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Biomedical subjects

C L Perng

Publications and source records attributed to C L Perng.

At least 37 records · Page 2Linked to original sources
PubMed1998

REP-PCR fragments as biomarkers for differentiating gastroduodenal disease-specific Helicobacter pylori strains.

We previously identified four potential putative gastroduodenal disease fragments by using the interspersed repetitive extragenic palindromic DNA sequence based PCR (REP-PCR) technique. We investigated these fragments with regard to their disease specificity. The putative disease-specific REP-PCR fragments were cloned, mapped by restriction enzymes, cross-hybridized, and confirmed by Southern hybridization. The four fragments were also used as probes against REP-PCR amplicons from H. pylori isolates obtained from gastritis (N = 20), duodenal ulcer (N = 30), and gastric cancer patients (N = 30). Three of these fragments (1.4- and 0.76-kb for gastritis; 1.35 kb for duodenal ulcer) were amplified without any discrimination between any disease-specific H. pylori isolates. However, amplification following hybridization with the fourth 0.81-kb fragment was observed only from gastritis (60%) and duodenal ulcer (52%) but with none (0%) of gastric cancer patients. Nucleotide sequence analysis of the 0.81-kb fragment revealed that it was an open reading frame of the hypothetical protein HP0373 matched to the position of 380,966 to 383,068 nucleotides of the H. pylori complete genome sequence. Hence, the REP-PCR sequence was not a extragenic palindromic DNA sequence. The hypothetical protein was also present in all the tested isolates. The REP-PCR fingerprinting technique is useful to differentiate disease-specific H. pylori strains based on the interspersed repetitive extragenic palindromic DNA sequences; however, it may not be useful to identify disease-specific virulence determinant(s) without being confirmed by DNA sequence analysis and functional studies.

Amino Acid Sequence↗
PubMed1998

One-week triple therapy with lansoprazole, clarithromycin, and metronidazole to cure Helicobacter pylori infection in peptic ulcer disease in Korea.

The efficacy and acceptability of classical bismuth triple therapy may be limited by poor patient compliance and adverse effects. It is widely agreed that improved, simpler, and reliable therapies are needed to cure Helicobacter pylori infection and foster patient compliance. We evaluated the efficacy and side effects of a Bazzoli triple therapy substituting lansoprazole for omeprazole for H. pylori infection in active peptic ulcer in Korea (30 mg of lansoprazole, 250 mg of clarithromycin, and 400 mg of metronidazole, all twice daily). H. pylori status was evaluated by rapid urease test, histology, and culture at entry and four or more weeks after ending antimicrobial therapy. Fifty-eight patients (mean age: 43 years) with gastric (N = 30) or duodenal ulcer (N = 28) and H. pylori infection were studied. H. pylori was cured in 47 (81%, 95% CI = 69-90%). Mild side effects, including vomiting, diarrhea, and itching, were observed in four patients (7%). Compliance averaged 95%. Fifty-five ulcers (95%) were healed. Pretreatment pylorobulbar deformity was observed in 49 patients (85%), and in 43 (88%) the deformity disappeared after treatment. Pretreatment metronidazole and clarithromycin resistance was observed in 87% and 2% of patients, respectively. The cure rate of H. pylori infection was significantly higher in patients >50 years of age than those <50. Treatment with low-dose one-week lansoprazole, clarithromycin, and metronidazole resulted in a relatively low cure rate, but was well tolerated. Studies to define the optimal duration, dose, and dosing interval of this combination therapy in Korea are needed.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Predictive factors for rebleeding in patients with peptic ulcer bleeding after multipolar electrocoagulation: a retrospective analysis.

