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Biomedical subjects

D B Chang

Publications and source records attributed to D B Chang.

At least 37 records · Page 2Linked to original sources
PubMed1993

Needle aspiration biopsy of malignant lung masses with necrotic centers. Improved sensitivity with ultrasonic guidance.

False-negative results from transthoracic needle aspiration biopsy of malignant lung masses may occur if a central necrotic area is present and is the source of the biopsy material. The purpose of this study is to determine if the use of ultrasonic guidance can improve the sensitivity of lung needle biopsies in this circumstance. Sixty patients with malignant lung masses underwent ultrasonic examination in an 18-month period. In 14 cases, ultrasound showed that the mass had a large central necrotic area that was at least half the diameter of the tumor. Under ultrasonic guidance, needle biopsy specimens were taken from the central necrotic area and from the tumor wall in each case. Adequate biopsy specimens were obtained in all 14 patients. In all cases, the mural biopsy material was diagnostic for malignant tumor, while the biopsy specimen from the necrotic center was nondiagnostic in 10 of 14 patients. No complications occurred. We conclude that ultrasonically guided lung biopsy is a useful and safe tool to avoid false-negative needle biopsy specimens in malignant lung tumors with necrotic centers.

Adenocarcinoma↗
PubMed1993

Comparison of DNA stemline and cell kinetics between primary breast cancer and its lymph node metastasis.

Quantitative measurement of nuclear DNA in individual cells was performed on imprint smears of surgical specimens from 25 primary breast cancers and their concurrent regional lymph node metastases (LNMs). Twenty-five paired imprints taken from primary tumors and their LNMs were stained with the modified Feulgen method. The DNA content was measured with a scanning microdensitometer at a wavelength of 550 nm. The status of estrogen receptors in the primary tumor was measured with the charcoal-dextran-coated method. The DNA modal values were identical in 22 (88%) of 25 paired imprints. Among 13 estrogen receptor-positive (ER[+]) tumors, the DNA modal values were diploid or near-diploid (< 2.5C) in 8 (62%) primary tumors and 7 LNMs. In 10 estrogen receptor-negative (ER[-]) tumors, only 1 (10%) LNM had a near-diploid DNA modal value; all others were aneuploid. In primary tumors the DNA modal values of ER(+) tumors were significantly different from those of ER(-) tumors. The S-phase fraction value of a primary tumor correlated significantly with that of its LNMs. The percentage of cells with DNA content > 6.0C correlated highly between the primary tumor and its LNM. Of primary tumors, ER(-) tumors had more cells with high DNA content (> 6.0C) than ER(+) tumors did. A great similarity in cumulative DNA histograms between primary tumors and their LNMs was found, irrespective of the status of estrogen receptors. In conclusion, the primary breast cancer and its LNM had similar DNA distribution patterns--e.g., DNA modal value, S-phase fraction value and percentage of cells with high DNA content.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneuploidy↗
PubMed1992

Ultrasonography and ultrasonographically guided fine-needle aspiration biopsy of impalpable cervical lymph nodes in patients with non-small cell lung cancer.

BACKGROUND: Neck ultrasonography (US) and ultrasonographically guided fine-needle aspiration (UGFNA) cytologic examination were used in the staging work-up of 51 consecutive patients with non-small cell lung cancer (NSCLC) with clinically impalpable cervical lymphadenopathy. METHODS: All patients had chest radiography, fiberoptic bronchoscopic examination, computed tomography (CT) scans of the chest and abdomen, bone scan, and US of the abdomen and the neck. RESULTS: Six patients (12%) were found to have cervical lymph nodes by neck US. The cytologic examination of the lymph node aspirates obtained from UGFNA confirmed the metastasis. The clinical stage thus was changed from Stage IIIa to Stage IIIb in one patient. In the other five patients, UGFNA of cervical lymph nodes prevented more invasive diagnostic procedures. CONCLUSIONS: This preliminary study shows that neck US and UGFNA of lymph nodes may be helpful in the pretreatment evaluation of patients with NSCLC with impalpable cervical lymph nodes. However, additional study is needed to confirm this result.

