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Biomedical subjects

F J Hsieh

Publications and source records attributed to F J Hsieh.

At least 19 recordsLinked to original sources
PubMed1995

Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound.

BACKGROUND: Much evidence has suggested that vascular density reflects the clinical behavior of cancer. In this study, the intratumoral blood flow in cervical carcinomas was assessed by transvaginal color Doppler ultrasound, and its clinical significance was evaluated. METHODS: Sixty-five patients with Stage Ib-IIb cervical carcinoma exhibiting visible cervical tumor by transvaginal ultrasound were enrolled. All patients were scheduled for radical hysterectomy and pelvic lymph node dissection. Transvaginal color Doppler ultrasound was performed before surgery to search for blood flow signals from the tumor and the main uterine artery. The corresponding arterial resistance index (RI) was calculated. Clinical and pathologic data were recorded. A cytokinetic study was performed by propidium iodide staining and flow cytometry. The human papillomavirus (HPV) status was assessed by polymerase chain reaction. RESULTS: Intratumoral blood flow was detected by color Doppler ultrasound in 46.2% (30/65) of the tumors. Patients with detectable intratumoral blood flow exhibited significantly more pelvic lymph node metastasis (10/30 vs. 2/35, P = 0.005), a higher percentage of cancer cells in the S- + G2M-phase (30.02 +/- 18.54% vs. 19.35 +/- 11.21%, P < 0.005), and a higher prevalence of HPV infection (30/30 vs. 25/35, P = 0.001) when compared with those without intratumoral blood flow. No significant difference was observed concerning the patient's age, tumor size, clinical staging, histologic type, and DNA ploidy status between these two groups. Regression analysis of the intratumoral RI value on the S- + G2M-phase fraction showed linear regression (n = 30, r2 = 0.501, P < 0.01). The RI values of the main uterine artery showed no significant difference between these two groups. CONCLUSION: The intratumoral blood flow by transvaginal color Doppler ultrasound correlated well with a higher proliferation index, higher incidence of HPV infection, and pelvic lymph node metastasis in cervical carcinoma.

Adult↗
PubMed1995

Limb defects after chorionic villus sampling.

OBJECTIVE: To clarify the association between limb defects and chorionic villus sampling (CVS). METHODS: Questionnaires were sent to 165 major obstetric units in Taiwan to survey the incidence of limb defects with and without CVS exposure during 1991. Limb defects with CVS exposure from September 1990 to June 1992 were also surveyed. The spectrum of limb defects in CVS-exposed and general populations were compared by the Poisson test. RESULTS: The incidence of limb defects in the surveyed general population in 1991 was 0.032% and that with CVS exposure was 0.294%, a statistically significant difference (P < .001). The incidence of severe limb defects in the general population was 0.0026% and that with CVS exposure was 0.22%, also statistically significant (P < .001). Twenty-nine cases of limb defects after CVS were reported from September 1990 until June 1992: 19 cases with transverse limb reduction, two with mid-palm reduction, seven with adactyly or hypodactyly, and one with syndactyly. Four cases also had oromandibular-limb hypogenesis syndrome. CONCLUSIONS: The incidence of limb defects, especially the severe types, was increased after CVS. The spectrum of limb defects with CVS exposure was more severe than the limb defects seen in the general population and showed a specific pattern ranging from hypodactyly, adactyly, and transverse limb reduction, to oromandibular-limb hypogenesis. A correlation between the severity of limb defects and the timing of CVS was suggested.

Abnormalities, Multiple↗
PubMed1994

Vascular patterns of gestational trophoblastic tumors by color Doppler ultrasound.

BACKGROUND: Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance. METHODS: Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions. CONCLUSION: Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.

Arteries↗
PubMed1994

Incremental angiogenesis assessed by color Doppler ultrasound in the tumorigenesis of ovarian neoplasms.