The role of endoscopic therapy for peptic ulcer bleeding is well-documented. Nevertheless, rebleeding occurs in 10% to 30% of patients, and such patients are at high risk for death without early retreatment or definitive surgery. The aim of our study was to predict which patients would rebleed within 1 month after successful multipolar electrocoagulation of 100 patients with active peptic ulcer bleeding (spurting, oozing, or nonbleeding visible vessel). We had achieved initial hemostasis in 97 patients and carried out univariate and multivariate analyses to predict which patients would rebleed. Rebleeding occurred within 1 month in 17 (17.5%) patients. we correlated 20 clinical and endoscopic factors with rebleeding episodes. With univariate analysis, blood transfusion of 500 ml or more at entry (p < 0.0001) and use of cimetidine (p = 0.01) were statistically significant for rebleeding. With multivariate analysis, use of omeprazole was an independent factor for preventing rebleeding (odds ratio, 7.68; 95% confidence interval, 1.642-35.929). We suggest that omeprazole may help to prevent rebleeding in patients who have had hemostasis with multipolar electrocoagulation.

Anti-Ulcer Agents↗
PubMed1997

Clarithromycin in the combination therapy for the eradication of Helicobacter pylori in peptic ulcer disease.

BACKGROUND: Clarithromycin is a new macrolide antibiotic which is known to be highly effective in eradicating Helicobacter pylori (H. pylori). In Chinese, the role of clarithromycin for H. pylori is still unclear. METHODS: Between January 1995 and February 1996, 75 patients with active H. pylori-positive duodenal ulcer were enrolled in this study. Three groups were randomized to have (1) 2 x 150 mg nizatidine twice daily, 2 x 250 mg amoxicillin four times daily, and 2 x 250 mg clarithromycin three times daily for two weeks (niz-amox-clar group, N = 25); or (2) 20 mg omeprazole twice daily plus 2 x 250 mg clarithromycin three times daily for two weeks (ome-clar group, N = 25); or (3) 300 mg bismuth subsalicylate four times daily, and 2 x 250 mg amoxicillin four times daily, 250 mg metronidazole four times daily for two weeks (triple therapy group, N = 25). All the patients received H2 receptor antagonist (150 mg nizatidine or ranitidine, or 400 mg cimetidine, twice daily) for the consecutive six weeks. RESULTS: The eradication rate of H. pylori eight weeks after the entry of study was 80%(20/25) in the niz-amox-clar group, 76%(19/25) in the ome-clar group, 88%(22/25) in the triple therapy group (p < 0.05 among the three groups). The ulcer healing rates eight weeks after the entry of study for the niz-amox-clar, the ome-amox, and the triple therapy groups were 84%(21/25), 80%(20/25), and 80%(20/25), respectively (p < 0.05 among the three groups). The number of patients experiencing adverse effects in the niz-amox-clar group, the ome-clar group, and the triple therapy group were 10(40%), 7(28%), and 4(16%), respectively (p > 0.05 among the three groups). CONCLUSIONS: Both nizatidine/amoxicillin/clarithromycin and omeprazole/clarithromycin regimens can achieve good eradication rates and may provide an effective alternative anti-H. pylori treatment in duodenal ulcer diseases.

Adult↗
PubMed1996

Natural history of bleeding peptic ulcers with a tightly adherent blood clot: a prospective observation.

BACKGROUND: The natural history of a bleeding peptic ulcer with a tightly adherent blood clot remains uncertain. Controversy exists concerning removal of such blood clots at the bleeding ulcer base. This article presents the natural history of a bleeding peptic ulcer with a tightly adherent clot and defines the characteristics of those requiring aggressive management. METHODS: Clinical parameters were analyzed to determine the independent predictors of rebleeding in these patients. One hundred one patients with bleeding peptic ulcers and tightly adherent blood clots were enrolled during a period of 12 months. RESULTS: Twenty-five patients (25%) rebled within 1 month. With a multivariate analysis, we found comorbid illness (odds ratio, 3.41), shock (odds ratio, 3.65), and initial hemoglobin at or below 10 gm/dL (odds ratio, 2.99) to be independent predictors of rebleeding. CONCLUSIONS: Most patients with a tightly adherent clot in an ulcer have an uneventful course. However, endoscopic therapy may prove to be beneficial in the subset of patients with independent predictors of rebleeding.

Blood Coagulation↗
PubMed1996

Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study.

