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Biomedical subjects

T C Wei

Publications and source records attributed to T C Wei.

At least 37 records · Page 2Linked to original sources

Gonadoblastoma and chroiocarcinoma in dysgenic gonads: report of a case.

Dysgenetic gonads are well known to be associated with gonadoblastoma and various germ cell tumors, but very rarely with choriocarcinoma. We describe a 16-year-old, phenotypic female patient with a 46XY karyotype who developed gonadoblastoma on the right gonad and choriocarcinoma on the left. There was no co-existence of the two tumor cell types in the same gonad. This case emphasizes the importance of bilateral gonadectomy for "46XY female" patients, as soon as the cytogenetic evidence is known.

Adolescent↗

Is previous abdominal surgery a contraindication to laparoscopic cholecystectomy?

Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. An analysis of 193 laparoscopic cholecystectomies was undertaken to determine whether this relative contraindication led to increased morbidity, an increased rate of conversion to open cholecystectomy, or longer operating time. The results of 55 patients who had previous abdominal surgery were compared with those of 138 patients without previous abdominal surgery. Morbidity, conversion rate, and operating time were not increased in patients with previous abdominal surgery. We found both previous upper and previous lower abdominal surgery to be risk for laparoscopic cholecystectomy. Laparoscopic cholecystectomy can be performed safely in patients with previous abdominal surgery if we (1) use the cutdown technique initially, (2) dissect the adhesion before the upper midline port is inserted, (3) retrogradely dissect the gallbladder from the liver bed, and (4) divide the cystic artery and duct last.

Abdomen↗

An uncommon cause of biliary obstruction (Mirizzi syndrome): report of five cases.

Mirizzi syndrome is a rare form of common hepatic duct obstruction resulting from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. Herein, we report five patients with this syndrome. Clinically, all patients had prominent jaundice. Ultrasound examination showed a large stone in the neck of the gallbladder. Endoscopic retrograde cholangiopancreaticography demonstrated a filling defect in the biliary tract the cystic duct level. Four patients possessed cholecystobiliary fistulas. Two patients also had common bile duct stones. Operations included simple cholecystectomy in one patient, and partial cholecystectomy with choledochoplasty with the use of gallbladder flap and T-tube insertion in the other four patients. All patients were uneventfully discharged. If a patient has clinical obstructive jaundice, a huge stone encased in the neck of the gallbladder and a filling defect of the biliary tract at the cystic duct level shown on a cholangiogram, Mirizzi syndrome must be considered. A cholecystobiliary fistula will probably be present if the cholangiogram further reveals an excavated filling defect or a block of the common duct; in this case, partial cholecystectomy and choledochoplasty with a gallbladder flap is the treatment of choice. Mirizzi syndrome is a contraindication for laparoscopic cholecystectomy which can easily result in common duct injury.

Adult↗

Therapeutic effect of liver resection in patients with metastatic liver tumors.

Thirty-five hepatectomies for metastatic liver malignancy were performed from January 1986 to July 1992 at the National Taiwan University Hospital. Twenty-six of them were of colorectal origin and nine were of other origins. We analyzed the risk factors for recurrence and survival rate after hepatectomy of colorectal origin under curative intention with both univariate and multivariate analysis. The calculated median disease free interval after hepatectomy was 11 months (recurrence rate 65% in one year and 85% in two years). The median survival rate was 24 months (calculated one-year survival 86%, two-year survival 41%). In univariate analysis, the number of metastatic lesions and operation procedures significantly affect the recurrence rate (p = 0.033 and p = 0.042, respectively). In survival univariate analysis, only a safety margin > 1 cm and age > 50 years had significant benefit (p = 0.0014 and p = 0.045, respectively). By multivariate analysis, only solitary metastasis was beneficial to the recurrence rate (p = 0.013), an age > 50 years had a borderline beneficial effect to the recurrence rate (p = 0.052), while earlier liver stage, older age, larger safety margin and minor operative procedures positively affected the survival rate (p = 0.039, 0.018, 0.034 and 0.017, respectively). As the sample number was small, it was hard to draw any conclusions for metastatic liver tumors of other origins. The complication rate (5/35) and mortality rate (1/35) of hepatectomy were low. We concluded that for selected cases of metastatic hepatic malignancy, especially from colorectal cancer, hepatectomy is a promising treatment of choice.