BACKGROUND: The crucial role of angiogenesis in tumor behaviour has been studied extensively in vitro. The authors assessed the in vivo angiogenesis in ovarian neoplasms by color Doppler ultrasound and waveform analysis. METHODS: The intratumor artery resistance index (RI) of 222 ovarian neoplasms referred for color Doppler ultrasound evaluation was measured, and the corresponding histopathologic diagnosis was recorded. RESULTS: Satisfactory intratumor artery waveforms were obtained at an average of 1.12 sites in 44.7% (68 of 152) of benign tumors and at 6.28 sites in 97.1% (68 of 70) of the malignant group. Great heterogeneity in RI values existed. The RI of the intratumor artery in the benign group during the follicular phase (mean, 0.678) was significantly higher (P < 0.001) than that of the luteal phase (mean, 0.414), epithelial ovarian carcinoma (n = 34; mean, 0.402), malignant germ cell tumor (n = 6; mean, 0.413), malignancy metastasized to the ovary (n = 18; mean, 0.357), and other rare malignancies (n = 4; mean, 0.435). The RI of primary ovarian malignancy (n = 41; mean, 0.411) was significantly higher than that of malignancy metastasized to the ovary (P < 0.05). The RI values of epithelium-originated neoplasms showed a significant incremental decrease from benign tumors (n = 48; mean, 0.695) toward borderline malignancy (n = 6; mean, 0.535; P < 0.01), early-stage ovarian carcinoma (n = 10; mean, 0.485; P < 0.01), and, finally, to advanced-stage ovarian malignancies (n = 29; mean, 0.398; P < 0.05). CONCLUSIONS: Angiogenesis is a common phenomenon in malignant ovarian neoplasms, but the intensity of neovascularization may depend on individual tumor characteristics. The authors documented the incremental decrease of the resistance index in ovarian neoplasms, which may reflect the increase in angiogenesis intensity as an indication of malignant potential.

Adolescent↗
PubMed1994

Prenatal diagnosis of X-linked hydrocephalus in a Chinese family with four successive affected pregnancies.

We report on a woman with four successive pregnancies affected with X-linked hydrocephalus (XLH). The first child had prenatal craniocentesis and died in utero. The second child had a postnatal shunting operation, but suffers from severe growth and mental retardation at 5 years of age. In the third pregnancy, prenatal ultrasound detected hydrocephalus at the 16th and 20th weeks of gestation and the pregnancy was terminated. In the fourth pregnancy, ultrasound scanning at the 17th and 20th weeks of gestation revealed no remarkable findings, but hydrocephalus was detected at the 24th week. Autopsy confirmed the prenatal diagnosis. DNA polymorphism analysis of the Bc1I site of exons 17-18 of factor VIII gene of the woman and her last two fetuses seemed to be compatible with a linkage between the XLH locus and factor VIII gene. Although XLH has a variable presentation of ventriculomegaly, ultrasound scanning is still a useful tool for prenatal diagnosis at present. Earlier and more accurate prenatal diagnosis will be feasible with molecular analysis of the XLH locus or its flanking regions.

Adult↗
PubMed1994

Intrauterine intervention in a case of recurrent meconium peritonitis.

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.

Adult↗
PubMed1994

Amniocentesis in mothers who are hepatitis B virus carriers does not expose the infant to an increased risk of hepatitis B virus infection.

Sixty-seven pairs of mothers with hepatitis B virus (HBV) surface antigen (HBsAg) and their infants were divided into two study groups to determine the effect of amniocentesis on intrauterine HBV infection. In the first study group (35 pairs), the infant's HBsAg status in cord blood was studied and the results were compared with those obtained in the cord blood from 65 infants born to HBsAg-positive women who did not have an amniocentesis. In the second study group (32 pairs), the HBV status of the infants was studied at the age of three months to five years and compared with the HBV status of 3,454 infants in the National HBV Prevention Program. In the first study group, one sample (2.9%) was weakly positive for HBsAg; while in the first control group, two (3.1%) were positive. In the second study group, three (10%) infants were positive for HBsAg. The failure rates of immunoprophylaxis in the second study and control groups were similar (9.4% vs 11% for HBsAg carrier mothers; 30% vs 14% for HBe antigen-positive carrier mothers). This suggested that genetic amniocentesis did not increase the risk of intrauterine HBV infection.

Adult↗
PubMed1994

Correlation of uterine hemodynamics with chemotherapy response in gestational trophoblastic tumors.

OBJECTIVE: To assess the uterine hemodynamics in gestational trophoblastic tumors and to correlate them with response to chemotherapy. METHODS: Using transvaginal color Doppler ultrasound, we measured the peak systolic velocity and the resistance index (RI) of the uterine arteries in 23 women with gestational trophoblastic tumors before each course of chemotherapy. Fifty-five nonpregnant women and another 15 women who had uneventful molar evacuation were enrolled as controls. Two-tailed Student t test was used for statistical analysis. RESULTS: A hyperdynamic uterine circulation was noticed at diagnosis in all gestational trophoblastic tumors, manifested as higher peak systolic velocity (mean +/- standard deviation 57.5 +/- 20.4 cm/second) of the uterine arteries compared to nonpregnant (28.3 +/- 3.41 cm/second; P < .0001) and uneventful post-mole uteri (26.8 +/- 3.08 cm/second; P < .0001). The RI values of the uterine arteries in gestational trophoblastic tumors at diagnosis ranged from 0.21-0.80. However, the mean value (0.56 +/- 0.19) was lower than those of nonpregnant (0.80 +/- 0.05; P < .0001) and post-mole uteri (0.75 +/- 0.06; P < .0001). A higher pre-treatment uterine artery RI (mean 0.71 +/- 0.09) was noted in ten patients with gestational trophoblastic tumors requiring fewer than five courses of chemotherapy, compared with the mean in 13 patients requiring longer courses of treatment (0.47 +/- 0.14; P < .0001). There was a marked decrease of peak systolic velocity during the first three courses of treatment in the former group (54.2 to 23.6 cm/second; P < .001), in contrast to no change in the latter group (60.1 to 60.5 cm/second). CONCLUSION: Uterine hemodynamic characteristics assessed by color Doppler ultrasound might predict and monitor the response to chemotherapy in gestational trophoblastic tumors.