The benefit of early endoscopy in the management of peptic ulcer bleeding remains controversial. In this study we looked at the role of early endoscopy in bleeding peptic ulcer patients with clear, "coffee grounds," or bloody nasogastric aspirate. A consecutive series of 325 patients with peptic ulcer bleeding were included (218 patients with clear aspirate, 77 patients with coffee-grounds aspirate, and 30 patients with bloody aspirate). They were randomized to receive early endoscopy (within 12 h of arrival at the emergency room) or delayed endoscopy (12 h after arrival at the emergency room). Early endoscopy did not benefit patients with clear or coffee-grounds aspirate. However, combined with endoscopic therapy, it did significantly benefit patients with bloody aspirate in reducing the need for blood transfusion (mean, 450 ml vs. 666 ml; p < 0.001) and hospital stay (mean, 4 vs. 14.5 days, p < 0.001). Early endoscopy and endoscopic therapy are not needed in bleeding peptic ulcer patients with clear or coffee-grounds nasogastric aspirate. However, early endoscopy and endoscopic therapy benefit patients with bloody nasogastric aspirate.

Aged↗
PubMed1996

Gastric secretion in Chinese patients with cirrhosis.

The role of gastric secretion has been controversial in patients with cirrhosis. Except for studies of gastric secretion in cirrhotic patients who underwent a shunt operation, there is no report correlating gastric secretion with portal pressure in patients with cirrhosis. In this study, we evaluated gastric secretion in cirrhotic patients and correlated it with hemodynamic parameters. Within 12 months, 20 normal volunteers and 16 cirrhotic patients were enrolled. Gastric secretion was assessed in all patients, but portal pressure hemodynamic studies were performed only in cirrhotic patients. We found that the median basal acid output, maximal acid output, and basal pepsin output in the controls (1.41 mmol/h, 9.2 mmol/h, and 0.02 mg/h, respectively) and in the cirrhotic patients (0.6 mmol/h, 7.84 mmol/h, and 1.5 mg/h, respectively) were not statistically different. However, maximal pepsin output was lower in the cirrhotic patients (1.5 mg/h) than in the normal subjects (5.14 mg/h) (p < 0.05). Gastric secretion correlated poorly with hepatic venous pressure gradient (HVPG) and the presence of congestive gastropathy in cirrhotic patients. The severity of congestive gastropathy correlated poorly with HVPG. Helicobacter pylori has difficulty replicating in the stomach when HVPG is > 14 mm Hg. We conclude that patients with cirrhosis have a lower maximal pepsin output than that of the healthy subjects. Gastric secretion correlates poorly with HVPG and the presence of congestive gastropathy in patients with cirrhosis.

Aged↗
PubMed1996

Characteristics of patients with benign gastric outlet obstruction requiring surgery after endoscopic balloon dilation.

OBJECTIVES: The aim of this study is to identify factors that will predict which patients with benign gastric outlet obstruction will not respond to endoscopic balloon dilation, in a long-term observation. METHODS: Over a 51-month period, 42 patients with benign gastric outlet obstruction received endoscopic balloon dilation. The "through-the-scope" technique with the aid of a guide wire was used for dilation. Fifteen factors were analyzed prospectively in 40 patients. Multivariate analysis was used to find the independent factors of the failure of treatment. RESULTS: The median follow-up period was 23 months (range 1-51 months). Twenty-eight (67%) patients achieved sustained improvement, and 14 (33%) patients underwent surgery. The overall symptom-free rates in 12, 24, 36, and 48 months were 85.3%, 78%, 68.8%, and 68.8%, respectively. The independent prognostic factor for failure of treatment was the need for more than two courses of endoscopic balloon dilation to relieve symptoms (odds ratio, 6.857; 95% confidence interval, 1,031-45,606). CONCLUSIONS: Endoscopic balloon dilation for the treatment of benign gastric outlet obstructions is an effective alternative to surgery. Patient who needs more than two courses of endoscopic balloon dilation to relieve symptoms should receive surgery.

Adult↗
PubMed1996

Intravenous omeprazole prevents rebleeding in peptic ulcer patients with a non-bleeding visible vessel: a preliminary report of a randomized controlled study.

