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Biomedical subjects

R J Chen

Publications and source records attributed to R J Chen.

At least 91 records · Page 5Linked to original sources
PubMed1994

Rupture of the diaphragm after blunt trauma.

OBJECTIVE: To analyse our cases of acute rupture of the diaphragm after blunt trauma to find out how to diagnose it earlier and manage it more promptly in future. DESIGN: Retrospective study of casenotes. SETTING: Division of general surgery, district hospital, Taiwan. PATIENTS: 50 Patients who presented with acute rupture of the diaphragm after blunt trauma during the 10 year period 1982-91. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The left hemidiaphragm was injured in 43 cases (86%), and the right in 7 (14%). The most common cause was road traffic accidents. 48 Patients had associated injuries, mainly to the chest and abdomen, and pelvic fractures. 44 Ruptured diaphragms were diagnosed before operation by chest radiography or upper gastrointestinal contrast examination. The transabdominal approach was the most appropriate, because 23 patients had intra-abdominal visceral injuries as well. 20 Patients (40%) had complications, and the rate was 33% among those treated within 24 hours and 70% among those whose treatment was delayed longer than 24 hours (p = 0.067). There were 3 deaths (6%); one patient died of empyema of the right chest as a result of simultaneous perforation of a hollow viscus. 6 Patients were permanently disabled by head and spinal injuries, and pelvic fractures. CONCLUSION: The prognosis of repairing diaphragmatic hernias is good as the disability rate is low. The diagnosis should be kept in mind in all patients with chest injuries, pelvic fractures, or abdominal injuries with hypoxaemia, as this will result in earlier treatment and improve prognosis. The transabdominal approach is the most appropriate because it makes simultaneous abdominal injuries easier to treat. Correct operative management at an early stage will keep mortality to a minimum.

Adolescent↗
PubMed1994

[Floating shoulder (ipsilateral scapular neck and clavicle fracture)--two cases report].

Fracture of either clavicle or scapular neck alone are generally stable and have satisfactory results by conservative treatment. However, displaced scapular neck and ipsilateral clavicle fractures are relatively unstable. Those sequelae as drooping shoulder and limited range of motion may develop if treated conservatively. Surgical intervention either fixation of clavicle alone or fixation of clavicle and scapular neck simultaneously can achieve stable reduction of the fractures and prevent those sequelae. We present two cases of floating shoulder treated surgically with excellent results.

Adult↗
PubMed1994

Loop electrosurgical excision procedure for conization of the uterine cervix.

The application of loop electrosurgical excision procedure (LEEP), a new method of conization of the uterine cervix used to diagnose cervical intraepithelial neoplasia (CIN) or cervical cancer is presented herein. A loop electrode consists of a thin wire that allows deep excision of the transformation zone (TZ). The cone-shaped tissue removed can be examined histologically. Over a period of one year, a total of 41 cases underwent LEEP. Without anesthesia, the patients did not have any noticeable pain during the procedure. There were no complications, such as fever, wound infection, massive bleeding or cervical stenosis. In low-grade CIN, follow-up colposcopy and cytology did not show persistence or recurrence. In two cases of high-grade CIN, subsequent hysterectomy revealed residual lesions on hysterectomized specimens. LEEP is a simple and quick procedure of diagnostic conization that can be done at the first visit without major complication. If the histopathology after LEEP is moderate- to high-grade CIN or invasive cancer, the conization cannot be regarded as a sufficient therapeutic procedure, and such a patient needs further treatment.

Biopsy↗
PubMed1994

Perforated intestinal lymphoma in post-renal transplantation--a case report.

This is a case report of a 39-year-old male. Sudden onset of abdominal pain occurred 5 months after a successful cadaveric renal transplant. The immunousuppressants chosen were cyclosporin-A, prednisolone and azathioprine. A small bowel perforation was noted 100cm proximal to ileocecal area during emergent laparotomy. Mesentery lymphadenopathy was also noted. Segmental resection with end-to-end anastomosis was done. The pathology revealed a diffuse mixed small and large cell malignant lymphoma. The postoperative course was smooth and one course of acyclovir therapy was given 2 months after the emergency procedure. From this case and literature review, we know posttransplant lymphoma of the small intestine is very rare, but it should be considered in every posttransplant victim with abdominal symptoms.

