Biomedical subjects

Yu-Yao Huang

Publications and source records attributed to Yu-Yao Huang.

6 recordsLinked to original sources

PubMed2006

Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction.

AIM: To summarize our experience with the application of self-expanding metallic stent (SEMS) in the management of acute left-sided colorectal malignant obstruction. METHODS: A retrospective chart review of all patients undergoing placement of SEMS between April 2000 and January 2004 was performed. RESULTS: Insertion of SEMS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SEMS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SEMS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 (85%) of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 (95%) patients. Three SEMS-related minor complications occurred, two stents migrated and one caused anal pain. CONCLUSION: SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.

Acute Disease↗

PubMed2005

Primary pituitary lymphoma presenting as hypophysitis.

A 47-year-old man had suffered from prolonged fever for two months without clinical evidence of infection. Blood biochemistry and endocrine dysfunction indicated that he had pituitary insufficiency. Thorough whole body imaging studies merely identified a 22 x 14 mm mass lesion in the sella turcica. Tumor pathology and special cell marker study revealed the infiltration of atypical T-lymphoid cells and concomitant presence of some B-lymphoid cells. The fever subsided gradually following subtotal tumor resection and steroid supplementation. However, the mass lesion had invaded the cavernous sinus and optic chiasma shortly after surgery. Six months after his initial visit, metastasis lesions in the liver, the left adrenal gland, and retroperitoneal lymph nodes were discovered. In contrast to cells in the pituitary, the pathological investigation of the liver mass confirmed it to be exclusively of T-cell origin. Therefore, it is plausible that the pituitary dysfunction was related to an inflammatory process, namely hypophysitis, as well as the T-cell lymphoma. This case exemplifies the rarely noted condition of primary pituitary lymphoma with concomitant hypophysitis. Clinical diagnosis is indiscernible until the occurrence of systemic tumor metastasis.

Fever of Unknown Origin↗

PubMed2005

Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and 20 years ago.

BACKGROUND: The aim of this study was to compare the clinical manifestations and outcomes of patients with diabetic ketoacidosis (DKA) today and 20 years ago. METHODS: A retrospective review was conducted of patients with DKA treated at our hospital from January 2001 through June 2002. The medical records were analyzed to identify clinical presentations, contributory factors, laboratory data, and outcomes. Additionally, data were compared with the records of patients with DKA in 1981 and 1982 at the same hospital. RESULTS: Data on 132 patients with 148 DKA episodes were included in the present study. When compared with the data from 20 years ago, clinical presentations, precipitating factors and laboratory data were similar. However, the mortality rate markedly decreased from 7.96% to 0.67%. Among patients with documented bacterial infections, a significantly high prevalence (70%) of Klebsiella pneumoniae infection was discovered. In patients with recurrent DKA, young women with type 1 diabetes accounted for most of the cases (67%) due to the omission of insulin. Eleven of 49 patients (22%) with newly diagnosed diabetes presenting with DKA were not insulin dependent during the 1.5-year follow up. CONCLUSIONS: After 20 years, the clinical presentations and precipitating factors of DKA were similar. However, the mortality rate was significantly reduced. Klebsiella pneumoniae was the leading cause of bacterial infections precipitating DKA in our hospital. Young women with type 1 diabetes were at high risk of repeat DKA.

Adolescent↗

PubMed2005

The postpartum metabolic outcome of women with previous gestational diabetes mellitus.

BACKGROUND: This study investigated postpartum metabolic abnormality in women with previous gestational diabetes mellitus (GDM) and predictive factors for postpartum glucose intolerance. METHODS: From March 2001 to February 2003, 127 prior-GDM women underwent a 75g oral glucose tolerance test (OGTT) and metabolic assessment at least six weeks after delivery. To identify the predictors, clinical variables obtained at the time of GDM were compared. RESULTS: The cumulative incidence rates of diabetes mellitus (DM) and abnormal glucose tolerance (AGT) i.e. impaired fasting glucose or impaired glucose tolerance, in women with previous GDM were 13.4% and 29.1%, respectively. Postpartum body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, blood pressure, waist-to-hip ratio and fasting C-peptide were not significantly different among DM, AGT and normal glucose tolerance (NGT) women. However, the C-peptide/glucose score was lower in DM than in AGT and NGT women (p < 0.01). DM or AGT women had higher prepregnancy BMI and fasting glucose level for 100g OGTT than NGT women (p < 0.05) at the time of GDM. The fasting glucose value was an independent risk factor. The cutoff point of three abnormal values in 100g OGTT provided 86% sensitivity and 43% specificity for the prediction of postpartum DM or AGT. CONCLUSIONS: High prepregnancy BMI and increased glycemic deterioration at the time of GDM are found in women developing postpartum DM and AGT. The fasting glucose value for 100g OGTT is an independent risk factor and more than three abnormal glucose values offers good diagnostic efficacy in predicting postpartum glucose intolerance.

