Biomedical subjects

Biing-Shiun Huang

Publications and source records attributed to Biing-Shiun Huang.

15 recordsLinked to original sources

PubMed2007

The pincer chopsticks: the investigation of a new utensil in pinching function.

The manipulation of chopsticks requires skillful motions of fingers. Therefore, it would be difficult to manipulate chopsticks for people with hand dysfunction. We designed a simple and convenient utensil, the pincer chopsticks, to simulate the pincers-pinching operation of traditional chopsticks. To compare the performance of the new device with that of traditional chopsticks and spoons, 32 volunteers applied these utensils to pick up four kinds of fool with either hand. For dominant hands, the manipulation time of both pincer and traditional chopsticks was shorter than that of spoons, while using pincer chopsticks with non-dominant hands revealed the best performance among the three experimental utensils for users without experience. In this study, the newly designed pincer chopsticks demonstrated advantages for operation and performance. It has the potential to benefit patients with impaired hands.

Adolescent↗

PubMed2006

A new type of chopsticks for patients with impaired hand function.

OBJECTIVES: To present a method for adapting chopsticks to persons with hand impairments and to compare the efficiency of the adapted chopsticks with spoons among adults with cervical spinal cord injury (SCI). DESIGN: Equipment development and pilot evaluation. SETTING: Rehabilitation center. PARTICIPANTS: Two adults with complete C8-level SCI and 9 adults with incomplete SCI from the C6 to C8 level. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Instructions for adapting chopsticks and the time to pick up and manipulate 4 types of food (noodle strips, cubed carrots, unshelled peanuts, tofu cube) by using adapted chopsticks as compared with spoons. RESULTS: The mean time for manipulating tofu was comparable between the adapted chopsticks and spoon, but the adapted chopsticks were sufficiently faster than spoons for noodle strips, carrots, and unshelled peanuts. CONCLUSIONS: Adapted chopsticks convert gross grasp into 2-point pinch. They are inexpensive, easily constructed, and may benefit patients with lower cervical SCI and residual gross grasp.

Cooking and Eating Utensils↗

PubMed2006

Non-Hodgkin's lymphoma presenting as a large chest wall mass.

BACKGROUND: Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. METHODS: From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. RESULTS: There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. CONCLUSIONS: Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.

Adult↗

PubMed2006

En bloc resection for lung cancer with chest wall invasion.

BACKGROUND: The aim of this study was to retrospectively assess the results of en bloc chest wall plus lung resection for patients with non-small cell lung cancer (NSCLC) invading the chest wall. METHODS: From January 1986 to December 2000, of 1,820 patients having surgery for NSCLC, 42 (2.3%) patients with neoplasms involving the chest wall underwent en bloc chest wall and lung resection. Patient demographics, preoperative symptoms, operative procedures, tumor cell type and size, removed nodal status, and pathologic stage were summarized. The 5-year survival rates of the groups were compared. RESULTS: Postoperative staging revealed 28 were T3N0M0, 4 were T3N1M0, and 10 were T3N2M0. The in-hospital mortality rate was 11.9% (5/42). The mean age was 79.0 +/- 2.8 years in the patients who died of complications, which was significantly older than the mean age of 67.9 +/- 8.1 years in the patients who survived the surgery (p = 0.005). The overall 5-year survival was 28.4%. The 5-year survival was significantly longer in the patients with negative (N0) nodal metastasis than in those with N1 and/or N2 nodal metastasis (39.6% versus 7.1%, p = 0.01). Eleven patients had tumor involvement of the parietal pleura. Thirty-one patients had tumor involvement of the soft tissue and/or bone. There was no significant difference of 5-year survival rate between the patients with involvement of the parietal pleura only and the patients with involvement of the parietal pleura and the soft tissue and/or bone (10.9% versus 33.5%, p = 0.94). CONCLUSION: En bloc resection for bronchogenic carcinoma invading the chest wall provides a favorable prognosis in cases without nodal metastasis. Significant postoperative mortality is associated with old age (> 80 years). The 5-year survival rate is not significantly different between the patients with involvement of the parietal pleura only and the patients with involvement of the parietal pleura and the soft tissue and/or bone.

Adult↗

PubMed2006

Management of primary chest wall tumors: 14 years' clinical experience.