Adult↗
PubMed1994

Delayed maternal death after perimortem cesarean section.

We report a case of perimortem cesarean section performed on a multigravida with congestive heart failure. This patient had a past history of repeated episodes of acute myocarditis and this time, congestive heart failure attacked her at the 36th week of gestation. The maternal condition deteriorated rapidly with frequent attacks of ventricular fibrillation and cardiac arrest, which gradually became unresponsive to active cardio-pulmonary resuscitation (CPR). The fetal condition also worsened accordingly. Cesarean section was therefore performed and a 2590 gm depressed female baby was delivered in less than one minute after skin incision and about twenty-seven minutes after the maternal condition became extremely unstable. The Apgar scores were 1 at one min, 4 at five min and 6 at ten min. The mother improved soon after delivery of the fetus and her consciousness returned. However, her condition deteriorated again and she died four hours after operation. The fetus survived and follow-up 21 months after delivery was normal.

Adult↗
PubMed1994

Infantile endodermal sinus tumor presenting with vaginal bleeding: report of a case.

Endodermal sinus tumor (EST) of the vagina is extremely rare and primarily affects infants. We report on a six-month-old female infant with EST of the vagina who presented with vaginal spotting of one month's duration. Pelvic ultrasound and computerized tomography showed a 3.8 x 3.5 cm heterogeneous mass between the bladder and the rectum. The serum alpha-fetoprotein (AFP) level was high (1270 ng/mL) and the beta-human chorionic gonadotropin was undetectable. She received surgical intervention followed by chemotherapy. The patient was disease-free and serum AFP remained undetectable during the eight-month follow-up period.

Endodermal Sinus Tumor↗
PubMed1994

Prenatal diagnosis of congenital rubella infection from maternal rubella in Taiwan.

OBJECTIVE: To determine the frequency of intrauterine rubella infection in Taiwan. METHODS: One hundred three pregnant women with evidence of rubella infection were enrolled. Congenital rubella infection was diagnosed by testing specific immunoglobulin (Ig) M in fetal cord serum obtained from funipuncture or amniotic fluid culture. The fetal outcomes were evaluated by ultrasonic examination, specific antibody detection in cord blood at birth, and complete physical examination during early childhood. RESULTS: Prenatal diagnosis was possible in 95 of 103 fetuses, 93 by funipuncture and two by amniocentesis. Five intrauterine rubella infections were detected prenatally, and another one was diagnosed after birth. The intrauterine infection rates were 10.0, 11.8, 2.9, and 6.5% after maternal infection at 1-10, 11-14, 15-19, and 20-29 gestational weeks, respectively. Among the six fetuses with serologic evidence of congenital infection, one had congenital rubella syndrome with sensorineural deafness, two were terminated during the second trimester, two others were normal, and one was lost to follow-up. With the exception of the infant with clinical congenital rubella syndrome, no evidence of rubella defects was found in the other 81 children who received follow-up to 2-4 years old. CONCLUSION: The risk of congenital rubella infection in seropositive pregnant women is relatively low in Taiwan.

Adult↗
PubMed1994

Factors contributing to the accuracy in diagnosing ovarian malignancy by color Doppler ultrasound.

