Biomedical subjects

K H Juan

Publications and source records attributed to K H Juan.

At least 19 recordsLinked to original sources

PubMed1998

Management of labyrinthine fistula in middle ear cholesteatoma.

Labyrinthine fistula is a complication of chronic otitis media with cholesteatoma. Canal wall down tympanoplasty with partial mastoid cavity obliteration and complete removal of cholesteatoma matrix was adopted in five cases of labyrinthine fistula. The operation resulted in elimination of vertigo. Sensory hearing has been saved in two cases. Air conduction hearing improved in one case. In three cases whose air conduction deteriorated post-operatively, bone conduction worsened in two cases and remained unchanged in one case (Tympanoplasty type 0 was performed in the other one case.) During the follow-up period, otorrhea improved in all cases and there was no evidence of recurrence of cholesteatoma. If the hearing of the other ear is acceptable, we suggest one-stage canal wall down tympanoplasty with complete removal of cholesteatoma matrix and partial mastoid cavity obliteration. It provides low recurrence rate of cholesteatoma and there is no need of re-operation.

Adolescent↗

PubMed1996

Nasal septal cyst--a case report.

The usual complications of submucous resection of the nasal septum (SMR) are septal hematoma, infection, hemorrhage, septal perforation, and nasal deformity. We present a case of nasal septal cyst which may be a rare complication of SMR. Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa is thought to be the cause. The patient underwent deroofment of the left cystic wall by lateral rhinotomy. There was no recurrence after one year.

Adult↗

PubMed1996

Significance of tumour markers in nasopharyngeal carcinoma.

Ninety-two nasopharyngeal carcinoma (NPC) patients were selected for a study to measure tissue polypeptide antigen (TPA), CA 125, CA 19-9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP). In all, 32 patients with chronic ENT disease and 40 healthy persons were asked to participate as diseased and normal control groups. The results showed (1) TPA was the most effective of all markers; (2) CA 125 was less useful, but had a definite correlation with TPA; (3) CA 19-9, CEA, and AFP were nearly useless; (4) the TPA level increased with advancing tumour, nodal stage, and stage groups; (5) when metastases occurred, the TPA level was extremely high; (6) the TPA level decreased significantly after irradiation at stages II, III, and IV, but increased at stage V; and (7) there was no difference in TPA level between the nonkeratinizing and undifferentiated carcinomas. This study demonstrated that the TPA marker was useful in determining the degree of NPC severity and especially for indicating the presence of metastatic disease.

Adolescent↗

PubMed1996

Detection of EBV in tumor tissue and peripheral blood by polymerase chain reaction in patients with nasopharyngeal carcinoma.

Sixty-nine untreated patients with a pathologically verified nasopharyngeal carcinoma were selected for the study of detection of EBV in nasopharyngeal tumor and peripheral blood by polymerase chain reaction (PCR). Primers were directed to conserved regions of EBV genome encoding capsid protein gp 220 (Bam HI L region). A distinct 239 bp band of the PCR products indicated the presence of EBV. Results showed that EBV DNA was obtained in 91.3% of 69 NPC patients and 16.7% of 18 healthy individuals on nasopharyngeal tissue, and the difference was statistically significant between the above two groups. Nevertheless, no EBV DNA was verified from the mononuclear cells of the peripheral blood of the two groups. There was no relationship between the positive EBV DNA and the titer of serological markers. Meanwhile, the positive EBV DNA did not show any relationship with the histology type, tumor and nodal bulk, or even metastasis. Although a high positive rate of EBV DNA was detected in nasopharyngeal tumor of patients, additional environmental and genetic factors must still be considered.

Adult↗

PubMed1996

Pneumocephalus in a case of nasopharyngeal carcinoma.

An extensive mass involving the skull base was found in a 49-year-old male patient with nasopharyngeal carcinoma. Deteriorating neurologic status developed 2 weeks after radiation to the nasopharynx with the initial dosage of 5480 cGy and boosted dosage of 3520 cGy. Computerized tomography revealed multiple foci of air occupying the subarachnoid space, and an air-fluid level was found in the lateral ventricle. Antibiotics and conservative treatments were administered to the patient and consciousness returned gradually. Unfortunately, he died of hypovolemic shock owing to massive bleeding from the nasopharynx 7 days later.

Humans↗

PubMed1995

Bacteriology of maxillary sinuses in rabbits.

