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Biomedical subjects

H T Chao

Publications and source records attributed to H T Chao.

At least 55 records · Page 3Linked to original sources

Multiple deletions of mitochondrial DNA are associated with the decline of motility and fertility of human spermatozoa.

Sperm motility is one of the major determinants of male fertility and is required for successful fertilization. In a previous study, we demonstrated that the occurrence and accumulation of the 4977 bp deletion of mitochondrial DNA (mtDNA) is associated with diminished fertility and motility of human spermatozoa. The possible relationship between multiple deletions of mtDNA and the decline of fertility and motility in human spermatozoa was further explored in 36 subjects including subfertile and infertile males in this study. Using long-range polymerase chain reaction (PCR), we confirmed the 4977 bp deletion and identified two novel deletions of 7345 and 7599 bp of mtDNA in the spermatozoa with poor motility. We used Percoll gradients to fractionate spermatozoa with differing motility, and then screened for two novel large-scale deletions of the mtDNA. The results showed that the ratio of the deleted mtDNA in the spermatozoa with poor motility and diminished fertility were significantly higher than those in the spermatozoa with good motility and fertility. In addition, we found that the frequencies of the three large-scale deletions in the spermatozoa from patients with primary infertility and oligoasthenozoospermia were higher than those of the fertile males. Our findings suggest that mtDNA deletions may play an important role in some pathophysiological conditions of human spermatozoa.

Base Sequence↗

Prognosis of primary fallopian tube adenocarcinoma: report of 25 patients.

PURPOSE OF INVESTIGATION: Because of the rarity of primary fallopian tube adenocarcinoma (PFTA), the optimal management has not been well-defined, especially in early-stage disease. Furthermore, prognosis of primary fallopian tube carcinoma has not been fully understood. METHODS: We retrospectively studied patients with proven surgico-pathological stage PFTA and excluded patients without a standard surgicopathological staging procedure. Twenty-five patients from 1970 to 1995 were identified. Eleven were in Stage I, four in Stage II and ten in Stage III and IV. Twenty patients received adjuvant chemotherapy with four to eight courses of CAP or CEP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2 or epirubicin 50 mg/m2, and cisplatin 50 mg/m2 intravenously, every three weeks) regimen. One patient received two courses of chemotherapy and another received one course of chemotherapy; both followed with radiotherapy due to refusal of further chemotherapy. The remaining three patients did not receive any adjuvant therapy. RESULTS: Accumulative disease-free survival rate in spite of different st ages was 36%. Univariate analysis showed postoperative adjuvant chemotherapy, optimal debulking surgery, nulliparity, extent of the disease, and tumor differentiation as significant factors for disease-free survival of patients with PFTA. However, multivariate analysis did not show significance due to the small number of cases. CONCLUSION: Nearly half of the patients (44%) were diagnosed in early stage of PFTA, but patient survival was still disappointing. Understanding possibile risk factors for therapeutic failure and more aggressive and effective multi-modality treatments should be further defined.

Adenocarcinoma↗

Fever of unknown origin in the puerperium. A case report.

BACKGROUND: Postpartum fever is a common problem for obstetricians, but fever of unknown origin (FUO) occurring in the puerperium may be relatively unfamiliar and a challenge to the majority of obstetricians. CASE: A 29-year-old woman had a FUO detected during the puerperium. Despite serial examinations and therapeutic trials, the fever persisted for three weeks without a clinical improvement or definite infection source. The presence of a huge uterine myoma was observed. The patient finally underwent myomectomy, and a pathology review revealed a cellular leiomyoma associated with massive infarction and acute inflammation. The fever subsided substantially on the third day postoperatively. CONCLUSION: Although a uterine leiomyoma as a cause of fever in the puerperium is not new, rarely does it cause prolonged fever. It should be taken into consideration in pregnant women known to have uterine myomas during pregnancy and in the puerperium, especially if FUO develops. Nonsteroidal antiinflammatory drugs can be a tool for making the differential diagnosis in such a patient, and exploratory laparotomy can be delayed until an emergency condition occurred, especially important during pregnancy.

Adult↗

Placenta previa accreta with cervical involvement causing tenacious postpartum hemorrhage: a case report.