Adult↗
PubMed1994

A study on the usefulness of local anaesthesia for the laser vaporization of conizations in the uterine cervix.

The purpose of our study is to evaluate the need to use anaesthesia during laser ablation treatment of cervical intraepithelial neoplasia (CIN) in populations of Asian women. Forty patients who were to undergo the ablation of CIN grade 1 or 2 were randomly divided into two groups. One group of patients was treated without any anaesthesia and the other group was treated using a paracervical block with lidocaine. The patients' experience of pain during the procedure was measured. These evaluations included an objective assessment made by the surgeons during the procedure using an objective pain scoring system, and a subjective estimation made by the patients themselves after the procedure using a visual analogue scale. Patients' feelings concerning the acceptability of either procedure were also elicited. Our results show that the case distribution of objective pain scores between the two groups of patients is not statistically different (p > 0.05). The mean visual analogue score of the patients who were not given anaesthesia (24.1%, SD 9.4) does not differ statistically from that of the patients who were administered a paracervical block (25.0%, SD 10.0, p > 0.05). Further, the acceptability rates of both groups are high (85% with paracervical block, 90% without anaesthesia), and the overall rates of the two groups are not statistically different (p > 0.05). These results imply that there may be differences in pain perception between Eastern and Western women. We conclude that in populations of Asian women, it is unnecessary to use anaesthesia during cervical laser ablation.

Adult↗
PubMed1993

Vulvar neoplasia associated with other primary malignancies.

It is recognized that a significant number of patients with vulvar neoplasia have had previous, concurrent, or subsequent genital tract neoplasia. This has resulted in speculation that there may be a common etiology and, in particular, of the possibility of an infection element. Among 59 cases of vulvar cancer diagnosed at the National Taiwan University Hospital from 1976 to 1991, there were seven cases (12%) associated with other primary malignancies. Carcinoma of the cervix was the most frequent other primary cancer (6/7, 86%). The possible role of human papilloma virus infection in genital neoplasia is discussed.

Adult↗
PubMed1993

Maternal and fetal outcome of pregnant women with idiopathic thrombocytopenic purpura: retrospective analysis of 25 pregnancies.

The optimal management of pregnant women with idiopathic thrombocytopenic purpura (ITP) is controversial. We reviewed our experience with 25 pregnancies in 19 women with ITP over a 14-year period. The incidences of bleeding during pregnancy and postpartum hemorrhage were 12.0% and 24.0%, respectively, in our series. No maternal mortality was noted. Thirteen infants were born by vaginal delivery and 12 by cesarean section. Moderate to severe neonatal thrombocytopenia (platelet count < 100 x 10(9)/L) was diagnosed in six newborns. One of them had intracranial hemorrhage complicated by a bilateral sensorineural hearing loss. ITP mothers with a prenatal platelet count < 30 x 10(9)/L and a platelet count < 100 x 10(9)/L at delivery had a higher risk of giving birth to infants with moderate to severe neonatal thrombocytopenia. Cesarean section may improve the outcome of these fetuses.

Adult↗
PubMed1993

Liver transplantation for a hepatitis B-related cirrhotic patient.

A patient with chronic end-stage liver cirrhosis resulting from a hepatitis B viral infection had a successful liver transplantation performed on 1 July 1991. Preoperative serology revealed that both HBsAg and HBeAg were positive, and the anti-HBs antibody was negative. Immunoprophylaxis included active immunization, as well as injections of large doses of hepatitis B immunoglobulin (HBIG) given perioperatively to reverse the antigen status. The patient has been anti-HBs antibody positive for more than 10 months since the transplantation. The immunoprophylaxis protocol used has been effective in the prevention of hepatitis B viral reinfection.

Adult↗
PubMed1993

Gastro-pleural fistula related with penetrating stab injuries of the chest and abdomen: laparotomy or thoracotomy.

A 30-year-old male presented with left side empyema due to gastro-pleural fistula following repair of penetrating stab injuries of left lower chest and abdomen. Exploratory thoracotomy was done due to persistent moderate amount of purulent discharge. However, fistula tract was not detected through this approach. The small fistula tract was repaired finally through laparotomy. We recommended the abdominal approach if the disease is not combined with diaphragmatic hernia. Transabdominal approach showed superiority in this rare entity.