To study whether normal sinus flora exist in normal sinus, we used 40 sinuses from 20 New Zealand white rabbits as the animal model. The histological examination was performed on sinus mucosa from each sinus and bacteria from these sinuses were cultured. Surprisingly, 70% of them (28 sinuses) were found to have sinusitis. These sinuses not only contained bacteria in culture but also showed various degree of histological inflammatory reaction in mucosa examination. Of the other 12 normal or near normal sinuses, only two showed positive bacterial culture, and ten of them showed negative bacterial culture either from discharge or mucosa studies. Accordingly, these data suggest that these two studies (bacterial culture and histological mucosa examination) are consistent. Thus, from this study it was concluded that there is no bacteria or few bacteria in normal sinus.

Animals↗

PubMed1995

Suture technique to correct caudal septal deviations.

The traditional submucosal resection of the septal deviation (SMR) is a good method to correct septal deviations, but it is not useful for treating either caudal end deviations or deformities from posterior septum to caudal ends. There have been several methods proposed to correct caudal end deviations, and Ellis's suture technique is considered to be the most effective and convenient one after many years of implementation. Our department has selected 18 cases of caudal end deviations for application of Ellis's suture technique in recent years. Sixteen of the 18 cases have been followed for at least one year, two of them for less than a year. The results are very satisfactory. This article is meant to present the outcome.

Adult↗

PubMed1994

Pseudocyst of the auricle: steroid therapy.

We have seen 13 cases of pseudocyst of the auricle in the past two years (1990-1991). Twelve of the 13 cases that were treated with needle aspiration and intralesional steroid injection are reviewed retrospectively. The results were quite satisfactory. In 10 cases, the cystic swelling disappeared without recurrence after such treatments. The remaining 2 cases were lost to follow-up after the first steroid injection. This method of treatment did not cause side effects or discomfort in our study. We also reviewed and analyzed 36 other cases of this cyst we have seen from 1986 to 1989.

Adolescent↗

PubMed1994

Increased production of tumor necrosis factor-alpha and release of soluble CD4 and CD8 molecules, but decreased responsiveness to phytohemagglutinin in patients with nasopharyngeal carcinoma.

Twelve patients with nasopharyngeal carcinoma (NPC) were studied for spontaneous and phytohemagglutin (PHA)-stimulated production of cytokines, soluble markers and [3H] thymidine incorporation by mononuclear cells. The same number of patients with skin cancer and healthy subjects were used as control groups. Our results showed that the NPC group produced much more tumor necrosis factor-alpha (TNF alpha), soluble CD4 (sCD4) and CD8 (sCD8) in PHA-stimulated mononuclear cell supernatants than those in the other two groups. The levels of soluble interleukin-2 receptor (sIL-2R) and gamma-interferon (IFN gamma) in PHA-stimulated supernatants were at the same high level in the NPC and healthy subjects groups while the concentrations were much lower in the skin cancer group. We also noticed that the early stage group in NPC patients had higher levels of interleukin-1 alpha (IL-1 alpha), TNF alpha, IFN gamma and sIL-2R in both spontaneous and PHA-stimulated mononuclear cell supernatants. The stimulation index of PHA-responsiveness was 155, 5.2 and 37, respectively, in the healthy subjects, skin cancer and NPC groups. The PHA-responsiveness was depressed in both the NPC and skin cancer groups. It seems that cancer patients have an impaired T cell mitogenic response after mitogen stimulation. NPC patients had better immune response than skin cancer patients in immune factor release or PHA-responsiveness.

Adolescent↗

PubMed1993

The mucoceles or pyoceles of the paranasal sinuses.

Fifty-five mucopyoceles in 53 patients were diagnosed during the 10-year period from 1982 to 1992 in our department. These included 8 from the frontal sinus, 25 from the maxillary sinus, 10 from the ethmoidal sinus, 1 from the maxillary and ethmoidal sinuses, 7 from the frontoethmoidal sinuses and 4 from the sphenoethmoidal sinuses. The patients ranged in age from 8 to 78 years (mean 47.1 years). The ratio of males to females was 31 to 22. The rhinologic symptoms occurred most often in maxillary mucopyoceles and were rare in the other groups whereas ophthalmic symptoms were noticed in most of the cases. All of the cases received surgery and postoperatively most of the initial symptoms subsided except that two patients still had occasional diplopia and one did not recover at all from complete blindness. Two cases had a recurrence and one suffered from subarachnoid hemorrhage shortly after discharge. Surgery is the only treatment modality for mucopyoceles and the building of a new patent communication between the lesion and nasal cavity is important for the success of this surgery.

