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Biomedical subjects

S H Kuo

Publications and source records attributed to S H Kuo.

At least 91 records · Page 5Linked to original sources
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

Immunosuppressive acidic protein in patients with lung cancer.

Using a single radial immunodiffusion method, serum immunosuppressive acidic protein (IAP) was determined in 117 patients with primary lung cancer, 34 patients with benign lung disease, and 45 healthy control subjects. The mean value of IAP for patients with lung cancer was significantly higher than that of normal control subjects. There were no significant differences in IAP levels among different histologic types and among different stages of lung cancer. It was concluded that serum IAP level was elevated in patients with lung cancer, especially during the early postoperative period, and serial measurements of serum IAP were of value in monitoring lung cancer patients.

Adult↗
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

Lobar bronchioloalveolar carcinoma: an ultrasound study.

To assess whether chest ultrasound (US) can be useful in the diagnosis of lobar bronchioloalveolar carcinoma, we retrospectively analyzed the US patterns of eight patients with bronchioloalveolar carcinoma presenting with lobar consolidation. For comparison, 15 patients with lobar consolidation of a benign etiology were also analyzed. We found that the US patterns of lobar bronchioloalveolar carcinoma had a characteristic homogeneous, echogenic pattern. The air-bronchograms and air-alveolograms were scarce when compared to benign consolidation. The sensitivity of using these US criteria in discriminating lobar bronchioloalveolar carcinoma was 75%, and the specificity was 93%. We also assessed the yield of US-guided transthoracic cutting biopsies in the diagnosis of lobar bronchioloalveolar carcinoma. The diagnostic rate of the US-guided cutting biopsy was 100%, which was superior to other diagnostic procedures, such as sputum cytology (37%), fiberoptic bronchoscopy with brushing or biopsy (32%) and trans-thoracic needle aspiration cytology (50%). None of the patients developed complications. We conclude that the distinct US pattern for lobar bronchioloalveolar carcinoma is a helpful diagnostic sign, and the US-guided biopsy is a useful approach in the diagnosis of lobar bronchioloalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1992

Age trends in lung cancer.

To investigate the relationship between the stages of cancer development and the age trends in histologic type found at the time of disease diagnosis, we studied 1,669 patients with histologically proven lung cancer. These patients were examined at the National Taiwan University Hospital using Mantel-Haenszel Chi-square testing to determine a linear trend. These patients were divided into three age groups: group 1 (< 45 years), 141 patients (8%); group 2 (45-64 years), 946 patients (57%); group 3 (65 years or more), 582 patients (35%). The ratio of men to women was 1.4 in group 1, 2.5 in group 2 and 2.3 in group 3. In men, there was a significant trend for the proportion of squamous cell carcinoma to increase from 26% to 42% and that of adenocarcinoma to decrease from 52% to 34% as age increased. In women, an age trend for histologic type was not observed. There was also a significant trend for local-stage squamous cell carcinoma in men to increase from 18% in group 1 to 35% in group 2 and to 42% in group 3. In men, but not in women, local-stage large cell carcinoma increased from 20% in group 1 to 31% in group 2 and to 64% in group 3. However, the age-stage trend for other cell types was not significant in men.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1992

Extraosseous Ewing's sarcoma: report of a case and review of literature.

Extraosseous Ewing's sarcoma is a primitive small round cell neoplasm found in children and young adults. Extraosseous Ewing's sarcoma has been recognized as being histologically indistinguishable from Ewing's sarcoma of the bone and other round cell tumors. Our study reports the clinical course and histopathologic features of this rare variant, occurring in a 13 year-old boy, who presented with a subcutaneous tumor of the right thigh without osseous involvement. Wedge resection of the tumor was done followed by chemotherapy with Actinomycin-D, Oncovin and Endoxan.

Adolescent↗
PubMed1991

Lung abscesses: US examination and US-guided transthoracic aspiration.

Examinations with ultrasound (US) and US-guided transthoracic aspiration were conducted in 35 patients to enable diagnosis of lung abscesses. Thirty-three of the abscesses (94%) were demonstrated at US, while two lesions were not depicted. At US, lung abscesses were depicted as hypoechoic lesions with irregular outer margins and an abscess cavity that was manifested as a hyperechoic ring. Twenty-five abscesses (71%) had local adhesion to parietal pleura (lesion-pleura symphysis). US-guided transthoracic needle aspiration of fluid from the abscess cavity was performed successfully in 31 of 33 patients (94%). A total of 65 pathogens were isolated from 31 aspirates (41 anaerobes and 24 aerobes), not-withstanding the fact that 23 of the patients had been previously treated with antibiotics. Only two of 65 pathogens (3%) could be recovered from blood culture, seven (11%) from sputum culture, and two from bronchoalveolar lavage (3%). Two patients developed minimal pneumothorax. The authors conclude that US examination and US-guided transthoracic aspiration are useful and safe diagnostic methods of collecting specimens to enable accurate diagnosis of lung abscesses.

