Biomedical subjects

C L Perng

Publications and source records attributed to C L Perng.

48 records · Page 3Linked to original sources

PubMed1994

Clinical courses and predictors for rebleeding in patients with peptic ulcers and non-bleeding visible vessels: a prospective study.

Detailed characterisation of non-bleeding visible vessels in terms of colour, size evolution, and time of rebleeding is important in determining the natural history of these lesions. The colour and size of non-bleeding visible vessels were observed endoscopically every day for three days and then every other day until rebleeding or flattening of visible vessels occurred in 140 patients. Rebleeding happened in 61 (44%) patients. Of them, 59 (97%) rebled within 72 hours. Flattening of visible vessels happened in 79 (56%) patients and 77 of 79 (98%) had flattening of visible vessels within 72 hours. Rebleeding rate increased with increasing length of exposed vessels (r = 0.96, p < 0.001). Coffee ground fluid or blood retention in the stomach and ulcer size > or = 2.0 cm were independent predictors for rebleeding using multivariate analysis. It is suggested that patients with non-bleeding visible vessels and independent predictors for rebleeding may need early aggressive treatment.

Adult↗

PubMed1994

Serum c-erbB-2 oncoprotein in the diagnosis of gastric cancer in comparison with CA 19-9, CEA, TPA, CA 125 and AFP.

BACKGROUND: Although many tumor markers can detect gastric cancer, they are still far from perfect. The aim of this study was to evaluate the role of a new tumor marker, serum c-erbB-2 oncoprotein, in patients with gastric cancer. METHODS: We tested this tumor marker in 35 patients of gastric cancer, 13 patients of hepatoma, 13 patients of colon cancer, 8 patients of lung cancer, and 22 patients without malignancy (4 of acute pancreatitis, 10 of benign gastric ulcer and 8 normal subjects) between July and December 1991. A newly developed enzyme immunoassay kit was used to assay serum c-erbB-2 oncoprotein. RESULTS: Abnormal level of c-erbB-2 oncoprotein was found in 11/32 (34.4%) of gastric cancer, 4/13 (30.8%) of hepatoma, 2/8 (25%) of lung cancer, 3/13 (23.1%) of colon cancer, 0/3 (0%) of gastric lymphoma, and 4 of non-malignant conditions (18.2%). Six tumor markers were assessed at the same time in 32 patients of gastric cancer. The abnormal level for CA 19-9 was found in 13/32 patients (40.6%); for TPA: 9/32 (28.1%); for c-erbB-2 oncoprotein: 11/32 (34.4%); for CEA: 8/32 (25%); for CA 125: 2/32 (6.3%); and for AFP: 1/32 (3.1%). CONCLUSIONS: C-erbB-2 oncoprotein is a new tumor marker. Practical application needs further mass survey.

Biomarkers, Tumor↗

PubMed1994

The influence of sham feeding on gastric acid and pepsin secretion in the Chinese with duodenal ulcer and liver cirrhosis.

BACKGROUND: This study was conducted to evaluate gastric acid and pepsin output in the Chinese patients with liver cirrhosis and duodenal ulcers. METHODS: In a period of one year and three months, we prospectively assayed the acid and pepsin responses to sham feeding in 10 healthy males, 20 males with duodenal ulcers, and 11 males with liver cirrhosis. RESULTS: Although basal and sham feeding stimulated acid outputs were higher in duodenal ulcer patients (2.7 +/- 0.3 and 3.7 +/- 0.3 mEq/h, mean +/- SEM) than in normal subjects (1.6 +/- 0.4 and 2.9 +/- 0.6 mEq/h) and in patients with liver cirrhosis (1.8 +/- 0.4 and 2.1 +/- 0.7 mEq/h), it did not reach statistical significance. Both basal and sham feeding stimulated pepsin outputs were significantly higher in duodenal ulcer patients (11.2 +/- 2.1 and 9.5 +/- 2.2 mg/h) than in normal subjects (2.4 +/- 0.5 and 4.3 +/- 1.2 mg/h) and in patients with liver cirrhosis (3.6 +/- 1.4 and 3.9 +/- 1.2 mg/h) (p < 0.05). The serum gastrin and pepsinogen I concentration in basal and sham feeding conditions demonstrated no statistically significant difference among three groups. CONCLUSIONS: Basal and sham feeding stimulated acid outputs in the Chinese were lower in normal subjects and duodenal ulcer patients as compared with those in the Occidentals. High basal pepsin output may play an important role in the pathogenesis of duodenal ulcers in the Chinese.

