ObjectivesThis case report describes the clinical presentation, diagnosis and management of a cas... more ObjectivesThis case report describes the clinical presentation, diagnosis and management of a case of acute rubella infection in the second trimester. The complex issues of prenatal diagnosis of a congenital rubella infection are discussed.MethodsA 30‐year‐old woman presented with a fine macular rash at 15 weeks' gestation. Laboratory testing included maternal rubella‐specific IgG and IgM detection (booking blood and acute‐phase sample) together with measurement of IgG avidity. Prenatal diagnosis at 19 weeks (amniocentesis) and 23 weeks (amniocentesis and fetal blood) was done using a reverse‐transcriptase polymerase chain reaction to detect rubella‐specific RNA. The fetal blood sample was also tested for rubella‐specific IgM.ResultsMaternal serological results confirmed an acute rubella infection at 15 weeks' gestation. Rubella‐specific RNA and IgM were detected in the fetal blood taken at 23 weeks' gestation. However, no rubella RNA was detected in either of the amniot...
With the advances in imaging technology, resolution and identification of images have improved. B... more With the advances in imaging technology, resolution and identification of images have improved. Breast ultrasound as a screening tool for breast cancer is a very popular topic. A few years ago, the Health Promotion Administration of the Ministry of Health and Welfare attempted to integrate related specialties countrywide, including obstetrics and gynecology, family medicine, radiology, and breast surgery, to formulate common criteria for developing an ultrasound-based breast cancer screening guideline suitable for women in Taiwan. Since 2003, the Taiwan Association of Obstetrics and Gynecology has been offering breast ultrasound examination technique training to medical specialists. Headed by Professor Fon-Jou Hsieh, the instructors' training classes were established, and the first training was complete for the charter group of approximately 20 obstetricianegynecologists in breast ultrasound examination. With the strong support of two breast surgeons, Professors King-Jen Chang and Ming-Feng Hou, and locations chosen by the Taiwan Society of Ultrasound in Medicine for practical ultrasound field training, we were able to become familiar with performing breast ultrasound examinations within a very short time. The author was the class leader of the training class, and was responsible for the smooth implementation of the program and arrangement of subsequent ultrasound field trainings. In 2008e2009, the Taiwan Association of Obstetrics and Gynecology completed the two-level "basic" and "advanced" Conflicts of interest: The author declares no conflicts of interest.
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interva... more In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interval between menopause and the onset of abnormal vaginal bleeding in postmenopausal women, 381 cases with a complete medical history and available histologic findings were enrolled in this study at the National Taiwan University Hospital from 1989 to 1991. The results showed that 212 (55.6%) of these women had normal histologic findings and 83 (21.9%) had benign pathologic findings, whereas 14 (3.6%) had cervical intraepithelial neoplasia (CIN), 42 (11%) had endometrial hyperplasia, 19 (5%) had cervical cancer and 11 (2.9%) had endometrial cancer. Twenty-nine (7.6%) of the cases suffered from either CIN III or cervical cancer; this number was twice as high as those with endometrial atypical hyperplasia and endometrial cancer (n = 13, 3.4%). In addition, various risk factors, especially obesity, were found to be significantly correlated with malignancy. Fractional curettage should be perform...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
Although cervical pregnancies account for a very small number of the ectopic pregnancies, they so... more Although cervical pregnancies account for a very small number of the ectopic pregnancies, they sometimes result in a tragic outcome due to the difficulty of surgical treatment and subsequent intractable hemorrhage. We report our experience with four cases of cervical pregnancy which were treated successfully with methotrexate. All four patients had a history of a previous abortion and two had previously had a cesarean section. High-resolution transabdominal and transvaginal color Doppler ultrasound was used for diagnosis, and the serial beta-human chorionic gonadotropin levels were checked to monitor the therapeutic effect. Hysterectomy was avoided, and the reproductive capability of these patients was preserved. Chemotherapy was well tolerated except for mild stomatitis in one case and a transient elevation of liver enzymes in another case. One patient delivered a healthy female infant two years after treatment. In conclusion, previous curettage and a low segment cesarean section m...
