Clinical characteristics and treatment response of Hodgkin's lymphoma in Taiwan

BACKGROUND/PURPOSE: Hodgkin's lymphoma (HL) is particularly rare in Asia, including Taiwan. The report concerning its clinical features and treatment outcomes in Asians is limited. An exploration of the characteristics of HL in this area is of importance for future studies. METHODS: In this study, 133 patients with HL diagnosed between January 1985 and December 2004 at National Taiwan University Hospital were analyzed retrospectively. RESULTS: The age distribution revealed a young-adult peak at the age around 20 years. The nodular sclerosis type (NS-HL) was the most common histopathologic subtype (45%), followed by mixed cellularity (29%), lymphocyte predominant (13%), and lymphocyte depleted subtype (2%). The incidence of NS-HL was, however, lower compared with that in the West (around 70%). The male to female ratio was approximately 1:2 in patients with NS-HL, in contrast to the male predominance in patients with other subtypes. Induction therapy led to complete remission (CR) in 87% of patients. At a median follow-up of 78 months, the 10-year overall survival (OS) was 79% in all HL patients and was 90% in those who achieved first CR. In multivariate analysis, the achievement of CR was the only independent factor associated with good OS. CONCLUSION: The treatment response of HL in Taiwan is good and comparable to that in Western countries. The epidemiologic differences between Taiwan and the West mandate further studies.     

Clinical characteristics of nosocomial rotavirus infection in children in Taiwan

BACKGROUND/PURPOSE: The aim of this study was to determine the incidence and clinical characteristics of nosocomial rotavirus infection (NRI) among hospitalized children. METHODS: We collected data of children in the Department of Pediatrics with positive stool rotavirus antigen tests. Cases of an admission diagnosis of acute gastroenteritis or a positive stool rotavirus antigen test within 3 days of admission, representing community-acquired infections, were excluded. Both VP4 and VP7 genotyping of the rotaviruses was done. RESULTS: There were 98 patients who met the inclusion criteria during the 3-year period. The incidence density was 0.58 per 1000 patient-days in our series. Among these patients, 59 (60%) had underlying diseases. The intermediate intensive care unit had the highest incidence density (2.8 per 1000 patient-days). Overcrowding of the care unit, inappropriate hand hygiene, and inadequate isolation and cohorting predisposed to the high rate. Genotypes among 79 (80%) rotaviruses tested showed that 42% belonged to the novel genotype, G9P[8]. CONCLUSION: NRI may cause significant morbidity in hospitalized children, especially young infants and those with underlying diseases. Infection control with hospital surveillance, strict isolation and cohort care should be adopted to prevent the spread of rotavirus among special care units.     

Liver function tests in patients on oral progestogens

145 women (age 11-43 years) attending the family planning clinic and gynecological outpatient department of Queen Mary's Hospital or admitted to the gynecology ward were studied for 16 months from August 1965-October 1966 to assess liver function under 2 steroid preparations: Gynovlar--3 mg norethisterone acetate. .05 mg ethinyl estradiol--for contraception, and Noracyclin--5 mg Lynestrenol, .15 mg mestranol--for gynecologic symptoms. Liver function was tested by serum bilirubin, serum alkaline phosphatase, cephalin cholesterol flocculation test, and zinc sulphide turbidity test. In 123 cases SGOT and SGPT estimations were made by colorimetric method of Reitman and Frankel. Results were analyzed on the basis of 2 diet categories--high protein, low-protein--and 2 sub-categories--vegetarian, nonvegetarian. Serum alkaline phosphatase and zinc sulphide turbidity revealed a significant change in cases of low protein diet. 1 patient in the low protein group had a significant change in cephalin cholesterol flocculation. A rise in SGOT and SGPT was demonstrated after 2 weeks of drug administration but was significant only in patients on low protein diets. Impairment of liver function was reversible in 4 months. Low protein diet "potentiates" hepatotoxicity of steroids. There was a very low continuation rate. A more prolonged follow-up was suggested to discover the pattern of hepatic dysfunction.     