Analysis of Variance↗

PubMed1994

Characteristics of patients with bleeding peptic ulcer requiring emergency endoscopy and aggressive treatment.

OBJECTIVES: Patients with an ulcer and active bleeding or a nonbleeding, visible vessel are high-risk for further bleeding and should receive aggressive therapy. In this study, we tried to identify clinical parameters that predict these high-risk groups. METHODS: Over a 7-month period, 16 clinical parameters were analyzed prospectively in 316 patients with bleeding peptic ulcer. A multivariate analysis was used to find the independent predictors for the high-risk patients. RESULTS: A total of 114 patients (36%) was found to have a spurting hemorrhage (eight patients), oozing hemorrhage (27 patients), or a nonbleeding visible vessel (79 patients). Using an univariate analysis, a statistically significant predictor was the appearance of coffee ground fluid or blood from the nasogastric tube. This predictor also emerged as an independent factor (odds ratio, 0.4333; 95% confidence interval, 0.263-0.714). CONCLUSIONS: Patients with bleeding peptic ulcer who have coffee ground fluid or blood from the nasogastric tube should receive an emergency endoscopy and aggressive treatment.

Emergencies↗

PubMed1993

Is sclerosant injection mandatory after an epinephrine injection for arrest of peptic ulcer haemorrhage? A prospective, randomised, comparative study.

A prospective, randomised, comparative study was performed to assess the need for a pure alcohol injection after an epinephrine injection in the arrest of active peptic ulcer bleeding. Sixty four patients with active ulcer bleeding were enrolled in the study. The two groups (epinephrine and epinephrine plus pure alcohol) were matched for sex, age, site of bleed, endoscopic findings, shock, haemoglobin, and concomitant illness at randomisation. The volume of injected epinephrine in the epinephrine and the epinephrine plus pure alcohol groups mean (SD) was 6.0 (3.0) ml and 5.5 (3.0) ml respectively (p > 0.05). The volume of injected pure alcohol in the epinephrine plus pure alcohol group was 1.9 (1.1) ml. Bleeding was initially controlled in 31 (97%) of the epinephrine group and all of the epinephrine plus pure alcohol group. Rebleeding occurred in 11 (36%) of the epinephrine group and in five (16%) of the epinephrine plus pure alcohol group (p > 0.05). Rebleeding was successfully controlled in some patients with treatment by a second injection. Other patients had heat probe thermocoagulation or surgery. Ultimate haemostatic rates were 69% (22/32) and 88% (28/32) for the epinephrine and the epinephrine plus pure alcohol groups respectively (p > 0.05). The epinephrine plus pure alcohol group achieved a better haemostatic effect for spurting haemorrhage (9/10 v 5/11, p < 0.05). The need for emergency operations and blood transfusions were comparable in both groups. The stay in hospital were less in the epinephrine plus pure alcohol group (mean 4.3 v 7.1, p < 0.05). It is concluded that pure alcohol injection after an epinephrine injection can improve the haemostatic rate in patients with spurting haemorrhage and shorten the hospital stay for patients with active bleeding.

Combined Modality Therapy↗

PubMedDate not supplied

Endoscopic injection for the arrest of peptic ulcer hemorrhage: final results of a prospective, randomized comparative trial.