Journal of the Formosan Medical Association = Taiwan yi zhi
Vascular endothelial damage is reported to be the prime cause of preeclampsia, and elevated level... more Vascular endothelial damage is reported to be the prime cause of preeclampsia, and elevated levels of fibronectin have been found before clinical signs of preeclampsia were manifested. The total plasma fibronectin concentrations in 212 blood samples from 173 normotensive healthy pregnant women at various gestational ages were measured. Fibronectin levels were also determined for 20 blood samples from 20 preeclamptic patients obtained at the time of clinical manifestation of preeclampsia. Blood samples from 46 non pregnant women of reproductive age were used as controls. The results showed that the total plasma fibronectin concentration during reproductive age was independent of age and the average level during pregnancy decreased with gestational age. Preeclamptic patients had a significantly elevated level of total fibronectin compared with healthy pregnant women. The total fibronectin concentration is a promising biochemical marker for preeclampsia, but a more specific endothelial...
Prenatal sonographic diagnoses of two cases of severe limb defects after first-trimester chorioni... more Prenatal sonographic diagnoses of two cases of severe limb defects after first-trimester chorionic villus sampling (CVS) are presented. Pathological examination after elective termination correlated well with the prenatal sonographic findings. Although the relationship between CVS and limb defects remains controversial, careful ultrasound examination for possible limb defects in cases receiving CVS is recommended.
To establish normative data for the width of the fetal cavum septi pellucidi at various gestation... more To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.
To investigate interfetal hemodynamics in acardiac twins and the implications for pathogenesis. A... more To investigate interfetal hemodynamics in acardiac twins and the implications for pathogenesis. A retrospective study. All acardiac twins involved in this study were identified by B-mode ultrasound at a teaching hospital in Taiwan. Color Doppler imaging and, in one case, color power angiography were used to assess umbilical blood flow between acardiac twins and their normal co-twins. Placental anastomoses were examined by pathologists after delivery. In total five sets of acardiac twins and their normal co-twins were enrolled. Autonomous cardiac activity in the form of a contractile pocket was detected in two cases. Analysis of the pattern of the Doppler waveforms in each case enabled us to classify the type of hemodynamics into one of three categories: 'collision-summation', typified by a pattern of cyclic alternations of bidirectional flow; 'twin-pulse', which described the simultaneous recordings of two opposite constant flows with different pulsating rates; and the 'pump in' pattern, which indicated pulsatile flow in the reversed direction towards the acardiac mass. In two cases we detected, we believe for the first time, an artery-to-vein placental anastomosis between the acardiac twin and its co-twin. The nature of the vascular connections were confirmed on pathological follow-up. Our observations suggest that acardiac twins may be not only the result of but also the cause of placental vascular anastomoses, which may involve either artery-to-artery or artery-to-vein anastomoses.
Renal blood flow is very important to fetal hemodynamics. To assess the development of fetal rena... more Renal blood flow is very important to fetal hemodynamics. To assess the development of fetal renal vascularization and blood flow in normal gestation, we measured the fetal renal vascularization and blood flow in healthy fetuses using three-dimensional (3-D) power Doppler sonography and quantitative 3-D power Doppler histogram analysis. This study was undertaken with a prospective, cross-sectional design. In total, 106 healthy singletons with gestational ages between 20 and 40 weeks were included. The 3-D power Doppler sonography and quantitative histogram analyses were used to assess the fetal renal vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) in each case. Our results showed that all the VI, FI and VFI increased significantly with gestational age (GA). Using GA as the independent variable, the linear regression equations for fetal renal VI, FI and VFI were VI = 0.214 x GA - 3.5289 (r = 0.84, n = 106, p < 0.0001); FI = 0.3326 x GA + 35.224 (r = 0.33, n = 106, p < 0.001); and VFI = 0.1047 x GA - 1.8064 (r = 0.82, n = 106, p < 0.0001). Our study indicates that normal fetal renal vasculature and blood flow increase with the advancement of gestational age. In addition to our previous study for fetal renal volume using 3-D sonography, our data in this series may serve as a reference for further studies of fetal renal blood flow in abnormal conditions.
Journal of Maternal-Fetal and Neonatal Medicine, 2000
Objective: To establish normative data of maternal serum chorionic gonadotropin (hCG) during the ... more Objective: To establish normative data of maternal serum chorionic gonadotropin (hCG) during the second trimester in an Asian population. Methods: We measured the maternal serum hCG levels in 17,955 normal singleton pregnancies between 15 and 21 weeks of gestation. The gestation age was estimated by measurement of fetal biparietal distance (BPD) in all cases. Median values of hCG at various gestational weeks were calculated and the values of hCG were converted to multiple of median (MoM). The incidences of low MoM value and high MoM value were also calculated. Results: The mean and median values of hCG were 57,153 mIU/ml and 50,120 mIU/ml, respectively, at 15 weeks of gestation and then decreased to 30,898 mIU/ml and 26,226 mIU/ml, respectively, at 21 weeks. We found 8.6% and 9.4% of normal singleton pregnancies have hCG MoM values Ͼ2.0 MoM and Ͻ0.5 MoM, respectively. Conclusions: Our report provides a normal reference data of second trimester maternal hCG levels by ultrasound dating in an Asian population.
Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of ... more Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks' gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.
We present a case of recurrent meconium peritonitis detected in the second trimester and treated ... more We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove imtating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome. KEY woms-Meconium peritonitis, recurrent, cystic fibrosis, intrauterine intervention.
Background: SEN virus (SENV) is a newly discovered DNA virus. We conducted this study to evaluate... more Background: SEN virus (SENV) is a newly discovered DNA virus. We conducted this study to evaluate potential modes of SENV transmission and the pathogenic effect of SENV on liver diseases in children. Methods: Polymerase chain reaction was used to detect 2 SENV variant (SENV-D and SENV-H) DNA in sera from healthy individuals and diseased children. Nucleotide sequence of SENV was determined by direct sequencing. Results: SENV infection was assessed in healthy individuals, including 50 newborns (sera collected from the umbilical cord), 24 infants, 46 preschool children (aged 1-6 years), 42 school children of an age before that of the first sexual experience (aged 7-12 years), 62 adolescents (13-18 years), 72 young adults (19-30 years) and 32 adults (Ͼ30 years). The prevalence of SENV-D and/or SENV-H (SENV-D/H) viremia in each group was 0%, 17%, 24%, 24%, 27%, 33% and 40%, respectively. The prevalence of SENV-D/H viremia in 18 children with non-A to E hepatitis, 64 thalassemic children, 80 children transfused during cardiac surgery, 30 children with chronic hepatitis B, 9 children with chronic hepatitis C and 32 infants with biliary atresia was 11%, 61%, 80%, 83%, 67% and 50%, respectively. SENV was found more frequently in all patient groups than in 174 age-matched controls (P Ͻ 0.01), with the exception of non-A to E hepatitis (11% versus 24% in the control group; P ϭ 0.27). In 2 infants with proven intrauterine hepatitis B viral infection, identical SENV-D nucleotide sequence existed in both the maternal and neonate serum. Elevated alanine aminotransferase concentrations were rarely observed in children who acquired isolated SENV viremia because of transfusion for surgery. Infection with SENV in children with chronic hepatitis C virus or hepatitis B viral infection was not associated with higher peak alanine aminotransferase values. Conclusion: SENV is transmitted mainly via nonparenteral daily contact and frequently occurs early in life. Transfusion can significantly increase the rate of SENV viremia. SENV does not appear to cause hepatitis in children.
Introduction. Biopsychological and sociocultural factors have been reported to be associated with... more Introduction. Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. Aim. To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). Methods. Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. Main Outcome Measures. CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Results. After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P = 0.0004), arousal (P = 0.0104), lubrication (P = 0.0016), orgasm (P = 0.0022), and pain (P < 0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P = 0.0005) and satisfaction (P < 0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P < 0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P < 0.0005). Medical conditions were positive predictors of sexual desire (P = 0.0023). Conclusions. The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.
ABSTRACT Breast cancer (BC) has become a global disease among women. Cost-effective strategies in... more ABSTRACT Breast cancer (BC) has become a global disease among women. Cost-effective strategies in reducing mortality caused by BC are highly desirable. Here, we suggest a working program based on an overall evaluation of the shortcomings and advantages of the current strategy for BC screening in Taiwan. From 1995 to 2002, cervical cancer was the most frequent cancer in women in Taiwan. However, invasive BC has moved from the second-most to the most frequent cancer since 2003. The incidence of BC increased by 14.69% between 2003 and 2008. In the same time interval, the incidence of cervical cancer decreased by 4.59%. Age analysis for BC incidence showed that 11% were at a relatively young age (30–39 years) and the peak incidence was in the group aged 40–49 years. Furthermore, only 31% of patients were at stage I according to data for newly diagnosed patients at National Taiwan University Hospital for 2004–2009. With the increase in pregnancy at an advanced maternal age, obstetrician–gynecologists should be alert to the possibility of coexisting BC and pregnancy. To facilitate early detection of BC, a campaign for “Three points examined together” should be implemented. Obstetrician–gynecologists should perform breast examination including palpation and ultrasound examination at the same time as the annual Pap smear. Mammography should be performed every 2–3 years or when indicated. If suspicious lesions are found, patients should be referred to a breast imaging laboratory, where a definitive diagnosis can be established. For confirmed cases of BC, appropriate surgery, chemotherapy and radiotherapy should be provided. In short, active participation of obstetrician–gynecologists is a must in the campaign against BC in Taiwan.