Adenocarcinoma↗
PubMed1992

Ultrasonographically guided biopsy of thoracic tumors. A comparison of large-bore cutting biopsy with fine-needle aspiration.

A prospective study to compare the safety and diagnostic accuracy of ultrasonographically guided transthoracic large-bore cutting biopsy histologic examination with fine-needle aspiration cytologic examination was conducted in 149 patients with thoracic tumors (29 mediastinal tumors and 120 pulmonary masses). The authors found that large-bore cutting biopsy under ultrasonographic guidance could be as safe as fine-needle aspiration, whereas diagnostic accuracy was significantly higher (97% versus 59% in malignant tumors, respectively, P less than 0.05; 85% versus 33% in benign lesions, respectively, P less than 0.05). The size, depth, and location of lesions did not influence the results of transthoracic needle aspiration or cutting biopsy. In 77 patients with primary lung cancer, fine-needle aspiration cytologic examination, although achieving 88% positive cytologic results, identified the histologic cell type accurately in only 70%, whereas Tru-Cut (Top Surgical, Tokyo, Japan) biopsy was 97% accurate in confirmative histologic diagnosis. Fourteen patients had discordant cytologic and histologic diagnoses, and the cases of 3 (3.9%) were between small cell lung cancer and non-small cell lung cancer. The diagnostic accuracy of Tru-Cut biopsy also was significantly higher than that of fine-needle aspiration in metastatic cancers (90% versus 33%, respectively) and mediastinal tumors (100% versus 46%, respectively). The authors conclude that transthoracic cutting biopsy under ultrasonographic guidance is safe and has a higher diagnostic accuracy as compared with fine-needle aspiration. This technique is particularly useful for benign lesions or tumors with pleomorphic morphologic characteristics, such as lymphomas and thymomas.

Adult↗
PubMed1992

Comparison of OK-432 and mitomycin C pleurodesis for malignant pleural effusion caused by lung cancer. A randomized trial.

A prospective randomized study to compare the effectiveness of pleurodesis by two new sclerosing agents: OK-432 and mitomycin C were conducted in 53 patients with malignant pleural effusion caused by lung cancer. None of the patients received concomitant systemic chemotherapy or radiation therapy during the study. After complete drainage of pleural fluid, the patients were allocated randomly to receive 10 Klinische Einheit units of OK-432 or 8 mg of mitomycin C by intrapleural injection at weekly intervals. The treatment was terminated if the pleural effusion disappeared or the patients had received four consecutive procedures. There were 26 patients who received pleurodesis with OK-432 and 27, with mitomycin C. Patient characteristics in the two treatment groups (age, sex, histologic type, performance status, and prior treatment before pleurodesis) were compatible. These results showed that pleurodesis with OK-432 achieved a higher complete response rate (73%) than that of mitomycin C (41%). The rates of objective treatment response (complete response plus partial response) were comparable in both groups (88% for OK-432 and 67% for mitomycin C). The average number of intrapleural injections needed to achieve complete response was fewer in the OK-432 group (1.9 +/- 0.9) than in mitomycin C group (2.8 +/- 0.9). There was no significant difference in the median survival of the patients who received pleurodesis with OK-432 (5.8 months) or mitomycin C (5.1 months). However, the effusion-free period in the OK-432 group was significantly longer than that in the mitomycin C group (7.0 months versus 1.5 months). Patients who underwent OK-432 pleurodesis had a higher complication rate (80%) than did those in the mitomycin C group (30%). Transient febrile reaction was the most common reaction encountered. The immunologic study in OK-432 group showed an increase in peripheral leukocyte count and decrease in the OKT4/OKT8 ratio. The mitomycin C group had a mild reduction in peripheral blood leukocyte count and no significant change in the OKT4/OKT8 ratio. It was concluded that pleurodesis with OK-432 is an effective alternative treatment for malignant effusion in patients with lung cancer.