BACKGROUND: Primary chest wall tumor is rare but it encompasses tumors of various origins. We analyzed our experience with primary chest wall tumors with emphasis on its demographic presentation and management. METHODS: From 1991 to 2004, 62 patients with the diagnosis of primary chest wall tumors were enrolled. Lipoma, chest wall metastasis, direct invasion from nearby malignancy, infection, and inflammation of chest wall were excluded. The clinical features, management, and the outcome of these patients were retrospectively reviewed. RESULTS: There were 37 males and 25 females. Malignant and benign tumors were equally distributed. Chondrosarcoma and lymphoma were the 2 most common types of malignant chest wall tumors. The most common clinical symptoms were palpable mass (54.8%) and pain (40.3%). Nine of 31 patients (29.0%) with benign chest wall tumors were free of symptoms whereas patients with malignant chest wall tumors were all symptomatic (p = 0.002). A definite diagnosis was obtained in 21 of 26 patients (80.7%) who received nonexcision biopsy. All patients with primary chest wall tumors, except 6 who had medical treatment only, underwent surgical resection. Patients with malignant chest wall tumors were older than those with benign tumors (p < 0.001). The mean largest diameter of tumors was also larger in malignant tumors than in benign tumors (p = 0.04). CONCLUSION: Patients with primary malignant chest wall neoplasm were older than those with benign tumors. The mean size of malignant tumors was larger than that of benign tumors. Adequate surgical resection remains the treatment of choice for patients with primary chest wall tumors. Nonexcision biopsy should be reserved for patients with a past history of malignancy, suspicion of hematologic disease, and with high operative risk. For patients with isolated chest wall lymphoma, surgical resection followed by chemotherapy can be considered to obtain a better outcome.

Adolescent↗

PubMed2005

EGFR mutations in malignant pleural effusion of non-small cell lung cancer: a case report.

EGFR mutations have been shown to correlate with the clinical responsiveness to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). The detection of EGFR mutations in non-small cell lung cancer (NSCLC) is important from the perspective of targeted anticancer therapy. We report the first case showing that the status of EGFR mutations can be successfully determined in malignant pleural effusion of NSCLC using polymerase chain reaction (PCR) technique, and correlated to the clinical responsiveness to gefitinib, an EGFR-TKI. This case demonstrated the importance of molecular cytology in the era of targeted therapy.

Antineoplastic Agents↗

PubMed2004

Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia.

Among patients with adenocarcinoma of the gastric cardia, we noted that patients with higher preoperative serum albumin levels appeared to survive longer than patients with lower levels. Thus, we evaluated serum albumin as a prognostic factor for patient survival. From 1987 to 1997, 314 patients with adenocarcinoma of the gastric cardia underwent curative resection. Patient serum albumin levels were evaluated on the second day after admission, before any nutritional support. Patients were divided into two groups: those with normal serum albumin levels (>3.5 g/dl) and those with abnormal serum albumin levels. The perioperative mortality and morbidity were 5.7% (18 of 314) and 22.3% (70 of 314), respectively. The surgical resectability rate was significantly better among patients with normal serum albumin levels (P < 0.001). The 5-year overall survival rate of patients with normal serum albumin levels was also better than those with abnormally low serum albumin levels (38.4% versus 19.1%, P=0.0003). In each cancer stage, the 5-year survival rate of patients with normal serum albumin levels was better than that among those with hypoalbuminemia. By multivariate analysis, serum albumin level and the pathologic T, N statuses were independent factors correlated with prognosis. Preoperative serum albumin level correlated highly with resectability and survival. Patients with abnormal serum albumin levels had worse survival than did those with normal serum albumin levels. We recommend that postoperative adjuvant therapy be given to all patients with hypoalbuminemia preoperatively.

Adenocarcinoma↗

PubMed2004

Pulmonary hamartoma.

