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Biomedical subjects

T C Tsai

Publications and source records attributed to T C Tsai.

At least 19 recordsLinked to original sources
PubMed2001

Primary cerebral anaplastic large cell lymphoma containing abundant reactive histiocytes and eosinophils. A case report and literature review.

Primary cerebral anaplastic large cell lymphoma (ALCL) is very rare. We report on our experience with such a case and review the literature. A 46-year-old Taiwanese woman presented with headache, weakness of her right extremity, and limited eye movement. A solid mass (5 cm x 4 cm) at the left occipital lobe was almost completely removed. The neoplastic cells, some of which had reniform or embryo-like nuclei, were large and were admixed with abundant eosinophils, histiocytes, and some small lymphocytes. These neoplastic cells expressed CD30, CD43, granzyme B and T-cell intracellular antigen-1, but not ALK1, CD3, CD20, CD45, CD79a, cytokeratin, and EMA. They were positive for Epstein-Barr virus-encoded mRNA by in situ hybridization. Polymerase chain reaction study of formalin-fixed tissue showed a clonal gene arrangement of the T-cell receptor-gamma chain. ALCL of T-cell lineage with cytotoxic phenotype was diagnosed. The patient received cranial irradiation and has remained with no evidence of disease for 25 months of follow-up.

Brain Neoplasms↗
PubMed2001

Suppression of choroidal neovascularization by adeno-associated virus vector expressing angiostatin.

PURPOSE: To test the efficacy of a recombinant adeno-associated virus (rAAV) vector that expresses mouse angiostatin in suppressing experimental choroidal neovascularization (CNV) in a rat model. METHODS: An rAAV vector, rAAV-angiostatin, was constructed to deliver the mouse angiostatin gene. rAAV-angiostatin and a control virus, rAAV-lacZ, were delivered in vivo by subretinal injection in Brown Norway rats, and the delivery was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). For a CNV suppression experiment, CNV was generated by fundus krypton laser photocoagulation 7 days after the viral vector injection and was evaluated by fluorescein angiography (FA) and histology. Apoptosis in retina was analyzed using the TUNEL assay. Inflammation in the retina was investigated by immunohistochemistry, using antibodies that recognize lymphocytes. RESULTS: rAAV-angiostatin injection led to sustained expression of the angiostatin gene in chorioretinal tissue for up to150 days. FA analysis revealed significant reduction of the average sizes of CNV lesions in rAAV-angiostatin-injected eyes when compared with rAAV-lacZ-injected eyes at both 14 (P = 0.019) and 150 (P = 0.010) days after injection. Moreover, histologic analysis of CNV lesions also revealed significantly smaller lesions in rAAV-angiostatin-injected eyes (P = 0.004). As for adverse effects, rAAV-angiostatin injection did not cause inflammation or apoptosis of cells in retina and choroid. CONCLUSIONS: This is the first report that subretinal injection of rAAV-angiostatin can significantly reduce the sizes of CNV lesions. This and the absence of apoptosis and inflammation in chorioretinal tissue indicate the feasibility of a gene therapy approach for treatment of CNV disease.

Angiostatins↗
PubMed2000

Efficacy of intrathecal neostigmine for the relief of postinguinal hemiorrhaphy pain.

BACKGROUND: Intrathecal administration of various doses of neostigmine has been reported to produce analgesia without neurotoxicity in both animal and human studies. The present study was undertaken to evaluate the efficacy and safety of intrathecal neostigmine for the relief of pain for patients having undergone inguinal herniorrhaphy surgery. METHODS: Sixty men scheduled for elective inguinal herniorrhaphy with spinal anaesthesia were randomly allocated to three groups: group I (n=20) received intrathecal (IT) tetracaine 15 mg, group II (n=20) received IT tetracaine 15 mg+ neostigmine 50 microg, and group III (n=20) received IT tetracaine 15 mg+neostigmine 100 microg. The onset of anaesthesia, duration of analgesia, time to use of first rescue analgesics, the overall 24 h VAS pain scores and the incidence of adverse effects were recorded for 24 h postdrug administration. RESULTS: Onset of anaesthesia (time to T6 sensory block) was significantly faster for group II and III patients compared with group I patients. Motor block (time to lift leg) was greatly prolonged for group III patients, with an average of 6.4 h, compared with 4.1 h for group II patients. Group III patients also showed a later onset of postsurgical pain, lower overall 24-h VAS pain score and prolonged time to first rescue analgesics than did group II patients. There was a significantly greater incidence of adverse effects associated with IT neostigmine, especially nausea and vomiting. CONCLUSION: Our study showed that intrathecal neostigmine at 50 pg or 100 microg enhanced the onset of tetracaine anaesthesia and provided analgesia lasting for 6-9 h, although increased incidences of prolonged motor blockade and nausea or vomiting were noted.