Methods: Sixty two pediatric patients from 55 unrelated families were enrolled for this study aft... more Methods: Sixty two pediatric patients from 55 unrelated families were enrolled for this study after obtaining written informed consent. Diagnosis of WD was based on clinical and biochemical analysis. Mutation screening was carried out for all exons (including the flanking splice sites) as well as the promoter region using a combination of Single Strand Conformation Polymorphism (SSCP) and Conformation Sensitive Gel Electrophoresis (CSGE). Sequencing was performed for samples showing mobility shift either in SSCP or CSGE. Detected sequence changes were also studied in 60 unrelated healthy adult controls. Results: Causative mutations were identified in 52 out of 62 (83.87%) samples studied. None of these mutations were detected in controls. A total of 25 different types of mutations were observed, including 14 missense, 3 nonsense, 2 splice site, 5 deletions and 1 insertion. Most of these mutations were identified in exon 2, followed by exon 14. Thirteen (52%) of the detected mutations were novel. In addition, fourteen sequence changes which are considered as non pathogenic were also observed. Conclusions: Commonly reported mutations H1069Q (Caucasian population) and R778L (Asian) were not detected in this study. A very heterogeneous spectrum of mutations emerged with varying clinical manifestations. Thus, genotype phenotype correlation could not be distinctly delineated. Our preliminary study on pediatric subjects indicates that there is a possibility that exon 2 (p.C271X) and exons 14 (p.G1061E) mutations maybe the most common in Indian population. The result of this study will widen the knowledge of molecular basis of pediatric Indian patients with WD. In a heterogeneous population like India, molecular studies can provide an accurate diagnosis, counseling, prenatal diagnosis and early treatment for WD.
To examine the inhibitory effect of anticonvulsants (AEDs) on carnitine transport by the human pl... more To examine the inhibitory effect of anticonvulsants (AEDs) on carnitine transport by the human placental carnitine transporter. Uptake of radiolabeled carnitine by human placental brush-border membrane vesicles was measured in the absence and presence of tiagabine (TGB), vigabatrin (VGB), gabapentin (GBP), lamotrigine (LTG), topiramate (TPM), valproic acid (VPA), and phenytoin (PHT). The mechanism of the inhibitory action of TGB was determined. Most of the AEDs inhibited placental carnitine transport. Kinetic analyses showed that TGB had the greatest inhibitory effect [50% inhibitory concentration (IC50, 190 microM)], and the order of inhibitory potency was TGB &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; PHT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; GBP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; VPA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; VGB, TPM &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; LTG. Further studies showed that TGB competitively inhibited carnitine uptake by the human placental carnitine transporter, suggesting that it may be a substrate for this carrier. Although the involvement of carnitine deficiency in fetal anticonvulsant syndrome requires further evaluation, potential interference with placental carnitine transport by several AEDs was demonstrated. Despite the higher inhibitory potency of TGB, given the therapeutic unbound concentrations, the results for VPA and PHT are probably more clinically significant.
To evaluate donor cell engraftment and the kinetics of cell repopulation in the injured mouse liv... more To evaluate donor cell engraftment and the kinetics of cell repopulation in the injured mouse liver following human umbilical cord blood cell transplantation. Nonobese diabetic/severe immunodeficient mice were treated with allyl alcohol to induce liver injury. Twenty-four hours later, umbilical cord blood derived mononuclear cells were transplanted by intra-splenic injection. Mice were sacrificed from 1 to 180 days after transplantation. Temporal changes in the ratio of human cells and fluorescence counts of human sex-determining region Y alleles in mouse liver were determined to evaluate the kinetics of cell repopulation. Mouse liver and sera were examined for the presence of human albumin. Human cell repopulation was extremely rapid in the first week following transplantation, with a doubling time of 1.16-1.39 days apparent. Thereafter cell doubling rate slowed significantly. Cells displaying characteristics of human hepatocytes were still evident at 180 days. Human albumin was detected in mouse liver and sera. These findings confirm those from previous studies demonstrating that cells derived from human umbilical cord blood have the capacity to differentiate into cells with human hepatocyte characteristics in mouse liver following injury. Moreover, the detailed information collected regarding the kinetics of human cell repopulation in mouse liver will be of relevance to future studies examining the use of umbilical cord blood cells in liver transplantation therapy.
