Clinical value of early cleavage embryo.

OBJECTIVE: This study was undertaken to see if embryo transfer containing early cleavage embryos resulted in better clinical pregnancy rate. METHODS: The treatment outcomes of IVF-ET were retrospectively reviewed. Out of 258 transfer cycles, 160 cycles contained no early cleavage embryos (Group I) and 98 cycles contained at least one early cleavage embryo (Group II). The definition of early cleavage embryo is the presence of two blastomeres 24-26 h after insemination. The implantation rate, clinical pregnancy rate were compared between two groups. Student's t-test and the Mann-Whitney U-test were used for continuous variables, and the Chi-squared (chi(2)) test was used for binary variables. Differences were considered statistically significant at P<0.05. RESULT: The implantation rate and clinical pregnancy rate were 11.6% and 25.6% in Group I, 18.6% and 38.8% in Group II (P<0.05). CONCLUSION: Early cleavage embryos possess greater implantation potential. Embryo transfer containing early cleavage embryos had a better clinical pregnancy rate.

Complete atrio-ventricular block as a major clinical presentation of the primary cardiac lymphoma: a case report.

It is uncommon for malignant lymphomas to present primarily with cardiac invasion as the main clinical feature. What we are interested in is not only where the disease is, but also those symptoms that it may induce. Sudden onset of complete atrio-ventricular block is one of the most common clinical presentations. Cardiac tamponade is another common disease entity which, if it locates over outlets of great vessels, may also exert symptoms of obstructive vessels. Diagnosis can be made by needle aspiration under the guidance of transcutaneous or transesophageal echocardiography. Both CT scan and MRI play positive roles in the diagnosis of cardiac lymphomas, and the latter can even provide much more image information than the former. We report a 70-year-old male with primary cardiac lymphoma with initial clinical pictures of sudden onset of complete atrio-ventricular block. Chemotherapy was utilized with cyclophosphamide, vincristine and prednisolone (COP) initially for four courses and followed by adding doxorubicin (CHOP) for another three courses. The patient was still in remission status after treatment for 2 years.

Surgical treatment of bronchiectasis: 10 years' experience.

BACKGROUND: Since antibiotic therapy and vaccination have been widely used in medical practice, the incidence of bronchiectasis has decreased steadily. The principal role of surgery associated with this disease is for the treatment of complications. We present an analysis of surgical results during a 10-year period. METHODS: The medical records of bronchiectasis patients who were surgically treated were retrospectively reviewed from July, 1987, to March, 1998. The surgical indications, complications and recurrences of bronchiectasis were evaluated. RESULTS: A total of 41 bronchiectasis patients underwent surgical treatment from 1987 to 1998 at our hospital. There were 18 males (mean age, 37.8 +/- 15.3 years; range, 16-73 years), and 23 females (mean age, 33 +/- 7.1 years; range, 21-46 years). The indications for surgery were hemoptysis in 30, failed medical treatment in eight, suspected neoplasm in two and retention of a foreign body in one patient. Anatomic resections of the diseased sites were carried out more frequently on the left lower lobes of the lungs. In total, there were 20 left lower lobes, five right lower lobes, 10 left lingular lobes, five right middle lobes, four left upper lobes and one right upper lobe that required surgery. Surgical complications included hemorrhage in one patient, bronchopleural fistula in one and galactorrhea in one patient. The follow-up intervals were from two to 131 months (mean, 72.5 +/- 37.6 months; median, 74 months). There were two cases of recurrent symptoms and six cases of recurrent hemoptysis; all were easily controlled by medication. There were no mortalities. CONCLUSIONS: Surgical treatment of bronchiectasis yields immediate resolution of symptoms, better quality of life and no mortalities. Cessation of smoking, avoiding air pollution and careful medical follow-up are mandatory.

Intracerebral hemorrhage caused by cerebral amyloid angiopathy: a case report.

Cerebral amyloid angiopathy (CAA) accounts for approximately 10% of spontaneous intracerebral hemorrhages (ICH), and typically occurs in the cortex and subcortical white matter. It is characterized by the deposition of amyloid fibrils in the leptomeningeal, cortical and subcortical arteries. Pathologically, amyloid is stained pink with Congo red and shows yellow-green birefringence when viewed under polarized light. Although there have been many reports of CAA in the literature, it has rarely been described in Taiwan. This is the report of a case of a 75-year-old man with ICH caused by CAA. The postoperative course was uneventful. The incidence of this disease increases with age. The authors, therefore, suggest conducting a brain biopsy and special stain for CAA in each operative case of spontaneous ICH, especially in the elderly.

Anorectal leiomyosarcomas.

In adults, rectal leiomyosarcoma is uncommon, and anal leiomyosarcoma is even more rare. We report one patient with anal leiomyosarcoma and one patient with a biphasic clinical history, with three occurrences of perineal leiomyosarcomas after surgically resected rectal leiomyoma. We discuss the characteristics of these rare entities based upon a review of the literature.

Gastric adenocarcinoma with microangiopathic hemolytic anemia and disseminated intravascular coagulation: a case report.

