Gray scale ultrasonography in the diagnosis of abdominal diseases.
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Abdominal Neoplasms↗
Biomedical subjects
J C Sheu
Publications and source records attributed to J C Sheu.
Cytophotometric measurements of nuclear DNA content in hepatocellular carcinomas.
The nuclear DNA contents of 54 hepatocellular carcinomas were measured on cytologic smears using a scanning microdensitometer at a wavelength of 550 nm. The cellular materials were aspirated under ultrasonographic guidance and stained with modified Feulgen method. The DNA modal values, which could be defined in 51 cases, ranged from 2.2 to 9.8 ploidy, with 46.3% (25/54) in hypertetraploidy. The hepatocellular carcinomas in patients with higher serum levels of alpha-fetoprotein contained more hyperploid cells. The DNA modal values did not correlate with the age, HBsAg status, tumor size and histological grading of hepatocellular carcinoma. The S-phase fraction values, which could be estimated on the DNA histograms in 43 cases (79.6%), ranged from 1 to 35 (mean +/- S.D. = 10.6 +/- 8.1). The S-phase fraction values were higher in high grade hepatocellular carcinomas (13.4 +/- 8.5) than low grade hepatocellular carcinomas (6.1 +/- 4.4), p less than 0.01. The mean S-phase fraction values were also significantly higher in hepatocellular carcinomas with alpha-fetoprotein levels of more than 100 ng per ml than those of less than 100 ng per ml (12.9 +/- 8.0 and 7.8 +/- 5.6, respectively). The S-phase fraction values also did not correlate with the age, HBsAg status and tumor size.
Adult↗
Effect of hepatitis C antibody screening in blood donors on post-transfusion hepatitis in Taiwan.
A national screening programme for antibody to hepatitis C virus (HCV) in blood donors in Taiwan began in July 1992 using a second-generation immunoassay. To study the impact of this screening on post-transfusion hepatitis in Taiwan, a prospective study on post-transfusion hepatitis, that was started in 1987, was continued. As of June 1994, 245 patients who received a blood transfusion after July 1992 had completed a follow-up period for more than 6 months post-transfusion. Of them, seven (2.8%) recipients developed acute post-transfusion hepatitis. The hepatitis in six cases could not be attributed to infection by hepatitis A, B, C, D, E viruses or cytomegalovirus (CMV) or Epstein-Barr virus (EBV). The remaining patient seroconverted to both IgG and IgM anti-CMV. All seven patients recovered in 6 months without development of chronicity, and the mean peak alanine aminotransferase level was lower compared with that of the cases before anti-HCV screening (i.e. pre-July 1992). These results indicate that the current anti-HCV screening has effectively interrupted HCV transmission through blood transfusion in Taiwan.
Adult↗
Perinatal findings in a male fetus with congenital megacystis and anorectal malformations.
We report the perinatal findings in a male fetus with congenital megacystis and anorectal malformations. A 17-year-old primipara was referred to our department at 13 weeks of gestation for management of a 4.6 x 3.8 cm massive intra-abdominal fetal mass consistent with megacystis. The fetal thorax was severely compressed. We used a 22-gauge needle to perform intrauterine fetal vesicocentesis, removing 30 ml of fetal urine, decreasing the fetal bladder diameter/crown-rump length ratio from 65.7 to 17%. Cytogenetic analysis revealed a 46, XY karyotype. Intermittent bladder aspiration was performed weekly from 13 to 20 weeks of gestation and every 2-3 weeks from 21 to 35 weeks of gestation for the purpose of decompression. Mild dilation of both renal pelves was noted beginning at 20 weeks of gestation, however, neither progression of hydronephrosis nor development of oligohydramnios was noted. At 36 weeks of gestation, a live male neonate was delivered with a normal phallus, duodenal atresia, mild congenital heart defects, a distended bladder, bilateral hydronephrosis, megaureters, imperforate anus with rectovesical fistula, cryptorchidism and bilateral vesicoureteric reflux. The postnatal renal function was normal. He underwent serial operations including colostomy, anoplasty with repair of rectovesical fistula, duodeno-duodenostomy, bilateral re-implantation of ureters, orchiopexy and reduction cystoplasty. At 20 months of age, the child had normal renal function. The intravenous pyelogram showed normal functional kidneys, moderate megaureters and moderate megacystis. He underwent clean intermittent catheterization for residual urine. The recurrent urinary tract infections were under control.