ObjectivesThis case report describes the clinical presentation, diagnosis and management of a cas... more ObjectivesThis case report describes the clinical presentation, diagnosis and management of a case of acute rubella infection in the second trimester. The complex issues of prenatal diagnosis of a congenital rubella infection are discussed.MethodsA 30‐year‐old woman presented with a fine macular rash at 15 weeks' gestation. Laboratory testing included maternal rubella‐specific IgG and IgM detection (booking blood and acute‐phase sample) together with measurement of IgG avidity. Prenatal diagnosis at 19 weeks (amniocentesis) and 23 weeks (amniocentesis and fetal blood) was done using a reverse‐transcriptase polymerase chain reaction to detect rubella‐specific RNA. The fetal blood sample was also tested for rubella‐specific IgM.ResultsMaternal serological results confirmed an acute rubella infection at 15 weeks' gestation. Rubella‐specific RNA and IgM were detected in the fetal blood taken at 23 weeks' gestation. However, no rubella RNA was detected in either of the amniot...
With the advances in imaging technology, resolution and identification of images have improved. B... more With the advances in imaging technology, resolution and identification of images have improved. Breast ultrasound as a screening tool for breast cancer is a very popular topic. A few years ago, the Health Promotion Administration of the Ministry of Health and Welfare attempted to integrate related specialties countrywide, including obstetrics and gynecology, family medicine, radiology, and breast surgery, to formulate common criteria for developing an ultrasound-based breast cancer screening guideline suitable for women in Taiwan. Since 2003, the Taiwan Association of Obstetrics and Gynecology has been offering breast ultrasound examination technique training to medical specialists. Headed by Professor Fon-Jou Hsieh, the instructors' training classes were established, and the first training was complete for the charter group of approximately 20 obstetricianegynecologists in breast ultrasound examination. With the strong support of two breast surgeons, Professors King-Jen Chang and Ming-Feng Hou, and locations chosen by the Taiwan Society of Ultrasound in Medicine for practical ultrasound field training, we were able to become familiar with performing breast ultrasound examinations within a very short time. The author was the class leader of the training class, and was responsible for the smooth implementation of the program and arrangement of subsequent ultrasound field trainings. In 2008e2009, the Taiwan Association of Obstetrics and Gynecology completed the two-level "basic" and "advanced" Conflicts of interest: The author declares no conflicts of interest.
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interva... more In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interval between menopause and the onset of abnormal vaginal bleeding in postmenopausal women, 381 cases with a complete medical history and available histologic findings were enrolled in this study at the National Taiwan University Hospital from 1989 to 1991. The results showed that 212 (55.6%) of these women had normal histologic findings and 83 (21.9%) had benign pathologic findings, whereas 14 (3.6%) had cervical intraepithelial neoplasia (CIN), 42 (11%) had endometrial hyperplasia, 19 (5%) had cervical cancer and 11 (2.9%) had endometrial cancer. Twenty-nine (7.6%) of the cases suffered from either CIN III or cervical cancer; this number was twice as high as those with endometrial atypical hyperplasia and endometrial cancer (n = 13, 3.4%). In addition, various risk factors, especially obesity, were found to be significantly correlated with malignancy. Fractional curettage should be perform...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
Although cervical pregnancies account for a very small number of the ectopic pregnancies, they so... more Although cervical pregnancies account for a very small number of the ectopic pregnancies, they sometimes result in a tragic outcome due to the difficulty of surgical treatment and subsequent intractable hemorrhage. We report our experience with four cases of cervical pregnancy which were treated successfully with methotrexate. All four patients had a history of a previous abortion and two had previously had a cesarean section. High-resolution transabdominal and transvaginal color Doppler ultrasound was used for diagnosis, and the serial beta-human chorionic gonadotropin levels were checked to monitor the therapeutic effect. Hysterectomy was avoided, and the reproductive capability of these patients was preserved. Chemotherapy was well tolerated except for mild stomatitis in one case and a transient elevation of liver enzymes in another case. One patient delivered a healthy female infant two years after treatment. In conclusion, previous curettage and a low segment cesarean section m...