Adenocarcinoma↗
PubMed1992

Mediastinal malignancy: ultrasound guided biopsy through the supraclavicular approach.

BACKGROUND: Malignancies located in the upper middle mediastinum usually do not have a sufficiently large acoustic window to permit a conventional ultrasound guided parasternal biopsy. This study was concerned with an alternative approach whereby ultrasound is applied through the supraclavicular paratracheal window to allow percutaneous biopsy of middle mediastinal malignancies. METHODS: Fifteen patients who had upper mediastinal malignancies not in contact with the chest wall underwent real time and Doppler ultrasonographic studies by the supraclavicular approach. None of these tumours could be reached by conventional ultrasound guided parasternal biopsy. The ultrasound was scanned downwards through the supraclavicular fossa, along the acoustic window of the paratracheal soft tissue space. Percutaneous aspiration biopsy was performed with a 22 gauge needle under ultrasound guidance. If fine needle aspiration could not obtain an adequate tissue smear an 18 gauge Trucut biopsy was performed to obtain a histological diagnosis. RESULTS: Twelve of 15 mediastinal malignancies were detected by ultrasound through the supraclavicular approach. These 12 patients underwent percutaneous needle aspiration biopsy under ultrasound guidance. Four of the patients also had a Trucut biopsy because the needle aspirates from the tumours were inadequate. The needle had to pass through the jugular veins in four patients who received fine needle aspiration but in none of the patients who required a Trucut biopsy. Definite histological diagnoses were obtained in all 12 of these patients. Ten of the tumours were malignant and two benign. None of the patients developed any complication. CONCLUSIONS: Ultrasound and ultrasound guided biopsy through the supraclavicular paratracheal window provides a new approach for malignancy located in the upper middle mediastinum, which cannot be reached by conventional ultrasound guided parasternal biopsy. The diagnostic yield of this technique is high and the procedure is relatively safe.

Adenocarcinoma↗
PubMed1992

Ultrasound guided percutaneous cutting biopsy for the diagnosis of pulmonary consolidations of unknown aetiology.

BACKGROUND: Ultrasound has been used to guide percutaneous aspiration biopsy of thoracic tumours with high diagnostic yield. This study assessed the diagnostic value of ultrasound guided percutaneous cutting biopsy for pulmonary consolidation of unknown aetiology. METHODS: Thirty patients with undiagnosed lobar or segmental consolidation underwent ultrasound guided percutaneous needle aspiration and large bore cutting biopsy. The needle aspirates and biopsy specimens were sent for cytological, microbiological, and histopathological examination. RESULTS: Percutaneous needle aspiration provided a diagnosis in nine of 30 patients (30%), whereas cutting biopsy obtained a satisfactory specimen for histological diagnosis in 28 patients (93%) and provided a definite aetiological diagnosis in 17 patients (57%). The combination of needle aspiration with Trucut biopsy provided a diagnostic rate of 63%. The underlying diagnoses were fungal pneumonia (five patients), tuberculosis (five), bacterial pneumonia (one), bronchioloalveolar carcinoma (three), lymphoma (two), adenocarcinoma (one), vasculitis (one), acute pneumonia of unknown aetiology (one), and chronic non-specific pneumonia (nine). Two patients, who had necrotic tissue only in the biopsy specimen, were found at thoracotomy to have an adenocarcinoma and aspergillosis. Two patients had complications from the technique, a small pneumothorax in one and a small haemoptysis in another. CONCLUSIONS: Ultrasound guided percutaneous cutting biopsy is a valuable method for diagnosing pulmonary consolidation of unknown aetiology. The diagnostic yield is high and the procedure appears to be relatively safe.

Adult↗
PubMed1992

Ultrasonographic evaluation of pulmonary consolidation.

