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Biomedical subjects

J H Chiang

Publications and source records attributed to J H Chiang.

At least 55 records · Page 3Linked to original sources

The significance of somatosensory stimulations to the human foot in the control of postural reflexes.

The purpose of this study was to investigate the possible pathways in the somatosensory system that relate to the postural reflexes in the leg muscles during a sudden, toes-up platform rotation. The inputs to the cutaneous mechanoreceptors in the sole of the foot as well as to the joint receptors in the ankle joint were modulated by standing on different supporting surfaces and by immobilizing the ankle joints; and three leg muscle responses (characterized by short latency, medium latency, and long latency) to the platform movement were recorded in 15 healthy young subjects. It was found that: (1) the short latency was not affected by the changes in either plantar pressure or ankle joint movement; (2) the medium latency was regulated by the plantar pressures under the foot, as sensed by the cutaneous mechanoreceptors in the sole of the foot, and by the ankle joint movement, as perceived by the joint receptors in the ankle joint; (3) the long latency was also related to the ankle joint movement, but this relation seems to be modulated by the plantar pressures under the foot; and (4) both medium and long latencies were well correlated with the time derivative of the pressure difference between the forefoot and the rear foot regions (r=0.7), as well as with the static pressure in the antagonist foot region (r>0.6).

Adult↗

Swallowing difficulty in Parkinson's disease.

Dysphagia is a frequent and potentially serious complication of Parkinson's disease (PD). We examined the oropharyngeal swallowing ability in 19 PD patients (15 men and 4 women, mean age 68.42 years, mean Hoehn and Yahr stage 1.8) using modified barium swallow before and after administering oral levodopa (in combination with benserazide). Twelve (63.2%) patients demonstrated objective evidence of swallowing abnormalities; although only six patients (31.6%) had subjective complaints. Vallecula sinus and pyriform sinus residues were the most frequent abnormalities (47.4% and 42.1%); followed by delayed swallowing reflex (26.3%). Three patients demonstrated silent aspiration. In the 12 patients with abnormal swallowing, six (50%) showed objective improvement after levodopa treatment, while the remaining six showed no change. Of the former group of six, one patient showed improvement in the oral phase, but deterioration in the pharyngeal phase. We concluded that PD patients had a high percentage of objective swallowing abnormalities which could be reduced in half of the patients through the administration of levodopa treatment.

Adult↗

Plantar pressure reduction in an incremental weight-bearing system.

BACKGROUND AND PURPOSE: Harness-supported treadmill ambulation has been advocated for patients to provide reduction in weight bearing to healing tissues and to reduce the energy cost of treadmill ambulation. The purposes of this technical report are to analyze the ability of one of these devices (Zuni Exercise System) to support a specific percentage of a subject's body weight during walking and running and to explore the relationship of unloading to pressure reduction in selected plantar surface regions of the foot. SUBJECTS: Ten male volunteers with no known foot pathology participated. METHODS: In-shoe plantar pressure and vertical ground reaction forces (GRFs) were measured during walking and running at full body weight and at 20% of body weight supported. RESULTS: Walking at a setting of 20% of body weight supported resulted in a reduction of the first and second vertical force peaks of 23.8% (SD = 7.3%) and 27.2% (SD = 4.1%), respectively. The total force-time integral during walking unloaded was 22.8% (SD = 3.3%). During running, the active vertical force peak and total force-time integral were reduced by 19.9% (SD = 6.0%) and 20.0% (SD = 3.3%), respectively, in the unloaded condition. Plantar pressures were reduced from 6.8% to 27.8% in the body weight-supported conditions. The reduction was variable across different regions of the foot. CONCLUSION AND DISCUSSION: The Zuni Exercise System appears to reduce the vertical component of the GRF during walking and running with 20% of body weight supported. Plantar pressures were reduced during body weight-supported conditions, but the reduction varied at different regions of the foot.

Adult↗

Lower gastrointestinal bleeding from a hepatocellular carcinoma invading the colon.

Bleeding from the gastrointestinal tract due to hepatocellular carcinoma invasion is unusual. We describe a 71-year-old man who had bloody stools caused by a hepatocellular carcinoma that directly invaded the transverse colon. The diagnosis was confirmed by colonoscopy and tissue examination. Our patient is the first with lower gastrointestinal bleeding from a hepatocellular carcinoma during the natural course of the tumor.

Aged↗

Hepatocellular carcinoma in the caudate lobe: early diagnosis and active treatment may result in long-term survival.

