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Biomedical subjects

T Y Chiu

Publications and source records attributed to T Y Chiu.

14 recordsLinked to original sources
PubMed2001

Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination.

BACKGROUND: Hepatitis B virus (HBV) infection is hyperendemic in Taiwan. Before universal HBV immunization was started in Taiwan in 1984, the carrier rate for hepatitis B surface antigen (HBsAg) was 15% to 20% in the general population. OBJECTIVE: To quantify the population impact of a mass vaccination program for HBV 15 years after its implementation. DESIGN: Descriptive analysis of serologic markers of HBV in healthy children and adolescents. SETTING: Chung-Cheng District, Taipei City, Taiwan, in 1999. PARTICIPANTS: 1357 persons younger than 15 years of age, who were born after the implementation of universal HBV vaccination, and 559 persons 15 to 20 years of age, who were born before the program began. MEASUREMENTS: Repeated serologic surveys similar to those done before and 5 and 10 years after the national vaccination program was implemented. All participants were tested for serum HBsAg, its antibody (anti-HBs), and hepatitis B core antibody (anti-HBc). RESULTS: During the 15 years since the vaccination program was implemented, the prevalence of HBsAg among persons younger than 15 years of age decreased from 9.8% in 1984 to 0.7% in 1999; among persons 15 to 20 years of age, the 1999 prevalence of HBsAg was 7% (P < 0.001). Hepatitis B core antibody seropositivity, which represents HBV infection, was found in 2.9% of persons younger than 15 years of age and in 20.6% of persons 15 to 20 years of age (P < 0.001); in the same age groups, the rate of anti-HBs seropositivity was 75.8% and 70.7%, respectively (P = 0.02). CONCLUSIONS: Universal vaccination significantly decreased the HBV carrier rate and infection rate among children and adolescents born since the program began. By decreasing the carrier pool, continuation of the national HBV immunization program should prevent HBV infection in the children of Taiwan, and, subsequently, adults as well.

Female↗
PubMed2001

Sedation for refractory symptoms of terminal cancer patients in Taiwan.

This study assessed sedation in terminal cancer patients in terms of three characteristics: frequency; relationship to intractable symptoms; and the extent to which medical staff, family, and patients found sedation to be ethically acceptable and efficacious. Two hundred seventy-six consecutive patients, who were admitted to the palliative care unit of National Taiwan University Hospital in Taiwan between August 1998 and the end of May 1999, were enrolled. A recording form was completed every day. This included demographic data, pain and common symptom scores, and the use of sedation in the terminal phase. Seventy (27.9%) of 251 patients who died received sedation. Sedation was administered to relieve agitated delirium in 40 (57.1%), dyspnea in 16 (22.8%), severe pain in 7 (10%) and insomnia in 5 (7.2%). The drugs used for sedation were haloperidol in 35 (50%), midazolam in 17 (24.3%), and rapidly increasing dosage of morphine in 9 (12.9%). In fewer than half (42.9%) of the patients, sedation was with the consent of both patient and family, and half (50%) had the consent of family alone. The overwhelming majority of medical staff and family felt the decision to use terminal sedation was ethically acceptable. There was no significant difference in survival time between sedated and non-sedated patients (28.49 vs. 24.71 days, t = -0.791, P = 0.430). Positive ethical acceptability and higher satisfaction with symptom control with terminal sedation were found in both medical staff and family in this study. Further work is needed to find the most appropriate time of intervention and to improve management of refractory symptoms in dying patients.

Adolescent↗
PubMed2000

Immunogenicity and reactogenicity of the combined hepatitis A and B vaccine in young adults.