Adolescent↗
Echo-guided lymphatic drainage by fine-needle aspiration in persistent isolated septated fetal nuchal cystic hygroma.
We report two cases of large, persistent, isolated, fetal nuchal cystic hygromas that underwent echo-guided lymphatic drainage by fine-needle aspiration during the second and third trimesters. Multiple punctures and fluid tapping from cystic hygromas under sonographic guidance proved to be easy procedures and not deleterious to the fetuses. The decompression effect caused by lymphatic drainage in utero can prevent polyhydramnios, irreversible fetal facial deformity and progression to hydrops fetalis. Furthermore, when carried out during the third trimester, especially before delivery, it helps avoid birth injury, dystocia and neonatal asphyxia.
Adult↗
The stage I yolk sac tumor of testis in children younger than 2 years, chemotherapy or not?
Yolk sac tumor is the most frequent germ cell tumor of testis in children. For stage I yolk sac tumor of testis in children younger than 2 years, high inguinal orchiectomy alone has been the standard treatment, with a cure rate of at least 75%. Here, we compare the treatment results of receiving chemotherapy or no chemotherapy after orchiectomy, to analyze the role of chemotherapy. From February 1987 to January 1997, 22 children younger than 2 years, with stage I yolk sac tumor of testis, were included in the study. All patients had high inguinal orchiectomy without retroperitoneal lymphadenectomy. Initial diagnostic imaging studies included computed tomographic scan of abdomen, chest radiography, and long bone survey. Clinical stage I was defined as a tumor completely resected with no evidence of local regional lymph node involvement or distant metastases. Serum alpha-fetoprotein (AFP) was assessed at diagnosis. After orchiectomy, diagnosis, and staging, patients were stratified into two treatment groups, with or without chemotherapy, according to the decision of the parents. Ten children received chemotherapy consisting of cisplatin, vinblastine, and bleomycin (PVB, modified "Einhorn regimen") for 12 weeks. The remaining 12 patients were followed up according to a "wait and see" policy. Determination of AFP was performed monthly during the first postoperative year, every other month during the second year, every 3 months during the third year, every 6 months during the fourth year, and yearly until the fifth postoperative year at least. The duration of follow-up ranged from 3 months to 119 months (median, 53 months). The Kaplan-Meier plot estimated an overall survival rate of 91.6% at 7 years after diagnosis. Among the 12 patients without chemotherapy, 2 children had relapses at 4 and 6 months after diagnosis, respectively. One was cured with PVB chemotherapy. The other patient died with refractory lung metastasis, in spite of intensive multimodality salvage therapy. The Kaplan-Meier plot showed a survival rate of 80% at 7 years and a relapse-free survival rate of 81.8% at 5 years after diagnosis. All children receiving chemotherapy were alive and free from relapse. There was no significant treatment-related toxicity. Our results may suggest that PVB chemotherapy after orchiectomy is an affective and safe regimen for stage I yolk sac tumor of testis in children younger than 2 years. Instead of four courses of PVB as used here, two or three courses could be enough. To elucidate the necessity for chemotherapy and to determine the number of courses of PVB needed (if chemotherapy is given), a randomized study of more cases is warranted.
Antineoplastic Combined Chemotherapy Protocols↗
Intrahepatic bilomas associated with hepatic arteriovenous malformation.
A 26 year-old female presented with progressive intermittent right upper quadrant pain. Hepatic arteriovenous malformation with small intrahepatic bilomas were found. She underwent hepatic artery ligation for control of her abdominal pain. Though the abdominal pain subsided after the hepatic artery ligation, the intrahepatic bilomas progressed. It is possible that the hepatic arteriovenous malformation (AVM) might reduce blood flow to the bile duct and then induce ischemia in the peribiliary capillary plexus, thus leading to bile duct necrosis and formation of bilomas, which could be further aggravated by hepatic artery ligation.
Adult↗
Serum hepatocyte growth factor before and after resection for hepatocellular carcinoma.
