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Biomedical subjects

C R Lai

Publications and source records attributed to C R Lai.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of clinico-pathological features in hepatitis B virus-associated hepatocellular carcinoma with or without hepatitis D virus superinfection.

BACKGROUND/AIMS: Hepatitis D virus superinfection in hepatitis B virus carriers produces additional damage in an already injured liver. Earlier reports noted that the development of hepatocellular carcinoma may be accelerated in hepatitis D virus-superinfected patients. This study aimed to investigate the impact of hepatitis D virus on the clinical course of hepatitis B virus-associated hepatocellular carcinoma. METHODS: A total of 42 consecutive hepatocellular carcinoma cases seropositive for antibody against hepatitis D virus antigen (anti-HDV) were found from 1986 to 1994; the clinical manifestations, treatment and outcomes were compared with 255 consecutive hepatocellular carcinoma cases seropositive for hepatitis B virus surface antigen but seronegative for anti-HDV. RESULTS: The mean age was 60 years in both groups of patients. Other features, including sex, duration of follow-up, presence of cirrhosis or ascites, serum biochemistry, status of HBV-e antigen, and gross and microscopic tumor appearance, were not significantly different between the two groups. Though more patients in the anti-HDV-positive group underwent active treatment (operation or transcatheter arterial chemoembolization) than those in the anti-HDV-negative group (54.8% in 42 versus 34.9% in 255 cases, p = 0.02), the cumulative 4-year survival rates (9.5% versus 9.8%) were similar. For the anti-HDV-positive hepatocellular carcinoma patients, tumor size < 5 cm and active treatment were favorable prognostic predictors associated with survival > 18 months. CONCLUSION: Hepatitis D virus superinfection does not accelerate the development of hepatocellular carcinoma. The clinical manifestations were similar, and the outcome in anti-HDV-positive patients was not worse than in the general HBV-associated hepatocellular carcinoma patients, as long as they were diagnosed at an early stage and actively treated.

Adult↗
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

Autoimmune hepatitis in an area endemic for hepatitis B virus infection: a report of three cases.

The role of autoimmune hepatitis (AIH) in the pathogenesis of chronic hepatitis is usually neglected, and its prevalence in Taiwan is uncertain. This report described three cases of AIH among consecutive patients with abnormal liver function tests encountered during the past six years. The minimal follow-up period was three years. Two of them were elderly males and one was associated with spontaneous clearance of hepatitis B surface antigen before being recognized as AIH. Though multiple relapses were encountered in two patients, good response to low-dose corticosteroid therapy was evidenced clinically and histologically. The possibility of AIH as the underlying etiology should be considered when other causes of chronic hepatitis are excluded. Prompt recognition and management prevent untoward outcome.

Aged↗
PubMed1996

Carcinoid tumors of the gastrointestinal tract in Chinese of Taiwan: an analysis of fifty cases.

BACKGROUND: Gastrointestinal carcinoids are uncommon and potentially metastasizing neoplasms. Many series have been reported but few of them concern Chinese people. In this paper we present data on 50 Chinese with gastrointestinal carcinoids, living in Taiwan, to analyze their clinical features and prognostic factors. METHODS: From 1971 to 1995, 50 Chinese patients with primary gastrointestinal carcinoids were seen at Veterans General Hospital-Taipei. All patients had pathological proof of carcinoids. RESULTS: There were 35 males and 15 females with a mean age of 55.9 +/- 2.1 years (range 20-76). The primary sites of the tumors, in order of frequency, were rectum (66%), duodenum (14%), stomach (8%), appendix (4%), ileum (4%), colon (2%) and cecum (2%). The cumulative 5-year survival rate was 73%. Carcinoids > or = 2cm in diameter were more frequently symptomatic and metastatic, and tended to have a lower survival rate than those < 2cm in diameter (p = 0.06). Carcinoids which had invaded the serosa were more frequently symptomatic and metastatic, and had a lower survival rate than intramural carcinoids (p < 0.05). CONCLUSIONS: Rectal carcinoids were the most common gastrointestinal carcinoids in the Chinese living in Taiwan. Carcinoids > or = 2cm and carcinoids invading the serosa correlated well with symptom presentations and metastases. Intramural carcinoids had a better prognosis than carcinoids invading the serosa. Carcinoids < 2cm was a potentially positive factor of prognosis.

Adult↗
PubMed1995

Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma.