Clinical manifestations, disease course, and complications of adult-onset Still's disease in Taiwan.

BACKGROUND AND PURPOSE: Data on the disease course and ultimate outcome of adult-onset Still's disease (AOSD) are limited. We analyzed the clinical manifestations, disease course, and complications of patients with AOSD in Taiwan. METHODS: A retrospective cohort design with prospective follow-up was used. Eighty two patients with AOSD diagnosed between 1983 and 2003 were evaluated. Their clinical features and laboratory findings at presentation, disease course, and complications were analyzed. RESULTS: Fifty nine patients (72%) were female and 55 (67.1%) were aged between 16-35 years at onset. The most common clinical manifestations were fever (100%), articular symptoms (100%), evanescent rash (87%), and sore throat (84%). Dermatographism was noted in 59% of patients. Elevation of erythrocyte sedimentation rate and C-reactive protein, which were significantly correlated with disease activity score (both p < 0.01) occurred in more than 90% of AOSD patients. Elevation of serum ferritin, which was significantly correlated with disease activity score and hepatic enzyme levels, was present in 91% of patients. Polycyclic systemic course was the most common (45%), followed by monocyclic systemic course (34%); only 20% of patients progressed to chronic arthropathy. CONCLUSIONS: The multisystemic involvement and various patterns of disease course in this series illustrate the heterogenic nature of AOSD. Serum ferritin levels can be used as a marker for monitoring disease activity in AOSD.     

特发性男性不育症患者精子功能检测的临床分析

目的:探讨特发性男性不育症的病因。方法:收集30例特发性男性不育症患者(病例组)和30例已生育的成年健康男性(对照组)的精液,同时应用伊红染色法检测精子膜结构完整性,应用精子染色质扩散实验(SCD)检测精子DNA完整性,应用凝集素免疫荧光染色法(PNA-FITC)检测精子顶体完整性,利用JC-1荧光探针检测精子线粒体膜电位去极化情况。结果:病例组精子顶体完整百分率为(35.15±11.28)%,低于对照组(50.20±12.34)%,差异有统计学意义(P0.05)。病例组与对照组精子伊红红染率、DNA碎片率及线粒体膜电位去极化情况差异无统计学意义(P0.05)。结论:精子顶体完整性检测对部分特发性男性不育症患者的诊疗有重要的临床意义。     

Clinical characteristics and assisted reproductive technology outcomes in infertile foreign brides: comparison with native brides in south Taiwan

ObjectiveThis study was conducted to determine if differences in clinical characteristics, embryonic development, and pregnancy outcomes exist between infertile foreign and native brides undergoing assisted reproductive technology (ART) treatment in a foreign-bride-immigrating country of Taiwan.Material and MethodsA retrospective, case-control design was use to recruit consecutive infertile women seeking ART treatment for study. The treatment protocol consisted of controlled ovarian hyperstimulation with down-regulation and gonadotropin and ART method with conventional in vitro fertilization or intracytoplasmic sperm injection. Among the 1083 ART treatment cycles, 97 (9%) were from foreign brides and 986 (91%) from native brides. Records of those who received transfer of fresh embryos obtained by using husband sperm for fertilization were collected for analysis. A case-control design with adjustment of bride age was used to select the records of 86 infertile foreign and 172 native brides for the study. Infertility cause, bride age, retrieved oocyte number and maturity, fertilization rate, embryo score, and post-embryo transfer results were assessed.ResultsThe foreign bride couples had significantly greater infertility due to tubal (36%) and combination (8.1%) factors than native bride couples (20.3% and 4.1%, respectively). Days of gonadotropin stimulation, number of oocytes retrieved, fertilization rate, embryo score, implantation rate, or clinical pregnancy rate, and live birth rate did not differ between the two groups.ConclusionThe cause of infertile foreign bride couples requiring ART treatment had a higher percentage of tubal and combination factors, but similar ART outcomes.     