Adult↗

Can cecal diverticulitis be differentiated from acute appendicitis?

Cecal diverticulitis is a rare disease entity, the diagnosis of which remains a difficult problem. The clinical picture of cecal diverticulitis is almost indistinguishable from acute appendicitis. We reviewed 11 cases of pathologically documented cecal diverticulitis who underwent treatment from May 1981 to April 1992. They were diagnosed incorrectly as acute appendicitis, ruptured appendicitis or appendiceal abscess prior to operative intervention. Thirty patients diagnosed correctly with acute appendicitis from March 1992 to April 1992 were included for a comparative study. We found that cecal diverticulitis presented with a longer duration of symptoms, initial pain over the right lower quadrant of the abdomen, older age, less migration of pain, nausea, vomiting, fever and leukocytosis, and an incidence of Alvarado's score > or = 7 than acute appendicitis.

Acute Disease↗

Estradiol administered in a percutaneous gel for the prevention of postmenopausal bone loss.

Sixty-one postmenopausal women were randomized into 3 groups. Two groups of women were treated with estrogen replacement therapy (ERT) by percutaneous administration of estradiol gel at a dosage of 1.25 g and 2.5 g, respectively. The third group of women, receiving no treatment except placebo, was studied concurrently as a control group. Bone mineral density (BMD) was measured by quantitative computed tomography (QCT) in the vertebrae from T12-L3 and hormones (E1, E2, FSH, LH and testosterone) were determined by radioimmunoassay at baseline, then at 6 monthly intervals thereafter. One year of the study has been completed thus far. The results of this study indicate that: (1) loss of BMD in the control group was observed significantly only in surgical menopausal women and no significant loss of BMD was observed in women receiving ERT treatment regimens; (2) decrease of E1 in control group and increase of E1 in the treatment group were both significant. These data suggest that percutaneous ERT may be used in prevention of postmenopausal bone loss, particularly in surgical menopausal women and the increased E1 may play a beneficial role in inhibiting loss of bone mass and relieving menopausal syndrome. Different dosages of estradiol gel which did not create any significant difference between the 2 treatment groups, need a longer period of follow-up.

Administration, Cutaneous↗

Carcinoma of the ampulla of Vater: long-term survival after surgical treatment.

Ninety-one patients were identified as having carcinoma arising from the ampulla of Vater. Radical pancreaticoduodenectomy, using either a standard or pylorus-preserving method, was performed in 69 consecutive patients over a 30-year period. Frequent clinical findings included jaundice (84%), a weight loss of more than 10% of the body weight (75%), abdominal pain (59%), chills and fever (52%), pruritus (48%) and a palpable gallbladder (38%). Acute pancreatitis was present in 10%. Postoperative mortality was 11.6%. Surgical mortality was 23.1% from 1962 to 1971 and 12.5% from 1972 to 1981, but was reduced to 6.3% from 1982 to 1991. Surgical mortality was primarily due to pancreaticojejunostomy leaks. The five-year survival rate was 52% and the 10-year rate was 50%. Radical pancreaticoduodenectomy for ampullary carcinoma has a low mortality and should remain the procedure of choice for ampullary carcinoma.

Adult↗

Distributional pattern of diverticular disease of the colon in Taiwan.

From May 1981 to October 1991, 66 patients with diverticular disease of the colon were analyzed retrospectively. Data were obtained from medical records. There were 29 men and 37 women, ranging in age from 32 to 85 years, with a mean age of 58.7 years. Forty-nine patients had a singular site of distribution in the diverticulum, and 17 patients had more than two sites of distribution in the diverticula. The locations of the diverticular disease were sigmoid colon (45.4%), ascending colon (36.4%), cecum (33.3%), descending colon (18.2%), transverse colon (12.1%) and rectum (1.5%). The left-sided lesions (46.9%) were approximately equal to the right-sided lesions (43.9%).

Adult↗

[Computed tomography of gastric carcinoma using water as a contrast agent].

