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Biomedical subjects

M-F Chen

Publications and source records attributed to M-F Chen.

17 recordsLinked to original sources
PubMed2006

Pulse pressure, aortic regurgitation and carotid atherosclerosis: a comparison between hypertensives and normotensives.

Pulse pressure (PP) has often been associated with cardiovascular morbidity and mortality. Patients with aortic regurgitation (AR) often have increased PP. The aim of this study is to investigate the associations among PP, AR and extracranial carotid artery (ECCA) carotid atherosclerosis (CA) in hypertensives and age- and sex-matched normotensives. Two hundred and sixty-three hypertensive patients and 270 normotensive subjects from the Chin-Shan Community Cardiovascular Cohort participated in this study in 1996. CA, expressed as maximal common carotid artery intima-media thickness (IMT) > or = 75th percentile and ECCA plaque score > 6, was measured using high-resolution B-mode ultrasonography. The presence of AR was assessed by echocardiography, and their relationships with CA were evaluated. Results showed measurements of CA significantly associated with increased PP. Presence of AR associated with CA, but this relationship was attenuated after controlling for age. Multivariate logistic regression analyses revealed that an ECCA score > 6 significantly increase the risk in conjunction with PP, age and smoking in hypertensives. Correspondingly, CA increased with age, smoking and left ventricular hypertrophy on electrocardiography but not PP in normotensives. In conclusion, higher PP is strongly associated with CA in patients with hypertension. In terms of risk stratification, PP is more important in hypertensives than in normotensives which seem to imply that pulsatile haemodynamic component of BP is crucial in association with atherosclerosis.

Aged↗
PubMed2005

Laparoscopic cholecystectomy for 58 end stage renal disease patients.

BACKGROUND: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions throughout the world. Because hemorrhage, infection, and delayed wound healing are the main causes of death after surgery for end-stage renal disease (ESRD), laparoscopic surgery is risky for ESRD patients. However, no information has been reported on such patients, so this study aimed to assess the safety of LC in ESRD patients. METHOD: From January 1994 to December 2003, the medical records of 58 ESRD patients under regular hemodialysis (HD) with gallbladder lesions undergoing LC were reviewed (ESRD-LC). The clinical features and outcomes of 6,182 patients with gallbladder lesions without ESRD undergoing LC were also summarized for comparison. RESULTS: Of 6,240 patients with gallbladder lesions undergoing LC, 58 (0.93%) had ESRD with regular HD. The ESRD-LC group clearly exhibited older age, higher frequency of associated disease, lower hemoglobin and platelet count, and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. However, only a higher frequency of high American Society of Anesthesiologists (ASA) grade and elevated creatinine value could differentiate ESRD-LC and LC patients by multivariate analysis. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were noted for the two groups. CONCLUSIONS: LC is safe for ESRD patients with gallbladder lesions. Only a higher frequency of high ASA grade and elevated creatinine value could differentiate ESRD-LC and LC patients. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were achieved by applying LC to treat ESRD patients. However, appropriate preoperative preparations and experienced operative techniques are still required to prevent mortality.

Adult↗
PubMed2005

Outcome of neonates less than 30 weeks gestation with histologic chorioamnionitis.

The purpose of this study was to determine the short-term outcome of newborns less than 30 weeks gestation when there is definite placental histologic chorioamnionitis. A retrospective analysis was performed of records of all neonates delivered at our institution from January 1989 through January 1999. This information was retrieved from our perinatal database and pathology database. The population was stratified according to the presence or absence of histologic chorioamnionitis. Statistical analysis was performed using student t-test and Mann-Whitney method. Logistic regression was used to control for potential confounding variables. There were 392 neonates less than 30 weeks gestation delivered during this time period. Complete placental histology was available for 342 patients (87.4%). Histologic chorioamnionitis was identified in 140 (40.9%) cases. Those with histologic chorioamnionitis delivered sooner (26.3 versus 27.5 weeks), were of lower birth weight (920.1 versus 1029.8 g), and had lower 5-minute Apgarscores. Neonatal septicaemia and pneumonia were strongly associated with underlying histologic chorioamnionitis. There was a significant reduction in the incidence of respiratory distress syndrome (RDS) when histologic chorioamnionitis was present. Severe histologic chorioamnionitis increases the risk of premature delivery and is strongly associated with neonatal sepsis. There is a significant reduction in the incidence of RDS and neonatal mortality.

