PubMed Health⌕ Search

Biomedical subjects

S L Hwang

Publications and source records attributed to S L Hwang.

At least 37 records · Page 2Linked to original sources

Expression and mutation analysis of the p53 gene in astrocytoma.

The role of p53 gene mutations in the formation or progression of human astrocytic tumors is controversial. We studied the distribution pattern of p53 immunoreactivity and analyzed p53 gene mutations to define the significance of p53 gene mutations in astrocytoma tumorigenesis or malignant progression. Twenty-three astrocytic tumors were evaluated with immunohistochemistry, single-strand conformation polymorphism (SSCP) analysis, and sequence analysis. We also searched MEDLINE to collect data on p53 gene mutation frequencies in astrocytic tumors in order to evaluate the association of p53 mutations and tumor grade. Strong immunoreactivity with a diffuse clustering pattern was found in three of five glioblastomas and seven of 12 anaplastic astrocytomas. Three of four low-grade astrocytomas were immunonegative. The p53 immunopositive cells in the only positively staining low-grade astrocytoma in our study appeared sparsely scattered. The results of immunostaining suggested that clonal expansion was associated with astrocytoma progression. Mutations of the p53 gene were detected in four of the 23 astrocytomas (one glioblastoma and three anaplastic astrocytomas). In the genetic data analysis, 76 of 367 astrocytomas had p53 gene mutations. A significantly greater p53 gene mutation frequency was found in anaplastic astrocytomas or glioblastomas than in the low-grade astrocytomas. The results of these immunohistochemical and genetic studies support the view that p53 gene mutation is associated with the malignant progression from low-grade to high-grade astrocytomas rather than with tumor initiation or promotion.

Adolescent↗

Subacute pituitary apoplexy-analysis of 17 cases.

We retrospectively study 17 cases (total cases 197), receiving surgery at Kaohsiung Medical College Hospital, which are proved to be subacute pituitary apoplexy via preoperative computerized tomograms, magnetic resonance imagings, operative findings and pathological proof. Fourteen patients had headache; 15 cases were with visual disturbance including visual defect, blindness. One case was found incidentally to have a cerebral vascular attack. None of these cases received bromocriptine. Preoperative computerized tomograms (CT) aided the initial diagnosis and magnetic resonance imaging (MRI) is preferred for radiological investigation in displaying the metabolic products of hemorrhage within the pituitary tumors. Operative findings revealed xanthochromic fluid with liquid-like tumor debris or chocolate-like content. All these patients received hormone supplement when pituitary apoplexy was highly suspected.

Acute Disease↗

Brain tumors with hemorrhage.

Various types of brain tumors may cause hemorrhage. The purpose of the study was to examine the clinical relevance of tumor hemorrhage and the hemorrhagic mechanism from the pathologic viewpoint. We retrospectively reviewed 761 consecutive brain tumor cases according to clinical, operative, and pathologic records. Pituitary adenomas and recurrent tumors were excluded. Twenty-seven patients (17 men and 10 women, mean age, 50 years) with brain tumor hemorrhage were identified, resulting in an incidence of 3.5%. In 632 cases of primary brain tumors, there were 15 cases with hemorrhage, resulting in an incidence of 2.4%. There were 12 cases of brain tumor hemorrhage in 129 patients with metastatic tumors, for an incidence of 9.3% Among hemorrhagic cases, 63.0% of patients presented with acute onset of clinical deterioration. In 72.7% of gliomas with hemorrhage, hematoma appeared within the tumor, and 75% of metastatic brain tumors with hemorrhage were intracerebral hemorrhages around the borders of the tumors. The highest hemorrhage rate for primary brain tumors occurred in pilocytic astrocytomas, while the highest hemorrhage rates in secondary tumors occurred in metastatic thyroid papillary carcinomas and hepatocellular carcinomas. In our pathology study, increasing intratumor vascularization with dilated, thin-walled vessels and tumor necrosis were the most important mechanisms of hemorrhage.

Brain Neoplasms↗

Postoperative short-term sedation with propofol in cardiac surgery.