To overcome the problem of poor mixing of gastrointestinal tract contents with a diluted iodinated contrast agent in abdominal computed tomography, pure water was adopted as an oral contrast agent. In 25 cases of clinically suspected gastric carcinoma, a subsequent pathological examination revealed six cases of early gastric cancer and 19 cases of advanced gastric cancer. We performed CT of the stomach using the following revised procedure: patients were given 600-1000 mL of water by mouth after an intramuscular dose of Buscopan to distend and immobilize the stomach. Gastric mucosal enhancement and the poorer enhanced submucosal layer were demonstrated by a bolus intravenous injection of iodine-containing contrast medium using an automatic injector synchronized with the CT machine. Based on abnormal gastric wall thickening and the abnormal mural enhancement patterns, an accuracy of 96% was attained in differentiating early gastric cancer from advanced gastric cancer, but the detection rates for extragastric invasion, gastric ulcers and lymphadenopathy were 67%, 43% and 63%, respectively. CT staging of gastric cancer was 72%, and was especially accurate for stages I and IV. Water as oral contrast agent for CT of the GI tract was readily accepted by patients and caused no side effects. Using water as an oral contrast for gastric CT is of great help in staging gastric cancer.

Adult↗

Somatostatin-containing carcinoid tumor of the duodenum in neurofibromatosis: report of a case.

We report a case of von-Recklinghausen's disease presenting with obstructive jaundice and found to have a somatostatin-containing carcinoid tumor in the papilla of Vater and a small neurofibroma in the duodenum. A 42-year-old woman with von-Recklinghausen's disease presented with intermittent jaundice, pruritus, and mild steatorrhea of a two-year duration. Abdominal ultrasonography and computed tomography showed dilated intrahepatic ducts, common bile duct and pancreatic ducts. Duodenoscopy showed a tumor at the papilla of Vater, but a preoperative biopsy failed to provide a definite diagnosis. Laparotomy revealed a yellowish tumor at the papilla of Vater and another nodule on the mesenteric side of the second section of the duodenum. Microscopically, the tumor at the papilla of Vater was found to be a somatostatin-containing carcinoid tumor. The small nodule on the mesenteric side was a neurofibroma. The jaundice, pruritus and steatorrhea disappeared after surgery.

Adult↗

Secular changes in the clinical manifestation and pathologic pattern of early gastric cancer in Taiwan.

To investigate whether there has been a time trend change in the percentage of early gastric cancer to gastric cancer and the clinicopathologic features of early gastric cancer in Taiwan, we reviewed 208 patients diagnosed between 1964 and 1992. Patients were divided into group I from 1964-1980 (n = 106) and group II from 1981-1992 (n = 102). The percentage of early gastric cancer among total gastric resections in group II (14.7%) did not differ from group I (12.7%; p = 0.19). Epigastralgia (58.2%) was the most common complaint; 11.8% (12/102) of cancers in group II were incidentally detected by endoscopy. Endoscopy provided a better diagnostic aid than did radiology. Tumors were frequently located in the antrum (50.9%) with a mean diameter of 2.8 cm. Small cancers of less than 1 cm in diameter were more prevalent in group II (37.3%) than group I (10.4%; p < 0.001). Cancers of the elevated type (17.8%) were uncommon in contrast to depressed ones (82.2%; p < 0.001). The frequency of mucosal carcinoma (51.0%) was similar to submucosal carcinoma (49.0%). Mucosal carcinoma had less lymph node metastases (3.1%) than submucosal carcinoma (12.2%; p < 0.05) with an overall frequency of metastases of 7.5% (14/186). The five-year survival rate of group I (91.7%) was not statistically different from group II (94.6%). We concluded that, except for the symptomatology and the ability to diagnose, the clinicopathologic features of early gastric cancer were similar between these two time periods. Repeated investigation of suspicious lesions and endoscopic screening on asymptomatic subjects may increase the rate of detection and thus guarantee a favorable outcome.

Adult↗

Intraoperative irrigation of the colon and primary anastomosis: report of three cases.