Adult↗
PubMed2000

Toxic megacolon secondary to infective colitis in children.

BACKGROUND AND PURPOSE: Toxic megacolon is a fulminating and potentially lethal complication of severe colitis. Toxic megacolon secondary to infective colitis in children is rare. We analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children. METHODS: The medical records of all 20 children treated for infective colitis complicated with toxic megacolon during a 12-month (October 1997-October 1998) period were retrospectively reviewed. RESULTS: There were 10 boys and 10 girls, with a mean (+/- standard deviation, SD) age of 26.2 +/- 12.9 months (range, 6-57 mo). With an initial presentation of nonspecific gastroenteritis syndrome lasting several days, the disease progressed rapidly. In the acute stage, most patients developed toxic signs such as mental change, ranging from irritability to stupor (20, 100%), fever (19, 95%), tachycardia (20, 100%), abdominal distension (20, 100%), and abnormal stool pattern (19, 95%). Initial investigations revealed anemia (11, 55%), leukocytosis (11, 55%), and elevated levels of C-reactive protein ranging from 25.0 mg/L to 483.0 mg/L with a mean +/- SD of 185.7 +/- 129.1 mg/L (normal range, < 8 mg/L) (20, 100%). Salmonella enteritidis (12 patients, 60%) and Clostridium difficile (1, 5%) were isolated from stool samples in some cases. Plain abdominal x-rays revealed severe colonic dilatation. Prolonged hospitalization (mean, 33.6 d) and intensive therapy including a combination of broad-spectrum antibiotics, physical decompression, and total parenteral nutrition were necessary. Three patients (15%) underwent surgical management; the pathologic findings in these patients demonstrated severe transmural inflammation. We believe that bacterial and/or endotoxin translocation played an important role in gut failure. Three patients (15%) in the study died. CONCLUSION: Toxic megacolon in infective colitis is a fulminating illness that has a high mortality rate. The disease course can be divided into three stages: the acute toxic stage, the gut failure stage, and the convalescence or deterioration stage. Early diagnosis and aggressive management are important.

Bacterial Infections↗
PubMed2000

Chronic focal encephalitis (Rasmussen's syndrome) in an adult.

Chronic focal encephalitis in adults is rare. Here we report a case of chronic focal encephalitis with epilepsy in a man. A 53-year-old man was admitted to our hospital because of right-sided focal seizures and epilepticus partialis continua. Brain imaging studies demonstrated progressive, focal, left cerebral atrophy. Prominent degenerative changes including neuronal loss and astrocytic gliosis were found on brain biopsy. Although the characteristics were typical of Rasmussen's encephalitis, unlike chronic focal encephalitis in children, his seizures were easily controlled by traditional antiepileptic therapy.

Chronic Disease↗
PubMed2000

Coronary artery bypass grafting on the beating heart using the octopus method--a case report.

A 74-year-old male was admitted due to chest tightness for one month. He had received percutaneous transilluminal coronary angioplasty (PTCA) because of single-vessel disease one year ago. Cardiac catheterization examination carried out during this admission revealed 90% stenosis of the left anterior descending coronary artery (LAD) and circumflex branch (CX). Because another attempt of PTCA was considered not optimal, the patient was advised to undergo surgical grafting to which he consented. After expediently balancing the merits and demerits of every practicable surgical procedure--the essential determinant in selection of which was that the patient's condition and criteria of indication of that procedure were in perfect harmony--we decided to carry out minimally invasive direct coronary artery bypass (MIDCAB) with the application of Octopus tissue stabilizer. We report the surgical course and anesthetic management of the patient and discourse some detail in MIDCAB.

Aged↗
PubMed1999

Clinical management of a quadruplet pregnancy combining a triplet pregnancy with a classical hydatidiform mole: case report and review of literature.