Adolescent↗
PubMed1991

Evaluation of ultrasonically guided biopsies of mediastinal masses.

Eighty patients with roentgenographic evidence of mediastinal abnormalities were examined with ultrasonography. Fifty-four lesions were malignant, and 26 lesions were benign. The histologic diagnoses were confirmed by ultrasonically guided fine needle aspiration/cutting needle (Tru-Cut) biopsy, surgical specimens, or transbronchial biopsy. There were no unique ultrasonographic features for diagnosis of specific tumors. Ultrasonically guided aspiration biopsies (UGAB) were performed in 44 of the malignant lesions and in 14 of the benign lesions (nine of the noncystic lesions and five of the cystic lesions). Cytologic diagnosis of malignancies was obtained in 34 (77 percent) of these 44 malignancies; however, accurate histologic classifications of malignancies were achieved in only 24 (55 percent). Accurate diagnoses were achieved in only three (33 percent) of the nine noncystic benign lesions. Ultrasonically guided cutting biopsies (UGCB) were performed in 24 malignant and five benign lesions. All attempts yielded satisfactory specimens for histologic diagnosis. Using UGAB and UGCB together, a positive diagnosis was achieved in 89 percent (39/44) of the malignancies, and accurate histologic diagnosis was achieved in 89 percent and 78 percent (7/9) in malignant and benign noncystic lesions, respectively. Correct histologic diagnosis with UGAB alone is lower in thymoma (55 percent [6/11]) and lymphoma (30 percent [3/10]) but higher in lung cancer (67 percent [8/12]) and metastatic cancer (78 percent [7/9]). There were no complications in this series. We conclude that ultrasonography with UGAB has a high diagnostic yield in diagnosing mediastinal tumors, and UGCB is necessary for thymic tumors, lymphoma, and benign lesions.

Adolescent↗
PubMed1991

Ultrasound-guided pleural biopsy with Tru-Cut needle.

We conducted a study of ultrasound (US)-guided pleural biopsy with a Tru-Cut needle and made a comparison with the results of a traditional pleural biopsy with an Abrams needle. A total of 49 patients with unilateral pleural effusion were included in this study. Twenty-four patients underwent a traditional pleural biopsy with an Abrams needle, and 25 patients underwent a US-guided pleural biopsy with a Tru-Cut needle. The age, sex, and underlying diseases in both groups were compatible. The amount of effusion was much less in the Tru-Cut group. In the patients who underwent the US-guided pleural biopsy with a Tru-Cut needle, the diagnostic sensitivity in pleural tuberculosis was 86 percent (6/7) and in pleural neoplasia it was 70 percent (7/10). In the patients who underwent traditional pleural biopsy with an Abrams needle, the diagnostic sensitivity in pleural tuberculosis was 20 percent (2/10) and in pleural neoplasia it was 44 percent (4/9). The result of US-guided pleural biopsy with a Tru-Cut needle was better than that of pleural biopsy with an Abrams needle, especially in pleural tuberculosis. No complication was found in the Tru-Cut group, but breakage and dislodgment of the tip of an Abrams needle occurred in one patient. The higher diagnostic yield in the Tru-Cut group may be attributed to the US guidance that can delineate the focal pleural abnormalities for biopsy. In conclusion, US-guided pleural biopsy by using a Tru-Cut needle was simple, safe, and well tolerated. It was particularly useful for patients with pleural tumor, thickened pleura, small amounts of pleural effusion, or loculated pleural effusion.

Adult↗
PubMed1991

Sonographic patterns of ribs with tumor involvement.

We analyzed the sonographic appearance of the ribs when there was tumor involvement in 16 patients (12 men and 4 women). The tumors included 11 carcinomas, 3 nonepithelial malignancies and 2 benign tumors. Three sonographic patterns on the cross section of abnormal ribs were identified. Pattern I was an eccentrical hyperechoic plate-like shadow inside a hypoechoic tumor. Pattern II was a round hyperechoic shadow or ring in the center of a hypoechoic tumor. Pattern III was a hypoechoic tumor only. The Pancoast tumor manifested pattern I. Metastatic cancer, mostly squamous cell carcinoma, manifested pattern II, and both malignant and benign tumors could manifest pattern III. In sonography, the margin and shape of the tumors, the change in the acoustic shadow of the rib and the pleural line did not differentiate the malignant tumors from benign tumors. When we routinely took a biopsy of these tumors under sonar guidance, the diagnostic yield was 100% without any complications. We conclude that the rib should be evaluated in chest sonography, and that pattern recognition and biopsy under sonar guidance are most useful.