Hepatocellular carcinoma (HCC) in the caudate lobe is rare and the prognosis of patients with HCC in the caudate lobe has been reported to be poor. Resection for HCC in the caudate lobe has carried a higher rate of surgical risk and early recurrence. The effect of transcatheter arterial embolization (TAE) in treating HCC in the caudate lobe remains unknown. With the wide application of modern diagnostic modalities, we can now detect HCC at an earlier stage for active treatment (surgery or TAE). The aim of the present study was to analyse the effect of different treatments for HCC in the caudate lobe. From 1985 to 1994, 15 patients with HCC in the caudate lobe were retrospectively studied. Another 264 consecutive patients with newly diagnosed HCC treated by TAE were selected as the control group. Two patients underwent surgical resection and survived well without recurrence after 43 and 136 months, respectively. Ten patients underwent TAE and their survival rate was similar to that of the 264 consecutively TAE-treated controls with HCC not in the caudate lobe (P = 0.19). The 1, 3 and 5 year survival rates for TAE-treated patients in the caudate lobe were 67.7, 31.1 and 12.6%, respectively, while in controls these figures were 53.0, 18.4 and 9.1%, respectively. Two of the three patients receiving supportive treatment died within 1 month after diagnosis. Those patients having a smaller solitary tumour without intrahepatic metastasis tended to survive longer. In conclusion, HCC in the caudate lobe does not always indicate a poor prognosis so long as early detection and active treatment (surgery or TAE) are available. Transcatheter arterial embolization may act as an alternative treatment modality for patients with HCC in the caudate lobe.

Adult↗

Primary low grade B-cell lymphoma of colon mimicking inflammatory bowel disease: a case report.

Primary lymphoma of colon is rare in clinical practice and sometimes difficult to diagnose. We described a case of primary, low grade B-cell lymphoma of colon, whose clinical pictures were similar to inflammatory bowel disease. Although the colon mucosa showed diffuse infiltration of lymphocytes with lymphoepithelial lesions on endoscopic biopsy, immunohistochemical stains for B- and T-cell markers were negative. However, the diagnosis of lymphoma was established by positive findings on rearrangement of antigen receptor gene. Clinical symptom of blood-tinged diarrhea subsided after six courses of chemotherapy. Follow-up colonoscopy revealed normal colon mucosa. However, biopsy of colon mucosa still revealed mild proliferation of small lymphocytes. This case has drawn our attention that primary colonic lymphoma may clinically simulate inflammatory bowel disease, and gene rearrangement analysis might be helpful in the diagnosis of malignant lymphoma when traditional histological and immunohistochemical studies fail to provide a definite diagnosis.

Aged↗

Cloning and sequencing a human homolog (hMYH) of the Escherichia coli mutY gene whose function is required for the repair of oxidative DNA damage.

We have cloned the human mutY gene (hMYH) from both genomic and cDNA libraries. The human gene contains 15 introns and is 7.1 kb long. The 16 exons encode a protein of 535 amino acids that displays 41% identity to the Escherichia coli protein, which provides an important function in the repair of oxidative damage to DNA and helps to prevent mutations from oxidative lesions. The human mutY gene maps on the short arm of chromosome 1, between p32.1 and p34.3.

Amino Acid Sequence↗

Ruptured hepatocellular carcinoma: treatment strategy and prognostic factor analysis.

BACKGROUND: The prognosis of ruptured hepatocellular carcinoma (HCC) is generally poor, but few studies have focused on the analysis of prognostic factors of this catastrophic event. METHODS: Eighty-four consecutive patients with ruptured HCC were included. Twenty-nine clinical and laboratory variables were correlated to prognosis by using uni- and multivariate analyses. RESULTS: Epigastralgia and/or right upper quadrant abdominal pain was the most common initial presentation (70%), followed by shock (42%), abdominal distension (27%) and others (17%). Of these 84 patients, 50 patients were treated by supportive measure, 21 by operation and 13 by transcatheter arterial embolization (TAE). The median survival was 13, 30 and 202 days in each group, respectively, and 24 days overall. TAE showed the lowest hemostatic failure rate (20%). Univariate analysis showed that active treatment (operation or TAE), group I tumor with a solitary nodule or single nodule with proliferation into surrounding area, serum creatinine (< or = 1.2 mg/ml), alkaline phosphatase (< or = 95 U/L), alanine aminotransferase (ALT, < or = 40 U/L), total bilirubin (< or = 1.6 mg/ml), initial systolic blood pressure (> or = 90 mmHg), and absence of main portal vein thrombosis were correlated with a survival longer than 90 days (p < 0.05) in univariate analysis. Active treatment, ALT level and initial systolic blood pressure were still significant in multivariate analysis (p < 0.05). CONCLUSIONS: TAE may help stop the tumor bleeding. Treatment regimen, ALT levels and initial blood pressure are correlated with the prognosis of ruptured HCC.

