Ming-Chao Huang

Concurrent Cisplatin-Based Chemoradiation for Cervical Carcinoma: Tumor Response, Toxicity, and Serum Cytokine Profiles

Purpose. To evaluate the relation between tumor response, treatment toxicity, and serum cytokine profiles in patients with cervical cancer receiving cisplatin-based chemoradiation. Patients and Methods. Forty-two patients with cervical carcinoma receiving chemoradiation were recruited. Hemogram, biochemistry profile, cytokine levels, tumor size, and toxicity were assessed weekly. Results. The absolute neutrophil count decreased accompanied by an increase in serum levels of G-CSF during chemoradiation. The sudden elevation of serum TGF-β 1 and VEGF levels after the first fraction of brachytherapy accompanied with the development of greater radiation therapy (RT) morbidity. Lower pretreatment TGF-β 1 and VEGF levels are associated with tumor response to chemoradiation. Conclusion. The serial changes in serum cytokines during chemoradiation may correlate with tumor regression and treatment morbidity.

Laparoscopic management of interstitial pregnancy

Interstitial pregnancy is relatively rare accounting for only 2—4% of all ectopic pregnancies. Conventionally it is treated by laparotomy with cornual resection or hysterectomy. Conservative medical management consists of systemic or local injection of methotrexate with an overall success rate of 83%. However if the serum h-hCG decreases slowly or the gestational sac continues to grow despite methotrexate surgery must be considered. Laparoscopic cornuostomy causes less cornual trauma than open surgery. However hemorrhage remains a major problem and has been the main cause of failure in this procedure. Most techniques use diluted intramyometrial vasopressin in the affected cornu to minimize blood loss. Bipolar electrocauterization tamponade with Surgicel fibrin glue and ligation of the ascending uterine artery have all been tried but these are not always sufficient to control hemorrhage particularly at the placental implantation site. (excerpt)

RECURRENT ECTOPIC PREGNANCY AFTER IPSILATERAL SEGMENTAL SALPINGECTOMY

OBJECTIVE We report an unusual case of recurrent ectopic pregnancy in the distal remnant after partial salpingectomy. CASE REPORT A 23-year-old woman underwent laparoscopic right partial salpingectomy because of right tubal pregnancy. She returned to our hospital 2 years later with a positive pregnancy test and lower abdominal pain. Transvaginal ultrasonography revealed no intrauterine gestational sac but a right adnexal mass measuring 2.4 x 2.3 cm. The serum beta-hCG (beta subunit of human chorionic gonadotropin) level was 2,918.06 mIU/mL. Videolaparoscopy was performed, and an ectopic pregnancy in the distal remnant of the right fallopian tube was identified. Right salpingectomy was effective and the pathologic report confirmed the diagnosis. The patients postoperative recovery was uneventful. CONCLUSION If conservative methods are not suitable for a patient with tubal pregnancy, total salpingectomy is the preferred option over partial salpingectomy. A remnant poses a risk for recurrent ectopic pregnancy owing to potential transperitoneal migration of either embryos or sperms.

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan.

Abstract Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long‐term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities.

Safety and efficacy of unidirectional barbed suture in mini-laparotomy myomectomy.

OBJECTIVE To estimate the safety and effectiveness of unidirectional knotless barbed suture compared to the traditional suture for repair of uterine wall defects through myomectomy via mini-laparotomy. MATERIALS AND METHODS This was a prospective clinical study performed by a single surgeon in a medical center. Sixty-eight women with symptomatic myoma were enrolled. Their uterine wall defects were repaired either by unidirectional knotless barbed suture (Group A) or by traditional suture (Group B). The surgical time, intraoperative blood loss, and number of myomas in the two groups were analyzed by two-sample t test. RESULTS Surgical time required from skin incision to complete closure was significantly lower in Group A than in Group B (50.2 ± 16.49 vs. 69.1 ± 25.33 min) (p = 0.0008). The intraoperative blood loss was also lower in Group A (mean, 260.9 mL; range, 20-850 mL) than in Group B (mean, 394.7 mL; range, 50-2200 mL) but not statistically significant. CONCLUSION The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.

Cri-du-chat (5p-) syndrome presenting with cerebellar hypoplasia and hypospadias: prenatal diagnosis and aCGH characterization using uncultured amniocytes.

We present prenatal diagnosis of a de novo distal deletion involving 5p(5p15.1→pter) using uncultured amniocytes in a pregnancy with cerebellar hypoplasia, hypospadias and facial dysmorphisms in the fetus. We discuss the genotype-phenotype correlation and the consequence of haploinsufficiency of CTNND2, SEMA5A, TERT, SRD5A1 and TPPP. We speculate that haploinsufficiency of SRD5A1 and TPPP may be responsible for hypospadias and cerebellar hypoplasia, respectively, in this case.

Osteogenesis imperfecta type II: prenatal diagnosis and association with increased nuchal translucency and hypoechogenicity of the cranium.

Department of Medicine, Mackay Medical College, New Taipei City, Taiwan Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Department of Biotechnology, Asia University, Taichung, Taiwan e School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan f Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan i Taiji Fetal Medicine Center, Taipei, Taiwan Pan Chun-Heng Obs/Gyn Clinics, New Taipei City, Taiwan Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan Department of Bioengineering, Tatung University, Taipei, Taiwan

Prenatal diagnosis of de novo interstitial deletions involving 5q23.1-q23.3 and 18q12.1-q12.3 by array CGH using uncultured amniocytes in a pregnancy with fetal interrupted aortic arch and atrial septal defect.

We present prenatal diagnosis of de novo interstitial deletions involving 5q23.1-q23.3 and 18q12.1-q12.3 by aCGH using uncultured amniocytes in pregnancy with interrupted aortic arch and atrial septal defect in a fetus. The fetus postnatally manifested facial dysmorphisms and long slender fingers. We discuss the genotype-phenotype correlation and the consequence of haploinsufficiency of FBN2, DTNA and CELF4 in this case.

Uterine sarcoma part III—Targeted therapy: The Taiwan Association of Gynecology (TAG) systematic review

Uterine sarcoma is a very aggressive and highly lethal disease. Even after a comprehensive staging surgery or en block cytoreduction surgery followed by multimodality therapy (often chemotherapy and/or radiation therapy), many patients relapse or present with distant metastases, and finally die of diseases. The worst outcome of uterine sarcomas is partly because of their rarity, unknown etiology, and highly divergent genetic aberration. Uterine sarcomas are often classified into four distinct subtypes, including uterine leiomyosarcoma, low-grade uterine endometrial stromal sarcoma, high-grade uterine endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Currently, evidence from tumor biology found that these tumors showed alternation and/or mutation of genomes and the intracellular signal pathway. In addition, some preclinical studies showed promising results for targeting receptor tyrosine kinase signaling, phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin pathway, various kinds of growth factor pathways, Wnt/beta-catenin signaling pathway, transforming growth factor β/bone morphogenetic protein signal pathway, aurora kinase A, MDM2 proto-oncogene, histone deacetylases, sex hormone receptors, certain types of oncoproteins, and/or loss of tumor suppressor genes. The current review is attempted to summarize the recurrent advance of targeted therapy for uterine sarcomas.

Discordant anencephaly and Cantrell syndrome in monozygotic twins conceived by ICSI and IVF-ET.

Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Department of Medicine, Mackay Medical College, New Taipei City, Taiwan Department of Biotechnology, Asia University, Taichung, Taiwan e School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan f Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan Gene Biodesign Co. Ltd, Taipei, Taiwan Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Department of Bioengineering, Tatung University, Taipei, Taiwan