We conducted a randomized double-blind study to assess the safety and effectiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery. Sixty hemodynamically stable adult patients who underwent cardiac surgery were randomly assigned to receive propofol postoperatively or no postoperative sedation. The propofol group (n = 30) received propofol infusion (1 mg.kg-1.hr-1) immediately after they awoke postoperatively. The infusion rates were adjusted to maintain a sedation level (Ramsay score) of 3. Nurses assessed the effectiveness of the sedation according to Ramsay scores; the patients also subjectively evaluated sedation. Postoperative pulmonary oxygenation dysfunction (PaO2/FiO2 < 300 mm Hg) was noted in 10 patients receiving propofol and in eight patients in the control group. The dysfunction was greatly improved after overnight ventilator support, and this improvement was not affected by propofol sedation. The propofol group received an average of 13.6 +/- 5.3 hours of propofol infusion, at an average infusion rate of 0.96 +/- 0.16 mg.kg-1.hr-1. Patients receiving propofol remained well sedated (Ramsay score > or = 2) during 99.3% of the study period, while the control patients remained anxious or agitated (Ramsay score, 1) during 12% of the study period. Patients receiving propofol were successfully extubated 9 +/- 4 minutes after cessation of propofol infusion, without complications. The turnover of intensive care unit beds was not delayed by propofol sedation. Subjective evaluations (scored on an analog scale: 0 = nil, 10 = extreme) revealed that patients receiving propofol felt less pain than those in the control group (2.3 +/- 2.7 vs 4.7 +/- 3.1, p < 0.05), had better sleep quality (7.8 +/- 2.9 vs 5.1 +/- 2.9, p < 0.05), and were more satisfied with the care they received (8.3 +/- 2.2 vs 5.8 +/- 3.9, p < 0.05). These findings suggest that propofol infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay score of 3 may be ideal. Postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or agitation.

Cardiac Surgical Procedures↗

Efficacy of a stress management program for patients with hepatocellular carcinoma receiving transcatheter arterial embolization.

Transcatheter arterial embolization (TAE), a common treatment for patients with unresectable hepatocellular carcinoma (HCC), can provoke severe physical discomfort and psychologic stress. The purpose of this study was to investigate the effect of a combination of health education, muscle relaxation, and back massage on reducing physical and psychologic stress in HCC patients receiving TAE. A quasi-experimental design was used. Forty patients with HCC (30 men and 10 women) with a mean age of 57 +/- 12 years were recruited and randomly assigned to the control or experimental group. The effectiveness of the stress management program was evaluated using a knowledge questionnaire, a worry inventory, a state-trait anxiety inventory, and a physical distress scale. After completing the stress management program, the experimental group had a greater mean increase in knowledge score than the control group (5.1 vs 0.8, p < 0.0001) and a greater mean decrease in worry score (-8.2 vs 1.1, p < 0.0001). The mean decrease in the anxiety score in the experimental group was also significantly greater than in the control group before TAE (-5.8 vs 3.2, p < 0.001) and 2, 4, 6, and 7 days after TAE (-8.2 vs 7.1, p < 0.001; -8.7 vs 3.2, p < 0.001; -9.8 vs -2.1, p < 0.05; -11 vs -0.9, p < 0.05). The patients in the experimental group had a smaller mean increase in physical distress score than the control group at 2, 4, 6, and 7 days after TAE (34.7 vs 50.2, 20.9 vs 29.6, 10.6 vs 18.2, 3.9 vs 11.2, all p < 0.05). This stress management program effectively reduces the stress of HCC patients undergoing TAE.

Adult↗

Pituitary adenomas in the old-aged.

From 1986 to 1996, 187 patients with pituitary adenoma were diagnosed and received surgery at Kaohsiung Medical College Hospital. Of which, 29 patients older than 60 years were retrospectively studied. Their initial clinical symptoms, pathological findings, immunoperoxidase staining, electronic microscopic findings and hormone levels were retrospectively recorded. We found that the old patients more often suffered from the neurological deficit such as headache and visual problems rather than endocrine of the tumors cells are compared, and fewer cells and nuclei are found in the older group than that in the younger group. The secretary granules in functioning tumors especially prolactinomas in old-aged patients are larger than those in the young patients. The tumor cells in the old-aged patients have fewer subcellular organelles and secretary granules but have large secretary granules. It is concluded that: (1) transsphenoidal surgery is feasible and safe in this age group; (2) plurihormonal tumors occur more frequently in old-age than young patients; (3) clinically endocrine-inactive pituitary adenomas occur more often in old-aged; (4) pituitary adenomas in old-aged cause neurological deficit more frequently than endocrine disturbance.