BACKGROUND/AIMS: Hepatocyte growth factor (HGF) is the most potent hepatocyte proliferation stimulator. Serum HGF levels are high in various liver disease states such as cirrhosis, hepatocellular carcinoma (HCC) and hepatitis. But the role HGF plays in HCC is not clear at present. The purposes of this study are: 1) to reveal the HGF profile pre- and post-HCC resection, which has not been well-described before; and, 2) to analyze the relationships between the pre- and post-operative HGF levels and various clinical parameters. METHODOLOGY: We performed a retrospective cohort study to check the HGF profiles before and after curative resections for HCC and to analyze the relationships between them by using clinical parameters from 35 consecutive patients at the Department of Surgery, National Taiwan University Hospital. Blood samples collected from another 23 healthy individuals admitted for health check-ups were used as normal controls. Serum HGF was determined with an ELISA kit. RESULTS: The baseline HGF concentration in HCC patients was significantly higher than that in normal controls (1743+/-73 vs. 948+/-54 pg/ml, p<0.0001). The HGF concentrations on post-operative days (POD) 1, 3, 5, 7, and 14 were all significantly higher than those seen in normal controls (all p less than 0.0001). The first and third POD HGF values were significantly higher than the pre-operative level (p=0.00135 and 0.00187 respectively). The HGF concentrations would return to the pre-operative level on the fifth POD, but they never returned to normal level at the end of the two-week study. The pre-operative HGF level was affected by patient age (p=0.0236), and the post-operative peak HGF level was positively correlated with the pre-operative indocyanin green retention rate (ICGR15) and GOT level (p=0.0320 and 0.0234 respectively). CONCLUSIONS: In this study, we proved, indirectly, that HGF was not secreted by the HCC tumor cells per se. The peak post-operative HGF level reflected the relative stress of the operation on the diseased liver, but did not reflect the absolute physical extent of liver resection. The relationships between HGF and the prognosis of the patients after HCC resection demands further investigation.
Adult↗
Correlation of E-cadherin expression and recurrence of hepatocellular carcinoma.
BACKGROUND/AIMS: We performed this study to clarify the relationship between E-cadherin expression and recurrence of hepatocellular carcinoma. METHODOLOGY: Forty-five surgically resected specimens of hepatocellular carcinoma were collected. The patients included 35 men and 10 women. The ages were between 30 and 77 years, with a mean age of 54 years. Western blotting and/or immunohistochemical staining of the tumor and non-tumor tissues for detection of E-cadherin were performed. Reverse transcription-polymerase chain reaction to check the levels of mRNA for E-cadherin and nucleotide sequencing of putative calcium binding domains were done if the tumor tissues showed negative E-cadherin expression. RESULTS: Three (6.7%) tumor tissues were negative for E-cadherin with both Western blotting and immunohistochemical staining. Of the 3, two showed decreased mRNA in tumor tissues while the other 10 randomly selected samples did not show this phenomenon. No mutation of nucleotide sequence in the putative calcium binding domains was found. Two of the 3 patients had invasive cancers by histological studies while 13 out of the other 42 E-cadherin positive cases showed invasive cancers. CONCLUSIONS: E-cadherin underexpression might have some contribution to the early recurrence of hepatocellular carcinoma. Transcriptional or post-transcriptional down-regulation may be the mechanism of underexpression of E-cadherin in hepatocellular carcinoma.
Aged↗
A different experience of hepatic adenoma in Taiwan with emphasis on clinical manifestations and ultrasonographic features.
BACKGROUND/AIMS: Hepatic adenoma is a rare benign hepatic tumor and it is difficult to differentiate it from other focal hepatic tumors. Ultrasonography has become the choice of methods to detect focal hepatic lesions. The study aims at analyzing ultrasonographic features of hepatic adenoma. METHODOLOGY: A total of 8 patients with pathologically proven hepatic adenoma were studied retrospectively during an 8-year period. The ultrasound scanners used were Toshiba SSA-100A, Toshiba SSA-240 and Aloka 630. The ultrasonographic features and clinical data were analyzed. RESULTS: There were 7 males and 1 female. The mean age was 50 years. Of the 8 cases, 2 symptomatic cases had a tumor larger than 10 cm. The remaining 6 cases were asymptomatic and had tumors smaller than 5 cm. The echogenicity was variable in these tumors. An irregular sonolucent was only noted in a 15 cm tumor and was histologically proven to be internal bleeding. All the tumors were well-defined, however, a hypoechoic rim was obvious only in the isoechoic and hyperechoic tumors. CONCLUSIONS: Ultrasonographic features of some hepatic adenomas are different from those of hepatocellular carcinomas and hemangiomas, although the differential diagnosis cannot be made in small hypoechoic tumors. When ultrasonography is used more widely, more asymptomatic patients with small-sized hepatic adenoma will be detected, even in male subjects. The concept about the pathogenesis of hepatic adenomas may be changed.