The case reported was a 54-year-old woman with adenocarcinoma of the stomach who developed microangiopathic hemolytic anemia (MHA) and disseminated intravascular coagulation (DIC). Clinical and laboratory data pertaining to this patient are presented. The patient died of multiple organ failure on the 12th hospital day. Since 1962, a total of 96 cases of MHA occurring in patients with malignancy have been reported. About half of them occurred in patients with gastric carcinoma. The possible pathogenesis of MHA and disseminated intravascular coagulation in patients with gastric adenocarcinoma is discussed.

Characterization of the promoter region of the human transforming growth factor-beta type II receptor gene.

Diminished cellular responsiveness to transforming growth factor-beta (TGF-beta) is frequently correlated with decreased transcription of the type II receptor for TGF-beta (TGF-beta RII). We have cloned and characterized the human TGF-beta RII promoter and, using S1 nuclease mapping and 5' rapid amplification of cDNA ends polymerase chain reaction, have identified five alternative transcription start sites within the region -33 to +57. DNA transfection experiments and electrophoretic mobility shift assays have revealed the existence of five distinct regulatory regions including two positive regulatory elements and two negative regulatory elements in addition to the core promoter region. The first positive regulatory element (-219 to -172) interacts with two distinct nuclear protein complexes, at least one of which appears to be a previously unidentified transcription factor. The second positive regulatory element (+1 to +35) also interacts with two separate protein complexes, both of which appear to be novel transcription factors. Deletion of either positive regulatory element markedly decreased expression of the target gene, suggesting that both positive regulatory elements are necessary for basal expression levels of TGF-beta RII.

Villous adenoma of ampulla of Vater: a case report.

A 56-year-old female patient presented with pain and tenderness over the epigastric region. Endoscopy showed a polypoid mass at the ampulla of Vater. Endoscopic biopsy showed villous adenoma with moderate cellular atypia. Wide excision of the tumor was performed. After resection, histological examination confirmed the tumor to be a villous adenoma of ampulla of Vater. This is a rare neoplasm with an incidence of 0.04-0.12% in postmortem series. A few cases have been reported in the literature, but only two documented in the Chinese literature to date. Wide excision has had good results and should be regarded as the treatment of choice for benign lesions.

Gastric perforation in the neonate: clinical analysis of 12 cases.

Gastric perforation is a rare abdominal catastrophe which associated with high mortality in newborn infants. From June 1978 to July 1991, twelve cases of neonatal gastric perforation presented at Chang Gung Memorial Hospital. Male to female ratio was 9:3. The most common presenting signs were abdominal distension (100%), feeding intolerance (92%), respiratory distress (67%) and poor activity (58%). All cases had significant symptoms between two and five days of age. All of the abdominal plain film showed pneumoperitonium. The most common site of perforation was the great curvature of the stomach (83%). Among the 10 pathological reports available, 8 cases had ischemic change and 2 cases had hemorrhage and inflammatory cell infiltration. There was a high mortality rate of 58% in this series. Male, hyponatremia (serum sodium < 130 meq/l) and metabolic acidosis (pH < 7.3) were poor prognostic factors. This report suggests that early diagnosis and early management before clinical deterioration of the metabolic status may improve prognosis for neonatal gastric perforation patients.

Changes of respiratory chain enzyme activities in growing rat muscle mitochondria.

The activities of three mitochondrial respiratory chain enzymes, namely rotenone sensitive NADH-cytochrome c reductase (NCCR), succinate-cytochrome c reductase (SCCR), and cytochrome c oxidase (CCO) in the extensor digitorum longus muscle were determined in Wistar rats, twenty each, at 3, 4, 5, 6, 10 and 26 weeks of age. The activity of NCCR was extremely low from birth up to 10 weeks of age. The activity of SCCR was stable at 64% to 72% during the first 6 weeks of life and increased to 78% of the adult level at 10 weeks of age. The CCO activity was only 52% of the adult level at 3 weeks of age, increased to 78% to 86% during the next 3 weeks and reached 92% at 10 weeks of age which was not statistically different from the adult level. We conclude that the activities of these 3 respiratory chain enzymes, in muscle mitochondria in rats, were low during development and reached the adult levels at various ages. Before the normal values of these enzyme activities can be established in human pediatric population, age-matched control should be used as the reference value for evaluation of mitochondrial myopathy.

Ganglioneuroma of the duodenum. Report of a case and literature review.

A 43-year-old male presented with upper gastro-intestinal bleeding. A polypoid tumor mass in the second part of the duodenum was found by endoscopic examination. Pathology revealed an extremely rare case of ganglioneuroma. The surgical local resection of the tumor was a sufficient procedure because of a lack of malignant potential. This is the fourth case since the first case was reported by Dahl et al in 1957 (1). We review the literature concerning duodenal paragangliomas, and discuss the histogenesis.

Dermatofibrosarcoma protuberans of the hand: a case report.

Dermatofibrosarcoma protuberans is a slowly growing, low-grade sarcoma originating in the dermis and subcutaneous tissue. It generally occurs with equal frequency on the trunk and proximal extremities. Only three cases have been reported to occur on the hand. A case of dermatofibrosarcoma protuberans of the right hand anterior to Guyon's canal is reported, and the literature is reviewed.