Adenoma↗

Stress-reducing effect of physician's tape-recorded support on cardiac surgical patients in the intensive care unit.

Staying in an intensive care unit (ICU) is very stressful for patients after heart surgery. Although it is a general belief that support from doctors is important to reduce patients' tension, no quantitative data are available. We investigated the stress-reducing effects of a tape-recorded message from the physician which provided information regarding the surgery and emotional support for heart surgery patients postoperatively in the ICU. Sixty patients who underwent cardiac surgery were randomly allocated to two equal groups. The patients in the experimental group listened to a tape-recorded message from their attending surgeon soon after they recovered from anesthesia, while the control group rested during the study period. The effectiveness of the tape-recorded support program was evaluated by the influence on heart rate, blood pressure, and finger skin temperature, as well as the degree of subjective pain, tension, anxiety, depression, and anger. The pain and tension levels of the patients were measured using a visual analogue scale, while the severity of anxiety, depression, and anger was evaluated using the Brief Symptom Rating Scale. Patients' evaluation of the usefulness of the program was also assessed. After listening to the physician's recorded message, the mean increase in the skin finger temperature in the experimental group was higher than in the control group (0.44 degree C vs 0.25 degree C, p = 0.0513). The experimental group had significant decreases in their mean scores of pain (-1.11 vs 0.36, p = 0.0043), tension (-2.26 vs -0.25, p = 0.0001), anxiety (-1.3 vs -0.57, p = 0.0473), and depression (-2.24 vs -0.37, p = 0.0253). The patients showed a high need for this support program (mean need score 8.4). These findings show that a physician's tape-recorded message providing information and emotional support can reduce stress in heart surgery patients in the ICU postoperatively.

Cardiac Surgical Procedures↗

Prostatic carcinoma with brain metastasis presenting as a tumor hemorrhage.

Adenocarcinoma of the prostate commonly metastasizes to the lymph nodes and bones, with occasional visceral deposits, however, metastasis to the brain is rare. A case of prostatic carcinoma with brain metastasis presenting as a tumor hemorrhage is reported. The pertinent literature is also reviewed.

Adenocarcinoma↗

Contralateral recurrent cerebellar hemangioblastoma--a case report.

Hemangioblastomas are regarded as benign neoplasms. They may recur in 3 to 10% of cases after apparently total excision. The opposite site recurrence is not found in the reported literature. A case is described in which, after successful removal of a cerebellar hemangioblastoma followed by two years of freedom from symptoms, developed a new growth of cerebellar hemangioblastoma contralaterally again. The histology of the tumor tissue is in no way different from that of a conventional hemangioblastoma. This case gives us some insights into the biological multipotentiality of cerebellar hemangioblastoma. We stress that close observation is absolutely necessary for this unique group of tumors, even after total removal.

Adult↗

Hypothalamic dysfunction in acute head-injured patients with stress ulcer.

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p < 0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p < 0.001). In the patients with stress ulcer, significant increases (p < 0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.

Acute Disease↗

Prognostic evaluation in supratentorial astrocytic tumors using p53, epidermal growth factor receptor, c-erbB-2 immunostaining.

Molecular pathology may play an important role in predicting the tumor prognosis, particularly p53, epidermal growth factor receptor (EGFR), and c-erbB-2. We investigated six variables (age, sex, histopathological grade, p53, EGFR, and c-erbB-2) to identify the role of such factors in predicting the outcome of patients with supratentorial astrocytic tumors. Thirty-seven tumors were studied including 9 well-differentiated astrocytomas (WHO grade 2), 19 anaplastic astrocytomas (WHO grade 3), and 9 glioblastomas multiforme (WHO grade 4). In univariate analysis, no statistical significance was found for the prognostic value of the sex (p = 0.2188), age (p = 0.5530), p53 immunostain (p = 0.2194), and c-erbB-2 immunostain (p = 0.4203). A significant correlation with the prognosis was found with respect to the histopathological grade (p = 0.0049) and EGFR expression (p = 0.0284). In multivariate analysis, the histopathological grade was shown to be significant independent variable (p = 0.0152). In WHO grade 2 and 3 astrocytomas, expression of p53 or EGFR was associated with poorer patient outcome. In glioblastomas, expression of p53 was also associated with poorer prognosis. Our studies suggested that conventional histological assessment of supratentorial astrocytic tumors remains the best guide to prognosis. Although no statistical significance was found between the immunostains and survival in variant grades of astrocytomas, there was a trend between p53 or EGFR proteins expression and the decrease of survival time.