Adult↗
PubMed1991

Tissue polypeptide antigen and carcinoembryonic antigen as tumor markers in lung cancer.

Simultaneous measurements of serum tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) were conducted on 106 patients with bronchogenic carcinoma and 19 patients with inflammatory pulmonary disease. The distribution of cell types was 63 with adenocarcinoma, 26 with epidermoid carcinoma, 9 with small cell carcinoma, 4 with large cell carcinoma and 4 with adenosquamous carcinoma. There were 20 patients in stage 1, 6 in stage 2, 38 in stage 3 and 42 in stage 4 of their disease. The cut-off values of TPA and CEA were 110 U/L and 3 ng/ml, respectively. The diagnostic sensitivity of TPA and CEA was 61% (65/106) and 47% (50/106), respectively. The diagnostic specificity of TPA and CEA was 90% (17/19) and 95% (18/19), respectively. In combination with TPA and CEA the diagnostic sensitivity and specificity to indicate at least one positive result was 73% and 84%, respectively. Both TPA and CEA revealed significantly higher mean serum levels in stage 4 patients than in stage 1 patients. The intermarker correlation between the serum levels of TPA and CEA was low in this study. Serial measurements of serum TPA after surgical resection were found to be useful in the monitoring of recurrence of tumors.

Adenocarcinoma↗
PubMed1991

Coefficient of variation of nuclear diameters as a prognostic factor in papillary thyroid carcinoma.

To determine whether the coefficient of variation (CV) of nuclear diameters can be used as a prognostic factor in papillary thyroid carcinoma, we reviewed fine needle aspiration smears with Riu's stain from 55 operated-on and pathologically verified cases with a median follow-up of 6.5 years. For each case we measured the nuclear diameters of 100 cancer cells by ocular micrometry and calculated the CV of the nuclear diameters. Then we correlated the CV with the clinical stage, recurrence and death. There was a positive correlation between the CV of the nuclear diameters and the clinical stage (r = .59, P less than .0001). Recurrent cases (n = 10) had a higher CV than did those without recurrence (n = 45) (18.04 +/- 4.1% [mean +/- SD] versus 13.2 +/- 2.7%, P less than .0005). All recurrent cases had a CV greater than 13%. The cases in which death occurred (n = 5) had a higher CV than did those with survival (n = 50) (20.1 +/- 4.9% versus 13.5 +/- 2.7%, P less than .0005). All cases in which death occurred had a CV greater than 15%. The extent of variation of nuclear diameters was one of the factors influencing prognosis in papillary thyroid carcinoma. It offers a prognostic adjunct to standard clinical and histologic analysis.

Adult↗
PubMed1990

Drug-induced cell cycle perturbation in chemotherapy of patients with non-small cell lung cancer.

To observe in vivo cell cycle perturbation in the chemotherapy of lung cancer, tumour cell kinetics during the first course of chemotherapy were measured in seven patients with histologically-verified non-small cell lung cancer. The tumour cells were aspirated from six lymph nodes and one subcutaneous nodule both prior to treatment and twice weekly after the administration of chemotherapeutic agents. The nuclear DNA content of aspirated tumour cells was measured with a scanning microdensitometer at a wavelength of 550 nm after the modified Feulgen reaction. The cell population in cell cycle was estimated with a cumulated percentage scale. Marked cell cycle perturbation occurred within one week after initiation of chemotherapy. There was a decrease in the G1 cell population, from 70.6 +/- 9.1% to 26.1 +/- 11.4%, and a corresponding increase of cells in G2-M phase, from 21.4 +/- 8.7% to 63.7 +/- 10.0%. The proportion of cells in S phase was slightly increased from 8.0 +/- 1.5% to 10.1 +/- 3.2% during this period. The degree of cell cycle changes was unrelated to the clinical response to chemotherapy.

Adenocarcinoma↗
PubMed1990

Lung tumors associated with obstructive pneumonitis: US studies.

Eleven patients who had lung tumors associated with obstructive pneumonitis and who failed to yield diagnostic material at conventional bronchoscopic biopsy underwent real-time ultrasonographic (US) studies and US-guided aspiration biopsy. Sonography of the consolidated lung showed a wedge-shaped hypoechoic lesion containing a fluid bronchogram. The presumed obstructing tumor was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Computed tomography (CT) was superior to US in demonstrating the bronchial obstruction (P less than .05). However, there were no significant differences between CT and US in demonstrating the obstructing tumor (P greater than .10). In all 11 patients the diagnosis was made by means of US-guided transthoracic aspiration biopsy and in eight patients also by means of Trucut biopsy. No complications were observed in the studies. It is concluded that US and US-guided aspiration biopsy are useful adjunct diagnostic techniques for lung tumor patients with obstructive pneumonitis.

Aged↗