Journal of the Formosan Medical Association = Taiwan yi zhi
Vascular endothelial damage is reported to be the prime cause of preeclampsia, and elevated level... more Vascular endothelial damage is reported to be the prime cause of preeclampsia, and elevated levels of fibronectin have been found before clinical signs of preeclampsia were manifested. The total plasma fibronectin concentrations in 212 blood samples from 173 normotensive healthy pregnant women at various gestational ages were measured. Fibronectin levels were also determined for 20 blood samples from 20 preeclamptic patients obtained at the time of clinical manifestation of preeclampsia. Blood samples from 46 non pregnant women of reproductive age were used as controls. The results showed that the total plasma fibronectin concentration during reproductive age was independent of age and the average level during pregnancy decreased with gestational age. Preeclamptic patients had a significantly elevated level of total fibronectin compared with healthy pregnant women. The total fibronectin concentration is a promising biochemical marker for preeclampsia, but a more specific endothelial...
Prenatal sonographic diagnoses of two cases of severe limb defects after first-trimester chorioni... more Prenatal sonographic diagnoses of two cases of severe limb defects after first-trimester chorionic villus sampling (CVS) are presented. Pathological examination after elective termination correlated well with the prenatal sonographic findings. Although the relationship between CVS and limb defects remains controversial, careful ultrasound examination for possible limb defects in cases receiving CVS is recommended.
To establish normative data for the width of the fetal cavum septi pellucidi at various gestation... more To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.
To investigate interfetal hemodynamics in acardiac twins and the implications for pathogenesis. A... more To investigate interfetal hemodynamics in acardiac twins and the implications for pathogenesis. A retrospective study. All acardiac twins involved in this study were identified by B-mode ultrasound at a teaching hospital in Taiwan. Color Doppler imaging and, in one case, color power angiography were used to assess umbilical blood flow between acardiac twins and their normal co-twins. Placental anastomoses were examined by pathologists after delivery. In total five sets of acardiac twins and their normal co-twins were enrolled. Autonomous cardiac activity in the form of a contractile pocket was detected in two cases. Analysis of the pattern of the Doppler waveforms in each case enabled us to classify the type of hemodynamics into one of three categories: &#39;collision-summation&#39;, typified by a pattern of cyclic alternations of bidirectional flow; &#39;twin-pulse&#39;, which described the simultaneous recordings of two opposite constant flows with different pulsating rates; and the &#39;pump in&#39; pattern, which indicated pulsatile flow in the reversed direction towards the acardiac mass. In two cases we detected, we believe for the first time, an artery-to-vein placental anastomosis between the acardiac twin and its co-twin. The nature of the vascular connections were confirmed on pathological follow-up. Our observations suggest that acardiac twins may be not only the result of but also the cause of placental vascular anastomoses, which may involve either artery-to-artery or artery-to-vein anastomoses.
Renal blood flow is very important to fetal hemodynamics. To assess the development of fetal rena... more Renal blood flow is very important to fetal hemodynamics. To assess the development of fetal renal vascularization and blood flow in normal gestation, we measured the fetal renal vascularization and blood flow in healthy fetuses using three-dimensional (3-D) power Doppler sonography and quantitative 3-D power Doppler histogram analysis. This study was undertaken with a prospective, cross-sectional design. In total, 106 healthy singletons with gestational ages between 20 and 40 weeks were included. The 3-D power Doppler sonography and quantitative histogram analyses were used to assess the fetal renal vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) in each case. Our results showed that all the VI, FI and VFI increased significantly with gestational age (GA). Using GA as the independent variable, the linear regression equations for fetal renal VI, FI and VFI were VI = 0.214 x GA - 3.5289 (r = 0.84, n = 106, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001); FI = 0.3326 x GA + 35.224 (r = 0.33, n = 106, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001); and VFI = 0.1047 x GA - 1.8064 (r = 0.82, n = 106, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Our study indicates that normal fetal renal vasculature and blood flow increase with the advancement of gestational age. In addition to our previous study for fetal renal volume using 3-D sonography, our data in this series may serve as a reference for further studies of fetal renal blood flow in abnormal conditions.
Journal of Maternal-Fetal and Neonatal Medicine, 2000
Objective: To establish normative data of maternal serum chorionic gonadotropin (hCG) during the ... more Objective: To establish normative data of maternal serum chorionic gonadotropin (hCG) during the second trimester in an Asian population. Methods: We measured the maternal serum hCG levels in 17,955 normal singleton pregnancies between 15 and 21 weeks of gestation. The gestation age was estimated by measurement of fetal biparietal distance (BPD) in all cases. Median values of hCG at various gestational weeks were calculated and the values of hCG were converted to multiple of median (MoM). The incidences of low MoM value and high MoM value were also calculated. Results: The mean and median values of hCG were 57,153 mIU/ml and 50,120 mIU/ml, respectively, at 15 weeks of gestation and then decreased to 30,898 mIU/ml and 26,226 mIU/ml, respectively, at 21 weeks. We found 8.6% and 9.4% of normal singleton pregnancies have hCG MoM values Ͼ2.0 MoM and Ͻ0.5 MoM, respectively. Conclusions: Our report provides a normal reference data of second trimester maternal hCG levels by ultrasound dating in an Asian population.
Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of ... more Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks&#39; gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.
We present a case of recurrent meconium peritonitis detected in the second trimester and treated ... more We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove imtating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome. KEY woms-Meconium peritonitis, recurrent, cystic fibrosis, intrauterine intervention.
Background: SEN virus (SENV) is a newly discovered DNA virus. We conducted this study to evaluate... more Background: SEN virus (SENV) is a newly discovered DNA virus. We conducted this study to evaluate potential modes of SENV transmission and the pathogenic effect of SENV on liver diseases in children. Methods: Polymerase chain reaction was used to detect 2 SENV variant (SENV-D and SENV-H) DNA in sera from healthy individuals and diseased children. Nucleotide sequence of SENV was determined by direct sequencing. Results: SENV infection was assessed in healthy individuals, including 50 newborns (sera collected from the umbilical cord), 24 infants, 46 preschool children (aged 1-6 years), 42 school children of an age before that of the first sexual experience (aged 7-12 years), 62 adolescents (13-18 years), 72 young adults (19-30 years) and 32 adults (Ͼ30 years). The prevalence of SENV-D and/or SENV-H (SENV-D/H) viremia in each group was 0%, 17%, 24%, 24%, 27%, 33% and 40%, respectively. The prevalence of SENV-D/H viremia in 18 children with non-A to E hepatitis, 64 thalassemic children, 80 children transfused during cardiac surgery, 30 children with chronic hepatitis B, 9 children with chronic hepatitis C and 32 infants with biliary atresia was 11%, 61%, 80%, 83%, 67% and 50%, respectively. SENV was found more frequently in all patient groups than in 174 age-matched controls (P Ͻ 0.01), with the exception of non-A to E hepatitis (11% versus 24% in the control group; P ϭ 0.27). In 2 infants with proven intrauterine hepatitis B viral infection, identical SENV-D nucleotide sequence existed in both the maternal and neonate serum. Elevated alanine aminotransferase concentrations were rarely observed in children who acquired isolated SENV viremia because of transfusion for surgery. Infection with SENV in children with chronic hepatitis C virus or hepatitis B viral infection was not associated with higher peak alanine aminotransferase values. Conclusion: SENV is transmitted mainly via nonparenteral daily contact and frequently occurs early in life. Transfusion can significantly increase the rate of SENV viremia. SENV does not appear to cause hepatitis in children.
Introduction. Biopsychological and sociocultural factors have been reported to be associated with... more Introduction. Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. Aim. To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). Methods. Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. Main Outcome Measures. CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Results. After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P = 0.0004), arousal (P = 0.0104), lubrication (P = 0.0016), orgasm (P = 0.0022), and pain (P < 0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P = 0.0005) and satisfaction (P < 0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P < 0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P < 0.0005). Medical conditions were positive predictors of sexual desire (P = 0.0023). Conclusions. The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.
ABSTRACT Breast cancer (BC) has become a global disease among women. Cost-effective strategies in... more ABSTRACT Breast cancer (BC) has become a global disease among women. Cost-effective strategies in reducing mortality caused by BC are highly desirable. Here, we suggest a working program based on an overall evaluation of the shortcomings and advantages of the current strategy for BC screening in Taiwan. From 1995 to 2002, cervical cancer was the most frequent cancer in women in Taiwan. However, invasive BC has moved from the second-most to the most frequent cancer since 2003. The incidence of BC increased by 14.69% between 2003 and 2008. In the same time interval, the incidence of cervical cancer decreased by 4.59%. Age analysis for BC incidence showed that 11% were at a relatively young age (30–39 years) and the peak incidence was in the group aged 40–49 years. Furthermore, only 31% of patients were at stage I according to data for newly diagnosed patients at National Taiwan University Hospital for 2004–2009. With the increase in pregnancy at an advanced maternal age, obstetrician–gynecologists should be alert to the possibility of coexisting BC and pregnancy. To facilitate early detection of BC, a campaign for “Three points examined together” should be implemented. Obstetrician–gynecologists should perform breast examination including palpation and ultrasound examination at the same time as the annual Pap smear. Mammography should be performed every 2–3 years or when indicated. If suspicious lesions are found, patients should be referred to a breast imaging laboratory, where a definitive diagnosis can be established. For confirmed cases of BC, appropriate surgery, chemotherapy and radiotherapy should be provided. In short, active participation of obstetrician–gynecologists is a must in the campaign against BC in Taiwan.