Adult↗

Prognostic analysis in patients of lung cancer with brain metastasis under surgical removal.

The outcome and prognostic factor in postcraniotomy patients with brain metastasis from lung cancer in south Taiwan were evaluated. There were 21 males and 12 females, with ages ranging from 35 to 72 years (mean, 56.4 years). The survival rate was determined from the date of craniotomy and was evaluated by the Kaplan-Meier product limit method. In the univariate analysis survival was significantly affected by systemic metastasis (P = 0.0109), brain radiotherapy (P = 0.0121) and chest radiotherapy (P = 0.0361). Preoperative and postoperative Karnofsky scores were evaluated using the paired t-test and the neurological condition, as evaluated by Karnofsky scores, significantly improved after craniotomy (P < 0.001). We concluded that an aggressive craniotomy and radiotherapy improves the quality of life and survival rate, especially in those patients with solitary brain metastasis and no extracranial metastasis.

Adult↗

Hypothalamic juvenile pilocytic astrocytoma presenting with intracerebral hemorrhage.

Hemorrhage of juvenile pilocytic astrocytomas is very rare. However, it is clinically important because a high probability of a fatal outcome exists if hemorrhage occurs outside the optic nerve. Hemorrhage of a hypothalamic juvenile pilocytic astrocytoma has been reported only once, from an autopsy examination. We present a successfully managed case. The patient, a 34-year-old man, presented with sudden loss of consciousness. Computed tomography (CT) and magnetic resonance imaging demonstrated an exophytic hypothalamic tumor with a hemorrhage. Craniotomy with total removal of the tumor and the hematoma was performed. Histopathologic examination revealed that the tumor was a juvenile pilocytic astrocytoma. Brain CT examination 18 months later revealed no evidence of tumor recurrence. The patient was well, without neurologic deficit, and had a normal social life as of the last follow-up examination 22 months after craniotomy.

Adult↗

Immunohistochemical demonstration with anti-bromodeoxyuridine monoclonal antibody in experimental meningeal carcinomatosis model.

The usefulness of immunohistochemical demonstration with anti-bromodeoxyuridine (BrdU) monoclonal antibody for estimating proliferative activity was evaluated in experimental meningeal carcinomatosis model. The experimental model was developed by inoculation of 1 x 10(4) Walker 256 carcinosarcoma cells into the cisterna magna of female Wistar rats. Every consecutive day after tumor inoculation, the rat was perfused by saline and then sacrificed 30 min after intravenous BrdU (200 mg/Kg) injection. The brain was removed, fixed in 80% ethanol and embedded in paraffin. Coronal sections of the brain 6 mu in thickness were obtained and stained immunohistochemically using the indirect immunoperoxidase (ABC) method with anti-BrdU monoclonal antibody (Becton-Dickinson). The sections were counterstained by hematoxylin. Labeling index (LI) which represented the percentage of tumor cells in synthetic phase was obtained by counting immunoreactive cells under the microscope. LI was as low as 10.8% to 16.9% in the first 3 days after tumor inoculation. Four to 6 days after tumor inoculation when tumor cells grew several layers in the subarachnoid space, LI was 24.0% to 40.1%. LI increased to reach a plateau around 40.7% to 48.2%, 7 to 9 days after tumor inoculation. Ten days after inoculation when necrosis appeared in the tumor, BrdU-positive cells declinded and LI was between 29.1% to 35.0%. It is a useful method to estimate the proliferative activity of the experimental brain tumors, design treatment modalities and evaluate the effect of chemotherapeutic agents by using immunohistochemical demonstration with anti-BrdU monoclonal antibody. Therefore, we suggest that chemotherapy against malignant leptomeningeal tumors shall be carried out in early or intermediate stage before the proliferative activity reaches its plateau stage.