Adult↗

PubMed2003

Adrenal incidentalomas in Taiwan: high prevalence and malignancy rate.

BACKGROUND: The endocrine adrenal gland has 3 zones comprised of the cortex and medulla. The character of multi-hormonal expression results in multiple clinical manifestations. To define the clinical characteristics of adrenal tumors in Taiwan, we reviewed 336 pathologically proven adrenal tumors at Chang Gung Memorial Hospital in Linkou. METHODS: We retrospectively analyzed 258 pathologically proven adrenal tumors with sufficient data treated from 1983 to 2000. Among them, 174 (67%) were functional and 84 (33%) were nonfunctional. The diagnosis was based on clinical features, hormonal status, imaging studies, and pathology. RESULTS: Of the 258 patients, 161 were women (mean age, 38.5 +/- 15.4; range, 1-75 years) and 97 men (mean age, 41.6 +/- 17.8; range, 1-81 years). The prevalence of cortical tumors was much higher in females than in males. Fifty-two percent of patients with an adrenal tumor were diagnosed at an age between 30 and 50 years. Incidentalomas (N = 84) accounted for about 1/3 of total tumor cases. Of the 46 cases proven to be malignant, 40 (87%) were found incidentally. All malignant tumors had a diameter of greater than 3 cm. Postoperative adrenal insufficiency was present in 18% of cases, and overall mortality in this study was 0.4%. CONCLUSIONS: In our series, adrenal incidentalomas corresponded to about 1/3 of adrenal tumors and accounted for 87% of malignancies. It is mandatory to increase medical attention for incidentally found adrenal masses in Taiwan. Those incidentalomas with a diameter of more than 3 cm should undergo a pathological examination.

Adolescent↗

PubMed2003

Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma.

BACKGROUND AND PURPOSE: Thyroid-stimulating hormone (thyrotropin, TSH)-secreting pituitary adenoma is a very rare cause of hyperthyroidism. Diagnosis of this condition is often delayed due to lack of availability of TSH radioimmunoassay (RIA), the failure to recognize the utility of RIA and the incorrect attribution of the condition to other causes of thyrotoxicosis. This retrospective study analyzed the clinical characteristics of patients with this disorder treated from 1991 to 2002. METHODS: Seven patients (6 females, 1 male; mean age, 48 years; range, 33 to 72 years) with a diagnosis of TSHsecreting pituitary adenoma based on detectable TSH levels with high serum free thyroid hormone or triiodothyronine concentrations and pituitary lesions found on neuroimaging were included in this study. Patient records including clinical features, endocrine studies, immunohistochemistry studies, and response to treatment were reviewed. RESULTS: All 7 patients had hyperthyroidism, elevated free thyroxine or triiodothyronine levels, and unsuppressed levels of TSH. Imaging studies demonstrated a pituitary mass or lesion in all patients. Six patients had macroadenomas and 1 patient had a microadenoma. One of the patients had coexisting acromegalic features and hypersecretion of growth hormone was diagnosed. All of the patients had been treated with thionamides or thyroidectomy for presumed primary hyperthyroidism. Serum alpha-subunit level was uncharacteristically normal in 2 patients and elevated in 1 patient. Alpha-subunit/TSH molar ratios were elevated in 3 patients. Five patients underwent transsphenoidal adenomectomy but only one of them remained well-controlled at follow-up. Three patients received administration of somatostatin analogs and they achieved normalization of serum TSH and free thyroid hormones during the period of therapy. CONCLUSIONS: TSH immunoassay has an important role in the evaluation of hyperthyroid patients to determine the presence of inappropriate secretion. TSH-secreting pituitary adenoma exhibits heterogeneity in clinical presentation, hormonal expression and therapeutic response.

Acromegaly↗