Diffuse pancreatic islet cell disease with hyperinsulinism in adults: problems in recognition and management.
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Adult↗
Biomedical subjects
King-Jen Chang
Publications and source records attributed to King-Jen Chang.
Magnetic resonance imaging characteristics of paraffinomas and siliconomas after mammoplasty.
BACKGROUND AND PURPOSE: Breast paraffinomas and siliconomas are granulomas caused by tissue reaction to paraffin oil and silicone injection after mammoplasty. These granulomas usually present as multiple hard masses that mimic breast cancer. Mammography and sonography have only a limited role in differentiating these masses. Magnetic resonance (MR) imaging findings of these granulomas have rarely been reported. This study evaluated the MR imaging manifestations of these granulomas. MATERIALS AND METHODS: MR imaging, mammography, and sonography were used to examine 58 breasts in 29 women with breast lumps who had undergone mammoplasty with injections of paraffin oil (n = 8) or liquid silicone (n = 50). The protocol included T1-weighted images (T1WI), fat-suppressed (FS) T2WI, post-contrast FS three-dimensional fast dynamic sequences, and FS T1WI. RESULTS: Deep structures of the 58 breasts could not be clearly evaluated by sonography or mammography. Two types of MR imaging characteristics were identified: type I lesions were hypointense on T2WI and type II lesions had mixed hypointense and hyperintense components on T2WI. Both showed intermediate intensity on T1WI and revealed no enhancement on post-contrast dynamic sequences and FS T1WI. Type II lesions were seen only in siliconomas. Mastectomy was performed on seven breasts and paraffinomas or siliconomas were confirmed by pathology. When correlating MR images with pathology, hypointense lesions on T2WI in both type I and II lesions were foreign body granulomas with fibrosis and calcification. Hyperintense lesions on T2WI in type II were liquid silicone. A case of infiltrating ductal carcinoma was found in one breast in which MR imaging was successful in identifying the strongly enhanced solitary tumor from a background of type I lesions of paraffinomas preoperatively. Of the 51 breasts that did not receive surgery, no breast cancers were detected clinically or by follow-up imaging after a median of 27 months (19-54 mo). CONCLUSIONS: Breast paraffinomas and siliconomas after mammoplasty have specific MR findings that are distinct from those of breast cancers. MR imaging is superior to sonography and mammography in the evaluation of breast paraffinomas and siliconomas.
Adult↗
Calcium concentration in rat liver mitochondria during anoxic incubation.
BACKGROUND AND PURPOSE: The impairment of mitochondrial respiratory function is an important problem in anoxia-reoxygenation injury in animal cells. This study investigated the role of mitochondrial calcium ions (Ca2+) in a model of anoxic incubation in isolated rat liver mitochondria. METHODS: Mitochondria isolated from Wistar rat liver were subjected to anoxic incubation for 5 to 60 minutes. Changes in oxygen consumption by anoxic mitochondria were recorded using polarography. Changes in NAD(P)H fluorescence were recorded simultaneously. Intramitochondrial matrix free calcium concentration ([Ca2+]) was measured using the fluo-3/AM loading method. Respiratory function in anoxic mitochondria was measured polarographically from oxygen consumption. RESULTS: Mitochondrial state 3 respiration decreased progressively with increased duration of anoxic incubation, while state 4 respiration increased progressively. The decrease in the ADP/O ratio with the duration of anoxic incubation indicated that the efficiency of oxidative phosphorylation decreased with increased duration of anoxia. As the duration of anoxic incubation increased, the amplitude and rapidity of the oxido-reduction change in NAD(P)H fluorescence decreased. The respiratory control ratio showed that the functional integrity of mitochondria was linearly correlated with the free [Ca2+] in mitochondrial matrix (r2 = 0.977) and the total calcium concentration (r2 = 0.934). The free [Ca2+] in mitochondrial matrix significantly decreased with increasing anoxic duration. Total mitochondrial calcium concentration also decreased with increasing anoxic duration (p < 0.01). CONCLUSIONS: The supply of NADH was reduced during anoxic incubation of isolated rat hepatocyte mitochondria, which resulted in impairment of mitochondrial respiratory function. The decrease in free [Ca2+] in the mitochondrial matrix with increased duration of anoxic incubation implies that calcium ions may be released into the cytosol during anoxia.
Analysis of Variance↗
Laparoscopic Ladd's procedure for intestinal malrotation: report of three cases.