A prospective, randomized comparative study was performed to compare the hemostatic effect of endoscopic injection with normal saline, 3% NaCl solution, 50% glucose/water solution, and pure alcohol during a period of 2 years. Only patients with peptic ulcers and active bleeding or nonbleeding visible vessels were considered. Each group comprised 50 patients. The four groups were matched at random for age, sex, location of bleeders, stigmata of recent hemorrhage, shock, hemoglobin, and concomitant illness. No statistically significant difference was observed among patients injected with normal saline, 3% NaCl solution, 50% glucose/water solution, or pure alcohol in achieving initial hemostasis (82%, 90%, 86%, and 92%, respectively); rebleeding rates (7.3%, 24.4%, 14%, and 10.9%, respectively); ultimate hemostasis (78%, 68%, 78%, and 84%, respectively); number of emergency operations (5, 7, 4, and 3, respectively); and average number of days in the hospital (6.7, 6.1, 6.1, and 5.8, respectively). A tendency toward a lower blood transfusion requirement was observed in the pure alcohol group, but this tendency failed to achieve statistical significance. One patient had a perforated ulcer develop 5 days after injection of 3 ml 50% glucose/water. Otherwise, no major complication was observed. We suggest that endoscopic injection with any of the above solutions can be used as the first-line modality for the arrest of peptic ulcer hemorrhage.

Adolescent↗

PubMedDate not supplied

Effect of non-steroidal anti-inflammatory drugs on gastric and duodenal prostaglandin concentrations in patients with Helicobacter pylori infection.

BACKGROUND/AIMS: Both Helicobacter pylori and non-steroidal anti-inflammatory drugs are reported to affect gastroduodenal prostaglandin synthesis. However, their influence on gastric mucosal prostaglandins remains unclear. The aim of this study was to investigate the influence of nonsteroidal anti-inflammatory drugs on mucosal prostaglandin synthesis in patients with Helicobacter pylori infection. METHODOLOGY: We enrolled 87 Helicobacter pylori-infected patients in this study (gastric ulcer: 33, duodenal ulcer: 41, and non-ulcer dyspepsia: 13). Of them, 27 patients received non-steroidal anti-inflammatory drugs. Endoscopy was performed and biospy specimens from gastric body, antrum and duodenal bulb were assessed for Helicobacter pylori and prostaglandin concentration. RESULTS: A significantly lower mucosal prostaglandin E2 level at gastric body (142.2 +/- 28.1 ng/mg vs. 222.0 +/- 12.4 ng/mg, mean +/- SEM) and antrum (131.3 +/- 26.4 ng/mg vs. 226.0 +/- 19.0 ng/mg) was noted in Helicobacter pylori-infected gastric ulcer patients with non-steroidal anti-inflammatory drugs ingestion than in that of patients without non-steroidal anti-inflammatory drugs ingestion (p < 0.05). Using a multivariate analysis, we found that non-steroidal anti-inflammatory drug was an independent variable affecting gastric and duodenal mucosal prostaglandin E2 synthesis in patients with Helicobacter pylori-infected gastric ulcer. CONCLUSIONS: Non-steroidal anti-inflammatory drugs decrease gastroduodenal mucosal prostaglandin E2 synthesis in gastric ulcer patients with Helicobacter pylori infection.

Adolescent↗

PubMedDate not supplied

The influence of intravenous omeprazole on intragastric pH and outcomes in patients with peptic ulcer bleeding after successful endoscopic therapy--a prospective randomized comparative trial.

BACKGROUND/AIMS: The role of omeprazole in preventing rebleeding in patients with peptic ulcer bleeding after successful endoscopic therapy has been controversial. In this study, we used 3 different formulas of intravenous omeprazole in the above patients. We wished to compare the intragastric pH and outcomes among them. METHODOLOGY: Between July 1996 and May 1997, after having obtained initial hemostasis with endoscopic therapy, a total of 20 patients with peptic ulcer bleeding (spurting/oozing/non-bleeding visible vessel: 6/4/10) received intravenous bolus of omeprazole 20 mg every 3 hours; 20 patients (3/5/12) received intravenous bolus of omeprazole 40 mg every 6 hours; and, 20 patients (5/4/11) received intravenous bolus of omeprazole 80 mg every 12 hours for 3 days. One intragastric pH meter (Gastrograph Mark III, Medical Instruments Corp. Switzerland) was used to record 24-hour intragastic pH. RESULTS: The intragastric pH in the patients receiving omeprazole 20 mg every 3 hours was 6.1, 6.0-6.2 (mean: 95% CI); in patients receiving omeprazole 40 mg every 6 hours it was 6.4, 6.2-6.5; and, in patients receiving omeprazole 80 mg every 12 hours it was 5.8, 5.7-5.9. The duration of intragastric pH > 6.0 in omeprazole 20 mg every 3 hours was 70.9%, 57.3%-84.4% (mean: 95% CI); in omeprazole 40 mg every 6 hours it was 83.1%, 73.1%-93.1%; and, in omeprazole 80 mg every 12 hours it was 66%, 51.5%-80.4%. Patients with peptic ulcers receiving omeprazole 40 mg intravenous bolus every 6 hours had the highest intragastric pH as compared with the other 2 groups (p < 0.0001). There were no significant differences concerning rebleeding rates, volume of blood transfusion, hospital stay, numbers of operation and mortality among the 3 groups. CONCLUSIONS: After initial hemostasis had been obtained, patients with peptic ulcer bleeding receiving 40 mg intravenous bolus every 6 hours had the highest intragastric pH. However, they had similar outcomes with the other 2 groups.