Abdominal Injuries↗
PubMed1993

Human chorionic gonadotropin pattern in maternal circulation. Amniotic fluid and fetal circulation in late pregnancy.

This study had two purposes. One was to investigate the placental gradients and the relationship of human chorionic gonadotropin (hCG) concentrations in maternal serum (MS), amniotic fluid (AF) and fetal serum (FS). The other was to study the fetal sex effect. This study included 93 patients with normal singleton term pregnancies. AF samples contaminated with blood were excluded. Fetuses did not have any abnormalities. We measured hCG by double antibody beta hCG radioimmunoassay. We found that there were conspicuous hCG slopes in MS, AF and FS levels. The hCG level in MS was 12.9 +/- 1.3 IU/mL (mean +/- SE, n = 93). It was much higher than levels in AF or FS. AF (0.461 +/- 0.053 IU/mL, n = 25) also had higher hCG level than FS (0.038 +/- 0.0056 IU/mL, n = 93). The hCG concentrations in AF and FS were highly correlated with those in corresponding MS (P < .001 and P < .05, respectively). The concentrations in AF were also positively correlated with those in corresponding FS (P < .05). The mean of MS/AF ratios for hCG was 413.6 +/- 23.4 (+/- SE); of MS/FS, it was 37.8 +/- 9.2; of AF/FS, it was 15.3 +/- 2.6. At late pregnancy, higher hCG levels of MS, AF or FS may result in female fetuses than in male fetuses. The results revealed that there were hCG concentration gradients on both placental and fetal membranes. It also implied that hCG levels in AF may decline as gestation ages advance. For biochemical studies in FS, using pure cord venous blood may have more consistent results than using mixed blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Conization with a carbon dioxide laser as a uterine-preservation operation for patients with preinvasive cervical carcinoma.

Preinvasive cervical carcinoma (PCC) is a disease entity of the uterine cervix resulting from carcinoma in situ and various degrees of dysplasia. These cases are conventionally treated by a total abdominal hysterectomy. Effective management that can preserve the uterus is more desirable than hysterectomy. In this report, we present the results and complications of laser conization as a uterine-preservation treatment. At our dysplasia clinic, cases of reproductive age diagnosed with PCC can voluntarily undergo laser conization. From June 1985 to May 1988, there were 26 cases who received this treatment. After treatment, they were regularly followed up for more than three years. Before and after surgery, these cases were evaluated by a Pap smear for cytology, colposcopy, a cervical punch biopsy and endocervical curettage for histopathology. Eighteen cases with a satisfactory colposcopy were treated by laser vaporizing conization. Eight cases with an unsatisfactory colposcopy were treated by laser excisional conization. Their mean age was 35.8 (SD 7.7) years, and parity was 1.5 (SD 0.9). The instrument used was a Sharplan CO2 laser model 720. The power density was around 1,000 W/cm2 for vaporization, and 1,500 W/cm2 for excisional conization. During the operations, there was little bleeding. No case required a blood transfusion. The vaginal discharge decreased within four days after treatment. The cervical epithelium on the operated wound began growing after the second week, and the cervix healed well in four to six weeks. After healing, the squamocolumnar junction in each case was visible on colposcopy. No case suffered from cervical stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Octreotide in the management of postoperative enterocutaneous fistulas and stress ulcer bleeding.

We report two clinical experiences in the treatment of postoperative enterocutaneous fistula and stress ulcer bleeding with octreotide acetate (Sandostatin). In both patients, upper gastrointestinal bleeding occurred 7 days after operation, and the bleeding proved to be stress ulceration, by panendoscopic examination. Enterocutaneous fistulas also were found in both patients. One was high output (750 ml/day), and the other was low output (50 ml/day). Octreotide 50-100 micrograms was given subcutaneously every 8 h. After three doses of octreotide, a significant reduction in fistula output and control of the stress ulcer bleeding were noted. The fistulas closed promptly after nine doses of octreotide, but the first patient's fistula recurred 2 days later, with fluid losses of about 100-200 ml/day. This fistula closed spontaneously 1 month after discharge. Octreotide appears to be useful as an adjunct to the conventional treatment of enterocutaneous fistulas, especially those complicated by stress ulcer bleeding.