OBJECTIVES: To evaluate the feasibility and results of segmentectomy for curative resection of hepatocellular carcinoma and to compare the clinicopathological findings of the patients according to the tumor location in the liver. DESIGN: Case series. SETTING: A tertiary care center. PATIENTS: Seventy-five patients with Child's grade A or B liver function who had hepatocellular carcinoma that was confined to one segment and who underwent segmentectomy for curative resection of the tumor. The patients were divided into four groups: group P (posterior segmentectomy, n = 23); group A (anterior segmentectomy, n = 10); group M (medial segmentectomy, n = 16); and group L (lateral segmentectomy, n = 26). MAIN OUTCOME MEASURE: Disease-free survival rate. RESULTS: Seventy-three percent of the patients had cirrhosis of the liver. The surgical mortality and morbidity rates were 5.3% and 36.0%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 61.9%, 39.1%, and 26.3%, respectively, and were not significantly different among the four groups (P = .86). Group L had the least operative blood loss and shortest operative time when compared with the other three groups (P < .05). The postoperative liver function changes were mild and transient in the four groups of patients. With regard to pathological factors, only tumor size differed among the groups (tumors in group L were significantly larger than those in the other three groups, P < .05). Forty-three percent of the recurrent tumors were solitary in the early stage, with 81% involving the segment(s) adjacent to the resected one and 57% being confined solely to the segment adjacent to the resected segment. Patients having recurrent hepatocellular carcinomas had significantly larger tumors at the time of resection than did those without recurrence (P = .03). CONCLUSIONS: Hepatic segmentectomy is an effective therapeutic approach for small hepatocellular carcinomas and can be done safely even in patients with chronic liver disease and impaired liver function.

Carcinoma, Hepatocellular↗
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

Leukemoid reaction resulting from multiple cytokine production in metastatic mucoepidermoid carcinoma with central necrosis.

We report a male patient with metastatic high-grade mucoepidermoid carcinoma and associated leukemoid reaction. The patient was transferred to our hospital due to persistent spiking fever, marked granulocytosis, and suspected liver abscess. After thorough bacteriological studies, including cultures of blood and material aspirated from the "liver abscess", no evidence of infection was documented. The patient suffered from persistent spiking fever for more than 4 weeks in spite of empirical antibiotic treatment, and repeated aspiration of the presupposed liver abscess. He underwent exploratory laparotomy for intended surgical evacuation of the liver abscess and bacteriological diagnosis. The operative findings were compatible with metastatic carcinoma with multiple liver and retroperitoneal lymph node involvement and tumor necrosis. The pathology report indicated high-grade mucoepidermoid carcinoma. Immunohistochemistry showed positive staining for interleukin-1 alpha (IL-1 alpha) and IL-6. Elevation of cytokine levels in the necrotic tumor fluid, including IL-1 alpha, IL-6, granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor was confirmed by ELISA test. This case shows that multiple cytokine production from a metastatic tumor and its central necrotic area in the liver can produce a febrile leukemoid reaction mimicking a pyogenic liver abscess.

Abdominal Neoplasms↗
PubMed1994

DNA flow cytometric analysis of primary breast cancer in Chinese women: the relationship of DNA aneuploidy to clinical characteristics.

One-hundred-and-forty fresh frozen breast tissue samples from Chinese patients collected from May 1991 to October 1992 were evaluated for DNA content by flow cytometric analysis. None of the 12 benign tumors displayed aneuploidy. One-hundred-and-twenty-eight of the 140 specimens were histologically proven to be malignant. Ploidy was compared to the clinical characteristics which included age, tumor size, lymph node involvement, menopausal status, steroid receptor status, histological grading and pathological staging. After univariate and multivariate analyses, aneuploidy was more frequently identified in progesterone receptor negative and high grade tumors. This study suggests that an aneuploid DNA content in a breast cancer specimen may indicate more aggressive cancer.

Asian People↗
PubMed1993

Hepatocellular carcinoma in Taiwan: clinicopathological study of 440 cases from a consecutive 6000 autopsies.

The clinico-pathological features of 440 autopsy cases of hepatocellular carcinoma collected in a 30-year period were analyzed. The statistical observations included sex, age, clinical presentations, initial symptoms and signs, physical findings, varices, ascites, alpha-fetoprotein, serum hepatitis B surface antigen, liver weight, gross anatomic and histologic features of the tumors, grade of anaplasia, changes in noncancer parenchyma, and survival. Multivariate analyses demonstrated that age, HBsAg, AFP, associated cirrhosis, liver weight, gross pathology, histologic grading and structural pattern, and presence of clear cells did not correlate to the prognosis. The presence of metastasis adversely influenced the outcome. Bile production was associated with better tumor differentiation and longer patient survival. It also found that the smaller tumor tended to be more well differentiated.

Adolescent↗
PubMed1991

The role of lasers in hemorrhoidectomy.

Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups. Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid. Group B was treated with closed Ferguson hemorrhoidectomy. The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B (P less than 0.001). The incidence of postoperative urinary retention was 7 percent in group A, vs. 39 percent in group B (P less than 0.05). No enema was required postoperatively in group A, vs. 9 percent in group B; 84 percent of the patients in group A were discharged on the second postoperative day, vs. 83 percent of the patients in group B discharged on the fifth postoperative day. The cost was 20 percent less in the former group. The overall complications in both groups were insignificant in difference, except prolonged wound healing in group A was noted. One year follow-up showed satisfactory results. Laser treatment is considered one of the alternatives to conventional treatment, but the surgeon needs to be aware of laser hazards.

Adult↗
PubMed1991

[The clinic diagnostic value of the rigid sigmoidoscopy].

