Chang-Ching Yeh

Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors

Background: To investigate recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility‐sparing surgery. Methods: This was a retrospective study. All women with BOTs from 2000 to 2006 were evaluated. Clinical outcomes were compared among groups that underwent radical, unilateral salpingo‐oophorectomy, or ovarian cystectomy. The effects of clinical characteristics on recurrence were analyzed by independent t test, chi‐square test, and Cox proportional hazard model. Results: After a mean follow‐up period of 56.5 months, all 61 patients were alive. Seven (11.5%) had developed disease recurrence, and all were in the fertility‐sparing group. Of these, five were in the cystectomy‐only group and two in the unilateral salpingo‐oophorectomy group. There was significant difference in tumor recurrence rates between the two groups (hazard ratio: 0.26, 95% confidence interval: 0.11–0.61). Nine pregnancies were achieved in six women, resulting in five deliveries Conclusion: Fertility‐sparing surgery is an acceptable and safe option for women with BOTs who wish to preserve fertility. Unilateral salpingo‐oophorectomy must be considered as the first choice.

Robertsonian translocations: An overview of a 30-year experience in a single tertiary medical center in Taiwan

Background: Advanced maternal age (AMA) is the most frequent indication for amniocentesis in predicting balanced reciprocal translocations, and abnormal ultrasound findings are indications in predicting unbalanced reciprocal translocations; however, to date, no studies have focused on Robertsonian translocations. Methods: A retrospective review was conducted on 16,749 pregnant women who underwent midtrimester amniocentesis between January 1981 and December 2010. Robertsonian translocations were identified in 39 cases. Results: The percentage of Robertsonian translocations in all amniocentesis cases was 0.23% (39/16,749); 31 were balanced and eight were unbalanced. De novo abnormality occurred in 17 cases, or in 43.6% of all Robertsonian translocations. The two major indications for amniocentesis with a diagnosis of Robertsonian translocations were AMA (41.0%, n = 16) and a parent with abnormal karyotypes (18.0%, n = 7). The highest percentage of Robertsonian translocations was found in parents with abnormal karyotypes (2.8%, 7/252), but neither of the indications were clearly superior for detecting de novo Robertsonian translocations. Conclusion: Although AMA is an indication for amniocentesis in approximately two‐fifths of cases with Robertsonian translocations, the indication of parent with abnormal karyotypes was more likely to lead to the detection of non‐de novo Robertsonian translocations, suggesting that parents with abnormal karyotypes need careful prenatal consultation.

Changes in maternal serum insulin-like growth factor-I during pregnancy and its relationship to maternal anthropometry.

Background: Insulin‐like growth factor (IGF)‐I is primarily produced by the liver under the stimulation of growth hormone, and has systemic growth effects. Placental growth hormone in maternal circulation increases from early pregnancy and is responsible for the increment in maternal serum IGF‐I. The purpose of this study was to evaluate the changes in maternal serum IGF‐I during pregnancy and their relationship to maternal anthropometry, including body weight (BW) and body mass index (BMI). Methods: We obtained 332 blood samples from 114 expectant mothers at different gestational ages (Gas) without adverse medical history. Serum IGF‐I levels were measured by immunoradiometric assay. Linear regression analysis for continuous variables and t test for comparisons of categorical variables were used to test for significance. Results: Maternal serum IGF‐I during pregnancy was significantly correlated not only to GA (p < 0.001, r = 0.358), but also to maternal BW (p = 0.001, r = 0.202), and maternal BMI (p < 0.001, r = 0.263). The mean maternal IGF‐I was highest in the third trimester [1st vs. 2nd, p < 0.001, 95% confidence interval (CI) = −70.17 to −28.22; 1st vs. 3rd, p < 0.001, 95% CI = −138.02 to −76.94; 1st vs. 3rd, p < 0.001, 95% CI = −88.86 to −27.71]. Conclusion: Maternal serum IGF‐I is significantly related to GA, maternal BW, and BMI during pregnancy.

Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy

Background To analyze the pregnancy complications and pregnancy outcome relating to the disease activity of systemic lupus erythematosus before conception and during pregnancy. Methods Seventy‐two pregnancies were collected in a single tertiary medical center within a 5‐year period. Twelve pregnancies were terminated due to various causes in the first half of pregnancy. Analysis of pregnancy complications and pregnancy outcome relating to the lupus activity before conception and during pregnancy was made among the remaining 60 pregnancies with gestational length > 26 weeks. The assessment of lupus activity was based on the routine monitoring, including urine routine, white blood cell count, hemoglobin and platelet count, erythrocyte sediment rate, serum titers of C3, C4, and double‐stranded DNA. Monitoring of renal function with daily urinary protein loss and clearance rate of creatinine was needed when worsened nephropathy was suspected. Results The etiologies of the terminated pregnancies were deteriorated nephropathy (6 cases), involvement of central nervous system (1 case), unwanted pregnancy due to drug exposure (3 cases), and two early intrauterine fetal deaths (both during the 23rd week of gestation). Pregnancy complications were related to the lupus activity before conception [odds ratio = 0.238, 95% confidence interval (CI) = 0.073, 0.778, p = 0.014] and during pregnancy (odds ratio = 0.153, 95% CI = 0.031, 0.754, p = 0.012). Meanwhile, pregnancy outcome significantly related to the lupus activity of the preconception period and during pregnancy. The gestational length was significantly longer in the pregnancies with remitted lupus activity either before conception (38.2 ± 1.6 weeks vs. 36.3 ± 3.4 weeks, p = 0.011 and 95% CI = −3.454, −0.478) or during pregnancy (38.2 ± 1.6 weeks vs. 35.2 ± 3.8 weeks, p = 0.005 and with 95% CI = −4.988, −1.005). Significant relationships were also found between newborn birth weights and lupus activity preconceptionally (2940 ± 389 g vs. 2448 ± 674 g, p = 0.002 and 95% CI = −792, −192) and after having conceived (2960 ± 383 g vs. 2136 ± 585 g, p < 0.001 and 95% CI = −1081, −568). Multivariate analysis showed that lupus remission during pregnancy was correlated with a significantly longer gestation, since pregnant women with active lupus had a three‐fold greater risk of preterm deliveries (hazard ratio = 3.022, 95% CI = 1.261, 7.242) compared with pregnant women without active lupus. Conclusion In order to reduce the incidence of pregnancy complication, especially preterm delivery, and to gain good pregnancy outcome, good preparation before conception and good control of the disease during pregnancy are mandatory.

An 11-year experience with ovarian surgery during pregnancy.

Background: The management of ovarian tumors during pregnancy can be challenging because of the risk of fetal wastage and the possibility of surgery‐related complications, or a delayed diagnosis of a possibly lethal disease or malignancy. The aim of this study was to study the characteristics and outcomes of pregnant women undergoing surgical intervention for ovarian tumors during pregnancy. Methods: We reviewed the data of 102 pregnant women who underwent ovarian surgery between 2000 and 2010 at Taipei Veterans General Hospital, Taiwan. Data subject to analysis included gestational age at the time of surgery, complications, surgical and pathological findings, and the outcome of pregnancy. Results: Fifty‐two women who underwent surgery were excluded, whether by cesarean section, during the postpartum period or during simultaneous abortion surgery. Ultimately, the data of 50 patients were analyzed. Almost all patients (n = 46, 92%) were asymptomatic and underwent elective surgery. Frequently, this surgery was done in the second trimester (n = 35, 70%). We determined that teratoma (26%), mucinous cystadenomas (20%), and endometriomas (16%) were the three most common pathological findings. Nonspecific ovarian tumors were common (28%), including seven corpus luteum cysts, six simple cysts, and one paratubal cyst. Two women were diagnosed with malignant ovarian tumors, but both were metastatic and the primary site was the colon. Ten women underwent laparoscopic surgery. General anesthesia was used in four patients, and all underwent emergency exploratory laparotomy. There was no surgery‐related complication or instance of preterm labor. Conclusion: In our study cohort, surgical intervention during pregnancy was safe, since neither surgical approach, such as exploratory laparotomy or laparoscopic surgery, nor anesthesia methods, for example general anesthesia or spinal anesthesia showed negative impact on the pregnancy outcomes. Reported cases of malignant ovarian tumor are still rare, thus, the possibility of metastatic tumor should be considered first.

Estrogen Effects on Wound Healing

Wound healing is a physiological process, involving three successive and overlapping phases—hemostasis/inflammation, proliferation, and remodeling—to maintain the integrity of skin after trauma, either by accident or by procedure. Any disruption or unbalanced distribution of these processes might result in abnormal wound healing. Many molecular and clinical data support the effects of estrogen on normal skin homeostasis and wound healing. Estrogen deficiency, for example in postmenopausal women, is detrimental to wound healing processes, notably inflammation and re-granulation, while exogenous estrogen treatment may reverse these effects. Understanding the role of estrogen on skin might provide further opportunities to develop estrogen-related therapy for assistance in wound healing.