A total of 161 patients with lobar or segmental consolidation were examined by realtime ultrasound and Doppler ultrasound. Air bronchograms were detected in 141 patients, fluid bronchograms in 27 patients, and parapneumonic effusion in 74 patients. In 36 patients with necrotizing pneumonia, ultrasound detected microabscesses in 33 (91.7%) compared with the air-fluid levels detected by standard chest radiographs in 20 patients (55.6%; p less than 0.05). Of 31 patients with tumors causing obstructive pneumonitis, 29 (93.5%) had tumors detected by chest ultrasound, whereas only 11 patients (35.5%) had chest radiographs that suggested a tumor was causing the obstructive pneumonitis (p less than 0.05). Chest ultrasound was used to guide thoracentesis for parapneumonic effusion in 65 patients, with a 100% success rate. Twenty-six patients with necrotizing pneumonia underwent ultrasound-guided needle aspiration of microabscesses. The procedure was successful in 24 patients (92.3%), and 21 patients (80.8%) had microbiologic confirmation. Twenty patients with tumor-associated obstructive pneumonitis received needle aspiration biopsy under ultrasound guidance; 19 patients (95.0%) had the histology confirmed. Five patients with malignancy manifesting as pulmonary consolidation underwent a diagnostic ultrasound-guided needle aspiration biopsy. Five patients (3.8%) developed complications of minimal pneumothorax or mild hemoptysis in 132 episodes of needle aspiration. We conclude that ultrasonography is useful for the evaluation of pulmonary consolidation. It can also be used for needle aspiration guidance for etiologic diagnosis of patients with complicated pneumonia.

Adolescent↗
PubMed1992

Ultrasound-guided core biopsy of thoracic tumors.

Two hundred and eighteen patients, with thoracic tumors larger than 3 cm in size, underwent ultrasound-guided percutaneous transthoracic core biopsy with a large-bore Tru-Cut needle. Fifty-five tumors were in the mediastinum, and 122 tumors were located at subpleural area, and 42 tumors were within the lungs. In 122 subpleural tumors, the sensitivity of ultrasound-guided core biopsy for the diagnosis of malignancy was 96.8%, and accuracy was 97.5%. Sensitivity for the diagnosis of malignant tumors located within the lungs was 94.6%, and accuracy was 95.2%. In 54 patients with mediastinal tumors, definite histologic diagnosis could be obtained in 48 patients (88.9%). The sensitivity of ultrasound-guided biopsy for the diagnosis of malignancy in these 48 mediastinal tumors was 97.1%, with an accuracy of 97.9%. Three patients had complications with minimal pneumothorax and one with mild hemoptysis. We conclude that percutaneous transthoracic core biopsy with Tru-Cut needle under ultrasound guidance is a safe and sensitive way to obtain specimens for accurate histologic diagnosis of thoracic tumors. The diagnostic yield is high, and the technique, relatively simple, can also be used for outpatients.

Adolescent↗
PubMed1992

Ultrasound-guided aspiration biopsy of small peripheral pulmonary nodules.

We compared the diagnostic yields of ultrasound-guided aspiration biopsy, sputum cytology, and fiberoptic bronchoscopy with biopsy in 30 patients with peripheral pulmonary nodules smaller than 3.0 cm in diameter. Among them, there were 4 minute nodules with diameter less than 1.0 cm, 12 between 1.1 to 2.0 cm, and 14 between 2.1 to 3.0 cm. The final diagnoses in these 30 patients, as confirmed by histologic findings, microbiology, and clinical follow-up, revealed 24 malignant lesions and 6 benign. All of these 30 nodules received ultrasound-guided transthoracic fine-needle aspiration biopsy, and confirmative diagnoses were obtained in 27 (90 percent). Twenty-two (92 percent) of 24 patients with malignant nodules had positive cytology for malignancy and 5 (83 percent) of 6 patients with benign lesions had diagnosis made by cytologic and microbiologic examinations. One patient developed asymptomatic pneumothorax after needle aspiration. The size of the lesions did not affect the diagnostic yield and complication rate. None of the lesions was diagnosed by sputum cytology (0 of 19; 0 percent). Two patients had diagnoses obtained by fiberoptic bronchoscopy with biopsy (2 of 10; 20 percent). We conclude that ultrasound-guided aspiration biopsy is a useful and safe method for diagnosis of peripheral pulmonary nodules, even when the size of the nodule is less than 3 cm in diameter. The diagnostic yield far exceeds that which can be obtained by sputum cytology and fiberoptic bronchoscopy with biopsy.