BACKGROUND: Pulmonary hamartoma is the most common type of benign lung tumors. We retrospectively reviewed the clinicopathological features of 61 patients with pulmonary hamartomas undergoing surgical resection in our institution. METHODS: From 1971 to 2002, 61 patients with 62 pulmonary hamartomas underwent surgical resection in the Division of Thoracic Surgery, Taipei Veterans General Hospital. 45 were men and 16 were women (approximately in 3:1 ratio). Their mean age was 56.9 years (range 20 to 77 years). The medical records of these patients were reviewed. The information collected using a standardized data-collection form consisted of the age at presentation, gender, initial manifestations or symptoms, history of tobacco consumption, location of hamartoma, size of the lesions, state of calcification in the hamartoma, the results of preoperative bronchoscopic examination, operative procedures and pathological report of intra-operative frozen section. All available histological slides were reviewed by the same pathologist to reconfirm the diagnosis of pulmonary hamartoma. RESULTS: Of the 61 patients with pulmonary hamartoma, 41 patients were clinically asymptomatic, 16 patients had new onset of respiratory symptoms and 4 patients had chronic cough. One patient had synchronous 2 separate lesions. The hamartomas were equally distributed in the pulmonary lobes with the mean transverse diameter of 1.8 cm measured in operation (range 0.2 to 5.0). No tumor recurrence developed after resection in our series. The mean follow-up was 8.9 years. CONCLUSIONS: The vast majority of pulmonary hamartomas represent as solitary pulmonary nodule. Definite diagnosis and the treatment can be achieved by surgical resection with minimal morbidity. No tumor recurrence was encountered in the follow-up period.

Adult↗

PubMed2004

Managements of locally advanced unresectable thymic epithelial tumors.

BACKGROUND: Surgery is the treatment of choice for thymic epithelial tumors (TET), but the resectability is about 60-70%. For those with locally advanced unresectable TETs (LAU-TETs), some controversies about the prognostic factors and treatment modalities existed. The aims of this study are to elucidate the roles of various therapeutic options and to determine the survival and prognostic factors of LAU-TETs. METHODS: Twenty-seven patients diagnosed with LAU-TETs underwent treatment in Taipei Veterans General Hospital between 1979 and 1997. Multiple treatment modalities, including surgical intervention, irradiation and chemotherapy, were advocated for these patients. The clinicopathological factors and the effects of the treatment modalities were evaluated retrospectively. RESULTS: Twenty seven cases of LAU-TETs, included 18 thymomas (12 at stage III and 6 at stage IVa) and 9 thymic carcinomas (4 at stage III and 5 at stage IVa), were enrolled for study. The overall 5-year and 10-year survival rates were 54.6% and 35.1%, respectively. Patients receiving debulking surgery and those with irradiation dosage higher than 4400 cGy had significantly better survivals (P = 0.021 and P = 0.016, respectively). CONCLUSIONS: Aggressive debulking surgery and sufficient irradiation dosage provide better survivals for patients with LAU-TETs, especially for those with thymoma.

Adult↗

PubMed2004

Surgical results of upper thoracic esophageal carcinoma.

BACKGROUND: Due to its anatomical location, carcinoma of the upper thoracic esophagus (i.e. below the thoracic inlet and above the carina) often results in early invasion of adjacent structures and precludes radical resection. The prognosis of carcinoma of the upper thoracic esophagus was considered worse than that of distal esophagus. There are few studies specifically addressing the prognostic factors in the surgical treatment for carcinoma in this location. Herein we report a retrospective study conducted to analyze the result of surgical treatment for carcinoma of the upper thoracic esophagus. METHODS: From January 1983 to December 2002, 298 cases were diagnosed with upper thoracic esophageal carcinoma in our institute. Among them, 78 cases underwent operation with curative intent and were enrolled for study. RESULTS: The tumors were stage I in 7.7%, stage II in 42.3%, stage III in 33.3% and stage IV in 12.8%. The postoperative morbidity and mortality rates were 59.0% and 6.8%, respectively. Pulmonary complication was the most common morbidity and also the leading cause of postoperative death. The overall median survival time after surgery was 13.1 months. The 1-, 3- and 5-year survival rates were 53.9%, 28.7% and 21.4%, respectively. There was an improvement in surgical result over time. The 5-year survival rate improved from 13.6% in the earlier 10-year period to 37.6% in the latter 10-year period (p = 0.0493). Univariate analysis revealed 5 positive prognostic factors: tumor length (p = 0.0012), pT status (p = 0.0274), pN status (p = 0.001), pathologic stage (p = 0.0322) and R category (p = 0.0009). Multivariate analysis identified pN status, R category and tumor length as independent prognostic indicators. In patients receiving neoadjuvant therapy, the 5-year survival rate after surgery was 23.4%, which was similar to those undergoing surgery alone (p = 0.5174). For patients with advanced tumor stages (ie. pT > 3, pN > 0, pM > 0) or with residual tumors (R1/2 resection), the 5-year survival rates were significantly different in patients with and without postoperative adjuvant chemoradiation therapy (16.0% vs. 0%, p = 0.0045). CONCLUSIONS; For carcinomas in the upper thoracic esophagus, the prognosis was dismal. Surgical resection remains the treatment of choice. In addition to lower resectability, the postoperative morbidity and mortality rates were relatively high. The length of tumor extension, status of lymph node involvement and radicality of surgery were independent prognostic factors.