Adenoma↗
Pancreatic tumors in children: report of three cases.
From 1981 to 1996, we experienced 3 cases of pancreatic tumors in children--two pancreatoblastomas (PB) and one solid and cystic tumor (SCT). The ages were 1 month, 4 years, and 13 years of age respectively. The two cases of pancreatoblastoma initially presented as chronic diarrhea with failure to thrive, the other case presented with abdominal mass. All of them were studied by laboratory examination, ultrasonography, computed tomography and pathology. Increasing alpha- fetoprotein (AFP) levels were found in the 2 pancreatoblastoma cases, however, the level in the SCT case was normal. Abdominal sonography showed pancreatic masses with or without calcification, and the echogenicity may be solid and/or cystic. All patients underwent total excision of the tumors. We have reviewed the literature and find no pancreatoblastoma with chronic diarrhea was reported in young children, especially in neonate. Therefore, we suggest that young children presenting with an abdominal mass and/or weight loss should undergo imaging studies for the possibility of pancreatic tumors.
Adolescent↗
Segmental dilatation of the ileum as an unusual cause of gastrointestinal bleeding: report of one case.
We report a case of segmental dilatation of the ileum in a 10-month-old male infant. Intermittent loose black-colored stool passage and normocytic anemia were noted at the initial visits to our hospital. There was no symptom or sign of intestinal obstruction such as abdominal distention or vomiting. On physical examination, he was found to be pale but his abdomen was soft and flat. Digital examination revealed brownish stool tinged with black-colored oil-like stool but no polyp. Laboratory studies excluded coagulopathy, hemolytic anemia and lead poisoning. During hospitalization, he was treated with nothing per mouth, intravascular fluids, ranitidine, and transfusion of packed red blood cells. All examinations including panendoscopy, Technetium-99m (99mTc)-pertechnetate Meckel's diverticulum scan, and double contrast colon series revealed no organic lesion except that 99mTc-red blood cell bleeding scans showed abnormal bleeding in the small intestine. Because of his persistent gastrointestinal bleeding with unknown cause, we did an exploratory laparotomy when the patient was 13 months old and idiopathic segmental dilatation of the ileum was confirmed. The dilated segment is supposed to be idiopathic because of histologically proven normal muscle layers without ectopic tissue. This case suggests that segmental dilatation of the ileum can only present as gastrointestinal bleeding without intestinal obstruction.
Dilatation, Pathologic↗
Recurrent hepatocellular carcinoma presenting with superior vena cava syndrome.
A 45-year-old male received wedge resection for his small hepatocellular carcinoma in April 1989 and extended right lobectomy for tumor recurrence 8 months later. Unfortunately, recurrent hepatic tumor with lung metastases were found 18 months after the second operation. Both the hepatic and pulmonary recurrent tumors were resected and transcatheter arterial embolization was added for the residual hepatic tumors. He remained symptom free for another 18 months. However, mediastinal lymphadenopathy, superior vena cava thrombus with superior vena cava syndrome, cardiac and brain metastases developed subsequently. He died of increased intracranial pressure. It is rare for hepatocellular carcinoma to have mediastinal metastases, superior vena cava thrombus and superior vena cava syndrome.
Carcinoma, Hepatocellular↗
Expression of matrix metalloproteinases in spontaneous regression of liver fibrosis.