Rigid sigmoidoscopy is beneficial as it detects rectal or distal sigmoidal lesions very efficiently and precisely. But it also has some complications, e. g. rectal injury, rectal perforation or transient bacteremia. In this prospective study, 800 cases were collected and divided into two groups. In group I, 400 O.P.D. symptomatic cases were chosen randomly and in group II 400 cases registered for routine physical examination were picked up. The positive detection rate was 7% in group I versus 2% in group II. The lesions detected in group I are 15 cases of cancer, 7 cases of polyp, 4 cases of irradiation proctitis, 2 cases of ulcerative colitis and 1 case of pseudomembranous colitis. Only 8 polyps are found in group II. The routine sigmoidoscopy is mandatory for symptomatic patients but it is not cost-effective for routine check-ups. The stool occult blood is the best screening test for detecting colorectal lesions. For routine physical examination, stool occult blood test is safe and easy to perform. If the stool occult blood test is positive, then further examinations will be necessary.

Adolescent↗
PubMed1990

Hepatocellular carcinoma coexisted with second malignancy--a study of 13 cases from a consecutive 440 autopsy cases of HCC.

In a consecutive 440 autopsy cases of hepatocellular carcinoma (HCC), 13 patients (2.95%) were found to have a second primary malignant tumor. All of the patients were male. The age ranged from 40 to 69 years old. (mean: 56.5) Peak incidence occurred in the seventh decade. The associated neoplasms included 4 cases of colorectal adenocarcinoma, 2 cases of thyroid cancer, 2 cases of retroperitoneal sarcomas, 1 case of pancreatic adenocarcinoma, 1 case of esophageal squamous cell carcinoma, 1 case of common bile duct adenocarcinoma, 1 case of renal cell carcinoma, and 1 case of prostatic adenocarcinoma. The organ most commonly involved was large bowel (4 cases). Epithelial origin neoplasms comprised the vast majority (84.6%). Of the 13 cases, 2 associated malignancies existed metachronously, 4 and 5 years before HCC. The others were found at the same time as HCC. The clinical and pathological observations included age, sex, serum alpha-fetoprotein (AFP), serum hepatitis B surface antigen (HBsAg), cirrhosis, gross and histologic appearance. The above presentations were similar in cases with and without second malignancy. We failed to find any factor that was possibly related to the etiology of the second neoplasm. Much more such cases are needed for further evaluation.

Adult↗
PubMed1990

Perianal Paget's disease--report of 4 cases.

Over the past nine years (from 1981 to 1989), four patients with perianal Paget's disease were treated. All were male with an average age of 58.5 years. Clinically, perianal Paget's disease manifests as a slowly enlarging eczematous, and sharply demarcated perianal skin rash that may be oozing or itching. In the characteristic pathology finding, Paget's cells appear as large, rounded signet-ring cells with abundant mucin stain positive cytoplasm in the basal layer of the acanthotic epidermis. All but one, who suffered from primary sweat gland carcinoma, had underlying rectal adenocarcinoma. The first two cases expired soon after a delayed diagnosis of terminal underlying malignancy. Only in the later two cases was there a preoperative suspicion of perianal Paget's disease. There is often a delay in diagnosis due to clinical ignorance. Patients with persisting perianal skin rash should be biopsied frequently. If perianal Paget's disease is diagnosed, the underlying malignancy should be surveyed and managed thoroughly.

Aged↗
PubMed1989

Non-traumatic perforation of colon and rectum.

Free perforation of the colon and rectum is an acute surgical condition. Possible factors affecting the prognosis include age, sex, underlying disease, surgical procedures, duration from onset to surgical treatment, general condition before surgery and degree of contamination. A series of 50 cases with acute, nontraumatic perforation of the colon and rectum treated at Chang Gung Memorial Hospital from 1979 to 1986 were reviewed and studied retrospectively according to these prognostic factors. The mortality rate was highest in the group with colo-rectal cancer (45%). The mortality rate was 50% in the group who underwent primary closure with proximal diversion and 40% in the group who underwent resection without anastomosis. The mortality may not be related to the surgical procedure: the selection of the procedure was based on the seriousness of the illness. The mortality rate was 87% in patients with septic shock, 62% when treatment was delayed for more than 72 hours, 72% with severe contamination and 56% with poor nutritional status. Age, sex and underlying diseases were not significant contributing factors.

Adult↗
PubMed1989

Medullomyoblastoma: a case report.

Medullomyoblastoma is a rare childhood tumor of the central nervous system and there have been only seventeen cases reported in the English literature. A case of medullomyoblastoma arising from the cerebellar vermis was reported. Postmortem examination revealed diffuse leptomeningeal dissemination and supratentorial metastasis. In addition to classical histologic examination, the immunohistochemical and ultrastructural features were studied. Besides skeletal muscle differentiation, neither neuronal nor astrocytic differentiation were identified. The myoblastic element was confirmed by the demonstration of thick and thin myofilaments and Z bands on electron microscopy and by positive immunostaining for myoglobin.

Cerebellar Neoplasms↗