Adult↗

PubMed2004

Pulmonary metastasectomy for hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is seldom resectable due to advanced status. Even though hepatectomy is feasible, a large proportional of patients may still develops extrahepatic recurrence. Pulmonary metastasis is the most common site of extrahepatic spread. Few articles have discussed the benefit of resection for lung metastasis after curative hepatectomy. We evaluated the general information and the result of lung resection for patients having lung metastasis after curative resection of HCC. METHODS: Six patients who underwent pulmonary metastasectomy for HCC at Taipei Veterans General Hospital between August 1995 and May 2004 were enrolled in the study. All of them had received the hepatectomy for primary HCC. The demographic information of patients, the site and number of extrahepatic recurrence, the method of surgical intervention and the outcome after surgery were retrospectively reviewed. RESULTS: There were 4 men and 2 women with the mean age of 47.3 years. All of them were HBV carriers. Five patients had multiple pulmonary metastases removed by wedge resection. Two patients had bilateral lung metastases upon diagnosis of extrahepatic recurrence. The mean duration of follow-up after hepatic resection was 75.0 +/- 25.1 months (32 to 104 months). The mean survival after pulmonary resection was 47.2 +/- 34.3months (1 to 94 months). Four patients are still alive and free of the disease. One patient is alive but with the disease. One patient who refused further aggressive treatment after resection of lung metastasis died of the disease 40 months after lung resection, 77 months after hepatic resection. CONCLUSIONS: Lung resection for the pulmonary metastasis of HCC can result in a favorable long-term survival when there is no other intrahepatic or extraphepatic recurrence of HCC. For patients with multiple lung metastases in different lobes or different lungs, aggressive surgical resection is recommended if complete resection can be achieved.

Adult↗

PubMed2003

Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control.

OBJECTIVE: The number of totally removed lymph nodes during thoracotomy was used alternatively to represent the quality of lymphadenectomy in patients with pathologic stage I non-small cell lung cancer (NSCLC). We combined this new parameter with other well-established prognostic factors and performed multivariate survival analyses to validate its usage as a stage control. METHODS: Three hundred and twenty-one patients who underwent complete surgical resection for stage I NSCLC were reviewed retrospectively. Aside from the number of lymph nodes removed during thoracotomy, other well-known clinical and histopathological factors were also included as possible prognostic factors for analysis. Two survival analyses, overall death and cancer-related death as study end-point, were performed, using the Kaplan-Meier method and multivariable Cox's proportional hazard regression analysis. Stepwise method of variable selection was employed to choose the 'best' Cox proportional hazard model in each survival analysis. RESULTS: The overall 5- and 10-year survival rates were 48 and 35%, and the cancer-related 5- and 10-year survival rate was 63.3 and 58.3%, respectively. The number of totally removed lymph nodes during thoracotomy, tumor size and smoking history in multivariable analysis significantly affected both overall and cancer-related survival rates. Cell type of adenocarcinoma or large cell carcinoma was associated with a worse cancer-related survival compared with other histological types. CONCLUSIONS: The quality of lymphadenectomy, represented quantitatively by the number of totally removed lymph nodes during thoracotomy, may impact on a more accurate tumor stage, and will affect the survival rate for patients with stage I NSCLC as well as other well known clinical and histopathological factors.

Adult↗

PubMed2003

The role of mediastinoscopy in the evaluation of thoracic disease and lung cancer.