Conservative treatment for placenta accreta has recently been popularly accepted even though serious postpartum hemorrhage, resulting in maternal death, may occur. We report a case of placenta previa accreta with cervical involvement resulting in tenacious postpartum hemorrhage. A 28-year-old pregnant woman, gravida-2 para-1, who had undergone a previous cesarean section, was scheduled for a repeat cesarean section because of complete placenta previa associated with placenta accreta. The patient underwent cesarean section and delivered a 3,700 g, male infant. Manual removal of the placenta was performed with some difficulty and redundant placental tissue remained adhered to the uterine wall. Oxytocin, ergometrine, uterine arterial ligation and packing of the lower uterine segment were used to control bleeding; the wound was closed as usual after achieving adequate hemostasis. While closing the abdominal wall, vaginal bleeding was noted. After conservative treatment, shock progressively emerged due to persistent vaginal bleeding. Emergency laparotomy found active bleeding from the cervix and total abdominal hysterectomy was performed without hesitation. Careful evaluation is mandatory to preserve the uterus. In the case of cervical involvement, aggressive treatment such as hysterectomy should be undertaken promptly to decrease the risks of both morbidity and mortality.

Adult↗

High resistance index of Doppler ultrasound in tuberculous peritonitis presenting as abdominal carcinomatosis: report of two cases.

The radiologic features of tuberculous peritonitis (TB peritonitis) are seldom reported, and the use of color Doppler ultrasound in the diagnosis of TB peritonitis is even less common. Herein, we present two patients (a 29-year-old woman and a 56-year-old woman) who were evaluated for months of progressive enlargement of the abdomen, poor appetite and weight loss. In both patients, clinical and laboratory examinations suggested carcinoma, except a very high vascular resistance (resistance index 1.0 and 0.89, respectively) of the tumor feeding vessels detected by color Doppler ultrasound. TB peritonitis was finally diagnosed by exploratory laparotomy. Both patients were treated using a four-drug regimen of isoniazid, rifampicin, ethambutol hydrochloride and pyrazinamide for nine months and were clinically cured. In conclusion, if color Doppler ultrasound reveals normal ovaries, ascites containing thin, delicate incomplete or complete septa, and only a few high-resistance tumor feeding vessels in the abdominal cavity (resistance index > or = 0.80), TB peritonitis should be considered.

Abdominal Neoplasms↗

Small cell carcinoma of the cervix: analysis of clinical and pathological findings.

PURPOSE OF INVESTIGATION: An attempt to better identify small cell carcinoma of the cervix and evaluate its prognosis. METHODS: From January of 1970 to March of 1995, a total of seven patients diagnosed with small cell carcinoma of the cervix by pathologic revision were retrospectively reviewed. Clinical information including age, clinical stage, lymph-vascular space invasion, lymph node metastases, prognoses were analyzed. RESULTS: All specimens stained positive for neuron-specific enolase (NSE) and four were positive for chromogranin (CGR). The majority of patients (71%) died of disease within 18 months. Only one patient had an abnormal Pap smear before definite diagnosis, and only one patient was well and alive after a combination of surgery and multi-agent chemotherapy (p<0.05). CONCLUSION: Pap smears may not be an appropriate screening method for detecting small cell carcinoma of the cervix. Immunohistological staining may be helpful in diagnosis of small cell carcinoma of the cervix. Because of a very poor prognosis, more effective therapeutic protocol should be further defined in the management of cervical small cell carcinoma.

Adult↗

High-risk gestational trophoblastic disease: analysis of clinical prognoses.

PURPOSE OF INVESTIGATION: An attempt to better define factors leading to patient survival in the high-risk group of malignant gestational trophoblastic disease (GTD). METHODS: From January 1, 1997 to December 31, 1995 25 cases of malignant high-risk GTD were retrospectively collected to evaluate prognostic factors by univariate and multivariate analysis. RESULTS: We identified the presence of liver metastases and/or brain metastases and the presence of intestinal metastases as significant by using univariate analysis. However, only the presence of liver metastases of brain metastases was significant by multivariate analysis (p=0.009). CONCLUSIONS: Although a high-risk group of GTD can be identified according to the modified World Health Organization (WHO) prognostic scoring system, liver metastases were not emphasized (only two points) in this scoring system. We suggested that these risk factors, including brain metastases and liver metastases, should be weighted more than other risk factors.

Adult↗

Ovarian surgery during pregnancy and puerperium: twelve-year experience at the Veterans General Hospital-Taipei.