Chorioamnionitis↗
PubMed2004

Analysis of sonographic features for the differentiation of benign and malignant breast tumors of different sizes.

OBJECTIVE: To analyze the value of various sonographic features in differentiating benign from malignant breast tumors of different sizes to improve the diagnostic accuracy in small lesions. METHODS: The sonographic features of 1203 histologically confirmed solid breast lesions were prospectively documented with respect to anteroposterior (AP) diameter/width ratio, shape, margin, echogenicity, echotexture, posterior echo and bilateral refraction sign. The sensitivity, specificity and accuracy of breast ultrasound were calculated for lesions grouped according to size (< or = 1, 1.1-2 and > 2 cm). Univariate and multiple logistic regression analyses including calculation of odds ratios for single sonographic features were used to analyze the significance of the different diagnostic features. RESULTS: The accuracy of breast sonography in differentiating between benign and malignant tumors < or = 1, 1.1-2 and > 2 cm in size was 75.6%, 86.4% and 88.4%, respectively. Univariate analysis demonstrated that all sonographic features were significant in tumors > or = 1.1 cm. Shape, margin, echogenicity and echotexture were the significant factors in those tumors < or = 1 cm. Multiple logistic regression analysis demonstrated that margin, shape, posterior echo and echogenicity were the significant factors for differential diagnosis in tumors > 2 cm. Echogenicity, margin, shape, bilateral refraction sign and echotexture were the significant factors for tumors 1.1-2 cm. On multiple regression analysis, margin was the only significant factor for tumors < or = 1 cm. CONCLUSION: Tumor margin is the most important sonographic feature in evaluating breast lesions in any size group. With the combination of significant factors and emphasis on specific features according to size of lesion, the diagnostic accuracy of ultrasound for the differential diagnosis of malignant and benign tumors may be improved.

Adolescent↗
PubMed2003

Laparoscopic treatment for Mirizzi syndrome.

BACKGROUND: Mirizzi syndrome is an uncommon complication of longstanding gallstone disease resulting in obstructive jaundice and remains surgically challenging. Mirizzi syndrome is generally considered a contraindication to laparoscopic surgery. We present the surgical experience of 11 consecutive patients with Mirizzi syndrome who were diagnosed correctly preoperatively and treated laparoscopically. METHODS: From January 1991 to December 2001, 4,560 patients underwent laparoscopic cholecystectomy for gallbladder lesions, 11 (0.24%) of whom were diagnosed with Mirizzi syndrome. RESULTS: The 11 patients diagnosed with Mirizzi syndrome included four men and seven women, with ages ranging from 21 to 72 years (median, 54). There were 10 patients with Mirizzi syndrome type I (one was caused by gallbladder cancer in the neck), and 1 patient with type II, according to McSherry's classification. Right upper quadrant abdominal pain was the most common symptom, occurring in all 11 patients. All 11 patients were diagnosed correctly preoperatively by endoscopic retrograde cholangiography (ERCP) with 100% sensitivity. Four of the 11 patients (36.4%) were converted to open procedure. The postoperative course was uneventful, except for one patient complicated with a residual common bile duct stone. Hospital stay ranged from 4 to 33 days (median, 7). CONCLUSIONS: Mirizzi syndrome is an uncommon disorder. Preoperative suspicion is crucial for correct preoperative diagnosis. ERCP is the most useful tool for correct preoperative diagnosis and consequent prevention of common bile duct injury during operation. Should Mirizzi syndrome be diagnosed, laparoscopic treatment is a feasible and safe procedure, especially for type I Mirizzi syndrome.

Adult↗
PubMed2003

Laparoscopic cholecystectomy for gallbladder lymphangiomas.

Intraabdominal lymphangiomas are rare benign tumors that can be difficult to diagnose preoperatively. The clinical presentation of these tumors is variable and potentially misleading. Therefore, complex imaging studies are required to evaluate this condition. Ultrasound and CT scan are important to make the correct preoperative diagnosis and also provide important information regarding location, size, and adjacent organ involvement. The treatment of choice is complete excision. This report describes two patients with cystic lymphangiomas originating in the gallbladder. The correct diagnosis was made preoperatively in one patient, and both patients were treated successfully by laparoscopy.