Adolescent↗

PubMed1993

The effects on basal anterior pituitary hormone concentrations by cranial irradiation in patients with nasopharyngeal carcinoma.

Hypopituitarism occurring in patients who received external cranial radiation therapy (RT) have been increasingly recognized. Fourteen healthy patients were collected as control Group I, and 25 patients with nasopharyngeal carcinoma (NPC) were enrolled as Group II. Another 18 NPC patients were enrolled as Group III. Blood was sampled from Group I, Group IIB (before RT), Group IIA (one week after RT) and Group IIIA (1 to 1.5 years after RT). The basal samples were taken for growth hormone (GH), adrenocorticotropic hormone (ACTH), cortisol, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyrotropin (TSH), triiodothyronine (T3) and thyroxine (T4). The results showed the T3 level was statistically low in Group IIB compared with Group I. The serum GH and FSH (male only) levels were higher and with statistical significance in Group IIA compared Group IIB. Both GH and ACTH levels decreased and PRL increased with statistical significance in Group IIIA compared with Group IIA. The ACTH decreased with statistical significance in Group IIIA compared with Group IIB. Clinical damage to the pituitary is usually manifested months to years after RT. Therefore, a careful exclusion of these glands from radiation treatment fields is recommended whenever possible.

Adult↗

PubMed1993

[Congenital nasopharyngeal teratoma: report of a case and review of the literature].

Teratomas are the most common congenital tumors, but teratomas of the nasopharynx are rare and seen almost exclusively in infants, usually in neonates. An unusual case of a neonate with respiratory distress is presented and a nasopharyngeal mass protruding into the oral cavity. After successful removal of the mass, pathological examination revealed a mature teratoma. The management and differential diagnosis are discussed, accompanied by a review of the literature.

Female↗

PubMed1993

The management of advanced subglottic carcinoma with stomal invasion: a case report.

Primary subglottic carcinoma is rare. The initial stage is usually asymptomatic and the carcinoma is advanced when the symptoms are in evidence. Because the trachea and thyroid gland adjoin to the subglottic area, the tumor invades them along with the superior mediastinum and lung by the way of paratracheal lymph drainage. To resuscitate a severe airway obstruction, an emergency tracheotomy is required, which, however, results in a higher frequency of stomal recurrence later. We treated a case with advanced subglottic carcinoma and performed extended radical neck dissection with the resection of total larynx, thyroid gland, and involved trachea with peristomal skin en bloc. In order to completely remove the paratracheal and superior mediastinal lymph nodes, the sternal manubrium and its adjoining clavicles and ribs were cut off. This was necessary to optimize the field of vision, and to prevent injury to the great vessels and pleura. Because of its availability, its thickness, and its skin paddle, the pectoralis major myocutaneous flap was formed to the skin defect and to protect the great vessels. Postoperative stoma was at the sternal level and did not compress the great vessels. Parathyroid gland, after chopping, was reimplanted into muscle tissue to prevent hypocalcemia. No more postoperative radiotherapy or chemotherapy was necessary because the lymph nodes were spared. There were no postoperative complications and the patient was discharged 2 weeks later. No recurrence occurred in the 28 months follow-up period.

Glottis↗

PubMed1993

[Relapsing polychondritis: report of a case and review of the literature].

Relapsing polychondritis (RP) is a rare disease of unknown etiology, characterized by episodic and progressive chondritis, ocular and audiovestibular involvement, and occasional cardiovascular abnormalities. The inflammation typically involves the cartilage of the ears, nose, trachea, larynx, ribs, joints, and Eustachian tubes. The major clinical features include auricular chondritis, arthritis, nasal chondritis, ocular inflammation, chondritis of the respiratory tract, audiovestibular damage, and cardiovascular disorders. RP occurs predominantly in Caucasians and is uncommon in Oriental patients. Two cases of RP have previously been reported in Taiwan. We report one Taiwanese patient who was diagnosed with RP according to the criteria proposed by Damiani and Levine. The patient has bilateral auricular chondritis, episcleritis, and uveitis. Successful treatment was accomplished with systemic corticosteroid and topical corticosteroid eye drops. At an outpatient visit one year and ten months after discharge, there was no evidence of recurrence.

Adult↗

PubMed1993

The effects of radiation therapy on salivary function in patients with head and neck cancer.