BACKGROUND: This study was performed in order to assess the surgical effects and characteristics of ovarian tumors during pregnancy and analyze their prognosis. METHODS: Between 1982 and 1993, 121 patients who had undergone ovarian surgery during pregnancy or puerperium were reviewed at the Veterans General Hospital-Taipei. These patients were analyzed with particular emphasis on the length of gestation at the time of surgery, complications related to the stage of pregnancy, surgical and pathologic findings and the outcome of pregnancy. RESULTS: Ovarian tumors were commonly detected during the second trimester (54.5%) and most of them (79.3%) were asymptomatic. The pathologic review found 38 patients (31.4%) with benign teratoma, 16 patients (13.1%) with corpus luteum and four patients (3.3%) with malignancy. There was a significant difference between emergent ovarian surgery and elective ovarian surgery in the spontaneous fetal wastage rate (14.1% vs 1%, p = 0.009). Compared with elective surgery, cases necessitating oophorectomy, with or without salpingectomy, increased significantly during emergency surgery (57% vs 36%, p = 0.03). All ovarian surgeries performed before a gestational age of seven weeks resulted in spontaneous fetal wastage. CONCLUSIONS: Although the majority of the ovarian tumors detected during pregnancy were benign, emergency laparotomy was sometimes required, which led to an increase in the risk of a fetal wastage. Preconception counseling should be emphasized because early removal of non-functional ovarian tumor before conception, especially teratoma, would decrease the incidence of ovarian surgery during pregnancy. Furthermore, elective and well-prepared surgical intervention appears to be a crucial factor for favorable pregnancy outcome.

Adult↗

Delayed postpartum hemorrhage in adenomyosis: a case report.

Adenomyosis of the uterus is a serious problem for women of reproductive age because of its possible consequence of infertility. We present the case of a woman who had adenomyosis of the uterus, a successful spontaneous pregnancy, and delayed and tenacious postpartum hemorrhage that did not respond to conservative treatment. The 26-year-old woman, gravida 1, para 1, suffered from fulminating vaginal bleeding and associated shock 20 days after the delivery of a 3,450-g female by Cesarean section. Conservative treatment included uterine compression and massage, blood transfusion, intravenous administration of high-dosage estrogen, oxytocin and sulprostone (prostaglandin E analogue), and gauze packing from the vagina into the uterine cavity. Despite treatment, the patient went into shock due to persistent vaginal bleeding. Emergency exploratoric assessment laparotomy was performed, followed by a stotal hysterectomy. Pathology revealed extensive adenomyosis of the uterus without other significant abnormality. The potential dangers of adenomyosis in pregnancy should not be overlooked when patients seek treatment for infertility.

Adult↗

Successful pregnancy in a woman with acute myeloid leukemia treated with high-dose whole-body irradiation.

BACKGROUND: Although radiotherapy is an integral part of managing certain types of hematologic malignancies, its effect on the reproductive system are well established. We report a case of successful pregnancy in a patient who received high-dose whole-body irradiation (WBI) (1,575 cGy) as part of her treatment for acute myeloid leukemia (AML). CASE: A 26-year-old woman received high-dose cyclophosphamide accompanied by high-dose (1,575 cGy) WBI as part of her treatment for AML when she was 23 years of age. The patient received oral contraceptives before, during and after treatment. After WBI, the patient developed ovarian failure and amenorrhea, which was confirmed by hormonal evaluation. The amenorrhea persisted for one year. No recurrence of AML was found. The patient was placed on hormone replacement therapy (HRT) because of vasomotor changes. An unexpected pregnancy occurred 14 months later; HRT was discontinued. The patient delivered a normal female infant at 38 weeks of gestation. The infant was followed for eight months; her development appeared to be normal. CONCLUSION: In this case report, it is unclear whether pregnancy resulted from active folliculogenesis remote from radiation therapy or from possible ovarian protection rendered by the use of oral contraceptives. The benefit of oral contraceptives in protecting the ovary from radiation injury is unknown and remains an area for future research.

Adult↗

Uterine myoma after cessation of gonadotropin-releasing hormone agonist: ultrasound and histopathologic findings.