Adult↗
PubMed1992

Late survival of non-small cell lung cancer patients with brain metastases. Influence of treatment.

The presence of brain metastasis in lung cancer patients is a highly unfavorable event that usually allows only palliative treatment. A retrospective study was conducted to evaluate the prognostic factors in patients with non-small cell lung cancer (NSCLC) associated with brain metastases. From July 1984 through June 1990, a total of 50 patients with NSCLC associated with symptomatic brain metastasis seen at National Taiwan University Hospital were included. Patients who had incomplete cancer staging workup or loss of follow-up were excluded. Several possible prognostic variables were analyzed initially with univariate analysis and subsequently with multivariate analysis with maximal partial likelihood ratio test in the Cox model. In the univariate analysis, several factors, including number of brain metastases, treatment for brain metastasis with brain tumor resection (BTR) or whole brain radiation therapy (WBRT), and chemotherapy (C/T) after brain metastasis were found to have significant influence on the survival. However, in the multivariate analysis, patients receiving BTR, WBRT, and/or C/T lived significantly longer. The median survival of patients treated with BTR was nine months, eight months in patients with C/T, and seven months in patients with WBRT. Taken together, these patients had a median survival of seven months, which was significantly longer than patients treated with supportive care only (with a median survival of two months). Treatment of brain metastases with WBRT, BTR, C/T, or in combinations also improved the quality of life. We conclude that NSCLC patients with brain metastases should be more aggressively treated with WBRT, BTR, C/T, or in combinations than supportive care only.

Adult↗
PubMed1992

Actinobacillus actinomycetemcomitans pneumonia with chest wall involvement and rib destruction.

There are four cases of Actinobacillus actinomycetemcomitans pulmonary infections reported in the English literature prior to 1990. We report a case of A actinomycetemcomitans pulmonary infection with invasion of overlying soft tissue, rib, and sternum. This manifestation has not been previously reported. The clinical manifestation is similar to that of Actinomyces israelii, which may be misinterpreted as malignancy initially. The portal of entry of A actinomycetemcomitans may be via hematogenous spread or aspiration. The diagnosis depends on culture after prolonged incubation of the involved tissue obtained by aspiration or biopsy. Elevated serum antibody is helpful for diagnosis of active infection. A actinomycetemcomitans is susceptible to most antibiotics, but is frequently resistant to penicillin, vancomycin, clindamycin, and erythromycin. Isolation of the organism and an in vitro drug sensitivity testing are important in managing the patient. Our patient recovered after a three-month regimen of penicillin.

Actinobacillus Infections↗
PubMed1992

Clearance of theophylline by hemodialysis in one patient with chronic renal failure.

The clearance of theophylline by hemodialysis was determined in one patient who had polycystic kidney with chronic renal failure and bronchial asthma. The serum levels of theophylline were determined by enzymatic immunoassay on two consecutive days, once on a dialysis day and again on a nondialysis day. Clearance of theophylline by hemodialysis was 119 ml/min, and the extraction efficiency was 0.56. The elimination half-life of theophylline shortened from 5.7 h to 1.6 h during hemodialysis. The dialysis rate constant (Kd) was 0.32/h, and 79 percent of the total body store of the drug was removed during a 4-h dialysis. Patients receiving theophylline who are maintained on hemodialysis should be closely monitored for bronchospasm during and after the hemodialysis procedure. Measurement of serum concentrations of theophylline should be employed to facilitate increases in dosage during hemodialysis.

Aminophylline↗
PubMed1992

Lung sequestration. Diagnosis with ultrasound and triplex Doppler technique in an adult.