Adult↗

PubMedDate not supplied

A 3-day anti-Helicobacter pylori therapy is a good alternative for bleeding peptic ulcer patients with Helicobacter pylori infection.

BACKGROUND/AIMS: One-week triple therapy has been recommended as a standard regimen for eradicating Helicobacter pylori infection. The emergence of antibiotic-resistant strains, adverse drug effects, poor compliance and high cost of therapy add problems to the management of these patients. In this study, we assessed whether a 3-day triple therapy could be effective in eradicating Helicobacter pylori infection in bleeding peptic ulcer patients. METHODOLOGY: Peptic ulcer patients with Helicobacter pylori infection were enrolled in this study. Patients enrolled at the outpatient department (group A) received a 7-day oral regimen: bismuth subcitrate colloid 300 mg + amoxicillin 500 mg + metronidazole 250 mg four times per day. Patients who were admitted to the wards due to peptic ulcer bleeding (group B) received a 3-day regimen including omeprazole 40 mg intravenously every 6 hours, amoxicillin 500 mg + metronidazole 250 mg orally four times daily after hemostasis had been achieved. Patients of both groups received omeprazole 20 mg once per day or cimetidine 400 mg twice daily per os for at least-one month after anti-Helicobacter pylori therapy. We followed every patient endoscopically two months after anti-Helicobacter pylori therapy. RESULTS: From June 1997 to April 1999, a total of 57 patients (30 in group A and 27 in group B) with gastric or duodenal ulcer and Helicobacter pylori infection completed anti-Helicobacter pylori therapy. Two months after anti-Helicobacter pylori therapy, peptic ulcer was found to be healed with a scar in 26 (86.7%) of group A and 23 (85.2%) of group B (P > 0.1). The eradication rates of Helicobacter pylori in the two groups were not significantly different in an intention-to-treat analysis [group A: 78.8% (26/33), 95% CI: 64.9-92.7%; group B: 80% (24/30), 95% CI: 65.7-94.3%, P > 0.1] and in a per protocol analysis [group A: 86.7% (26/30), 95% CI: 74.5-98.9%, group B: 88.9% (24/27), 95% CI: 77.1-100.7%, P > 0.1]. Fewer side effects occurred in group B (3/30) than those in group A (7/33) (P > 0.1). CONCLUSIONS: In patients with peptic ulcer bleeding a 3-day anti-Helicobacter pylori therapy is a good alternative for eradicating Helicobacter pylori infection.

Adult↗

PubMedDate not supplied

Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.

BACKGROUND/AIMS: Polyps of the gastrointestinal tract are usually removed due to their link to bleeding, obstruction and malignancy. However, complications may occur following polypectomy. The aim of this study was to assess whether submucosal epinephrine injection before polypectomy could reduce the incidence of bleeding and perforation. METHODOLOGY: Between June 1997 and November 1999, patients with sessile polyps of the gastrointestinal tract found in our endoscopic unit were randomized to receive submucosal epinephrine injection (epinephrine group) or no injection (control group) before polypectomy. In the epinephrine group, epinephrine (1:10,000) was injected surrounding the stalk of the polyp until the mucosa was blanched and bulged. The patients were observed for complications in the following month. RESULTS: A total of 120 patients with 151 sessile polyps were enrolled in this study. In the epinephrine group, 75 polyps (n = 68) were randomized to receive epinephrine injection before polypectomy. In the control group, 76 polyps (n = 61) underwent polypectomy without epinephrine injection. In both groups, there was no significant difference in clinical features including the sizes of the polyps and their stalks, the location of polyps and the pathological diagnosis. There were a total of nine episodes of post-polypectomy hemorrhage, two in the epinephrine group and seven in the control group (2/75 vs. 7/76) (P = 0.07). One case in the epinephrine group experienced delayed bleeding (4 days later). Immediate hemorrhage occurred less in the epinephrine group than that in the control group (1/75 vs. 7/76, P = 0.03). There was one case of perforation in each group. CONCLUSIONS: Epinephrine injection prior to polypectomy is effective in preventing immediate bleeding.