The combination of hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccinations can offer convenience, increased compliance and cost saving. We have studied the immunogenicity, reactogenicity and safety of combined hepatitis A and B vaccination in young adults (16-35 years old). Eighty healthy young adults were divided into two random groups. One group received the combined hepatitis A and B vaccine (HAB) in one arm while the other group was administered concomitant hepatitis A and B vaccines (HAV + HBV) in the right and left arms, respectively. The immunogenicity, reactogenicity and safety were assessed after each dose in both the groups. In local symptoms, the percentage of the combined HAB group was lower than the HAV + HBV group, and the general symptoms were noted in approximately 30% of each group without any significant difference. No serious adverse effects were noted. All the subjects were seropositive for antibody to hepatitis A virus (anti-HAV) after one dose of vaccine, and remained seropositive after three doses in both groups. The seropositive rate for antibody to hepatitis B surface antigen (anti-HBs) was significantly higher (84%) in the combined HAB group than the concomitant HAV + HBV group (62%), (p<0.05) after dose two, and all the subjects were seropositive (100%) after the third dose. The GMTs of anti-HAV and anti-HBs were not significantly different between groups 1 and 2 (p>0.1) except in month 6 when the GMT of anti-HBs was higher in HAB group (p=0.0039). The combined HAB vaccine was found to be safe, well tolerated and had less local symptoms in young adults. The immunogenicity and reactogenicity were similar to the concomitant HAV + HBV vaccines.

Adult↗
PubMed2000

Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan.

This paper reports a prospective study conducted between September 1997 and July 1998 in 232 consecutive patients with terminal cancer. A structured data collection form was used daily to evaluate symptoms, which were analyzed at the time of admission, 1 week after admission and 48 h before death. Terminal cancer patients in this study were polysymptomatic. There were no statistically significant differences in the prevalence of most symptoms with the primary site of cancer. The majority of symptoms improved at the end of the 1st week after admission, but many symptoms worsened just before death. The high prevalence of symptoms and lack of significant difference among primary tumor sites may be related to shorter survival times caused by late referral, which is common in Taiwan.

Aged↗
PubMed2000

Ethical dilemmas in palliative care: a study in Taiwan.

OBJECTIVES: To investigate the incidence and solution of ethical dilemmas in a palliative care unit. DESIGN: Health care workers recorded daily all dilemmas in caring for each patient. SETTING: Palliative care unit of National Taiwan University Hospital in Taiwan. PATIENTS: Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. MAIN MEASUREMENT: Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. RESULTS: The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). CONCLUSIONS: The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.

Aged↗
PubMed1998

Penile cancer in Taiwan--20 years' experience at National Taiwan University Hospital.

To analyze the characteristics and prognostic factors of penile cancer in Taiwanese, we retrospectively reviewed the clinical data of patients with a diagnosis of penile cancer treated during a 20-year period (1977-1996) at National Taiwan University Hospital (NTUH). Of 71 patients treated for penile cancer during the study period, 17 were referred from other hospitals or clinics. Our analyses focused on the 54 previously untreated patients. Growth on the penis was the main symptom in all cases. Palpable inguinal lymph nodes were found only in 14 patients. All 54 patients with primary tumors were treated surgically. Pathologic examination showed squamous cell carcinoma (SCC) in 43 cases, extra-mammary Paget's disease in three, verrucous carcinoma in three, Bowen's disease in two, cutaneous lymphoma in two and basal cell carcinoma in one. Twenty-six (48%) patients had stage I penile cancer, 13 (24%) had stage II, seven (13%) had stage III, and eight (15%) had stage IV cancer. The five-year survival rate was 78% among patients with SCC and 84% among those with nonsquamous malignancies (p = 0.80). The five-year cumulative survival rates according to Jackson's cancer stage were 100% for patients with stage I, 88.9% for those with stage II, 66.7% for those with stage III, and 0% for those with stage IV (p < 0.001). Tumor staging (p = 0.027) and adjuvant chemotherapy (p = 0.042) were found to be the most significant prognostic factors. Penile cancer accounted for 0.254% of all malignancies among male patients at the NTUH during the study period. Our findings indicate that penile cancer is uncommon in Taiwanese and its prognosis is closely related to tumor staging and management. Early diagnosis and appropriate treatment may lead to prolonged survival.

Adult↗
PubMed1996

Simple nephrectomy by retroperitoneoscope.