Adolescent↗

Adenomyomatosis of the gallbladder.

BACKGROUND: Adenomyomatosis of the gallbladder in Chinese patients has rarely been analyzed. METHODS: The clinical, radiological and pathological features of 18 patients with histologically-proven adenomyomatosis, collected during a 5-year period, were retrospectively analyzed. RESULTS: According to the extent and site of involvement, adenomyomatosis of the gallbladder was conventionally classified into three types: localized, generalized and segmental. In our series, the disease was localized in 17 patients (15 in the fundus and 2 in the neck), generalized in one patient and segmental in none. Only 5 patients showed sonographic features correlative to pathologic findings, and 2 of them were correctly diagnosed before operation. Only mild nonspecific abnormalities of liver function test or urine analysis were noted in some patients with gallbladder adenomyomatosis. The clinical manifestations were not related to coincidental diseases in 11 patients. All these 11 patients, with gallstone in 9 and without in 2, complained of epigastralgia, right upper quadrant abdominal pain or dyspepsia, which relieved all after cholecystectomy. CONCLUSIONS: Some patients with adenomyomatosis may be symptomatic and relieved by cholecystectomy. In patients with adenomyomatosis of the gallbladder and right upper quadrant pain of abdomen without other explanation, cholecystectomy may be considered. Infrequent accurate diagnosis in Chinese patients calls for a high suspicion of the disease entity in clinical practice.

Adenomyoma↗

Examination of pericardial effusions by cytology and immunocytochemistry.

BACKGROUND: Cytologic examination of pericardial effusions (PE) has been uncommonly reported in the literature. Fewer reports have studied the role of immunocytochemistry in diagnosis of PE. We described our experience, according to cytologic examination and immunocyto-chemical staining of PE. METHODS: Over a four-year period, 50 PE specimens from 36 patients were examined cytologically by Wright-Giemsa stain and/or Papanicolaou stain, at Tri-Service General Hospital. Immunocytochemical stainings were further performed to ensure the cell nature. RESULTS: Eighteen of these patients had benign etiologies; the others suffered from malignant diseases. Sixteen cases, including eight benign and eight malignant, received pericardial biopsy for comparison. Commonly encountered cells in PE with any kind of etiology included neutrophils, lymphocytes macrophages and mesothelial cells. Cancer cells were additionally seen in malignant PE, but not in all cases with cancers. Furthermore, reactive mesothelial cells and macrophages were sometimes not easily distinguished from cancer cells, and reactive lymphocytes frequently mimicked hematopoietic malignancies. Further, the nature of small round tumor cells can hardly be ensured by morphologic examination only. Immunocytochemical studies were successfully used to solve these dilemmas in some suspicious cases. CONCLUSIONS: This study showed that cytology together with clinical information and immunocytochemistry can achieve excellent sensitivity and specificity in identification of malignant PE. The use of immunocytochemistry can even ensure the nature of certain cancers such as small cell carcinoma and B cell lymphoma.

Adult↗

Mesial temporal dysembryoplastic neuroepithelial tumor mimicking oligodendroglioma: a case report and review of the literature.

Dysembryoplastic neuroepithelial tumor (DNT) is an uncommon congenital tumor occurring in children. We report a 12-year-old boy who had a focal motor seizure involving his left face 6 months prior to admission. Preoperative computed tomography of the brain demonstrated a focal calcified tumor measuring 2.5 cm in diameter in the right temporal lobe. Initial pathological diagnosis was oligodendroglioma, and postoperative radiotherapy with a total dose of 5000 cGy in 28 fractions over 5&1/2 weeks was given. At follow-up 8 months later, neither clinical nor radiological recurrence was found. Because of the benign clinical course, a review of the surgical specimen was made, which led to the diagnosis of DNT. It is important to distinguish DNT from other tumors that have a worse prognosis. Correct diagnosis may prevent unnecessary radiotherapy or chemotherapy. The pathologic and radiologic diagnostic criteria of DNT are discussed, with a review of the literature.