Adult↗
PubMed2003

Decrease of deleted in malignant brain tumour-1 (DMBT-1) expression is a crucial late event in intrahepatic cholangiocarcinoma.

AIMS: To investigate the participation of DMBT-1, a candidate tumour suppressor gene, in the development of intrahepatic cholangiocarcinoma via intraductal papillary neoplasm of the liver (IPN-L) arising in hepatolithiasis. DMBT-1 plays a role in mucosal immune defence. METHODS AND RESULTS: The expression of DMBT-1 was examined immunohistochemically in biliary epithelial cells in hepatolithiasis (n = 25), invasive and non-invasive cholangiocarcinoma associated with hepatolithiasis (n = 52), IPN-L with hepatolithiasis (n = 49), cholangiocarcinoma without hepatolithiasis (n = 32), and 10 normal control livers. DMBT-1 was expressed more frequently in the biliary epithelia of hepatolithiasis when compared with normal livers (P < 0.05). DMBT-1 expression was also frequent in IPN-L (57%) and non-invasive cholangiocarcinoma (79%). By contrast, DMBT-1 was decreased in invasive cholangiocarcinoma with and without hepatolithiasis (50% and 30%, respectively) (P < 0.05). The homozygous deletion of the DMBT-1 gene was recognized in four (20%) of 20 cholangiocarcinoma tissues and two (50%) of four cholangiocarcinoma cell lines, corresponding to the reduction of DMBT-1 expression. No deletion was detected in hepatolithiasis tissues. CONCLUSION: DMBT-1 expression is increased in IPN-L and non-invasive cholangiocarcinoma as well as in biliary epithelia in hepatolithiasis. Decreased expression of DMBT-1 and homozygous deletion of the DMBT-1 gene in invasive cholangiocarcinoma suggest that they occur in the late stage of cholangiocarcinogenesis.

Agglutinins↗
PubMed2003

Sonographic differentiation of invasive and intraductal carcinomas of the breast.

The purpose of this study is to evaluate the diagnostic ability of ultrasound and define the sonographic features of symptomatic intraductal and invasive breast carcinoma. To achieve this the ultrasound features of 488 invasive carcinomas and 65 non-screening detected intraductal carcinomas were compared retrospectively. The features included size, AP/W (anteroposterior diameter/width) ratio, shape, margin, internal echogenicity, internal echotexture, posterior acoustic transmission, bilateral edge shadowing sign and calcifications. The sensitivity and specificity of the detection of calcifications by ultrasound in comparison with mammography were also studied. The accuracy of ultrasound diagnosis is 92.0% for invasive carcinoma of breast and 84.8% for intraductal carcinoma. Differentiation of ultrasound features of intraductal and invasive carcinoma can be based on the internal hypoechogenicity, loss of bilateral edge shadowing, posterior acoustic transmission, irregular shape and non-uniform internal echotexture with odds ratio of 0.3, 0.3, 0.4, 0.5 and 0.5, respectively. Internal echogenicity was the only significant differentiating factor on multiple logistic regression analysis. Non-comedo type ductal carcinoma in situ can be differentiated from comedo type by irregular shape with odds ratio of 0.3. The sensitivity, specificity and accuracy rate for the detection of calcifications in invasive carcinomas by ultrasound were 65.1%, 61.9% and 63.2%; in comedo type intraductal carcinoma 62.5%, 66.7% and 63.6%, and in non-comedo type intraductal carcinoma 30.0%, 86.7% and 64.0%, respectively. The ultrasound appearance of non-screening detected intraductal carcinoma is relatively isoechoic in comparison with invasive carcinoma. More than 60% of microcalcifications in comedo type intraductal carcinoma can be accurately demonstrated by ultrasound. However, the role of ultrasound in detecting symptomatic intraductal carcinoma warrants further study.

Breast Neoplasms↗
PubMed2002

Estimation of prognosis after hepatectomy for hepatocellular carcinoma.