Retroperitoneoscopic simple nephrectomy was successfully performed in 10 of 12 patients with nonfunctioning kidneys. The other two patients underwent traditional open surgery. The surgical procedures, technical pitfalls, surgical results and perisurgical complications of this simple retroperitoneoscopic approach are described. Retroperitoneoscopic nephrectomy is a viable alternative for simple nephrectomy and has the benefits of minimal invasiveness, more rapid convalescence and better quality of life for patients.

Aged↗
PubMed1996

Treating benign prostatic hyperplasia with finasteride in Chinese men: one-year experience.

To evaluate the long-term efficacy and safety of finasteride in the treatment of symptomatic benign prostatic hyperplasia (BPH), 50 patients with symptomatic BPH were initially evaluated in a double blind, placebo-controlled study for 6 months. The patients were then treated with finasteride in an open extension study in which all received the same dose of finasteride (5 mg/day) for another 6 months. Among the patients (n = 23) who completed the extension study, prostate volume was significantly reduced from baseline by 15%, maximum urine flow rate improved by 1.9 mL/second, symptom scores improved by 37% and serum prostatic specific antigen (PSA) level decreased by 1.34 ng/mL. Other than serum PSA level, these data differed insignificantly from data at the end of the first 6 months. The adverse events observed at the end of the first 6 months (two patients with decreased sexual libido and two with impotency) persisted throughout the study extension period. At the end of the 12 months study, one more patient reported decreased libido. The sustained clinical efficacy and low incidence of side-effects of daily treatment with finasteride 5 mg for 1 year indicate that finasteride is safe and effective for managing symptomatic BPH in Chinese men.

Aged↗
PubMed1995

Relationship between serum prostate specific antigen concentration and prostate volume.

Serum prostate-specific antigen (PSA) levels and prostate volume were evaluated in 553 healthy men aged 40 to 79 years, who entered a study program for benign prostatic hyperplasia from December 1993 to August 1994. Digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum PSA assay were performed on all participants. After excluding men with suspected prostate cancer and incomplete data, 542 cases qualified for analysis. The mean serum PSA level was 1.4 +/- 1.7 ng/mL which increased with age from 0.8 +/- 0.9 ng/mL in men aged 40 to 49 years to 2.7 +/- 2.8 ng/mL in those aged 70 to 79 years. In this study group, 250 men (46.1%) were documented to have various degrees of benign prostatic hyperplasia (BPH). The prostate volume averaged 22.3 +/- 9.1 mL which increased from 18.5 +/- 6.1 mL in the fifth decade to 27.2 +/- 13.7 mL in the eighth decade. There was a modest correlation between serum PSA level and both age and prostate volume. However, when the prostate volume was adjusted, the PSA level correlated more weakly with age in a multivariate analysis. On the other hand, the serum PSA level correlated more strongly with prostate volume when age was adjusted. Although 5.4% of the men had serum PSA levels > 4 ng/mL, there was no evidence of prostate cancer by DRE and TRUS. Serum PSA levels increased with age and prostate volume, and correlated better with the latter. These factors should be taken into account when determining the significance of a given PSA value in a patient without clinical evidence of prostate cancer.

Adult↗
PubMed1993

Renal hemodynamics in patients with obstructive uropathy evaluated by duplex Doppler sonography.

Duplex Doppler sonography was performed to differentiate varied degrees of obstructive uropathy by demonstrating the intrarenal arterial impedance in terms of pulsatility index and resistive index. We evaluated 56 kidneys in 28 normal subjects and 53 kidneys in 27 patients with unilateral or bilateral obstructive uropathy. The degrees of renal obstruction were determined by clinical criteria, such as excretory urography, antegrade pyelography and/or retrograde ureteral catheterization. There was excellent positive correlation between pulsatility index and resistive index values (correlation coefficient 0.77, p < 0.001). In patients with obstructive uropathy there were significant differences in pulsatility index and resistive index values between the 33 obstructed and 20 nonobstructed kidneys (p < 0.001 for both indexes). Significant differences were also found between the obstructed kidneys and the kidneys of normal subjects (p < 0.001 for both indexes) even after controlling for the age factor (p < 0.001). No difference was found between the nonobstructed kidneys of the patient group and those of normal subjects (p = 0.58 and 0.45 for pulsatility and resistive indexes, respectively). The resistive index values correlated well with the degrees of obstruction (p < 0.001). The mean resistive index values for mildly and significantly obstructed kidneys were 0.64 +/- 0.08 and 0.74 +/- 0.05, respectively. More than 93.3% of the significantly obstructed kidneys had resistive index values greater than or equal to 0.70. The obstruction may be significant and demands surgical intervention when the resistive index reaches that value. In contrast, with resistive index values of less than 0.70 renovascular resistance is minimally altered and obstruction may be mild. The results can be applied clinically to help justify the indications for surgical intervention to relieve symptoms of obstructive uropathy.