Animals↗

Unusual large cystic acoustic neurinomas: report of two cases.

Two rare cases of large cystic acoustic neurinomas are reported in this paper. Such cases are sometimes misdiagnosed preoperatively because their computed tomography appearances resemble those of other cystic lesions in the cerebellopontine angle. The diagnosis of acoustic neurinoma should be kept in mind if one finds a large cystic cerebellopontine angle tumor, even if there are no typical clinical symptoms or erosion of the internal auditory canal. Magnetic resonance imaging of large cystic acoustic neurinomas are also described in this paper.

Adult↗

An analysis of intraspinal tumors in south Taiwan.

A series of 120 pathologically verified intraspinal tumors was analyzed for the relative incidence and location of the tumors as well as the distribution of age and sex. These data were compared to series from Taiwan, mainland China, Thailand, Korea, Japan, Iran, India, and countries in the West. The ratio of brain to intraspinal tumors was about 5:1 in Taiwan, higher than those reported in China, Korea, and in the West. The male to female ratio is about six to five. For most tumors, male predominance is noted except for meningioma. The incidence of intraspinal tumors in the order of frequency is nerve sheath cell tumor(NSCT), metastatic tumors, meningioma, glioma, congenital tumors, and vascular tumors. In the East, the incidence of NSCT is about 40%, and meningioma is about 10%. In the West, they are both about 20%. Congenital tumors accounted for only 3.3%. In China, it was about 12% and this is the highest incidence of dysembryoplastic tumors in the world. Glioma has similar incidence (about 10%) in Taiwan, China, Thailand, Japan, and Iran (about 10%), whereas it is about 15% in the West and India. Korea has the highest incidence of glioma, (32.3%). Low incidences of metastatic intraspinal tumors (4.6-5.5%) were noted in China and Japan, but a higher incidence (14.2-24.2%) was seen in Taiwan, Iran, and the West. The most common metastatic tumors in the order of frequency is tumors of unknown origin, lung cancer metastasis, hepatoma, and breast cancer. The high percentage of unknown origin of metastasis may have resulted from loss of follow-up and lack of postmortem studies.

Adolescent↗

The familial occurrence of brain tumors.

This is a report of two parent-child families which developed intracranial neoplasm. There is no known history of brain tumor in other family members. Two instances of familial brain tumors are reported which are different from those seen in phakomatosis. Family one had posterior fossa tumors including astrocytoma and hemangioblastoma. The second family had endocrine-associated tumors consisting of pituitary adenoma and yolk sac tumor.

Adenoma↗

Expression of epidermal growth factor receptors and c-erbB-2 proteins in human astrocytic tumors.

Tumorigenesis is the result of sequential or multiple genetic alterations. The overexpression or amplification of various oncogenes in diverse human brain tumors have been observed. While numerous studies on the immunohistochemical demonstration of EGFR-overexpression have been reported, little has been found in the literature about the c-erbB-2 protein in human astrocytic tumors. In the present study, we evaluated the expression of EGFR and c-erbB-2 protein in 33 astrocytic tumors with immunohistochemistry. According to the World Health Organization brain tumor classification, the study included 9 low-grade astrocytomas (grade 2), 15 anaplastic astrocytomas (grade 3), and 9 glioblastomas multiforme (grade 4). The positive EGFR immunoreactivity was detected in 28 (85%) of 33 tumors. The expression of EGFR increased with the grade of malignancy in low-grade astrocytomas (67%), anaplastic astrocytomas (87%), and glioblastomas (100%). For the expression of c-erbB-2 protein, 17 (51.5%) of 33 tumors were positive immunostain, including 3 low-grade astrocytomas (37.5%), 9 anaplastic astrocytomas (81.8%), and 5 glioblastomas (62.5%). Different degrees of immunoreactivity for c-erbB-2 protein were found in variant grades of astrocytomas. However, the positive immunostain of EGFR displayed moderate or strong reactivity. The coexpression of EGFR and c-erbB-2 protein was found in 17 (15.5%) of 33 tumors. The results emphasize that the overexpression of EGFR parallels astrocytoma progession and higher frequency of c-erbB-2 immunoreactivity was seen in snaplastic astrocytomas and glioblastomas than in low-grade astrocytomas.

Adolescent↗