BACKGROUND: This study attempted to search for the possible mechanism of regrowth of uterine myoma after cessation of gonadotropin-releasing hormone agonist (GnRHa) therapy. METHODS: Five premenopausal women presenting with symptomatic uterine myoma were prospectively studied in this trial. All patients were treated with a subcutaneous injection of goserelin depot 3.6 mg every four weeks for 16 weeks. Clinical examinations as well as hormonal and ultrasound determinations were performed before, during and after treatment to monitor the efficacy of therapy. At the end of the treatment period, all patients underwent myomectomy. The ultrastructural change of the myoma was evaluated postoperatively. RESULTS: The volume of the uterus decreased 21-57% and the volume of the uterine myoma decreased 21-65% after therapy. There was no significant change in resistance index of the uterine vessels or major vessels supplying the uterine myoma between pretreatment and post-treatment values. The morphologic features of the treated myoma showed marked cellular shrinkage and loss of myofibrillar structure. CONCLUSIONS: There is no significant cellular damage to the cellular structure that contributes to regrowth of treated intramural uterine myoma following cessation of treatment.

Antineoplastic Agents, Hormonal↗

Preoperative diagnosis of primary fallopian tube carcinoma by magnetic resonance imaging: a case report.

Because of the rarity and insidious onset of primary adenocarcinoma of the fallopian tube, early diagnosis is very difficult. Primary fallopian tube carcinoma is also rarely diagnosed preoperatively. This report reviews the value of magnetic resonance imaging (MRI) in aiding the detection of early-stage primary fallopian tube carcinoma in a 48-year-old female. The diagnosis was based on clinical suspicion, elevated CA-125 and MRI. MRI demonstrated the tumor as an area of solid masses with marked enhancement after gadolinium-diethylenetetraaminepentaacetic acid (Gd-DTPA) administration. Primary fallopian tube carcinoma was confirmed by pathologic examination. We hope that, with improvements in imaging, early diagnosis of such a malignant disease could become routinely possible in the future.

Fallopian Tube Neoplasms↗

Port site metastasis after laparoscopic-assisted vaginal hysterectomy for endometrial cancer: possible mechanisms and prevention.

Only 19 cases of metastases at the cannula insertion site after laparoscopy for gynecological malignancy have been reported in the literature. One case has been diagnosed with cervical squamous cell carcinoma, whereas the others have been diagnosed with ovarian cancer and borderline ovarian tumor. We present a novel case of laparoscopy-site abdominal wall metastasis from endometrial cancer after laparoscopic-assisted vaginal hysterectomy (LAVH). The 56-year-old female patient exhibited metastases of an abdominal wall trocar site and a perineal site after undergoing LAVH and laparoscopic-assisted (LA) bilateral pelvic lymph node sampling as well as LA para-aortic lymph node sampling for treating endometrial carcinoma, surgical staging IIIC, G3. The interval between the surgical extirpation of endometrial carcinoma and diagnosis of the tumor recurrence was 6 months, suggesting that overmanipulation of the diseased organ during laparoscopic surgery may have resulted in tumor spillage, intraperitoneal dissemination, and wound contamination. Although this procedure has been proven beneficial to patients with benign disease or early-stage gynecologic malignancies, laparoscopic-assisted vaginal hysterectomy may not be efficacious to eradicate advanced gynecological malignancy.

Abdominal Muscles↗

Rapid detection of trisomy 21 by homologous gene quantitative PCR (HGQ-PCR).

Down's syndrome results from the production of three copies of chromosome 21 within a cell. We have devised a method termed the homologous gene quantitative polymerase chain reaction (HGQ-PCR), which uses one pair of primers and which can directly identify the additional copy of chromosome 21 by simultaneously amplifying two highly homologous genes of the human liver-type phosphofructokinase located on chromosome 21 (PFKL-CH21) and the human muscle-type phosphofructokinase located on chromosome 1 (PFKM-CH1) for self-detecting determination. On analysis of 34 cases of Down's syndrome, including two cases of unbalanced translocation 46, XY, der (14; 21) (q10; q10), + 21, and 100 normal individuals, the relative ratio of the PFKM-CH1/PFKL-CH21 product was 1.33 +/- 0.323 (mean +/- SD) and 0.40 +/- 0.16 (mean +/- SD) for disomy DNA and trisomy DNA, respectively. The difference between these two groups was highly significant (P < 0.001). These results indicate that this quantitative method is practical and may be used for the prenatal diagnosis of Down's syndrome caused by trisomy 21.