BACKGROUND: In patients with peptic ulcer bleeding, acid can enhance platelet disaggregation and cause lysis of the clot. Omeprazole, a potent acid suppressor, may be helpful in reducing their rebleeding rate. METHODS: Between March and October 1994, 40 patients with a non-bleeding, visible vessel (NBVV) at ulcer bases were enrolled for study. They were randomized into four groups. Group 1 (n = 10) patients received cimetidine 300mg intravenously (i.v.) q6h; Group II (n = 10) patients received heater probe thermocoagulation therapy and cimetidine 300mg i.v. q6h; Group III (n = 10) patients received omeprazole 40mg intravenous bolus initially followed by 40mg i.v. qd and Group IV (n = 10) patients received omeprazole 40mg intravenous bolus initially followed by 40mg i.v. q12h. Endoscopic examination was done for follow-up, daily, for 1-3 days. RESULTS: Preliminary results showed that the age, initial hemoglobin, ulcer size as well as NBVV size in Groups I-IV were not significantly different (p < 0.05). The rebleeding rates were 40% in Group I, 20% in Group II, 20% in Group III and 0% in Group IV, (p < 0.05 when Group IV is compared with Group I). CONCLUSIONS: Intravenous omeprazole 40mg given q12h can reduce the rebleeding rate of patients with a NBVV.

Adult↗
PubMed1996

Omeprazole plus amoxicillin versus triple therapy eradicates Helicobacter pylori in the Chinese with peptic ulcer disease.

BACKGROUND: Omeprazole/amoxicillin regimen has proved elsewhere to be effective in the eradication of Helicobacter pylori (H. pylori). However, in the Chinese, its role in H. pylori is still unclear. METHODS: Between November 1993 and June 1994, 112 patients with active, H. pylori positive peptic ulcer were enrolled in this study. Five groups were arranged randomly to have 20 mg omeprazole q.d. for 28 days plus 750 mg amoxicillin b.i.d. for the first 10 days (omep-20-amox group, N = 22), 20 mg omeprazole b.i.d. for 28 days plus 750 mg amoxicillin b.i.d. for the first 10 days (omep-40-amox group, N = 22), 300 mg bismuth subsalicylate q.i.d. for 28 day, and 750 mg amoxicillin b.i.d., 500mg metronidazole t.i.d. for the first 7 days (triple therapy group, N = 25), 20 mg omeprazole q.d. for 28 days (omep-20 group, N = 22), or 150 mg ranitidine b.i.d. or 400 mg cimetidine b.i.d. for 28 days (H2-antagonist group, N = 21). RESULTS: The eradication rate of H. pylori eight weeks after the entry of study was 38.1% in the omep-20-amox group, 66.7% in the omep-40-amox group, 77.3% in the triple therapy group, 4.7% in the omep-20 group and 0% in the H2 antagonist group (p < 0.05 between the triple therapy and the omep-20-amox, the omep-20, and the H2 antagonist groups). Eleven patients in the triple therapy group suffered from adverse effects (45.8%) (p < 0.05 as compared with other groups). The ulcer healing rates four weeks after the entry of study for the omep-20-amox, the omep-40-amox, the triple therapy, and the omep-20 groups were 80.9%, 80.9%, 68.2%, and 85.7% respectively (p > 0.05). For the H2 antagonist group, the ulcer healing rate eight weeks after the entry of study was 70%. CONCLUSIONS: Both medium-dose omeprazole/amoxicillin and triple therapy can achieve good eradication rates. However, medium-dose omeprazole/amoxicillin had a much lower side effect. Therefore, we recommend medium-dose omeprazole/amoxicillin for the eradication of H. pylori.

Adult↗
PubMed1995

Changes in portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation: an endoscopic observation.