Aged↗
PubMed1991

Experience of human chorionic gonadotropin assays in gestational trophoblastic tumors.

From May 1979 through December 1988, 146 patients with gestational trophoblastic tumors (71 hydatidiform mole, 3 partial mole, 15 choriocarcinoma and 57 persistent trophoblastic tumors) were studied. A total of 1178 daily urine samples were collected before and/or after treatment, and in the course of follow-up. H93 RIA (an HCG specific assay), H80 RIA (an assay detecting hCG and hLH) and a hCG alpha assay measured levels in the urine specimens. Three hCG declining patterns (pattern D, P and R) based on the H93 RIA assay were noted. Patients showing pattern D had the most favorable outcome (no mortality at all). However, pattern P and R had a 10% and 14.3% mortality rate, respectively. The ratios of H80/H93, hCG alpha/H93, hCG alpha/H80 in the urine specimens were similar in both pattern D and R (excluding samples from a patient who expired later). However, the ratios of H80/H93, hCG alpha/H93, hCG alpha/H80 of samples from the patient (CK) who expired later were significantly different from those of the pattern D and R. This was suggestive of a marked unbalanced secretion of hCG and its subunit in the urine specimens of patient CK. The molecular forms in pattern D were similar to the standard hCG. However, the molecular form in pattern R of 3 fatal choriocarcinomas showed a great variation, from smaller to larger than the standard hCG. The isoelectric points of hCG in pattern D and R were all acidic. In clinical practice, we can measure the ratios of H80/H93, hCG alpha/H93 and hCG alpha/H80, molecular forms, and isoelectric points of hCG.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1991

Effect of fetal sex on maternal and fetal human chorionic gonadotropin levels and comparison of their levels in paired umbilical arteries and veins.

There were discordant results regarding the effect of fetal sex on human chorionic gonadotropin (hCG) concentrations in maternal or fetal circulation and regarding whether the levels in umbilical arteries are equal to those in umbilical veins. Totally, 188 singleton pregnancies at 36 to 42 weeks of gestation without any obstetrical or medical complication were studied. The hCG levels were measured by radioimmunoassay specific for hCG using Sb3 antibody raised against beta-subunit of hCG. The maternal ages and parities between those who gave birth to a male or a female baby were not different statistically. The birth weights between male and female babies were also not different. The serum hCG levels had a wide range in maternal circulation (200-75,200 mIU/ml) and their distribution was positively skewed. The mean value (geometric mean, G.M.) in maternal circulation for those who carried a female fetus (11,500 mIU/ml) was significantly higher than that for those carrying a male fetus (6,470 mIU/ml) (P less than 0.001, Student's t-test). The hCG concentrations in umbilical veins of female fetuses were also higher than in those of male fetuses (G.M., 26.8 vs 19.5 mIU/ml, P less than 0.01, Student's t-test). Umbilical arterial hCG levels (G.M., 10.05 mIU/ml) were statistically not different from umbilical venous levels (G.M., 10.92 mIU/ml) (paired t-test).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Interaction of calcium and cholesterol sulphate induces membrane destabilization and fusion: implications for the acrosome reaction.

Cholesterol sulphate is a potent stabilizer of membrane bilayer structure in both dielaidoylphosphatidylethanolamine and egg phosphatidylethanolamine model membranes, however, the addition of calcium abolishes this bilayer stabilization. Calcium also induces fusion and leakage of egg phosphatidylethanolamine large unilamellar vesicles containing cholesterol sulphate, but has no effect on fusion or leakage of egg phosphatidylcholine large unilamellar vesicles containing cholesterol sulphate. With egg phosphatidylethanoiamine liposomes, the initial rate, and extent of fusion, at constant calcium concentration, vary inversely with the mol percentage of cholesterol sulphate present in the vesicle membrane. The interaction of calcium and cholesterol sulphate, which causes membrane destabilization and fusion in phosphatidylethanolamine containing model systems, may play a role in the acrosome reaction in human sperm.

Acrosome↗