Brain Neoplasms↗

The "Fisherman's Waders" sign in a bone scan of inferior vena cava thrombosis associated with nephrotic syndrome.

This paper presents a 61-year-old male patient with nephrotic syndrome, hypercoagulability and IVC thrombosis. Increased soft tissue uptake below the level of the mid chest was seen in his bone scan. The term "Fisherman's Waders" sign is suggested for this finding, whose recognition may permit the identification of inferior vena cava obstruction in bone scans. The existence of a cavo-portal shunt was also confirmed by dynamic scintigraphy.

Blood Coagulation Disorders↗

Epstein-Barr virus-associated gastric adenocarcinoma in Taiwan.

Fifty-five gastric carcinoma tumors from Chinese patients in Taiwan, including 40 tubular type (one lymphoepthelioma-like carcinoma subtype), eight signet ring cell type, one papillary type, and six mucinous type gastric carcinomas, were investigated for the presence of Epstein-Barr virus (EBV) transcripts by in situ hybridization using fluorescein-conjugated EBV oligonucleotides for EBERs (Epstein-Barr virus early RNAs) expression and the polymerase chain reaction for viral DNA. Epstein-Barr virus was detected in six of 55 lesions (11%), a significantly lower proportion than has been observed in a North American series. Epstein-Barr virus involvement was more common among male patients. Epstein-Barr virus DNA and its EBERs were specifically present within gastric carcinoma and adjacent dysplastic cells but were absent in surrounding lymphocytes and normal gastric mucosa. Epstein-Barr virus DNA and EBERs were found in one sample of lymphoepithelioma-like carcinoma (LELC) and five specimens of typical gastric adenocarcinoma. Among the EBV-positive gastric adenocarcinomas, four were tubular type of varied differentiation and one was signet ring cell type. Furthermore, we evaluated the expression of the latent membrane protein (LMP) with monoclonal antibodies. We found that LMP was expressed in two EBV-positive samples. In addition, the presence of the EBV receptor was studied by probing samples with CD21 monoclonal antibody. Epstein-Barr virus receptor was not detected in any sample. Southern blot analysis indicated single clonal proliferation of tumor cells. These findings confirm and extend the results of Shibata et al. They also indicate that EBV infection might be related to oncogenesis not only in rare gastric cancers that resemble nasopharyngeal lymphoepithelioma but also in typical gastric adenocarcinoma.

Adenocarcinoma↗

Subpubic sinus: a remnant of cloaca.

A 14-month-old girl had purulent discharge from a sinus over the subpubic region for 2 weeks. Radiography and voiding cystourethrography revealed a 4.5 cm. long fistula extending to the retropubic region without any connection to the lower urinary tract. The fistula was excised. Histological findings revealed that the fistula had 3 different types of epithelium: stratified squamous, transitional and columnar. Clinical and pathological findings indicated that the sinus was most likely a remnant of the cloaca.

Cloaca↗

X-linked agammaglobulinemia: a case report.

A 20-year-old male was admitted with fever and hemoptysis. Agammaglobulinemia was found, with bronchiectasis and sinusitis. Clinical and laboratory evidence included immunological examinations, bone marrow and small intestinal biopsies. Results suggested a diagnosis of X-linked agammaglobulinemia. After treatment with antibiotics and intravenous human immunoglobuline, the clinical symptoms demonstrated progressive improvement. The case is reported along with a review of the literature.

Adult↗

Intestinal schistosomiasis japonica: CT-pathologic correlation.

PURPOSE: To study the pathologic basis of intestinal wall calcification caused by Schistosoma japonicum visualized with computed tomography (CT). MATERIALS AND METHODS: Twelve patients underwent CT of the abdomen to detect what pathologic examination proved to be schistosomiasis japonica. Eight intestinal specimens from five of the patients were subjected to radiography, and the pathologic and radiographic findings were correlated. RESULTS: CT demonstrated curvilinear or nodular calcification in the colon in 11 patients, in the appendix in two, and in the distal ileum in one. In five patients, calcifications resembling tram tracks were found in the sigmoid colon. Pathologic examination of the specimens showed calcified eggs of S japonicum deposited more extensively in the submucosa and subserosa than in the muscularis propria, which led to the tram-track appearance. CONCLUSION: The extensive curvilinear or tram-track calcification found in the colon in patients with schistosomiasis japonica is calcification of deposited eggs.

Aged↗