To determine the effect of endoscopic variceal sclerotherapy or ligation on portal hypertensive gastropathy, 90 cirrhotic patients with esophageal variceal bleeding were randomized to receive sclerotherapy (n = 44) or ligation (n = 46). Follow-up endoscopic observations of the gastric mucosa were recorded at 3-month intervals after variceal eradication. Clinical characteristics in both groups were similar. Probability for a change in the severity of portal hypertensive gastropathy was not related to method of eradication. Most cases of portal hypertensive gastropathy that changed in severity returned to baseline status with time, but the return was faster after ligation than after sclerotherapy. According to the results of multivariate analyses, sclerosant volume was the only factor associated with a significant difference between the group with static gastropathy (n = 15) and that with dynamic change in gastropathy (n = 23) after sclerotherapy. No relevant factors were found in the patients receiving ligation. We conclude that changes in the severity of portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation are reversible. Most cases of gastropathy return to baseline status sooner or later.

Esophageal and Gastric Varices↗
PubMed1995

Treatment of duodenal carcinoid by strip biopsy.

In a 70-year-old man with diarrhea and weight loss, upper gastrointestinal endoscopy showed a 0.4-cm nodular lesion at the anterior duodenal bulb with a fissure at the tip of the lesion. The histologic diagnosis of the biopsied specimen revealed a duodenal carcinoid confined to the submucosa. We used strip biopsy to resect the lesion. After resection, diarrhea subsided and weight was increased. Strip biopsy may be a safe and effective choice for management of a duodenal carcinoid if it is < 1 cm in size or confined to the submucosa, especially when mitoses are absent.

Aged↗
PubMed1995

Octreotide and heater probe thermocoagulation for arrest of peptic ulcer hemorrhage. A prospective, randomized, controlled trial.

We carried out a prospective, randomized, controlled trial over a 7-month period to assay the hemostatic effects of octreotide and heater probe thermocoagulation (HPT) in 54 patients with active peptic ulcer bleeding or nonbleeding visible vessels at the ulcer base. Nineteen patients received octreotide 100 micrograms bolus i.v. followed by 25 micrograms/h i.v. for 3 days. Twenty patients received HPT. Fifteen patients received ranitidine 100 mg i.v. every 12 h. The three groups were matched for sex, age, location of bleeders, endoscopic findings, shock, and initial hemoglobin. Ultimate hemostasis was obtained in 11 (58%) of the octreotide group, 18 (90%) of the heater probe group, and 8 (53%) of the control group (p < 0.05). Volume of blood transfused, number of patients receiving operation, hospital stay, and number of deaths were not statistically significant among the three groups. We conclude that HPT is more effective than octreotide in the arrest of peptic ulcer bleeding.

Aged↗
PubMed1995

Heater probe thermocoagulation and multipolar electrocoagulation for arrest of peptic ulcer bleeding. A prospective, randomized comparative trial.

Both heater probe thermocoagulation (HPT) and multipolar electrocoagulation (MPEC) are promising techniques to control peptic ulcer bleeding. However, their hemostatic effects are still not proven conclusively in controlled trials. Here we have tried to do that. Patients with a bleeding ulcer or a nonbleeding visible vessel at the ulcer base received either HPT or MPEC randomly. We compared hemostatic rates, rebleeding rates, hospital stay, volume of blood transfusion, number of operations, and mortality between both groups. A total of 80 patients entered this trial. Patients of both groups had similar ultimate hemostatic rates (HPT 92.5%, MPEC 85%), days in hospital (HPT 5.4, MPEC 5.0), volume of blood transfusion (mean values: HPT 1,774 ml, MPEC 1,974 ml), number of operations (HPT 3, MPEC 3), and mortality (HPT 2, MPEC 3). Both therapeutic approaches are safe and effective for peptic ulcer bleeding.

Aged↗
PubMed1995

Hemostatic effects of heat probe thermocoagulation for patients with peptic ulcer bleeding: an experience of 329 patients.

