Biomedical subjects

Chi-Cheng Chuang

Publications and source records attributed to Chi-Cheng Chuang.

11 recordsLinked to original sources

PubMed2007

Polymorphism of C-terminal activation region 2 of Epstein-Barr virus latent membrane protein 1 in predicting distant failure and post-metastatic survival in patients with nasopharyngeal carcinoma.

BACKGROUND: The C-terminal activation region 2 (CTAR2) of Epstein-Barr virus latent membrane protein 1 is the major site that correlates with metastasis-related signaling pathway. The variation of CTAR2 sequence may affect the incidence of distant metastasis in patients with nasopharyngeal carcinoma (NPC). METHODS: Two hundred forty-nine specimens from consecutive patients with nonmetastatic NPC were collected. Amplification by polymerase chain reaction and sequence analysis of CTAR2 were performed. DNA sequence identical to the Cao strain was grouped as Cao CTAR2, whereas sequences differing from Cao made up non-Cao CTAR2. Clinical characteristics and CTAR2 status were subjected to statistical analysis for distant metastasis. RESULTS: Non-Cao CTAR2 was associated with a statistically significant lower distance metastasis and superior survival rate. A combination of clinical stage and CTAR2 expression provided an accurate method of identifying high risk of metastasis. CONCLUSION: NPC patients with non-Cao CTAR2 were less likely to have metastasis develop than those characterized by Cao CTAR2.

Adult↗

PubMed2006

Intrasellar cavernous hemangioma.

Reports of intrasellar cavernous hemangioma are rare. They are usually incidental findings at autopsy, or initially mistaken for pituitary adenoma and treated accordingly. There are no specific symptoms. Cranial nerve palsy has occasionally been reported in patients with cavernous hemangioma, with or without sellar extension. However, intrasellar cavernous hemangioma with extension into the cavernous sinus resulting in oculomotor palsy has not been reported. We present a rare case of intrasellar cavernous hemangioma and discuss the diagnosis and management. Total surgical removal is recommended. However, attempts to resect the parasellar component of the lesion may be associated with high morbidity. Therefore, surgical cranial nerve decompression in the acute stage followed by stereotactic radiosurgery for the residual lesion may be an alternative.

Female↗

PubMed2006

Surgical treatment for severe visual compromised patients after pituitary apoplexy.

BACKGROUND: Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness. The timing of rapidly expanded mass was strongly related to the treatment outcome. METHODS: Thirteen patients who presented with severe visual defect after pituitary apoplexy were enrolled retrospectively. Six patients without severe underlying diseases were considered non-complicated and were treated early. Another seven patients who received delayed treatment after medical problems were stabilized and/or conservative management failed were considered to be complicated. The visual acuity of each individual eye was evaluated and organized into six grades based on visual acuity. Twelve patients received transsphenoidal surgery and one craniotomy was performed for tumor removal. RESULTS: The delay of surgical treatment was 3.5 days and 8.7 days in the two groups, respectively. Overall, 19 out of 26 eyes (73%) improved after surgery; 100% in non-complicated group and 50% in complicated group. The average grade of visual improvement was 2.66 vs. 0.71 by each individual eye, and the difference was statistically significant (P<0.000). The ratio of regained useful vision was significant in non-complicated patients (P<0.000). The incidence of requirement long-term hormone replacement was high in the complicated group (2/6 vs. 6/7). The resection rate was total in 8 patients, subtotal in 3, partial in 1, with one loss of image follow-up. CONCLUSIONS: Early decompression significantly improved visual outcomes and the need for hormone replacement was minimal. We postulated old age, underlying malignant diseases, and coagulation disorders played the predisposing factors of poor outcome in these cases.

Adenoma↗

PubMed2006

Traumatic internal carotid artery dissection.

Traumatic internal carotid artery dissection is a serious condition that may cause ischemic stroke in young patients. It has been under-diagnosed in the past. We present three cases of traumatic internal carotid artery dissection. The clinical manifestations include hemicrania, hemiparesis, partial Horner's syndrome and cranial nerve palsy. Diagnosis is with carotid color Doppler ultrasound, CT angiography of the neck and conventional angiography. The outcome may be poor with hemiparesis, persistent vegetative state and death. We review the literature and discuss the clinical presentation, diagnosis, grading and treatment choices for traumatic internal carotid artery dissection and stroke.

Adult↗

PubMed2005

Spinal cord injury without radiological abnormality in preschool-aged children: correlation of magnetic resonance imaging findings with neurological outcomes.