Three male patients with obstructive left-sided colonic lesions received intraoperative irrigation of the colon and primary anastomosis after resection of the lesions. Their postoperative courses were smooth except for one patient with mild wound infection. Intraoperative irrigation of the colon is an effective method of facilitating primary anastomosis in the management of obstructive left-sided colonic lesions.

Aged↗

Liver resection for hepatic metastasis from colorectal carcinoma.

One hundred and eighteen patients who suffered from metastatic liver tumors from colorectal carcinoma during the period from January 1980 to June 1991 at the National Taiwan University Hospital were retrospectively reviewed. The modes of treatment included hepatic resection (n = 18), transarterial embolization (TAE, n = 17), chemotherapy only (C/T, n = 36), and no treatment (n = 47). In the 18 patients who underwent hepatic resection during the last 10 years, the types of surgery included: wedge resection (n = 8), segmentectomy (n = 2), right hepatic lobectomy (n = 5), left hepatic lobectomy (n = 2) and extended right hepatic lobectomy (n = 1). There were no operative mortalities in this series. The overall three-year actuarial survival rate of the resection group was 57.5%. It was better than that of the TAG group (17%, p < 0.05). For a solitary tumor, the three-year actuarial survival rate rose to 64% in the resection group. There were no three-year survivors in the nonsurgical solitary tumor group. This experience defends aggressive surgical treatment of resectable hepatic metastatic liver cancer from colorectal carcinoma as a safe procedure which is able to prolong a patient's life.

Adult↗

Transient hyperprolactinemia in gonadotropin-stimulated cycles for in vitro fertilization and its effect on conception.

The significance of transiently increased serum prolactin (PRL) levels on pregnancy rates in vitro fertilization (IVF) is unknown. The aim of this study was to evaluate PRL levels in IVF patients who conceived and in matched controls who did not. Ten IVF cycles resulting in pregnancy and forty nonpregnant cycles were compared. Prolactin was measured before ovarian stimulation with gonadotropins and estradiol (E2), progesterone (P) and PRL were measured 36 hours, 12 hours, 10 minutes before and 12 hours after human chorionic gonadotropin (hCG) administration at mid-cycle. Serum PRL levels at various time were not significantly higher in the nonpregnant women than in the pregnant women. Twelve hours before hCG, P levels were significantly higher in the nonpregnant women than in the pregnant women (1.5 +/- 0.2 ng/ml [mean +/- standard error] and 0.9 +/- 0.3 ng/ml, respectively; P < 0.05). All women had transient hyperprolactinemia for one to three times during ovarian hyperstimulation. There was no correlation between PRL and E2 in either group. These results do not support the treatment of transient hyperprolactinemia with dopamine agonists in IVF patients.

Chorionic Gonadotropin↗

Molecular dynamics of water in foods and related model systems: multinuclear spin relaxation studies and comparison with theoretical calculations.

A review of recent studies of molecular dynamics of water in foods and model systems is presented, and the theoretical results are compared with experimental data obtained by several techniques. Both theoretical and experimental approaches are discussed for electrolytes, carbohydrates, and food proteins in solution. Theoretical results from Monte Carlo simulations are compared with experimental NMR relaxation data for quadrupolar nuclei such as those of deuterium and oxygen-17. Hydration studies of wheat, soybean, corn, and myofibrillar proteins by multinuclear spin relaxation techniques are discussed, and several new approaches to the analysis of the experimental data are considered. Correlation times of water motions in hydrated food systems are determined from NMR and dielectric relaxation data. The values of the correlation times for dilute solutions of electrolytes and carbohydrates estimated by NMR are in good agreement with those calculated from dielectric relaxation data, but seem to differ significantly from those proposed from Monte Carlo simulations. Several new and important results concerning the hydration of potato and cereal starches are presented, showing the very different hydration behaviors of these two major groups of starches. The combination of molecular dynamics computations with NMR relaxation techniques will hopefully stimulate novel technological developments in food engineering based on such fundamental studies.

Carbohydrates↗

Transcatheter control of intractible gastrointestinal bleeding.