A 28-year-old Taiwanese woman who had received ovulation induction by clomiphene citrate (CC), follicular-stimulating hormone (FSH), and human chorionic gonadotrophin (hCG) treatment was diagnosed with a quadruplet pregnancy containing a hydatidiform mole and three fetuses at nine weeks' gestation. Expectant management failed to achieve any viable neonate due to massive antepartum haemorrhage and preterm delivery at 25 weeks' gestation. Five other cases previously reported involving quadruplets or triplets with a complete hydatidiform mole and two or three fetuses are reviewed. All cases ended as premature non-viable fetuses. Analysis of the clinical features, management, and outcome both in our patient and these reports suggest that more efficacious treatment planning, such as selective feticide, should be considered in order to improve the likelihood of attaining an advanced gestational age for a single fetus.

Abortion, Spontaneous↗
PubMed1999

Adrenal cancer with hypertension but low plasma renin and aldosterone.

Patients with malignant lesions of the adrenal gland may present with a syndrome of excess mineralocorticoids. Both primary hyperaldosteronism and excess mineralocorticoids other than aldosterone resulting from adrenal carcinoma have rarely been reported. In most patients with adrenal tumors secreting mineralocorticoids other than aldosterone, distant metastasis had already occurred at the time of diagnosis and the prognosis was poor. We present a rare case of adrenal cancer with hypertension in a patient with low plasma renin activity and a low plasma aldosterone concentration. The patient's blood pressure returned to normal after removal of the tumor. The patient is still alive and without recurrence 6 years after surgery. This case illustrates the value of thorough evaluation of hypertension and prompt surgical treatment for patients with adrenal cancer.

Adrenal Cortex Neoplasms↗
PubMed1999

Rhinosino-orbital mucormycosis causing cavernous sinus thrombosis and internal carotid artery occlusion: radiological findings in a patient with treatment failure.

The authors describe a case of rhinosino-orbital mucormycosis with cavernous sinus thrombosis in association with internal carotid artery occlusion diagnosed by use of computerized tomography (CT) and magnetic resonance imaging (MRI). Cranial CT is a useful imaging tool in the diagnosis of rhinosinal invasive fungal disease and MRI offers excellent aid in the detection of intracranial extension. Early diagnosis and rapid institution of surgical debridement and antifungal therapy is the rule of thumb in treating this disorder. In our patient, surgically inaccessible bone lesion and involvement of the central nervous system are taken as major causes for his grave outcome. In addition, failure to advance appropriate amphotericin B dosage may also make the infectious process uncontrollable in this patient.

Carotid Artery Thrombosis↗
PubMed1998

Sonographic findings in familial juvenile nephronophthisis-medullary cystic disease complex.

PURPOSE: Familial juvenile nephronophthisis-medullary cystic disease complex (JN-MCD) is an autosomal inherited renal disease with insidious symptoms that ultimately progresses to renal failure. We describe the abnormal sonographic findings in JN-MCD at various stages of the disease in a Taiwanese family. METHODS: We collected 8 cases in a family via 2 symptomatic index siblings. The affected members were 4 males and 4 females whose ages at diagnosis ranged from 1 to 39 years (mean, 16.8 years). Serial sonographic examinations were performed. RESULTS: There were 4 abnormal findings: renal hyperechogenicity, poor corticomedullary differentiation, small kidney size, and corticomedullary cysts. Renal hyperechogenicity and poor corticomedullary differentiation were found in all cases. Renal cysts and reduced renal size sometimes appeared later, after the disease had progressed. Three cases had no visualized cysts. CONCLUSIONS: Because abnormal renal sonographic findings can be seen long before the appearance of any clinical symptoms or signs, sonography is the best technique for diagnosing JN-MCD and for screening a patient's family.

Adolescent↗
PubMed1998

Results of surgery for vesicoureteral reflux in children: 6 years' experience in an Asian country.