The application of chest US with triplex Doppler technique to detect the systemic feeding artery of lung sequestration in an adult patient is described. To our best knowledge, this is the first description of the use of this technique to diagnose pulmonary sequestration in adult patients. This 35-year-old man had necrotizing pneumonia with abscess formation at the left lower lobe. Chest US demonstrated a large tortuous vessel in the central part of the lesion. Spectral wave Doppler analysis showed that this vessel was a systemic feeding artery and had pulsatile arterial wave-form. The color Doppler mapping delineated the blood flow originating from the descending aorta and toward the lesion, thus confirming the diagnosis of pulmonary sequestration. We conclude that chest US with triplex Doppler technique is a valuable method in evaluating a patient with a pulmonary lesion who was thought to have lung sequestration before performing invasive aortography.

Adult↗
PubMed1992

Value of sonography in determining the nature of pleural effusion: analysis of 320 cases.

To assess the value of sonography in determining the nature of pleural effusions, we prospectively analyzed the sonographic findings in 320 patients with pleural effusion of various causes (224 with exudates and 96 with transudates). The nature of the effusions was established on the basis of chemical, bacteriologic, and cytologic examination of pleural fluid; pleural biopsy; and clinical follow-up. All patients had high-frequency, real-time sonography performed by one of three sonographers who had no clinical information concerning the patients. The sonographer evaluated the images for internal echogenicity of the effusion, thickness of the pleura, and associated parenchymal lesions of the lung. The images were also printed out and interpreted a second time by the other two sonographers to reach a consensus. Our results showed that the two types of effusions could be distinguished on the basis of sonographic findings. Transudates were anechoic, whereas an anechoic effusion could be either a transudate or an exudate. Pleural effusions with complex septated, complex nonseptated, or homogeneously echogenic patterns were always exudates (p less than .01). Sonographic findings of thickened pleura and associated parenchymal lesions in the lung also were indicative of an exudate (p less than .01). Homogenous echogenic effusions were due to hemorrhagic effusion or empyema. Sonographic evidence of a pleural nodule was a specific finding in patients with a malignant effusion. We conclude that sonography is useful in determining the nature of pleural effusion.

Adolescent↗
PubMed1992

Diagnostic and therapeutic use of chest sonography: value in critically ill patients.

OBJECTIVE: Portable chest radiography, used for critically ill patients, often fails to depict thoracic disease clearly. Chest sonography allows good characterization of pleural diseases, mediastinal lesions, and pulmonary consolidations, and provides accurate and safe guidance for interventional procedures. Accordingly, we evaluated its usefulness in the diagnosis and management of critically ill patients. SUBJECTS AND METHODS: Sonography was used prospectively to evaluate 41 critically ill patients, when portable chest radiographs were difficult to interpret and failed to explain the clinical findings. An initial diagnosis was made on the basis of clinical and radiologic information. The final diagnosis was confirmed by thoracentesis (n = 15), image-guided aspiration biopsy (n = 7), surgery (n = 3), and clinical follow-up (n = 16). All 41 sonographic examinations were performed by a sonographer who had no knowledge of the initial diagnosis. The sonographic findings were recorded and analyzed. The usefulness of sonography in diagnosis and management was then evaluated according to the following criteria: diagnostic value--(1) made diagnosis, (2) changed diagnosis, (3) additional information, (4) no benefit; and management aid--(1) affected decision, (2) affected decision and guided thoracentesis, (3) affected diagnosis and guided aspiration, (4) no benefit. RESULTS: Chest sonography was helpful in diagnosis in 27 (66%) of 41 patients and in treatment in 37 (90%) of 41 patients. A significant influence on treatment planning occurred in 17 (41%) of 41 patients. A diagnostic aspiration biopsy under sonographic detected sonographically. Thoracentesis were attempted in 25 of 29 patients with pleural effusion and were successful in 24 patients (96%); a minimal pneumothorax developed in one patient (4%). CONCLUSION: Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. This technique can be particularly helpful when CT is not available or when critically ill patients cannot be moved.

Aortic Aneurysm↗