Adult↗

PubMedDate not supplied

Octreotide for arrest of peptic ulcer hemorrhage--a prospective, randomized controlled trial.

BACKGROUND/AIMS: A prospective, randomized controlled trial was performed over a 10-month period to evaluate the hemostatic effects of octreotide and ranitidine in 84 patients with active peptic ulcer bleeding or nonbleeding visible vessels at the ulcer bases. PATIENTS AND METHODS: Forty-two patients received octreotide 100 mcg bolus intravenously followed by 25 mcg/h intravenously for 1.4 +/- 0.6 days (mean +/- SD). The other 42 patients received ranitidine 100 mg intravenously every 12 h. The two groups were matched for sex, age, location of bleeders, endoscopic findings, shock, and initial hemoglobin. RESULTS: Hemostasis was obtained in 35 (83.3%) of the octreotide group, and 23 (54.8%) of the control group (p<0.01). Volume of blood transfused, numbers of patients receiving aggressive management (endoscopic hemostasis or operation), and hospital stay were significantly less in the octreotide group as compared with those of the controls (p<0.05, p<0.05 and p<0.001, respectively). No obvious side effect was found in the octreotide group. CONCLUSION: We suggest that octreotide is a safe and effective drug in arresting peptic ulcer hemorrhage. It may be used as the first-line therapy for a patient with massive peptic ulcer hemorrhage before he is transferred to a medical center.

Anti-Ulcer Agents↗

PubMedDate not supplied

Can optimal acid suppression prevent rebleeding in peptic ulcer patients with a non-bleeding visible vessel: a preliminary report of a randomized comparative study.

BACKGROUND/AIMS: The hypothesis that profound acid suppression might prevent clot lysis and thus benefit patients with a non-bleeding visible vessel has not been confirmed. Omeprazole can suppress gastric acid remarkably and may be beneficial for patients with peptic ulcer bleeding. METHODOLOGY: Fifty-two patients with a non-bleeding visible vessel at the ulcer base were enrolled and randomized into four groups (N = 13 in each group). In the cimetidine group, the patients received cimetidine 300 mg i.v. bolus followed by 300 mg i.v. every 6 hr during hospitalization. In the heater probe thermocoagulation + cimetidine group, the patients received heater probe thermocoagulation and cimetidine 300 mg i.v. bolus followed by 300 mg i.v. every 6 h during hospitalization. In the omeprazole q.d. group, the patients received omeprazole 40 mg i.v. bolus followed by 40 mg i.v. daily for two days. In the omeprazole q 12 h group, the patients received omeprazole 40 mg i.v. bolus followed by 40 mg i.v. every 12 h for two days. A 24 hr intragastric pH was recorded for every case. RESULTS: The mean 24 hr intragastric pH were higher in the omeprazole q.d. (mean 5.8) and the omeprazole q 12 h groups (mean 6.4) than in the cimetidine (mean 4.3) and the heater probe thermocoagulation + cimetidine groups (mean 4.9) (p < 0.05). Rebleeding occurred in 5, 2, 2 and 2 patients in the cimetidine, heater probe thermocoagulation + cimetidine, omeprazole q.d., and omeprazole q 12 h groups, respectively (p > 0.05). Volume of blood transfusion and number of days in hospital were not statistically different among the four groups. CONCLUSIONS: Omeprazole can remarkably suppress gastric acid when it is compared to that of the H2 receptor blocker. Patients with a non-bleeding visible vessel using omeprazole do not exhibit a decrease in the rebleeding rate as compared with those patients using cimetidine.

Anti-Ulcer Agents↗