BACKGROUND: The mortality rate of peptic ulcer bleeding has kept around 6-10% over the past thirty years. Rebleeding is the most important adverse prognostic factor. Heat probe thermocoagulation is suspected to have good hemostatic effect, there is doubt whether the experience of performing the HPT treatment for peptic ulcer bleeding will influence the hemostatic rate. So we report our experience of a large series for heat probe thermocoagulation. METHODS: Patients with an active bleeding source (spurting or oozing) or a nonbleeding visible vessel (NBVV) in a peptic ulcer disease were enrolled in this study. We used an Olympus GIF IT-10 or GIF 2T-10 panendoscope, an Olympus heat probe unit and a 3.2 mm probe (Olympus Co., Taipei, R.O.C.) to treat peptic ulcer bleeding. We classified the faculty into junior physician, having experience in less than 20 procedures, and senior physician, having experience in more than 20 procedures. RESULTS: Between September 1986 and October 1993, we treated 329 patients with active bleeding or nonbleeding visible vessels at the ulcer craters. The stigmata of recent hemorrhage in these patients included spurting hemorrhage in 102 cases (31%), oozing hemorrhage in 105 cases (31.9%), nonbleeding visible vessels in 122 cases (37.1%). The bleeders were most frequently found in the stomach (181,55%), then the duodenum (133,40.4%). The energy applied to each case was 886 +/- 844 joules (mean +/- SD). The initial hemostatic rate was 95.1% (313/329). Rebleeding occurred in 74 cases (23.6%), and 52 cases received a second heat probe thermocoagulation with to result in ultimate hemostasis in 43 cases (82.7%). Junior physician obtained similar initial hemostasis rate and rebleeding rate (92.6%, 26.4%) as compared with 96.2% and 22.7% of senior physician. Totally 33 patients received emergency operation, and 5 patients died. The volume of total blood transfusion was 2830 +/- 2184 ml (mean +/- SD). The hospital stay was 7.4 +/- 4.6 days (mean +/- SD). CONCLUSIONS: Heat probe thermocoagulation is very effective in the arrest of peptic ulcer bleeding with minimal complications and it is easy to learn in a short period of time.

Adult↗
PubMed1995

Long-term results of heater probe thermocoagulation for patients with massive peptic ulcer bleeding: a prospective observation.

OBJECTIVE: The long-term rebleeding rate of a bleeding ulcer after endoscopic hemostasis is, so far, not clear. The goal of this study is to present the natural history of bleeding ulcers after heater probe thermocoagulation. METHODS: Between September 1986 and June 1991, we used heater probe to treat 202 patients with active bleeding or nonbleeding visible vessels at the ulcer craters. We were able to follow 159 patients for 2-7 yr (mean +/- SD: 54.5 +/- 19.9 months). Patients with active bleeding or nonbleeding visible vessels who did not receive endoscopic hemostasis or surgery in our previous studies served as controls. RESULTS: The energy applied to each patient in the heater probe group was 886 +/- 844 J (mean +/- SD). The ultimate hemostatic rate in the heater probe group was 91.2% (145/159). In the period of long-term follow-up, there were 32 episodes of rebleeding in 24 patients (16.6%). Most rebleeding episodes (22/32) subsided spontaneously. Only one rebleeding patient died before a surgical attempt. The rebleeding rate was less than that of the controls (43/87, p < 0.0001). CONCLUSION: Heater probe thermocoagulation is very effective in arrest of peptic ulcer bleeding. In the long-term follow-up, heater probe thermocoagulation can decrease rebleeding rate in most patients with peptic ulcer hemorrhage.

Adult↗
PubMed1995

Pseudomelanosis duodeni: report of eight cases.

Pseudomelanosis duodeni is an uncommon endoscopic sign characterized by diffuse small black spots on the first and second portions of the duodenum. It occurs predominantly in female and elderly patients and is linked to chronic illnesses and related medications. Between 1988 and 1994, the authors saw eight patients with pseudomelanosis duodeni. To evaluate the nature of the pigments, special staining was performed in seven cases. Iron stain was strongly positive in three cases. Electron microscopy was performed in two cases. This revealed amorphous bodies within macrophage lysosomes in one case and angular crystals in another case. These tests suggest that in pseudomelanosis duodeni iron metabolism may be impaired and iron is pooled within macrophages.

Aged↗