Ladd's procedure for laparoscopic repair of malrotation has many advantages over conventional surgical techniques, such as earlier feeding and discharge. However, this procedure is still not commonly used in Taiwan. This report describes the results of treatment of intestinal malrotation in three patients using laparoscopic Ladd's procedure. The patients, aged 8 days, 17 days, and 3 years, underwent laparoscopic Ladd's procedure between July 1999 and September 2000. All three patients had symptoms of intermittent vomiting and were shown to have intestinal malrotation by upper gastrointestinal series study. The procedure was performed using three trocars of 5 mm diameter placed at the infraumbilical ring and the right and left lower quadrants. All procedures were completed laparoscopically. The operative times were 4.8, 3.6, and 3.5 hours, respectively. Feeding was started on postoperative Day 2 to 5, and the hospital stay was 6 to 11 days. Our results suggest that laparoscopic Ladd's procedure can be performed safely in pediatric patients. In addition, patients are expected to benefit from the smaller incision, earlier feeding, shorter hospital stay, and fewer complications compared with traditional Ladd's procedure.
Child, Preschool↗
Prognostic factors for the survival of Taiwanese breast cancer patients.
BACKGROUND: The incidence of breast cancer is increasing rapidly in Taiwan. Prognostic factors for survival in Taiwanese breast cancer patients have not been comprehensively studied. METHODS: Registry records of 979 newly diagnosed breast cancer patients who received initial therapy at National Taiwan University Hospital from January 1991 to December 1995 were linked to the national mortality file from 1991 to 1997 using the citizen ID of each patient. The effects of potential prognostic factors were assessed using Cox's regression model. Five-year survival rates of common characteristics were predicted according to the model. RESULTS: Among the 979 patients, 174 died within the 7-year study period (163 died from breast cancer). The overall 5-year survival rate was 81% (95% confidence interval, CI = 78-84%). The adjusted hazard ratio (HR) of mortality for patients aged at least 50 years versus patients aged less than 50 years was 1.49 (95% CI = 1.08-2.05); the HR of mortality for tumors of at least 5 cm in diameter versus those less than 2 cm was 2.45 (95% CI = 1.33-4.51); the HR of mortality for positive versus negative nodes was 3.65 (95% CI = 2.33-5.71); and the HR of mortality for pathology of infiltrating ductal carcinoma versus other types was 2.63 (95% CI = 1.32-5.27). Five-year survival rates for patients without node involvement were higher than 90% regardless of tumor size, while those for patients with positive nodes were significantly lower, except for patients with tumors of less than 2 cm in diameter. CONCLUSIONS: Patients who had a small tumor and involvement of fewer nodes, and who were younger, had a higher probability of survival. Node involvement was more important than tumor size in the prediction of survival.
Adult↗
Quality of life of breast cancer patients in Taiwan: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-BR23.
The objective of this study was to test the reliability and validity of the Taiwan Chinese version of the EORTC QLQ-C30 (version 3) and EORTC QLQ-BR23. The authors followed the guidelines of translation and pilot testing of the questionnaires. The questionnaires were given to 35 breast cancer patients under active treatment and 54 under follow-up at the National Taiwan University Hospital from November 2000 to October 2001. A retest was conducted one to two weeks after the first interview/form completion for the follow-up group. The intraclass correlation coefficients of the two questionnaires were moderate to high in the follow-up group. The Cronbach's alpha coefficients of most scales of the two questionnaires were > or = 0.70 except that of physical functioning (0.68), cognitive functioning (0.53), and arm symptoms (0.59). Correlations of scales measuring similar dimensions of the EORTC QLQ-C30 and the SF-36 were moderate. Patients in the active treatment group had more serious QOL problems due to disease and treatment. Results of this study showed that the Taiwan Chinese version of the two questionnaires had good test/retest reliability, high internal consistency in most scales, and could show the expected differences between patients in active chemotherapy and follow-up group.
Adult↗
Effects of a medium-chain triacylglycerol/long-chain triacylglycerol fat emulsion containing a reduced ratio of phospholipid to triacylglycerol in pediatric surgical patients.
OBJECTIVE: Medium-chain triacylglycerol (MCT) has been shown to provide better nutritional support than long-chain triacylglycerol (LCT). We compared the efficacy of MCT/LCT fat emulsions containing a usual (0.12) or a decreased (0.06) ratio of phospholipid to triacylglycerol (PL:TG) in pediatric patients under surgical stress. METHODS: Three patient groups (n=10 in each) received equivalent amounts of glucose (12 g.kg(-1).d(-1)) and amino acids (2 g.kg(-1).d(-1)), but group A received a 10% MCT fat emulsion (PL:TG 0.06), group B received a 20% MCT fat emulsion (PL:TG 0.06), and group C received a 10% MCT/LCT fat emulsion (PL:TG 0.12) in amounts of 1.5 g.kg(-1).d(-1) in a randomized study. Total parenteral nutrition was given for 7 d. Blood samples were collected before total parenteral nutrition administration and on days 4 and 7 for determination of various biochemical indexes. RESULTS: Serum phospholipid concentrations were significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). Serum triacylglycerol and cholesterol concentrations and the very-low-density lipoprotein percentage were also significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). The high-density lipoprotein percentage was significantly higher in group B on days 4 and 7 (P<0.05). CONCLUSIONS: In pediatric patients under surgical stress, a total parenteral nutrition regimen containing an MCT/LCT fat emulsion with a decreased PL:TG ratio (0.06) is likely to result in partly better lipid and lipoprotein metabolism than an emulsion containing the usual ratio (0.12).
