Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association最新文献

Conventional methods of speech aid fabrication have little control over the pharyngeal extension or over the adequacy of the velopharyngeal closure. These limitations can be overcome by using a nasopharyngoscope, which provides the operator with direct vision during the molding of the pharyngeal section. Likewise, the use of a videofluoroscope also permits visualization of the prosthesis in relation to the surrounding structures during various activities, and is equally valuable in the evaluation of the velopharyngeal mechanism. In both instances, the evidence of inadequate closure could be seen as mucus bubbling or refluxing of barium from the junction of the prosthesis with the soft palate defect. Also the standard Mandarin phrases used in the speech test and the advantages of nasal endoscopy over oral endoscopy are discussed.

Short- and long-latency somatosensory evoked potentials (SEPs) were elicited by stimulation of the median nerve in 104 stroke patients, 59 men and 45 women. Their ages ranged from 25 to 90 years, with a mean age of 68 years. All of the patients presented with acute unilateral motosensory or sensory deficits. Based on CT findings, the patients were divided into four groups: thalamic hemorrhage (52 cases), thalamic infarct (21 cases), putaminal hemorrhage or infarct (13 cases) and infarction in the corona radiata or subcortical white matter (18 cases). The criteria for abnormal SEP responses were as follows: (1) absence of N18, (2) prolongation of central conduction time, (3) delay in peak latency of N32, (4) delay in peak latency of N60, and (5) decrease in response amplitude. In patients with thalamic stroke, the abnormality rate of SEPs was 93% (68 out of 73 cases). When the lesions were located primarily in the posterolateral thalamus, all SEP components, particularly the N18 (short-latency) component, were affected. Lesions in other thalamic areas caused changes in the N32 (mid-latency) and the N60 (long-latency) components. In putaminal, corona radiata and subcortical lesions, the abnormality rate of SEPs was 84% (26 out of 31 cases). The N18 component was absent in 3 patients with putaminal hemorrhage. Infarct in the corona radiata and subcortex tended to affect the mid- and long-latency components with relative preservation of the short-latency components.

To establish a norm for cardiac velocities in healthy Chinese adults, we examined 30 normal subjects (15 men and 15 women) with pulsed- and continuous-wave Doppler, and color flow mapping. The subjects ranged in age from 18 to 60 years (mean 37 years). We found that the early (E) and late (A) diastolic peak velocities for the mitral valve were 87 +/- 16 cm/sec and 61 +/- 15 cm/sec, respectively. The E/A ratio was 1.5 +/- 0.4. The E and A peak velocities for the tricuspid valve were 57 +/- 10 cm/sec and 40 +/- 7 cm/sec, respectively. The peak velocities for the left ventricular outflow tract, the ascending aorta, the proximal descending aorta and the main pulmonary artery were 77 +/- 19, 106 +/- 20, 96 +/- 24 and 74 +/- 17 cm/sec, respectively. None of the velocities exceeded 154 cm/sec. There were no significant differences between men and women. However, older subjects (greater than or equal to 40 years) had a higher mitral A velocity (69 +/- 13 cm/sec vs 57 +/- 17 cm/sec, p less than 0.05) and a lower E/A ratio (1.3 +/- 0.4 vs 1.6 +/- 0.3, p less than 0.05) than did subjects under 40 years of age. Mild tricuspid regurgitation was detected in 8 of the 30 subjects (27%), mitral regurgitation in 3 of the subjects (10%) and pulmonic regurgitation in one of the subjects (3%). There was no aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic sphincterotomy (EST) was performed in 53 patients with biliary disease. Indications for sphincterotomy were: 48 patients with choledocholithiasis, 3 patients with malignant biliary obstruction, and 2 patients with papillary stenosis. The procedure was successful in 52 patients (98.1%). In patients with choledocholithiasis, the stones were successfully removed or passed out spontaneously in 42 patients (87.5%). Endoscopic retrograde biliary drainage (ERBD) was successfully carried out in 2 cases of malignant biliary obstruction after EST. The clinical and biochemical evidence of cholestasis resolved in both patients with papillary stenosis. Complications consisted of hemorrhage (2 patients) and cholangitis (1 patient), resulting in one death. The overall complication and mortality rates were 5.7% and 1.9% respectively. Thirty-two patients received regular ultrasound examination follow-up with a mean of 13.4 months. Two patients had recurrent common bile duct stones and one had restenosis of papilla. The conditions were managed by endoscopic therapy. Endoscopic sphincterotomy is a relatively safe and effective means of relieving extrahepatic cholestasis; however, its comparison with surgical techniques needs long-term, randomized studies.

Factors affecting pregnancy rates in gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) were evaluated. Higher pregnancy rates were found when more mature oocytes were recovered (6.2 +/- 2.5 vs 3.8 +/- 3.0) and more oocytes (4.6 +/- 1.0 vs 3.3 +/- 1.2) or zygotes (4.7 +/- 1.4 vs 3.0 +/- 1.7) were transferred. Ultrasound-guided follicular aspiration was successful for in vitro fertilization and had a pregnancy rate (14.3%) comparable to the laparoscopic approach (13.3%). Laparotomy for correction of pelvic pathology concomitant with oocyte retrieval should be used cautiously despite the high preliminary pregnancy rate (42.9%). Failed fertilization of the surplus oocytes left after gamete intrafallopian transfer did not mean a poor chance of pregnancy (27.6%). The combined treatment of gamete intrafallopian transfer and in vitro fertilization may have a higher chance of pregnancy (43.5% vs 21.4% in GIFT and 13.3% in IVF), and more multiple pregnancies (40.0% vs 22.2% in GIFT and 16.7% in IVF). Cycles with spontaneous LH (luteinizing hormone) surges, detected by daily morning urine samplings, need not be aborted and the timing of ovum recovery should be individually evaluated.

