had decreased by an amount ranging from 0.4% to 74.0%. Two of nine women achieved remission of the mass effect of an enlarged uterus. Thirteen of 16 patients achieved bleeding control and 5 returned to eumenorrhea or hypomenorrhea. Twelve of 16 patients achieved control of dysmenorrhea and 6 were analgesic free. However, nine women experienced nonmenstrual pain after surgery, three of whom underwent hysterectomy later. Treatment was rated as satisfactory by 15% of patients, but 45% were dissatisfied. Seventeen women would have refused to undergo the procedure if they could make the decision again. CONCLUSION: Poor satisfaction in this preliminary study suggests that symptomatic adenomyosis may not be effectively treated by laparoscopic uterine artery ligation.

Adult↗
PubMed2002

Combined laparoscopic uterosacral and round ligament procedures for treatment of symptomatic uterine retroversion and mild uterine decensus.

STUDY OBJECTIVE: To evaluate the efficacy of a new modified technique to treat a symptomatic retrodisplaced uterus. DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: Thirty-one women with symptomatic uterine retrodisplacement but without significant pelvic pathology. INTERVENTION: Laparoscopic shortening and plication of uterosacral ligaments with modified Gilliam suspension. MEASUREMENTS AND MAIN RESULTS: In average follow-up of 3.3 +/-1.0 years, all patients had an anteverted, anteflexed uterus. Mean +/- SD operating time was 24.1 +/- 4.7 minutes. There were no complications during or after surgery. Dyspareunia scores before and after surgery were 5.4 +/- 1.4 and 0.5 +/- 0.7, respectively (p <0.001). Chronic pelvic pain was satisfactorily relieved in seven of nine women. Vagina lengths before and after surgery were 5.9 +/- 0.7 and 7.0 +/- 0.3 cm, respectively (p <0.001). CONCLUSION: Our technique achieved long-lasting good results in suspending uteri in anteverted, anteflexed position and relieved symptoms caused by retrodisplacement.

Adult↗