OBJECT: Spinal cord injury without radiological abnormality (SCIWORA) was defined in the era when magnetic resonance (MR) images were not popularly used as diagnostic tools. Although it is generally accepted that MR imaging can effectively illustrate the level and severity of spinal cord injury in the acute phase of trauma, only a few reports of MR imaging studies of SCIWORA have been published. The authors retrospectively reviewed nine preschool-aged patients with SCIWORA to study the correlation between MR imaging findings and the outcomes of neurological deficits, with an elimination of the bias for age. METHODS: Clinical manifestations, radiological images, surgical records, and MR imaging studies were reviewed. The pre- and postoperative neurological statuses of the patients were reappraised using American Spinal Injury Association scores and Nurick grades. Nonparametric tests were used to analyze the correlations among the variables of patient characteristics, MR imaging appearances of the injured spinal cord, and neurological outcome. CONCLUSIONS: Among the patients with SCIWORA younger than 8 years old, the different patterns of the injured spinal cords could be identified using MR imaging as transection, contusive hemorrhage, traumatic edema, and concussion. The MR imaging patterns of SCIWORA had significant prognostic correlations with the neurological outcomes of these patients; that is, a normal spinal cord appearance was prognostic of a complete recovery of neurological deficits, and intramedullary lesions correlated with permanent deficits with functional disability.

Accidental Falls↗

PubMed2004

Prevalence of LMP-1 gene in tonsils and non-neoplastic nasopharynxes by nest-polymerase chain reaction in Taiwan.

BACKGROUND: The purpose of this study was to investigate the frequency of Epstein-Barr virus (EBV) latent membrane protein-1 (LMP-1) in tonsils and non-neoplastic nasopharynxes in Taiwan. METHODS: Nest-polymerase chain reaction (nest-PCR) was used to examine the presence of LMP-1 gene in lymphoid hyperplasia from non-neoplastic tonsillar and nasopharyngeal tissues and in tonsillar cancers. RESULTS: In 152 cases, 64 biopsy tissues were obtained from lymphoid hyperplasia of nasopharynxes, 57 from tonsillectomy of non-neoplastic tonsils, and 31 from tonsillar cancers. LMP-1 was detected in 43.4% of the study group. Nineteen (29.7%) and 29 (50.9%) lymphoid hyperplasias from normal nasopharynxes and tonsils, respectively, and 18 (58.1%) biopsies from tonsillar cancers had positive LMP-1. The 30-base pair (bp) deleted variant was detected in 89.5% and 82.8% of normal nasopharynxes and tonsils, respectively, and in 66.7% of biopsies from tonsillar cancers (p =.198). CONCLUSION: This study found that the 30-bp variant was the predominant type of LMP-1 from a healthy population in Taiwan.

Asian People↗

PubMed2004

Linear accelerator-based radiosurgery in the management of skull base meningiomas.

From May 1994 to December 1999, 43 patients with meningiomas in the base of the skull underwent linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) at Chung Gung Memorial Hospital. SRS was performed as a primary treatment in 14 patients, and after resection in 29 patients. The mean tumor volume was 5.68 cc, and the mean target surface dose was 16 Gy, delivered with an average of three isocenters. The median follow-up was 74.5 months. The 7-year local control rate and 7-year overall survival rate were 89.7% and 80.2%, respectively. The 7-year local control was 100% and 84.4% in SRS alone group and surgical excision with SRS group (p = 0.21), respectively. A stationary tumor following SRS was seen in 23 (53.5%) patients, partial shrinkage was seen in 16 (37.2%) patients, and complete disappearance in one patient was seen (2.3%). Furthermore, disease progression was noted in three (7%) patients, one of whom died of disease. The median time to tumor response was 15.4 months (range 5.8-52.8 months). Cases remained stable or had improved neurological statuses without any deterioration in 37.9% and 78.7% of the groups treated with surgery and SRS and SRS alone, retrospectively. In summary, LINAC-based SRS is an effective and safe modality of treating unresectable or partially resected meningiomas in the base of the skull. For tumors with diameters of 3 cm or less, particularly in patients without or with minimal clinical neurological symptom, SRS alone can provide a good local control without causing cranial neuropathy.

Adult↗

PubMed2004

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience.

OBJECTIVES/HYPOTHESIS: Many reports have advocated the feasibility of using an endoscope for the treatment of cerebrospinal fluid (CSF) rhinorrhea and skull base defect, and diversified endoscopic techniques and repairing materials have recently been proposed. This study determined the effectiveness of endoscopic repair of CSF leaks and interpreted the indications of the lumbar drain. STUDY DESIGN: Retrospective follow-up. METHODS: A total of 39 patients with CSF rhinorrhea (20 traumatic, 13 iatrogenic, and 6 spontaneous) were treated in one institution over a 10-year period. An underlay procedure was used to make eight (20.5%) repairs by way of a turbinate composite graft (4 patients), turbinate mucosa graft (3 patients), or the Dura Substitute (Preclude) (1 patient). A free turbinate graft with the applied fibrin glue was used to repair the defect by way of an overlay procedure in 23 (59.0%) lesions. Abdominal fat was used to repair the other eight (20.5%) lesions. RESULTS: Defects in the cribriform plate and anterior ethmoid sinus comprised the majority (61.5%) of all lesions. The successful rates for overlay, underlay, and fat obliteration procedures were 91.3% (21/23), 87.5% (7/8), and 100% (8/8), respectively. There were no statistical difference between underlay and overlay techniques (P = .792, Student's t test). Lumbar drainage was performed in 18 of 39 (46.2%) cases. Most patients required nasal packing (89.7%) and prophylactic parenteral antibiotics (97.4%). CSF rhinorrhea was resolved during the first attempt in 36 of 39 (92.3%) patients. All leaks were successfully repaired after a second attempt. No major complications were encountered. CONCLUSION: The endoscopic approach is safe and effective for the treatment of CSF rhinorrhea, even in the cases not successfully treated by previous neurosurgical approaches. Lumbar drain was suggested for defects in the frontal and sphenoid sinus and defects associated with meningocele or encephalocele. Complete exposure of the defect, appropriate selection of a fitting graft, as well as accurate placement and stabilization of the graft are critical to the success of repair.