BACKGROUND: Mediastinoscopy is a widely used technique in the diagnosis of mediastinal disease and the staging of bronchogenic carcinoma. Its efficacy in the preoperative staging of lung cancer is well-established, with a procedural sensitivity of greater than 90% and specificity of 100%. Mediastinoscopy can also establish the diagnosis in greater than 90% of mediastinal disease. We conducted a retrospective study of mediastinoscopy performed at our institution between 1998 and 2001 to evaluate the safety and efficacy of mediastinoscopy. METHODS: We collected 100 consecutive mediastinoscopies performed in Thoracic Division of Taipei Veterans General Hospital between 1998 and 2001. The indications for mediastinoscopy included mediastinal mass or lymphadenopathy and the staging of lung cancer. Some patients had the undetermined lung mass with enlarged mediastinal lymph node. RESULTS: There were 69 men and 31 women aged from 13 to 87 (mean 60.9). Sixty-seven patients had mediastinoscopy for the staging of lung cancer, 29 patients for diagnosis of mediastinal mass or lymphadenopathy, and 4 patients for undetermined lung mass with mediastinal lymphadenopathy. Among the patients with mediastinal disease, sarcoidosis was diagnosed in 13 patients, and lymphoma in 5 patients. N2 or N3 nodal metastasis was revealed in 38 of 67 patients who had lung cancer. Fifteen patients with negative mediastinoscopy proceeded to thoracotomy for tumor resection. Seventeen patients received neoadjuvant chemotherapy followed by resection. There were three complications, all due to bleeding, and no mortality. CONCLUSIONS: Mediastinoscopy is a safe and effective procedure for the diagnosis of mediastinal disease and the staging of lung cancer. In cases of lung cancer, mediastinoscopy can provide more accurate evaluation of mediastinal lymph node metastasis than conventional diagnostic tools like computed scan or magnetic resonance image with low morbidity and mortality.

Adolescent↗

PubMed2003

Surgical results of squamous cell carcinoma of the esophagus in young patients.

BACKGROUND: Squamous cell carcinoma of the esophagus (ESCC) is one of the ten most common cancers in Taiwan. Surgical resection is the mainstay of the treatment. Young patients with ESCC are reported to have poor surgical outcome. This retrospective and comparative study is to evaluate the clinicopathologic difference and survival between young and elderly patients. METHODS: From January 1985 to December 2000, totally 797 patients with esophageal cancer received esophagectomy with reconstruction at our institution. Among them, 12 patients who received neoadjuvant concurrent chemo-radiotherapy followed by esophagectomy were excluded from this study. The other 785 patients were divided into two groups. Group I included 67 patients aged 50 or younger (8.5%) and group II included 718 patients aged over 50 years (91.5%). The clinical data were collected by chart review and follow-up data were collected through outpatient department record or telephone contact. These two groups were analyzed and compared regarding sex ratio, exposure to tobacco or alcohol, surgical mortality rate and 5-year survival rate. RESULTS: There was no difference in gender distribution between young and old patients groups. More patients in the young patients group had the habits of alcohol and tobacco consumption than in the elder patients group. The surgical (30-day) mortality was 2.98% in the young patient group, and 5.43% in the elder group. The 5-year survival rate was better in young patients group than in elder patients group but there was no statistical significance. Survival in young patients group was significantly related to TNM staging system. CONCLUSIONS: More young patients with ESCC had the habit of smoking and drinking. There was no statistical difference between the groups in clinical variables, surgical mortality and survival. The survival rate was significantly related to the TNM tumor stage.

Age Factors↗

PubMed2002

Pulmonary resection for metastases from colorectal adenocarcinomas.

BACKGROUND: Colorectal cancer is one of the most common cancers in Taiwan, as in the other part of the world. Surgical intervention is the best treatment of choice, yet some patients still developed distant metastasis after primary lesions were controlled. Metastasectomy is reported to improve the survival. This retrospective study was carried out to evaluate the relationship between the prognostic factors of lung metastasectomy and patient survival. METHODS: From 1981 to 2000, 68 patients undergoing complete lung metastasectomy in our section were studied. The prognostic factors influencing survival were analyzed, and the survival analysis was made with Kaplan-Meier method and compared by log-rank test. RESULTS: There was no surgical mortality in our series. The 5-year survival was 36.1%. None of parameters such as age, sex, stage of primary colorectal cancer, surgical method, size, number of metastatic deposits and disease free interval showed to relate with the survival. CONCLUSIONS: We concluded that lung metastasectomy for colorectal cancer is safe and effective to improve the survival. Since there were no significant factors influencing the survival, there should be no absolute contraindication against resectable pulmonary metastasis after primary lesions were adequately controlled.

Adenocarcinoma↗