OBJECTIVE: To determine whether resistance index values obtained by color Doppler ultrasound contribute to the accuracy in diagnosing ovarian malignancies. METHODS: Four hundred ten patients with ovarian neoplasms referred for color Doppler ultrasound evaluation were enrolled, excluding patients examined during the luteal phase. Resistance index of the intra-tumor arteries was measured by color Doppler ultrasound. The corresponding clinical and histopathologic information was recorded. For statistical determinations, we used the Yates corrected chi 2 analysis, Fisher exact test, Student t test, and linear regression analysis. RESULTS: Satisfactory intra-tumor artery waveforms were obtained in 96.1% (99 of 103) of ovarian malignancies. Resistance index values varied at 0.23-0.82. Regression analysis of resistance index values on tumor size and amount of ascites demonstrated a linear association (R = 0.498 and 0.362, respectively; P < .01 in both). If we regard a resistance index of 0.4 as a cutoff value, the overall sensitivity and specificity in detecting malignancy were 68.0 and 97.4%, respectively. Primary ovarian malignancies exhibited significantly more false negatives (30 of 79) than malignancies metastasized to the ovary (three of 24) (P = .018). Malignancies containing mainly cystic components exhibited more false negatives (20 of 41) than did tumors with primarily solid components (13 of 62) (P < .01). Significantly more false negatives were encountered in malignancies with larger diameters (greater than 10 cm) compared to smaller ones (27 of 63 versus six of 40; P < .01), and in malignancies accompanied by considerable ascites (greater than 1000 mL) (13 of 25 versus 20 of 78; P < .05). CONCLUSIONS: Tumor origin, size, component nature, and amount of ascites contributed to the accuracy in diagnosing ovarian malignancies using resistance index values obtained by color Doppler ultrasound.

Adolescent↗
PubMed1994

Pregnancy following cardiac prosthetic valve replacement.

OBJECTIVE: To determine the effect of cardiac valve replacement on pregnancy outcome. METHODS: We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, chi 2, and Fisher exact tests were used for analysis. RESULTS: There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively; P < .05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%). CONCLUSION: Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.

Adult↗
PubMed1993

Alpha-thalassemia in the four major aboriginal groups in Taiwan.

A total of 1309 unrelated blood samples from four major Taiwan aboriginal groups, including 522 of the Ami, 246 of the Bunun, 227 of the Atayal, and 214 of the Paiwan groups, were collected. Subjects with a mean corpuscular volume below 85 fl and Hb A2 values below 3.5% were further studied with Southern hybridization to determine the status of alpha-globin genes. In the Ami, 43 (4.1%) chromosomes had alpha-thalassemia 1 and 43 (4.1%) had alpha-thalassemia 2. Of the 43 alpha-thalassemia 1 chromosomes, 33 were of the Thailand, one of the Philippine, and nine of the Southeast Asian deletion. Of the 43 alpha-thalassemia 2 chromosomes, 42 were of the type I rightward deletion and one was of leftward deletion. In the Bunun group, one chromosome (0.2%) was of the Thailand deletion and two (0.4%) were of type I rightward deletion. In the Atayal group, only one chromosome (0.2%) was of the Philippine deletion. In the Paiwan group, four chromosomes (0.9%) were of the Southeast Asian deletion and three (0.7%) were of the Thailand deletion. Among the four groups, the Ami had the highest prevalence of alpha-thalassemia, which was also higher than that of the Chinese living in Taiwan.

Blotting, Southern↗
PubMed1993

Ultrasonography and color Doppler imaging of metastatic pulmonary choriocarcinoma.

Chest ultrasound and color Doppler flow imaging were used to assess the pulmonary nodule of a 24-year-old pregnant woman with dyspnea and hemoptysis. The ultrasonogram showed multiple hypoechoic subpleural nodules. Color Doppler imaging of the nodules revealed characteristics of high vascularity and high blood flow. A percutaneous needle aspiration under ultrasonic guidance confirmed the diagnosis of choriocarcinoma.

Adult↗
PubMed1993

Doppler sonographic detection of reverse twin-twin transfusion after intrauterine death of the donor.

We report a "stuck" twin, in which a reverse blood shunt from the recipient to the donor was detected by Doppler sonography after death of the donor. This acute reverse transfusion caused intrauterine fetal distress and severe neonatal anemia of the surviving recipient. We believe that acute hemodynamic change after death of one fetus, in addition to causing a derangement in coagulation, causes immediate danger or subsequent organ damage for the surviving co-twin.

Adult↗
PubMed1993

Methotrexate treatment for cervical pregnancy: experience of four cases.

Although cervical pregnancies account for a very small number of the ectopic pregnancies, they sometimes result in a tragic outcome due to the difficulty of surgical treatment and subsequent intractable hemorrhage. We report our experience with four cases of cervical pregnancy which were treated successfully with methotrexate. All four patients had a history of a previous abortion and two had previously had a cesarean section. High-resolution transabdominal and transvaginal color Doppler ultrasound was used for diagnosis, and the serial beta-human chorionic gonadotropin levels were checked to monitor the therapeutic effect. Hysterectomy was avoided, and the reproductive capability of these patients was preserved. Chemotherapy was well tolerated except for mild stomatitis in one case and a transient elevation of liver enzymes in another case. One patient delivered a healthy female infant two years after treatment. In conclusion, previous curettage and a low segment cesarean section may contribute to the development of a cervical pregnancy. Fortunately, methotrexate therapy offers an effective nonsurgical treatment for this potentially catastrophic condition.

Adolescent↗