Adult↗
PubMed1992

Characterization of a newly established human bladder carcinoma cell line, NTUB1.

A new human bladder cancer cell line, NTUB1, has been derived from the surgical specimen of a 70-year-old female patient diagnosed with poorly differentiated transitional cell carcinoma. It has been successfully propagated in vitro for over 24 months without evidence of reaching senescence. Population doubling time was about 21 hours at the 32nd passage. It was tumorigenic in nude mice, and the histologic findings of the heterotransplanted tumor resembled the original tumor. Expression of keratin proteins confirmed its epithelial origin. Cytogenetic analysis showed multiple chromosome changes. Anticancer drugs, including thiotepa and adriamycin, were tested in vitro, and the cytotoxicity did not exceed 50% of the control value; likewise, in this patient chemotherapy was not effective. On the other hand, a combination of recombinant tumor necrosis factor and interferon tau in vitro was more effective against this tumor.

Aged↗
PubMed1991

Serum level of immunosuppressive acidic protein in patients with urological malignancies.

Immunosuppressive acidic protein (IAP) is a non-specific immunoreactive protein arising from inflammatory or malignant conditions in the human body. We determined the IAP levels in 65 cases with urological malignancies and in 31 cases with benign diseases as a control group during a 9-month period. There were significantly higher serum levels of IAP in cases of bladder transitional cell carcinoma (p = 0.025), prostate adenocarcinoma (p less than 0.00001) and upper urinary tract urothelial cancer (kidney and/or ureter, p = 0.013) as compared with those of the control group. Significant differences in IAP between different tumor stages were found in the bladder cancer group with high stage cases having higher IAP levels (p less than 0.0005). However, no significant differences were found between different tumor gradings. Most of the prostate cancer patients had extremely high IAP values (1,029 +/- 490 micrograms/ml) in this study. Renal cell carcinoma and testicular tumors showed no statistical differences from the control group (p = 0.89 and 0.37, respectively). No differences could be found in the different age groups (by decades) or sexes. The serum IAP level can be a good non-specific tumor marker for bladder cancer staging and probably a good follow-up tool for most urological malignancy patients.

Adenocarcinoma↗
PubMedDate not supplied

Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized double-blind controlled trial.

The clinical effects of finasteride, a 5 alpha-reductase inhibitor, in patients with benign prostatic hyperplasia (BPH) were evaluated in a double-blind, placebo-controlled study. Forty-six patients with symptomatic BPH were randomly assigned to 2 groups, the finasteride group and the placebo group. The finasteride group received 5 mg of finasteride daily for 6 months. Prostate volume, urinary flow, urinary symptoms, serum prostate-specific antigen (PSA) and adverse events were determined before and after treatment. After 6 months of treatment the patients treated with 5 mg of finasteride per day had a 30% decrease in their total urinary symptom score, a 14% decrease in prostate volume and a 0.9 ng/dL decrease of PSA. Their maximal urinary flow rate increased by 1.42 mL per second and the mean urinary flow rate increased by 0.64 mL per second. The patients given placebo showed no significant changes in their prostate volume, serum PSA and maximal and mean urinary flow rate. However, the symptom scores in the placebo group also decreased significantly. When compared with the placebo group, those in the finasteride group had significantly lower prostate volume, serum PSA, maximal urinary flow rate and urinary symptoms, but not mean urinary flow rate. The frequency of adverse events was low in both the finasteride and placebo groups. These results show that finasteride may be an effective and safe alternative for the treatment of patients with BPH.

Aged↗