BACKGROUND: The preferred means of treatment for hepatocellular carcinoma is surgical resection. However, the tumour recurrence rate is high. Accurate estimation of the risk of tumour recurrence after hepatectomy may facilitate the administration of adjuvant therapy after hepatectomy to patients with a high likelihood of tumour recurrence. METHODS: The clinical and pathological profiles of 176 patients undergoing hepatectomy for hepatocellular carcinoma from March 1992 to August 1998 were reviewed. The Kaplan--Meier method and log rank test were used to analyse univariate prognostic factors. The Cox proportional hazard model was used for multivariate analysis. Disease-free and overall cumulative survival rates were estimated with respect to the number of prognostic factors. RESULTS: Independent factors associated with a lower disease-free survival included the presence of venous infiltration, presence of daughter tumours, absence of tumour encapsulation and tumour size exceeding 5 cm. Factors decreasing the overall survival rate included the presence of venous infiltration, absence of tumour encapsulation and surgical resection margin less than 1 cm. The 1-year disease-free survival rate decreased from 77.5(s.e. 5.6) to 14.0(8.5) per cent when the number of risk factors present increased from zero to three. The 5-year survival rate decreased from 60.2(11.7) per cent to zero when the number of risk factors increased from zero to three. CONCLUSION: The deterioration of disease-free or overall survival of patients with hepatocellular carcinoma after hepatectomy correlates with increasing number of risk factors. The number of risk factors can be employed to accurately estimate disease-free and overall survival.

Carcinoma, Hepatocellular↗
PubMed2002

Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. Ruptured HCC is an uncommon and potentially fatal complication of the condition. Information on the impact of ruptured HCC on hepatic resection is, however, limited. METHODS: The clinical features of 60 patients with ruptured HCC who underwent hepatic resection from 1986 to 1998 were reviewed. Clinical features and factors influencing the outcome of 475 patients with non-ruptured HCC were used for comparison. RESULTS: Of 535 surgically resected HCCs, 60 (11.2 per cent) were ruptured. Univariate analysis showed that sudden onset of abdominal pain, physical signs of haemodynamic unstability, reduced haemoglobin level and a raised aspartate aminotransferase level were more frequently found in patients with ruptured HCC than in those with non-ruptured tumours. Multivariate stepwise logistic regression analysis revealed sudden-onset abdominal pain to be the only independently significant factor in patients in the ruptured HCC group. The 1-, 3- and 5-year survival rates of patients with non-ruptured HCC were 72.1, 47.3 and 33.9 per cent, and those of patients with ruptured HCC were 54.2, 35.0 and 21.2 per cent respectively. Similar overall survival rates were found in patients with ruptured and non-ruptured HCC, although patients in the non-ruptured HCC group had a significantly better disease-free survival rate (P = 0.023). CONCLUSION: The presence of sudden-onset abdominal pain is the only independent indicator of ruptured HCC. Hepatic resection, when feasible, is the treatment of choice and can result in an overall survival rate comparable to that of patients with non-ruptured HCC.

Abdominal Pain↗
PubMed2002

Sonographic features of phyllodes tumors of the breast.

OBJECTIVE: The aim of this study was to examine the sonographic features of phyllodes tumors of the breast. METHODS: Retrospective analysis of prospectively recorded sonographic features was performed on 2268 patients with phyllodes tumors or fibroadenomas during 1995-98. Data from 110 phyllodes tumors (76 benign, 11 borderline, 23 malignant) and 2204 fibroadenomas were analyzed. RESULTS: The patients with phyllodes tumors were older than the patients with fibroadenoma (mean +/- standard error, 39.7 +/- 1.1 years vs. 33.4 +/- 0.3 years; P < 0.0001). Sixty-four percent of patients with phyllodes tumors were aged 31-50 years, while 68.5% of those with fibroadenoma were aged 21-40 years. Phyllodes tumors were larger than fibroadenomas (5.90 +/- 0.43 cm vs. 1.95 +/- 0.03 cm; P < 0.0001). The ratio of length to anteroposterior diameter of phyllodes tumors was smaller than the ratio of length to anteroposterior diameter of fibroadenomas (1.72 +/- 0.06 vs. 1.89 +/- 0.02; P = 0.0105). Seventy-seven percent of phyllodes tumors were lobulated and 79.5% of fibroadenomas were oval. Lobulated shape of the tumor, heterogeneous echo pattern and absence of microcalcification are significant independent sonographic features in multiple logistic regression analysis to distinguish between phyllodes tumors and fibroadenoma. Benign, borderline and malignant phyllodes tumors displayed no significant differences in tumor size or the ratio of length to anteroposterior diameter. CONCLUSIONS: There is a substantial overlap in the sonographic characteristics between phyllodes tumors and fibroadenoma of the breast. If lobulation and heterogeneous hypoechoic internal echoes are observed and calcifications are absent, a diagnosis of phyllodes tumors should be considered. Sonography cannot distinguish between malignant, borderline and benign phyllodes tumors.

