Biomedical subjects
Publications and source records attributed to T J Chen.
Cerebral phycomycosis is a rare disease. We describe two patients with unusual features of focal intracranial phycomycosis: a diabetic patient with chronic epidural abscess and a healthy individual with an isolated intracerebral abscess. Biopsy established the diagnosis in both patients. Treatment was successful in the patient with intracerebral abscess.
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Hepatocellular carcinomas (HCCs) were resected in eight patients who had preoperative transcatheter arterial embolization (TAE) and in 25 patients without preoperative TAE. Three patients in the former group had ruptured HCCs before operation. Two of the former group and three of the latter group were found to have recurrences after a follow-up of 1 1/2 years. Although preoperative TAE resulted in significantly increased tumor necrosis, it increased the risk of gangrenous change of the gallbladder, induced adhesion of the hepatoduodenal ligament, and was not effective in reducing operative blood loss or operative time if the vessel selected for TAE was inadequate. Pathologic examination revealed tumor emboli still existing in the intrahepatic veins. Daughter nodules and capsular invasion by tumor cells were not affected by TAE. Transcatheter arterial embolization seems to be effective in controlling bleeding from ruptured HCC prior to staged resection of the tumor.
In a consecutive series of 562 patients with pathologically documented hepatocellular carcinoma (HCC), 12 patients (2.1%) were found to have a second primary malignancy elsewhere. Of these, eight were male, four female, with ages ranging from 49 to 76 years (mean 60.7 +/- 9.3 years). The associated cancers included eight cases of gastric cancers, an esophageal cancer, a stump cancer, a case of myelocytic leukemia and a histiocytic lymphoma. Eight cases had both malignancies diagnosed at the same admission. In the other four, HCC were detected after an interval of 4, 10, 12 and 39 months. Two had received previous chemotherapy or radiotherapy. Fifty percent of the 12 patients were hepatitis B surface antigen (HBsAg) positive. Their liver function tests and alpha-fetoprotein levels were consistent with those of patients with HCC alone. The results suggest that the occurrence of HCC concomitant with or arising after another primary malignancy in Taiwan is not rare.
The hydroxylapatite-column assay procedure for progesterone receptors is described. The method is rapid and easy to perform. The receptor proteins bound to labeled ligands are adsorbed on the column at low temperature (2 degrees C) and eluted by ethanol. It is particularly advantageous for measuring receptors in samples of large volume and low protein content. The sensitivity of the technique is much higher than other commonly used methods. The method is capable of detecting progesterone receptor in hamster's uterine cytosol containing protein as little as 13.5 micrograms. The affinity of the receptor can be calculated from specific binding data by Scatchard analysis. Under controlled condition, one point assay can also be applied for receptor determination in small sample with relative confidence.
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A prospective surveillance of hepatocellular carcinoma (HCC) using serum alpha-fetoprotein and high-resolution, linear-array, real-time ultrasonography was carried out in 432 patients with clinicopathologically proven chronic type B hepatitis. During a follow-up period of 6-85 mo (median 23, mean 26.9 +/- 16.8 mo), asymptomatic HCC was identified in 8 patients, with a calculated annual incidence of 826/100,000, and 2768/100,000 for patients over age 35 yr. The relative risk of developing HCC in hepatitis B surface antigen-positive chronic hepatitis patients was 2 when compared to those that were hepatitis B surface antigen-negative, and was 5 when compared in patients over age 35 yr. Hepatocellular carcinomas detected by these methods were in a relatively early stage as most tumors were small, only 50% were associated with cirrhosis, 37.5% were positive for hepatitis B e antibody, and most were still resectable. We, therefore, recommend a combination of alpha-fetoprotein and ultrasonography surveillance in patients with chronic hepatitis in order to improve the chance of early HCC detection as well as the chance for successful resection. In addition, the low incidence of cirrhosis and hepatitis B e antibody in these patients with "early" HCCs and the occurrence of hepatitis B e antigen/hepatitis B e antibody seroconversion after HCC had developed suggest that the development of HCC and progression from hepatitis to cirrhosis were two independent (though related) sequelae of chronic hepatitis B virus infection.
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To examine the frequency and significance of alpha-fetoprotein (AFP) elevation, radioimmunoassay for AFP was performed every 3-6 months in a prospective follow-up study on 432 hepatitis B surface antigen (HBsAg)-positive and 105 HBsAg-negative patients with clinicopathologically proven chronic hepatitis. In a period of 6-85 months (mean 26.9 +/- 16.8), AFP elevation (greater than 20 ng/ml) was recorded in 45.6% of the HBsAg-positive patients. In addition, 19.4% of the HBsAg-positive patients had AFP levels greater than 100 ng/ml, with a highest level of 2520 ng/ml in the absence of hepatocellular carcinoma (HCC). All these figures were much greater than those for HBsAg-negative patients (P less than 0.001). Most episodes of AFP elevation were transient, with parallel moderate SGPT elevation (greater than 200 IU/L). The AFP levels in such episodes correlated closely with the presence of bridging hepatic necrosis, only weakly with peak SGPT levels, but not with age, sex or hepatitis B e antigen/antibody status. None of the transient episodes was followed by subsequent development of HCC. On the other hand, AFP elevation (greater than 100 ng/ml) without parallel SGPT elevation could predict the presence of HCC with very high specificity (98.7%). However, the sensitivity was not high enough (66.7%) for one to rely solely on AFP for the detection of HCC at its earlier stage.
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