Methods: Sixty two pediatric patients from 55 unrelated families were enrolled for this study aft... more Methods: Sixty two pediatric patients from 55 unrelated families were enrolled for this study after obtaining written informed consent. Diagnosis of WD was based on clinical and biochemical analysis. Mutation screening was carried out for all exons (including the flanking splice sites) as well as the promoter region using a combination of Single Strand Conformation Polymorphism (SSCP) and Conformation Sensitive Gel Electrophoresis (CSGE). Sequencing was performed for samples showing mobility shift either in SSCP or CSGE. Detected sequence changes were also studied in 60 unrelated healthy adult controls. Results: Causative mutations were identified in 52 out of 62 (83.87%) samples studied. None of these mutations were detected in controls. A total of 25 different types of mutations were observed, including 14 missense, 3 nonsense, 2 splice site, 5 deletions and 1 insertion. Most of these mutations were identified in exon 2, followed by exon 14. Thirteen (52%) of the detected mutations were novel. In addition, fourteen sequence changes which are considered as non pathogenic were also observed. Conclusions: Commonly reported mutations H1069Q (Caucasian population) and R778L (Asian) were not detected in this study. A very heterogeneous spectrum of mutations emerged with varying clinical manifestations. Thus, genotype phenotype correlation could not be distinctly delineated. Our preliminary study on pediatric subjects indicates that there is a possibility that exon 2 (p.C271X) and exons 14 (p.G1061E) mutations maybe the most common in Indian population. The result of this study will widen the knowledge of molecular basis of pediatric Indian patients with WD. In a heterogeneous population like India, molecular studies can provide an accurate diagnosis, counseling, prenatal diagnosis and early treatment for WD.
To examine the inhibitory effect of anticonvulsants (AEDs) on carnitine transport by the human pl... more To examine the inhibitory effect of anticonvulsants (AEDs) on carnitine transport by the human placental carnitine transporter. Uptake of radiolabeled carnitine by human placental brush-border membrane vesicles was measured in the absence and presence of tiagabine (TGB), vigabatrin (VGB), gabapentin (GBP), lamotrigine (LTG), topiramate (TPM), valproic acid (VPA), and phenytoin (PHT). The mechanism of the inhibitory action of TGB was determined. Most of the AEDs inhibited placental carnitine transport. Kinetic analyses showed that TGB had the greatest inhibitory effect [50% inhibitory concentration (IC50, 190 microM)], and the order of inhibitory potency was TGB &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; PHT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; GBP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; VPA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; VGB, TPM &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; LTG. Further studies showed that TGB competitively inhibited carnitine uptake by the human placental carnitine transporter, suggesting that it may be a substrate for this carrier. Although the involvement of carnitine deficiency in fetal anticonvulsant syndrome requires further evaluation, potential interference with placental carnitine transport by several AEDs was demonstrated. Despite the higher inhibitory potency of TGB, given the therapeutic unbound concentrations, the results for VPA and PHT are probably more clinically significant.
To evaluate donor cell engraftment and the kinetics of cell repopulation in the injured mouse liv... more To evaluate donor cell engraftment and the kinetics of cell repopulation in the injured mouse liver following human umbilical cord blood cell transplantation. Nonobese diabetic/severe immunodeficient mice were treated with allyl alcohol to induce liver injury. Twenty-four hours later, umbilical cord blood derived mononuclear cells were transplanted by intra-splenic injection. Mice were sacrificed from 1 to 180 days after transplantation. Temporal changes in the ratio of human cells and fluorescence counts of human sex-determining region Y alleles in mouse liver were determined to evaluate the kinetics of cell repopulation. Mouse liver and sera were examined for the presence of human albumin. Human cell repopulation was extremely rapid in the first week following transplantation, with a doubling time of 1.16-1.39 days apparent. Thereafter cell doubling rate slowed significantly. Cells displaying characteristics of human hepatocytes were still evident at 180 days. Human albumin was detected in mouse liver and sera. These findings confirm those from previous studies demonstrating that cells derived from human umbilical cord blood have the capacity to differentiate into cells with human hepatocyte characteristics in mouse liver following injury. Moreover, the detailed information collected regarding the kinetics of human cell repopulation in mouse liver will be of relevance to future studies examining the use of umbilical cord blood cells in liver transplantation therapy.
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