Eikenella corrodens is a slow-growing, facultatively anaerobic, gram-negative bacillus. It is part of the normal flora of the human upper respiratory tract. We report a 68-year-old man who developed lung abscesses caused by E. corrodens while on long-term corticosteroid therapy for polymyositis. It was isolated by percutaneous transthoracic aspiration of an abscess under real-time sonographic guidance. The organism has a very unusual antimicrobial susceptibility: sensitive to penicillin, ampicillin, cephapirin, chloramphenicol, minocycline and erythromycin but resistant to clindamycin, oxacillin and gentamicin. The patient was treated empirically with penicillin G and gentamicin. The latter was discontinued after the results of the bacterial culture and sensitivity test were available. He was discharged one month later with marked improvement. Our report clearly demonstrates that E. corrodens can be the sole pathogen of a respiratory tract infection.

Spontaneous pneumothorax is a rare complication in both primary and metastatic pulmonary neoplasms. Occasionally, pneumothorax is associated with chemotherapy of pulmonary malignancies. Pneumothorax after chemotherapy has been reported only in cases with osteogenic sarcoma, synovial sarcoma, fibrosarcoma, germinal tumors, and lymphoma with lung metastasis. We report a case of a patient with malignant thymoma who suffered from lung metastasis after radiation and adjuvant chemotherapy from lung metastasis after radiation and adjuvant chemotherapy (cyclophosphamide, adriamycin, and cis-platinum). A chest X-ray taken 2 days after chemotherapy showed bilateral pneumothorax, which was resolved with conservative treatment. The pneumothorax in this patient is believed to have been caused by the rupturing of the tumor into the pleural cavity and the bronchi.

A 28-year-old Chinese woman having sarcoidosis with ocular involvement was reported. She demonstrated bilateral hilar lymphadenopathy in a chest X-ray which was taken for a cough. Transbronchial lung biopsy revealed noncaseating epithelioid granulomas. Blurred vision occurred 8 months later when conjunctival follicle-like masses, granulomatous keratic precipitates, iridocyclitis, "snow-ball" vitreous opacity, and retinal periphlebitis developed in both eyes. Biopsy of the conjunctival follicle-like masses revealed noncaseating granulomas composed of epithelioid cells and multinuclear giant cells, typical of sarcoidosis. The ocular lesions waned under topical steroid treatment and vision improved. This is the only case with an ocular involvement among the 10 cases of sarcoidosis seen during the past 20 years at the Taipei Veterans General Hospital.

Squamous cell carcinoma (SCC) antigen was measured by double-antibody radioimmunoassay in the sera of 113 patients with gynecologic malignancies and 30 controls. The mean serum SCC antigen level was 9.24 ng/ml in those with cervical squamous cell carcinoma, 2.15 ng/ml in those with other gynecologic malignancies, and 1.25 ng/ml in controls. With a cutoff value of 2.23 ng/ml (2 SD above the mean of the control group), the rate of SCC antigen elevation was 54% in cervical cancer (78), 14% in vulvar or vaginal cancer (7), 22% in ovarian cancer (18), and 10% in endometrial cancer (10). In cervical squamous cell carcinoma, the rates of elevated SCC antigen level increased with disease advancement in stages 0, I, II, III, and IV, by 13, 50, 53, 78, and 100%, respectively. In early-stage cervical squamous cell carcinoma, SCC antigen was not sensitive enough for screening. However, if elevated, serum SCC antigen levels decreased rapidly after successful surgical treatment. One case with a serum SCC antigen level above 65 multiples of the cutoff value had widespread cancer and postoperative recurrence. In the advanced case, the sensitivity was much higher. In the recurrent case, the positive rate was 73%. Serum SCC antigen level is useful in predicting the prognosis and monitoring the course of cervical squamous cell carcinoma, especially in the detection of a recurrence.

Obstructive jaundice secondary to external compression of the extrahepatic bile duct caused by tumor of non-liver origin was found in 5 of 199 consecutive children with cancer between 1986 and 1988 at the Department of Pediatrics, National Taiwan University Hospital. Of the 5 patients, 2 had non-Hodgkin's lymphoma and the other 3 had acute promyelocytic leukemia, histiocytosis X and neuroblastoma, respectively. Extrahepatic biliary obstruction occurred as part of the initial presentation of malignancy in 3 cases, and later in the course of disease in the other 2 cases. In each instance, abdominal ultrasonography and computed tomography revealed dilatation of intrahepatic biliary trees due to mass compressing effects. A huge multilobulated tumor and multiple enlarged lymph nodes near the porta hepatis were found in all 3 patients who underwent an exploratory laparotomy. Wedge biopsy of the liver showed no cancer cell invasion. One case died before chemotherapy had commenced. The other 4 patients received chemotherapy and 3 of them received additional radiotherapy. Although jaundice and tumor regressed dramatically with this mode of treatments, subsequent recurrence of tumor without jaundice rapidly ensued in 3 patients. They all died, except 1 case, within 18 months from the occurrence of jaundice. This suggests that these patients were in an advanced stage of disease and should be diagnosed early and treated vigorously. Accordingly, cancer of non-liver origin, although rare, should be considered in the differential diagnosis of obstructive jaundice if survival is to be improved in these cancer children.