Child↗
Intravasation-related metastatic factors in colorectal cancer.
Alterations in adhesion molecules, angiogenesis, and matrix metalloproteinases have been associated with metastasis and intravasation. The present study investigated the role of these metastatic factors in the context of primary colorectal tumor. Intravasated colorectal epithelial cells were detected by an RT-PCR assay, and the expression of E-cadherin, alpha-catenin, or beta-catenin as well as the vascularity of tumor were assessed by immunohistochemical staining. Activity of matrix metalloproteinase was assessed by gelatin zymography. The tumor venous blood was positive for guanylyl cyclase C (GCC) mRNA expression in 40 of 68 patients, but alteration in expression of E-cadherin, alpha-catenin, or beta-catenin was not significantly associated with the presence of colorectal epithelial cells in paired portal venous blood. Further, matrix metalloproteinase activity did not correlate with the presence of intravasated colorectal epithelial cells. Multivariate analysis demonstrated that the only factor associated with intravasated colorectal tumor cells was the vascularity of the tumor. Thus, metastasis of colon cancer may result from passive entry into the circulation secondary to angiogenic factors and does not appear to involve other metastatic factors studied in our experiments.
Adult↗
Microbiology difference between colonized catheters and catheter-related bloodstream infections.
BACKGROUND/AIMS: Central vein catheters for patients receiving total parenteral nutrition have a high incidence of colonized catheters and catheter-related bloodstream infections. However, the actual incidence and bacterial pattern have not been well studied. This study was undertaken to investigate the difference in bacteriology between colonized catheters and catheter-related bloodstream infections. METHODOLOGY: From January 1997 to March 1998, 354 patients receiving total parenteral nutrition were included in this study. The patients ranged in age from 49 to 80 years, 151 women and 203 men. Colonized catheters and catheter-related bloodstream infections were defined. RESULTS: The culture was performed in 249 catheter tips (249 of 614, 40.6%). Sixty tips were found to have organisms. The organisms cultured from colonized catheters were Gram(+) aerobic bacteria (34, 56.7%), fungi (14, 23.3%), and Gram(-) aerobic bacteria (12, 20%). The organisms cultured from catheter-related bloodstream infections were fungi (16, 64%), Gram(-) aerobic bacteria (5, 20%), and Gram(+) aerobic bacteria (4, 16%). Dermatogenic infection in colonized catheters should be stressed, but systemic fungal infection in catheter-related bloodstream infections should be emphasized. CONCLUSIONS: A striking difference exists in bacterial species between colonized catheters and catheter-related bloodstream infections. Further studies on different treatment strategy for colonized catheters and catheter-related bloodstream infections should be undertaken. The combined approach of a total parenteral nutrition team, sterile protocols, and early diagnosis of fungemia should be advocated for the total parenteral nutrition patients.
Aged↗
Is imatinib justified as an adjuvant chemotherapy for patients with recurrent gastrointestinal stromal tumors.
Imatinib, an inhibitor of the tyrosine kinase activity of c-kit, was used as an adjuvant chemotherapy in two patients who underwent curative surgery for recurrent gastrointestinal stromal tumors. One patient has maintained tumor-free survival for 12 months, while the other had rapid recurrence and metastasis of tumors 3 months after he discontinued the drug. The indication and effects of imatinib for prevention of recurrence of GIST after ablative surgery were discussed.
Adult↗
Optimal interval from decompression to semi-elective operation in sigmoid volvulus.
BACKGROUND/AIMS: The initial non-operative decompression and subsequent semi-elective operation is a common strategy in managing sigmoid volvulus. However, the optimal interval between decompression and operation is still unclear. METHODOLOGY: From 1994 to 2004, 25 patients operated on for sigmoid volvulus at the National Taiwan University Hospital were enrolled. The treatment strategy and clinical outcome in these patients were retrospectively reviewed and analyzed. RESULTS: Twenty-one patients underwent successful non-operative decompression initially, and the remaining 4 patients underwent emergent operation. Gangrene of the colon was found in 3 patients, and all of them eventually died of medical complications, i.e. multiple organ failure, pneumonia and myocardial infarction. One leakage but no mortality occurred in the patients undergoing semi-elective operation. The rate of postoperative complication was not significantly different between the patients operated on 2 days and more than 2 days after the decompression. CONCLUSIONS: The initial non-operative decompression and subsequent semi-elective operation results in a satisfactory outcome in managing sigmoid volvulus. In the view of surgical result, a two-day interval seems adequate for bowel preparation and optimization of the patient's condition.
Adult↗