Eighty nasopharyngeal carcinoma (NPC) patients and another eighty head and neck cancer (HNC, non-NPC) patients were enrolled as two experimental groups to study their salivary function by using Tc99m sialography. Twenty healthy subjects were also employed as a control group. The patients received an intravenous injection of 4 mCi of 99mTc-pertechnetate (Tc-99mO4-). The data were collected at a rate of 1 frame per 15 seconds for the total time of 30 minutes, and the patients received stimulations for salivary secretion by ingesting 0.5cc of lemon juice 15 min after the start of data acquisition. The salivary function was measured on Pre-RT (radiation therapy), During-RT and Post-RT periods. The results showed no statistical significance for maximum uptake (%) and excretion rate (%) between Control and Pre-RT group on parotid or submandibular glands function. This was the same in the age groups (age below 40 and age above 40) and sex groups. The NPC group had a decreasing maximum uptake (%) 3 months after RT on both parotid glands and submandibular glands, whereas the HNC group showed no obvious difference. The excretion rate (%) of both parotid and submandibular glands reached its lowest mark after 3-6 months in both the NPC and HNC groups and then started to recover progressively. For NPC patients, the radiation damage to the parotid glands was greater than to the submandibular glands, whereas the effect was reversed on HNC patients. It is important that the radiation therapist should preserve salivary function whenever possible.

Adolescent↗

PubMed1993

[Contralateral hearing and tympanoplasty].

The contralateral hearing level of the operated ear is closely related to its preoperative hearing level, and is an important index to the success of tympanoplasty. We analysed 146 cases of chronic otitis media who had received tympanoplasty by the same surgeon at Kaohsiung Medical College Hospital. From the results of pure tone audiometry, we divided the hearing acuity into the following 5 categories: normal hearing, mild hearing loss, moderate hearing loss, severe hearing loss, and deafness. Referring to the categories of contralateral hearing, we discuss the preoperative hearing level of the operated ear, the occurrence of cholesteatoma, the type of the tympanoplasty, and the auditory gain of the operation. While 23.97% cases had moderate or severe loss of contralateral hearing, their hearing acuity of the operated ear was also poor. Most of cases with normal contralateral hearing received type I tympanoplasty. Compared to the above group, half of the cases with moderate or severe contralateral hearing loss received type III or type IV operations to reconstruct the ossicle chain. Though the type I cases had more hearing gains than the type III cases, those with moderate contralateral hearing loss had good results from the type III tympanoplasty. We also found the cases with cholesteatoma in the operated ear had better contralateral hearing in the contralateral ear than the cases without cholesteatoma. The decision to perform tympanoplasty in cases of the better hearing ear with poor contralateral hearing should be very carefully made so as to improve the postoperative social life of the patients.

Adult↗

PubMed1993

The effect of adjuvant chemotherapy for nasopharyngeal carcinoma: a preliminary report.

In the past, radiation therapy was the main treatment modality in nasopharyngeal cancer, but recently, combined induction chemotherapy has become a trend. In this study patients with NPC were divided into two groups. In Group I, 46 cases were treated with chemotherapy (Cisplatin + 5-Fu) and radiation. In Group II, 49 cases were given radiation only. The side effects of chemotherapy were tolerable except for 2 dropouts due to intractable vomiting and semi-coma respectively. Only 17 cases got leukopenia and one case was graded I in BUN evaluation. All of the cases were within normal limits in the platelet and creatinine evaluation. Nine cases acquired hyponatremia. The response rate was 72.7% in the primary site which included 22.7% of the complete response and 50.0% of the partial response with a 80.0% response rate in neck site, which included 56.7% of complete response and 23.3% of partial response. But after the consecutive radiation, the differences of response rate did not show any significance between the two groups. The difference in the response rate between non-keratinizing and undifferentiated carcinoma were significant.

Adult↗

PubMed1992

Internal jugular phlebectasia.

Phlebectasia, defined as abnormal venous dilation, may occur in a number of different sites. Two cases with definite diagnosis of internal jugular phlebectasia were reported. The first case was a 6-year-old girl with a bulging mass on right neck for 3 years. Angiography and CT scan showed definite diagnosis, and the bulging mass was resected from the internal jugular vein (IJV). The second case was a 66-year-old female patient, also complained of a bulging mass on her right neck. Sonogram and CT scan also showed the same diagnosis. Because it did not bother the patient, she was just under close observation. From the three kinds of diagnostic modalities, we found sonography is an effective technique because of its clarity, safety and low cost.

Aged↗