From January 1990 to December 1995, a total of 181 patients underwent reimplantation of 318 ureters for primary vesicoureteral reflux (VUR); 87.8% received bilateral reimplantation. Surgical indications included breakthrough infection (35%), high-grade (> or = IV) reflux (33%), or both (29%). The operative success rate was 99.4% at 3 months postoperatively and 100% ultimately. The complications included: contralateral sequential reflux in 3.9%, postoperative bladder diverticula in 1.1%, postoperative urinary infection in 1.1%, residual reflux in 0.3%, postoperative vesicoureteral stenosis in 0.3%, and slippage of the drainage tube in 0.3% of cases. Two patients had renal failure due to VUR that was proven by renal biopsy (one 4-year-old and one 8-year-old). The incidence of associated anomalies was higher than in the normal population. The average number of hospital admission days was 7.9 (3-63). After 1992, no ureteral stent was left in postoperatively. All patients received prophylactic antibiotics for 3 months postoperatively until the VUR disappeared. The surgical results were satisfactory in this series.

Adolescent↗
PubMed1998

Is surgery necessary for primary non-refluxing megaureter?

From January 1990 to December 1995, a total of 22 patients with primary non-refluxing megaureter were treated in our hospital. The age distribution was 7 days to 8 years. The follow-up period was from 1 to 6 years. Nineteen of these 22 children underwent surgical intervention: 3 were operated upon at the time of diagnosis; the other 16 were initially treated conservatively, but underwent subsequent surgery due to impairment of renal function (13) or breakthrough infections (3). The failure rate for conservative management was about 84% (16/19): only 3 patients treated conservatively showed spontaneous resolution. The surgical success rate was 89.5% (17/19). The pathological change in the ureterovesical junction (UVJ) was adynamic in 13 cases and fibrotic in 6 (including 1 ectopic ureter). The postoperative complications were vesicoureteric reflux in 3 cases, with spontaneous resolution 6 months later, and UVJ stenosis in 1, which was resolved by reoperation. It is concluded that surgery is not necessary in every case, but still plays an important role in most cases. Early surgery can achieve good results and reduce renal damage.

Child↗
PubMed1998

Asymptomatic vesicoureteral reflux detected by neonatal ultrasonographic screening.

Renal ultrasonography was performed in 2,384 healthy and asymptomatic neonates. The definition and grading of hydronephrosis was according to the system of the Society for Fetal Urology. Voiding cystourethrography was performed in the cases with moderate to severe hydronephrosis or persistent mild hydronephrosis. In cases with vesicoureteral reflux (VUR), a dimercaptosuccinic acid (DMSA) renal scan was arranged immediately to evaluate the renal parenchyma. VUR was diagnosed in 30 infants with a prevalence of 1.26%; 7 had bilateral VUR. The male/female ratio was 4:1 and the right/left ratio was 1.85:1. Comparing with the abnormal ultrasonographic findings, VUR appeared ipsilaterally in 23 ureters and contralaterally in 14 ureters. Using ultrasonography for diagnosing VUR, the sensitivity, specificity, positive predictive value, and negative predictive value were 62.2%, 36.1%, 11.0%, and 88.2%, respectively. DMSA renal scan was performed in 31 refluxing kidneys, and congenital renal scarring was found in 9 (29.0%) kidneys. Six neonates underwent reimplantation surgery. We conclude that although ultrasonography is not a reliable tool for diagnosing VUR, it can detect many cases of VUR during the newborn stage using our screening program, which thus makes early treatment from the neonatal period possible. Whether our screening program can improve the outcome of VUR will require further follow-up.

Female↗
PubMed1996

Retroperitoneal fibrosis and juvenile rheumatoid arthritis.

We describe a 13-year-old girl with juvenile rheumatoid arthritis who developed obstructive uropathy and renal failure. Retroperitoneal fibrosis (RPF) was confirmed by surgery. Although the renal failure and hydronephrosis resolved after surgery, the symptoms of vascular occlusion persisted. We consider that early diagnosis and treatment are essential. In cases of autoimmune disease, RPF should be considered when there is acquired obstructive uropathy accompanied by vascular occlusion syndrome.

Acute Kidney Injury↗
PubMed1996

The regulation mechanism of c-jun and junB by human papillomavirus type 16 E5 oncoprotein.

In this study, we show that HPV-16 E5 induced anchorage-independent growth in immortalized human epidermal keratinocytes and that HPV-16 E5 in human keratinocytes had higher expression of c-jun and junB; also, we investigated the role of transcriptional initiation pathways in the expression elevation. In addition, Ras-dependent pathway, as well as PKC-dependent pathway, leads to HPV-16 E5-induced c-jun gene expression.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1996

Fertilization and embryo cleavage after intracytoplasmic spermatid injection in an obstructive azoospermic patient with defective spermiogenesis.