Adolescent↗
PubMed2002

Characterisation of oestrogen receptor, progesterone receptor, trefoil factor 1, and epidermal growth factor and its receptor in pancreatic cystic neoplasms and pancreatic ductal adenocarcinoma.

BACKGROUND AND AIMS: The pancreatic cystic neoplasms, including solid pseudopapillary tumour (SPT), mucinous cystic neoplasm (MCN), and intraductal papillary mucin producing tumour (IPMT), have their characteristic clinicopathological features. A systematic investigation of oestrogen receptor (OR), progesterone receptor (PR), trefoil factor 1(TFF1), and epidermal growth factor and its receptor (EGF and EGFR) expressed in pancreatic cystic neoplasms and pancreatic ductal adenocarcinoma was determined to elucidate their corresponding sex and age predilection, cell origin, and pathway of malignant transformation. METHODS: Surgical specimens of SPT (n=10), MCN (n=12), IPMT (n=10), and ductal adenocarcinoma (n=20) were studied. The expression of OR, PR, TFF1, EGF, and EGFR were each determined in each disease entity using monoclonal antibodies by immunohistochemical method. The results were correlated with the clinicopathological data. RESULTS: PR was expressed in all 10 SPT, whereas OR was expressed in none of 10 SPT. TFF1 was not or weakly expressed in SPT. Although EGF was strongly expressed in seven of 10 SPT, synchronous expression of EGF and its receptor was expressed in none of 10 SPT. Of the 12 MCN, six had PR expression in the stroma cells but not in the neoplastic epithelium, seven had a moderate or strong expression of TFF1, and 10 had no or weak EGFR expression, irrespective of their benigneity or malignancy. Synchronous expression of EGF and EGFR was observed in only one of 12 MCN. Among 10 IPMT, TFF1 and EGFR were moderately or strongly expressed in all six malignancies, whereas TFF1 and EGFR were not or weakly expressed in three of four benigneity. Of 20 ductal adenocarcinomas, TFF1 and EGFR were moderately or strongly expressed in 16 and 12, respectively. Synchronous expression of EGF and EGFR was observed in six of 10 IPMT and nine of 20 ductal adenocarcinoma, respectively. CONCLUSION: PR was uniquely expressed in SPT, and OR and PR were expressed in stroma of MCN, reflecting their sex and age predilection. TFF1 expression was related to EGFR such as in IPMT and ductal adenocarcinoma, not related to EGFR such as in MCN, and not related to hormonal receptors such as in SPT. EGF and its receptor might play a part in the malignant transformation of IPMT and ductal adenocarcinoma, but not of SPT and MCN.

Adult↗
PubMedDate not supplied

Large hepatic mesenchymal hamartoma leading to mid-trimester fetal demise.

This report describes a fetus with a large multiloculated cystic liver mass. Two small abdominal cysts were seen on ultrasound at 19 weeks of gestation but the patient was referred to us at 23 weeks, after the mass had grown to 8.0 x 5.6 x 7.0 cm, displacing intra-abdominal organs, heart and diaphragm. There was a small amount of ascites but no hydrops. There was polyhydramnios and a thick hyperechoic placenta. After detailed sonograms and MRI suggested the diagnosis of cystic mesenchymal hamartoma of the liver, cyst decompression was favored and consent was obtained. Unfortunately, absence of fetal cardiac activity was noted on the day of the planned intervention. Autopsy confirmed the diagnosis and demonstrated placental changes consistent with mesenchymal stem villous hyperplasia of the placenta. Large fetal cystic abdominal masses that compress the heart, lungs and other organs may benefit from prenatal decompression. This is the first report of cystic hamartoma of the liver apparent on second-trimester sonography, and the fourth time such a lesion is associated with fetal or neonatal death out of 11 cases diagnosed prenatally.

Adult↗