子宫内膜异位症相关性卵巢癌患者临床特征及预后

目的:探讨子宫内膜异位症相关性卵巢癌(EAOC)患者的临床及预后特点。方法:回顾分析2013年1月至2018年9月在南京医科大学附属苏州医院初次诊治的156例卵巢上皮癌患者的临床资料,根据是否伴有内异症分为EM相关性卵巢癌组(EAOC组)和non-EAOC组,比较两组的一般资料、临床表现、辅助检查、手术及术后随访资料。结果:与non-EAOC组患者比较,EAOC组患者痛经、扪及包块及阴道不规则出血症状发生率高(P0.05),剖宫史比例高(21.62%vs 5.04%,P=0.002),并发子宫肌瘤比例高(35.14%vs 15.97%,P=0.012)。EAOC组和non-EAOC组的血清CA125水平、淋巴结转移比例、FIGO分期分布、肿瘤早期晚期比例比较,差异均有统计学意义(P0.05)。Kaplan-Meier生存分析发现,EAOC组的中位总生存期、无进展生存期较长(P=0.0256,P=0.0242)。结论:与non-EAOC患者比较,EAOC患者的痛经及阴道不规则出血症状较明显,有剖宫产史者较多,更易合并子宫肌瘤,肿瘤分期早,血清CA125水平低,侵犯淋巴结可能性低,预后好。     

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.     

妊娠期尿崩症七例临床特点分析

目的 探讨妊娠期尿崩症的临床特征、治疗方法和预后.方法 对温州医学院附属第一医院、温州市中西医结合医院和浙江省台州医院1993年6月至2006年6月间收治的7例妊娠期尿崩症患者的临床资料进行回顾性分析.结果 7例妊娠期尿崩症患者均有烦渴、多尿、多饮症状,24 h尿量平均在11-13 L之间,均为低比重尿,平均尿比重为1.003±0.003,24 h饮水量平均在10-12L之间.7例患者中有3例口服醋酸去氨加压素、3例口服氢氯噻嗪、1例口服螺内酯治疗,分别于产后7 d至3个月烦渴、多尿、多饮症状消失,24 h尿量降至1000～2000 ml之间,尿比重在1.015～1.025间,血钠水平为135～147 mmol/L,平均病程52 d.7例患者共分娩8例新生儿,均存活,其中2例转新生儿科治疗(转科原因为1例因子痫而早产;另1例为双胎之一发生双肾积水),早产儿于新生儿科住院3周后出院,肾积水新生儿产后2周双.肾积水消失,全部新生儿随访至分娩后42 d未发现明显异常.结论 妊娠期尿崩症是一种罕见的妊娠合并内分泌疾病,以烦渴、多饮、多尿、低比重尿、电解质紊乱为主要临床表现,多为一过性症状.醋酸去氨加压素是首选治疗妊娠期尿崩症药物,次选为氢氯噻嗪.如能早期诊断及正确处理,则母婴预后良好.     

Peritoneoscopy as a diagnostic supplement to liver function tests and liver scan in patients with carcinoma.

Liver function tests, liver scintigraphy and peritoneoscopy were carried out in 240 patients with carcinoma. Hepatic invasion was demonstrated by peritoneoscopy essentially when both of the other tests were positive. However, in one-third of the patients, peritoneoscopy revealed the presence of other pathologic changes which could account for the positivity of either of the other diagnostic procedures. The status of the liver, with regard to presence or absence of metastases, could be microscopically documented in 59 patients. False-negative findings of liver chemistry tests, liver scan and peritoneoscopy were seen in 27, 42 and 36 per cent, respectively, of the patients while the rate of false-positive results was 15, 10 and 3 per cent, respectively. The rate of false-negative peritoneoscopy examinations in the absence of simultaneous positivey of the two other investigations was insignificant. These data indicate that liver chemistry tests, liver scan and peritoneoscopy play a major and complementary role in the screening of patients with carcinoma.