Adipose Tissue↗

PubMed2004

Anterolateral thigh fasciocutaneous flap for simultaneous reconstruction of refractory scalp and dural defects. Report of two cases.

Infected full-thickness defects of the calvaria including the scalp, cranial bone, and dura mater, are often refractory to treatment and pose a difficult and urgent therapeutic problem for reconstructive surgeons. The authors report two cases in which successful reconstruction was achieved in one stage by using an anterolateral thigh fasciocutaneous flap. The well-vascularized fascia components were used to repair the infected dural defects. The skin flaps were used for coverage reconstruction.

Adult↗

PubMed2003

Presence of the latent membrane protein 1 gene in nasopharyngeal swabs from patients with mucosal recurrent nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in southeastern China and Taiwan. Early detection of the local disease followed by timely and appropriate treatment is essential to increasing cure and survival rates. Detection of Epstein-Barr virus (EBV) genomic DNA, such as the latent membrane protein 1 gene (LMP-1), in patients postirradiation during follow-up may indicate mucosal recurrence. METHODS: Seventy-one patients with NPC underwent serial nasopharyngeal swabs for LMP-1 polymerase chain reaction assay before, during, and after irradiation. All of patients achieved a complete disease remission of the LMP-1 gene after irradiation that lasted for at least 6 months. RESULTS: The median LMP-1 disease remission time after the beginning of irradiation was 4.3 weeks. Patients with early LMP-1 disease remission (</= 4 weeks after the beginning of irradiation) and delayed LMP-1 disease remission (> 4 weeks) had 3-year local control rates of 93.5% and 76.9%, respectively (P = 0.0529). The LMP-1 gene was detected again (reexpression of LMP-1 [re-LMP-1]) in 10 patients after irradiation with at least 6 months of follow-up. Nine of 10 patients (90%) in the re-LMP-1 positive group and 2 of 61 patients (3.3%) in the re-LMP-1 negative group developed local recurrence. Mucosal recurrence developed in nine patients, and all displayed re-LMP-1. By detecting re-LMP-1 using nasopharyngeal swabs, mucosal recurrence was diagnosed with a sensitivity of 100% (9 of 9 patients) and a specificity of 98.4% (61 of 62 patients). The 3-year overall survival rate, the disease free survival rate for the entire group, and the estimated local mucosal control rates in the re-LMP-1 positive and re-LMP-1 negative groups were 86.5%, 76.5%, 19.4%, and 96.7%, respectively. CONCLUSIONS: Expression of EBV LMP-1 in nasopharyngeal swab specimens from patients with irradiated/treated NPC can provide a highly sensitive and specific method of forecasting mucosal recurrence. This investigation confirmed the reliability and feasibility of nasopharyngeal swabs in screening for mucosal recurrences in patients with NPC.

Adult↗

PubMed2002

Stereotactic radiosurgery for locally recurrent nasopharyngeal carcinoma.

BACKGROUND: Stereotactic radiosurgery has been used to treat intracranial tumors. Recently, it has also been used for the treatment of head and neck tumors involving the base of skull, including recurrent NPC. METHODS: From October 1994 to April 1999, 36 patients with recurrent NPC, were retreated by stereotactic radiosurgery. These patients received radiosurgery as a boost treatment after reirradiation for recurrence. The external RT dose ranged from 20 to 60 Gy. The tumor volume ranged from 3.58 to 24.6 cc. The target surface dose ranged from 8 to 20 Gy. The median follow-up was 22.1 months. RESULTS: The 3-year local control rate was 56%. The 5-year overall survival was 49%. Persistence after radiosurgery had a worse survival than those who had secondary recurrence. Age and gender were marginally significant. No patient had new severe complications after retreatment. Four patients (11%) had nasopharyngeal necrosis after radiosurgery, none had nasal bleeding or headache, but a foul odor was present in one patient. CONCLUSIONS: Conformal radiotherapy and stereotactic radiotherapy provide good local control and survival without severe complications for patients with recurrent NPC.

Adult↗