A series of 23 patients with intractible gastrointestinal (GI) bleeding were managed by the transcatheter method. The series included 5 with hemobilia, 8 with upper GI (UGI) bleeding, 5 with lower GI (LGI) bleeding and 5 with variceal bleeding. The etiology of the hemobilia was surgery, or percutaneous transhepatic cholangiography and drainage (PTCD) complicated by various degrees of biliary tract infection. The causes of UGI bleeding included erosive gastritis, gastric and duodenal ulcers, and traumatic duodenal laceration. All 5 LGI bleedings were due to ischemic colitis and all 5 variceal bleedings were due to hyperdynamic portal hypertension from arterio-portal (A-P) shunting for hepatocellular carcinomas (HCC). Intra-arterial vasopressin infusion was performed on 17 (4, hemobilia; 8, UGI; and 5 LGI bleeding) of these 23 cases as initial management. The success rate for vasopressin in hemobilia, UGI and LGI bleeding was 75% (3/4), 38% (3/8), and 60% (3/5), respectively. The overall initial success rate of vasopressin was 52% (9/17). The relatively poor success rate of vasopressin infusion for UGI bleeding was due to ulcers and laceration. The incidence of rebleeding for vasopressin infusion was 22% (2/9) including one case each of UGI and LGI bleeding. Three patients (1 hemobilia and 2 UGI bleeding) among these 17 cases underwent transarterial embolization (TAE) after failure of intra-arterial vasopressin infusion. One of these 23 cases with hemobilia underwent TAE for initial transcatheter control of the GI bleeding. Five cases of active esophageal variceal bleeding, caused by A-P shunting in HCC, were all successfully controlled by TAE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Buserelin treatment of endometriosis in Chinese women.

Twenty five patients with endometriosis of varying degree had been treated with Buserelin (GnRH analogue) for 6 months. Among them, 83.4% reached castrated level by measuring the serum estradiol (E2) 2 months after therapy. Dysmenorrhea was alleviated or completely disappeared during therapy. Hot flush was the one mostly complained. Vaginal dryness was the second and decreased libido the third. Persisted periodic bleeding was noted in 3 patients. Ovulation was suppressed as evidenced by low serum progesterone throughout the whole course of treatment. Second-look laparoscopy was done at the end of 6-month therapy. Scoring assigned by the American Fertility Society (AFS) was reduced by 27.5%. The adrenal gland, liver and renal functions as well serum calcium and phosphate were retained at the end of treatment. Ovulation and menstruation also returned to normal within 2 months after cessation of therapy. There were 4 pregnancies during the 6-month follow period (4/15 = 26.6% pregnancy rate). 7 patients had improved symptoms whereas 7 patients sustained recurrent dysmenorrhea. The hormonal profile showed that dysmenorrhea improved group had better ovarian suppression than the dysmenorrhea recurrent group.

Adult↗

Status of hepatitis B virus DNA in hepatocellular carcinoma: a study based on paired tumor and nontumor liver tissues.

To investigate the hepatitis B virus (HBV) DNA status in the liver when hepatocellular carcinoma (HCC) has developed, 35 paired nontumorous and tumorous liver tissues from 27 hepatitis B surface antigen (HBsAg)-seropositive and 8 HBsAg-negative patients with HCC were studied by Southern blot analysis. The hybridization patterns of HBV DNA were different in the nontumor and tumor parts in 26 (96.3%) of the 27 HBsAg-positive patients. In the nontumor parts, integration of HBV DNA into the host genome was significantly less when compared to the tumor parts (15/27 vs. 25/27, P less than 0.05), whereas free replicative viral forms were significantly more frequent (17/27 vs. 7/27). The integrated HBV DNA in the nontumor parts showed discrete band patterns in the majority of cases (13/15). Hepatitis B e antigen (HBeAg) was significantly associated with the expression of free replicative forms of HBV DNA in the tumor tissues. An integrated HBV DNA sequence was detected in the tumor part of one HBsAg-negative patient, but not in her nontumor counterpart. Our observation that discrete integrated HBV DNAs are present in the nontumor part, representing subclinical clonal expansion that precedes the development of HCC, suggests the risk of future new tumor growth from these cell clones.

Carcinoma, Hepatocellular↗