BACKGROUND/AIMS: Spontaneous regression of liver fibrosis would depend on the degradation of the excessive matrix in the liver. In this study, we tried to determine the kinetics of the expression of genes for matrix metalloproteinase-2 and -13. METHODOLOGY: Liver fibrosis induced by carbon tetrachloride was resolved after withdrawal of this toxin. Histological staining for fibrous septa and determination of liver collagen content were used to evaluate the extent of liver fibrosis. Expression in liver of matrix metalloproteinase-2 and -13 was determined by reverse transcription-polymerase chain reaction. RESULTS: The fibrous septa became thinner and interrupted and liver fibrosis resolved rapidly within 10 days. Expression of matrix metalloproteinase-2 and -13 was elevated to 2.5- and 8.7-fold, respectively, at peak fibrosis. The former was maintained at 88%-76% and the later dropped rapidly to 30%-20% in the recovery periods. CONCLUSIONS: Resolution of liver fibrosis began within 10 days but only to 70%. Gene expression kinetics suggested metalloproteinase-13 might play a more important role in the resolution because it surged more markedly at peak fibrosis and returned to nearly basal levels in the recovery periods in parallel with liver collagen content.
Animals↗
Less reversal of liver fibrosis after prolonged carbon tetrachloride injection.
BACKGROUND/AIMS: It was generally believed, but not proved, that early cirrhosis may be reversible, while advanced cirrhosis may not. This present study is to compare in mice the spontaneous regression of liver fibrosis between early and more advanced stage. METHODOLOGY: Liver fibrosis in mice was induced by intraperitoneal injection of carbon tetrachloride for 4, 10, and 16 weeks. After the last dose of each schedule, mice were sacrificed 1 day later (progression model) or left untreated for 10, 20, and 60 days (regression model). Tissue sections were stained by Sirius red. Liver hydroxyproline levels were determined to assess severity of fibrosis. Gelatinases in tissue extracts were assayed by zymography. RESULTS: During regression, diminution of fibrotic bands was more prominent in the 4-week group than in the others. Liver hydroxyproline levels in the progression model increased and resolution of liver fibrosis in the regression model decreased as carbon tetrachloride injection was prolonged. Liver matrix metalloproteinase-2 and -9 activities in the progression model also decreased as the injection was prolonged. CONCLUSIONS: These data demonstrated that reversibility of liver fibrosis would be gradually lost as liver injuries were prolonged. Gradual loss of the expression of matrix metalloproteinases may be responsible for the loss of reversibility.
Animals↗
The management of anorectal malformations.
From 1982 to 1990, 120 cases of anorectal malformation (84 males and 36 females) were admitted to Mackay Memorial Hospital; 101 cases were corrected surgically. Among these, 40 cases were high (H) or intermediate (I) type, and 61 cases were low (L) type. In the 40 cases of the H and I type, 13 (Group 1) received Stephens' procedure (SPR) and the remaining 27 (Group 2) received Peña's procedure (PSARP). For the L type, translocation anoplasty, cut-back anoplasty and limited PSARP were employed in 10, 45 and 6 cases, respectively. Anorectal continence results were evaluated by Kiesewetter's criteria. In Group 1, the results were good in 25%, fair in 17% and poor in 58%. In Group 2, the results were good in 70% and fair in 30%. In addition to better anorectal continence, the PSARP resulted in a lower rate of major complications. In the L type, the results were excellent without significant difference among the types of surgery employed.
Anal Canal↗
Treatment of esophageal atresia with distal tracheoesophageal fistula: are gastrostomy and prophylactic esophageal dilatation necessary?
Fourteen cases of esophageal atresia with distal tracheoesophageal fistula were treated by primary anastomosis (11 cases) or delayed primary anastomosis (3 cases) between August 1980 and September 1985. Postoperative esophageal dilatation was not used in the 13 survivors and none developed esophageal stricture. In the 11 cases of primary anastomosis, gastrostomy was performed simultaneously only in the first 2 cases. The omission of gastrostomy did not aggravate the preexisting pulmonary condition. Rather it shortened the operation time. It is considered that prophylactic esophageal dilatation is not necessary and gastrostomy is required only when primary anastomosis is not possible.
Dilatation↗
Floating fetal head in primiparas at term.
A total of 924 pelvimetries made for floating fetal head at term in primiparas was analyzed according to the pelvic parameters and outcomes. More android and platypelloid type pelves, and more OP position and Naegele's obliquities were found. Significant shortening of obstetrical conjugate. A-P diameter of actual inlet and reduced Mengert area of the inlet were the common characteristics in this series. One third of the patients required abdominal delivery, and half of the vaginal deliveries needed instrumental help.
Female↗