Cells, Cultured↗

Hydroxyl radical-induced decline in motility and increase in lipid peroxidation and DNA modification in human sperm.

We employed the xanthine-xanthine oxidase system to produce H2O2 or simply used commercially available H2O2 solution to investigate the effects of exogenous hydroxyl radicals on the motility characteristics and on lipid peroxidation and DNA modification of human sperm. The functional parameters of sperm motility declined concomitantly upon incubation of sperm with hydroxyl radicals. After incubation of freshly ejaculated human sperm with 0.23 mM H2O2 in the presence of 1.8 mM ADP and 2.7 mM FeSO4 for 1 hr at 37 degrees C, 90% reduction of motility was observed. Effect of hydroxyl radicals on sperm motility was dependent on the concentrations of FeSO4 and H2O2, respectively. The remaining motility of sperm after 1 hr incubation showed negative linear correlation with FeSO4 concentration. The response of sperm motility to FeSO4 was also dependent on the concentration of H2O2. Except for the amplitude of lateral head displacement, functional parameters of sperm declined with the increase of H2O2 concentration. Moreover, we found that lipid peroxidation measured as malondialdehyde (MDA) and accumulation of modified DNA indicated by 8-hydroxy-2'-deoxyguanosine (8-OH-dG) in human sperm were significantly accelerated by exogenous hydroxyl radicals. The contents of lipid peroxides and 8-OH-dG in the spermatozoa were increased from 24.6 +/- 2.4 nmol MDA/1 x 10(7) sperm and 0.17 +/- 0.02% in the untreated group to 30.6 +/- 1.2 nmol MDA/1 x 10(7) sperm and 1.9 +/- 0.47%, respectively, in the sperm treated at 37 degrees C for 1 hr with 2.03 mM H2O2, 1.8 mM ADP and 4.5 mM FeSO4. Taken together, these results suggest that the detrimental effects of hydroxyl radicals on human sperm functions may be mediated, at least partly, through lipid peroxidation and DNA modification.

8-Hydroxy-2'-Deoxyguanosine↗

Successful management of a solitary peritoneal metastasis of unknown origin. Report of a case.

A solitary peritoneal metastasis from a poorly differentiated adenocarcinoma of unknown origin in a 38-year-old female is described. The patient presented with a left ovarian tumor and elevated cancer antigen 125. She underwent complete excision of tumor and received six courses of postoperatively adjuvant cisplatin-based combination plus radiation therapy simultaneously. Second-look operation was done later and complete surgicopathologic remission was demonstrated. Two further courses of consolidation chemotherapy were given. She has been followed up for 25 months, and is living and well. We suggest that the combination of aggressive surgery, cisplatin-based chemotherapy and an open-field technique of abdominopelvic irradiation (concurrent chemoradiation) may be an appropriate approach to manage solitary peritoneal metastases from poorly differentiated adenocarcinoma of unknown origin.

Adenocarcinoma↗

Severe bleeding from a pregnancy tumor. A case report.

BACKGROUND: Hyperplastic gingivitis and gingival hyperplasia accompanying gestation have been termed "pregnancy gingivitis" and "pregnancy tumor." The condition is benign but, rarely, is complicated by severe bleeding that is difficult to manage. A single case of a pregnancy tumor is reported. CASE: A 28-year-old woman in the third trimester was evaluated for treatment of a pregnancy granuloma with recurrent episodes of severe bleeding for two weeks. Conservative management by firm pressure on gauze packs was applied to control the bleeding, but in vain. Induction of labor was conducted at 37 weeks partially because of term pregnancy and uncontrollable bleeding from the gingiva. An emergency cesarean section was done because of acute fetal distress during induction of labor. A healthy infant was delivered. The gingival bleeding stopped spontaneously five days afterwards. The patient was given thorough dental prophylaxis and oral hygiene instructions. The buccal granulomatous tumor was decreased in size four weeks postpartum. CONCLUSION: Careful oral dental hygiene, removal of dental plaque and debris, and use of soft toothbrushes are important during pregnancy to avoid occurrence of a pregnancy tumor. If uncontrolled bleeding occurs, management should be based on the individual condition and should range from supportive therapy--such as desiccation of bleeders; local, firm compression and oral hygiene to blood transfusion--as well as medication to accelerate fetal lung maturity or even termination of pregnancy to save the patient's life, as with treatment of uncontrollable eclampsia.

Adult↗