OBJECTIVE: To achieve fertilization and cleavage by spermatids without tails from testicular biopsy. DESIGN: Clinical trial. SETTING: Reproductive unit of a university teaching hospital. PATIENT: A patient of obstructive azoospermia with defective spermiogenesis. INTERVENTION: Testicular biopsy after scrotal exploration and spermatid injection into the cytoplasm of oocyte. MAIN OUTCOME MEASURES: Fertilization and cleavage. RESULTS: Four of 13 spermatid injections achieved normal fertilization and 2 of them cleaved. CONCLUSION: Intracytoplasmic spermatid injection may be a possible treatment for patients of defective spermiogenesis who have no viable spermatozoa available.

Adult↗
PubMed1996

Combined cytotoxic effects of tamoxifen and chemotherapeutic agents on bladder cancer cells: a potential use in intravesical chemotherapy.

OBJECTIVE: To evaluate whether tamoxifen enhances the cytotoxicity of chemotherapeutic agents on bladder cancer cells, and the possible mechanism(s) of action. MATERIALS AND METHODS: The in vitro inhibition of cell growth was examined in a model simulating intravesical chemotherapy using two bladder cancer cell lines (TSGH-8301, HTB9) and three commonly used intravesical cytotoxic agents (doxorubicin, mitomycin C, and thiotepa) in the presence or absence of tamoxifen or verapamil as modulators. The expression of the multi-drug resistance-related gene mdr-1 was evaluated by reverse-transcription polymerase chain reaction and Southern blotting (RT-PCR-SB) to determine its transcript level, by flow cytometric analysis of the P-glycoprotein (P-gp) product level with C-219 monoclonal antibody and by the rhodamine-123 retention and efflux assay for P-gp activity. Transforming growth factor beta-1 (TGF beta-1) levels in tamoxifen-conditioned culture medium were determined with enzyme-linked immunosorbant assay (ELISA). RESULTS: Tamoxifen at concentrations > or = 30 microM significantly enhanced the cytotoxicity of the three chemotherapeutic agents to both cell lines, as shown by a marked reduction in the drug concentration which inhibited growth by 50% (IC50). The enhancement of cytotoxicity was significantly dependent on the concentration of tamoxifen. However, tamoxifen alone caused significant toxic effects to TSGH-8301 at > or = 40 microM and to HTB9 at > or = 30 microM. Median-effect analysis showed additive or less-than-additive combination effects between tamoxifen and chemotherapeutic agents and only a minimal synergism in a narrow range of maximal cytotoxicity (fraction affected > 0.9). Thus, the reduction of IC50s by tamoxifen was mostly because it was cytotoxic to the bladder cancer cells used. No enhancement of cytotoxicity was observed in verapamil-modulated cells. Transcripts of mdr-1 could not be detected by RT-PCR-SB, nor was P-gp detected by flow cytometric analysis in the two cell lines. Furthermore, no active P-gp function was detected by the rhodamine-123 retention and efflux study, indicating that the primary chemoresistance mechanisms of the two cell lines were not mediated by mdr-1, nor could tamoxifen or verapamil act through modulation of the mdr-1 pathway in the two cell lines. Tamoxifen at 3 and 10 microM down-regulated the secretion of TGF beta-1 from TSGH-8301 in a concentration-dependent manner, in contrast to the findings that tamoxifen was cytotoxic to the bladder cancer cells used and that tamoxifen up-regulated TGF beta-1 in a breast cancer model, suggesting that there may be a different mechanism of response to TGF beta-1 in these bladder cancer cells. CONCLUSION: Tamoxifen enhanced the cytotoxicity of chemotherapeutic agents largely through its toxic effects on the bladder cancer cells. The mode of action of tamoxifen was not through the regulation of TGF beta-1 or the function of mdr-1. Although cytotoxic levels of tamoxifen (> 50 microM) can be achieved easily in the intravesical model, further study is necessary before tamoxifen can be used clinically in intravesical chemotherapy.

ATP Binding Cassette Transporter, Subfamily B, Mem↗