[Uterine lipoleiomyoma with calcification: report of a case].

Uterine lipoleiomyoma is uncommon and has received little attention from gynecologists. We report a case of uterine lipoleiomyoma with subsequent pelvic abscess after rupture of the appendix. Its clinical picture mimicked uterine malignancy. The patient was a 60-year-old woman, who presented with a 2-week period of lower abdominal pain which was exacerbated 10 days later. After admission, gynecologic examination revealed a large pelvic mass of firm consistency. On a plain film of the abdomen, there was a large calcified mass in the pelvis. Pelvic ultrasound demonstrated a 15 yen 12 yen 12 cm mass with strong echogenicity in the margin, but the central component of the mass was attenuating and revealed a poorly defined echogenic mass. A computed tomography scan of the pelvis demonstrated a well-encapsulated mass that was predominantly the density of fat (-65 Hounsfield unit) in the central part, with calcification present in the peripheral layer of the mass. There was also a cystic lesion measuring 3 yen 2.5 yen 1.5 cm in the right adnexal area. A preoperative diagnosis of uterine lipoleiomyoma with necrosis, liposarcoma of the uterus or teratocarcinoma of the ovary was made by the CT scan. A diagnostic dilatation and curettage (D&C) revealed a uterine cavity length of 12 cm by sounding, and the specimen showed no malignant tissue. Therefore, the preoperative suspicion of ovarian teratocarcinoma could be excluded. The patient underwent an exploratory laparotomy, multiple pockets of pelvic abscess, enlargement of the uterus and induration of omentum surrounding the appendix were found.(ABSTRACT TRUNCATED AT 250 WORDS)

[Expression of epithelial and nervous-system-related antigens on pleomorphic adenoma of the salivary glands--an analysis of 20 cases].

The expression of cytokeratin (40-52 kD), carcinoembryonic antigen (CEA), vimentin, neuron-specific enolase (NSE), S-100 protein, glial fibrillary acidic protein (GFAP) were investigated in 20 cases of pleomorphic adenoma of the salivary glands and 10 cases of normal salivary glands, in order to analyze and correlate the antigens' expressions with the probably histogenetic mechanisms of the various histopathological differentiations in pleomorphic adenoma of the salivary glands and their probably original cells in normal salivary glands. Immunohistochemistry has provided some evidence for the relationship of the tumor cells to normal salivary glands: In the normal glands, the acinic cells exhibited cytokeratin, CEA and focal, predominantly nuclear S-100 protein staining. In both normal glands and pleomorphic adenomas, the duct-lining cells were immunoreactive for cytokeratin, CEA and had both cytoplasmic and nuclear S-100 positivity; The myoepithelial cells of the normal glands as well as the periduct cells, epithelial nests/cords, squamous metaplasia and the stellate/spindle/cartilaginous cells in the myxomatous-chondroid areas of the pleomorphic adenoma contain immunoreactive vimentin, NSE, S-100 proteins and GFAP, and lesser amounts cytokeratin (40-52 kD)/CEA. The varicosities of the terminal axon may lie directly on the basal membrane, or penetrate the basal membrane and lie in direct contact with the effector cells (duct-acinar-myoepithelial cells) of the salivary glands. The peripheral neurons and axons of the autonomic nervous system were identified by vimentin, NSE, S-100 proteins and GFAP. The combination of epithelial cytokeratin and nervous system-related vimentin, NSE, S-100 and GFAP immunostaining in myoepithelium of the normal glands and in all component elements (particularly the periduct cells) of pleomorphic adenoma reflects pleomorphic adenoma of the salivary glands is an epithelial tumor, the probably original cells or the probably histogenetic mechanisms of the various histopathological differentiations is correlated not only with "duct-acinar-myoepithelial cells" but also with the neuroectoderm in the normal salivary glands."

Expression of various antigens by different components of uterine mixed müllerian tumors. An immunohistochemical study.

An immunohistochemical study of keratin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), vimentin, desmin, myoglobin and S-100 protein in 15 cases of uterine mixed Müllerian tumor was performed in order to analyze the expression of various antigens in different elements of this tumor. In general, the epithelial and mesenchymal components were separated easily by the presence of keratin/EMA or vimentin, respectively. However, in eight cases vimentin was expressed by epithelial cells and in four cases keratin by solid "sarcomatous" element. EMA was also identified in the "sarcomatous" areas of two cases. Specific differentiation was much easier to identify by immunohistochemical staining than by routine histologic examination. Areas with muscle differentiation were positive for desmin; myoglobin was identified in rhabdomyoblasts. S-100 protein was present in chondrosarcomatous and liposarcomatous areas. S-100 protein was also widely distributed in other elements. Quite diverse expression of various antigens revealed by immunohistochemistry reflects the histologic multiplicity of this tumor.

Eosinophilic gastroenteritis: report of two cases.

Eosinophilic gastroenteritis is a rare disease, not previously been reported on Taiwan. Two male cases are reported. One was 19 years old and the other one was 54 years old. Both patients responded to corticosteroid therapy.