Dectin-1-Mediated Pathway Contributes to Fusarium proliferatum-Induced CXCL-8 Release from Human Respiratory Epithelial Cells

Fusarium species are causative agents of human respiratory disorders and are distributed widely in our environment. Little is known of their interaction with human respiratory epithelial cells, which may contribute to allergic airway responses. In this study, we report on the release of C–X–C motif chemokine ligand 8 (CXCL-8) from human bronchial epithelial BEAS-2B cells upon stimulation with Fusarium proliferatum extracts. F. proliferatum-induced cytokine release from BEAS-2B cells was determined by cytokine array and CXCL-8 enzyme-linked immunosorbent assay (ELISA) kits. Blocking antibodies and signaling pathway inhibitors were employed to delineate cell surface receptors and signaling pathways participating in CXCL-8 release. F. proliferatum extracts induced the release of CXCL-8 in a time-dependent manner. The dectin-1 receptor ligands, curdlan and laminarin, reduced CXCL-8 release. Cells pre-treated with anti-Dectin-1 antibodies (2 µg/mL) decreased CXCL-8 release by 24%. Furthermore, F. proliferatum-stimulated CXCL-8 release was reduced by 32%, 53%–81%, 40% and 26% after BEAS-2B cells were pretreated with activation inhibitors of spleen tyrosine kinase (Syk)—piceatannol—, mitogen-activated protein kinases (MAPKs)—PD98059, U0126, SB202190, SP600125—, phosphatidylinositol-3-kinase (PI3K)—LY294002—and nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB)—BAY117082—, respectively. These results suggest that Dectin-1-mediated activation of the Syk, MAPKs, PI3K and NF-κB signaling pathways contributes to F. proliferatum-stimulated CXCL-8 release from BEAS-2B cells and provides an important basis for developing novel therapeutic strategies in clinical allergy.

Synchronous breast invasive ductal carcinoma and endometrial endometrioid adenocarcinoma: Case report

Diagnosis of synchronous primary cancers in one patient is a relatively rare event. The well‐known synchronous primary cancers of women are combined ovarian and endometrial cancers, especially when both are the endometrioid cell type. Although breast cancer and endometrial cancer are two common female malignancies, they often occur during the postmenopausal period. Therefore, the possibility of concomitant breast cancer and endometrial cancer in a younger woman (premenopausal) is often neglected. The reported case is an example of this situation. A 37‐year‐old woman was diagnosed with synchronous breast invasive ductal carcinoma and endometrial endometrioid adenocarcinoma. Since this condition is rarely reported, the correlated risk factors are worthy of our attention and the strategy for prevention is highlighted.

Perspective of Taiwan's experience in the management of meconium peritonitis

Meconium peritonitis, a rare condition with an incidence of 1 in 30,000 births, is an aseptic chemical peritonitis resulting from intrauterine bowel perforation, associated with significant neonatal risk with morbidity and mortality [1]. Based on our search of PubMed (1970eMay 2017; search terms: “meconium peritonitis,” “Taiwan”; https://www.ncbi.nlm.nih.gov/pubmed/? term1⁄4meconiumþperitonitis%2CþTaiwan), there are a few cases of fetal meconium peritonitis available in Taiwan [2e16]. To share the Taiwans experience in the management of meconium peritonitis, we would like to report one new case and update this topic. A 32-year-old, gravida 1, womanwith 32 gestational weeks was referred to the Taipei Veterans General Hospital for further management, because of accidental findings of fetal dilated bowel loops and maternal polyhydramnios. Prenatal ultrasound confirmed fetal dilated bowel loops, abdominal pseudocyst and maternal polyhydramnios (amniotic fluid index of 29 cm). Two weeks later, repeat ultrasound showed the similar findings. After thorough and detailed discussion, the male neonate weighting 2560 g was delivered at 35 weeks of gestation by cesarean section. Apgar scores were 7 at 1 min and 9 at 5 min. The newborn was transferred to the neonatal intensive care unit for further treatment. Physical examination showed abdominal distension. Therapeutic trial of gastrograffin by nasogastrotube feeding was done and the following abdominal radiograph revealed dilated loops of small and large bowel. He was started on metronidazole and underwent laparotomy 24 h after birth. Meconium peritonitis with cyst calcification in the central abdomen was noted. There were jejunum atresia, bowel necrosis, and bowel perforation. Resection of jejunum and an end-to-end anastomosis were performed. Postoperative recovery was unremarkable. The newborn has a normal development 5 months after birth. In Taiwan, the first English article addressing the diagnosis and management of meconium peritonitis was reported by Yeh and Chen in 1982 [2]. Wu CC first reported the typical sonographic findings of generalized meconium peritonitis in 1988 [3]. Professor Hsieh shared the experience of prenatal diagnosis and postnatal management of surgically correctable fetal malformations, including meconium peritonitis [4]. Hsu and colleagues have summarized 20 cases of meconium peritonitis addressing the outcomes of these newborns after surgical intervention [5]. The authors concluded that early aggressive operation and meticulous postoperative care had a better survival after 1986 (nomortality [0/6] after 1986 vs. mortality rate of 42.9% [6/14] between 1980 and 1986) [5]. Lin and colleagues reported a prenatal ultrasound diagnosis of meconium peritonitis in the second trimester, and found fetal meconium peritonitis could bemade by the findings of fetal ascites, intra-abdominal calcification and maternal polyhydramnios [6].