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Biomedical subjects

C S Chang-Chien

Publications and source records attributed to C S Chang-Chien.

At least 19 recordsLinked to original sources
PubMed1994

Ultrasonically-guided needle aspiration with preparation of cell blocks in the diagnosis of liver tumors.

To evaluate the diagnostic value of a method combining ultrasonically-guided Chiba needle aspiration and histological block preparation of aspiration specimen, 50 consecutive patients with histologically confirmed focal or diffuse lesion of the liver were studied. In addition to conventional aspiration cytology, the aspiration specimen was mixed 1:1 by volume with 95% alcohol and centrifuged. The precipitated specimen was then embedded in paraplast. Serial sections were obtained and stained with hematoxylin and eosin (H & E) technique. The diagnostic specificity and positive predictive value of the cell block technique in diagnosing hepatic malignancies were both 100%, as was those of aspiration cytology. The diagnostic sensitivity and overall accuracy of cell blocks were significantly better than those of aspiration cytology (89.5% vs. 63.2%, P < 0.01; and 92.0% vs. 72.0%, P < 0.01). The negative predictive value of cell blocks was also better than that of aspiration cytology, but the difference was not statistically significant (75.0% vs. 46.2%, P > 0.05). In terms of cellular differentiation, the accuracy of the diagnosis of cell blocks was 78.6% (22/28) in hepatoma; 80.0% (4/5) in metastatic adenocarcinoma and 100.0% (1/1) in small cell carcinoma. No complications were encountered in any of the patients. The results suggest that the preparation of cell blocks of the aspiration specimen is a reliable and accurate method for the diagnosis of hepatic malignancies. This method also elevates the diagnosis of the aspiration specimen from the cytological to the histopathological level.

Adult↗
PubMed1992

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases.

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Adult↗
PubMed1992

Liver biochemical tests and dengue fever.

The impact of dengue on liver function was studied by biochemical tests on 125 male and 145 female patients diagnosed with this disease during an outbreak that extended from November 1987 to December 1988. Abnormal levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (G-GT) were observed in 93.3%, 82.2%, 7.2%, 16.3% and 83.0% of the patients, respectively. The elevation of transaminases was mild to moderate in most cases, but was 10-fold greater than the normal upper limit for AST and ALT in 11.1% and 7.4% of the patients, respectively. Initially, the level of AST was greater than that of ALT, increasing to maximum levels nine days after the onset of symptoms, then decreasing to normal levels within two weeks. Results of the biochemical tests did not differ significantly between the cases with and without hepatitis B or hepatitis C virus infection, but significantly higher elevations of AST, ALT, and G-GT were observed in patients with episodes of bleeding. Liver biopsies of two patients showed features of lobular hepatitis. Of the five fatal cases, three died of hepatic failure. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever infection should be considered in the differential diagnosis of hepatitis.

Adolescent↗
PubMed1989

Sonographic demonstration of free air in perforated peptic ulcers: comparison of sonography with radiography.

Abdominal sonography was performed in 283 patients with acute abdominal pain. Of these patients, 10 were diagnosed as having an acute perforated peptic ulcer (PPU) and 2 were diagnosed as having a sealed-off PPU. Sonographic findings of acute PPU are summarized. The presence of an interference echo with the shifting phenomenon is a very strong indication of the presence of free air in the abdominal cavity. Using these sonographic criteria, intraperitoneal free air was diagnosed as 9/10 patients with PPU in comparison to 8/10 by abdominal and chest radiographs. Two patients with sonographic evidence of free air, but negative X-ray studies, were later found to have free air in the subsequent radiographic studies. These findings suggest that sonography is highly sensitive in the small number of patients in whom air is found. Sonographic studies also have the advantage of detecting other changes associated with PPU, such as fluid accumulation, inflammatory mass, and thickening of the gallbladder.

Abdomen, Acute↗
PubMed1988

Different implications of stigmata of recent hemorrhage in gastric and duodenal ulcers.

A prospective study was conducted to evaluate the prognostic value of stigmata of recent hemorrhage in patients with bleeding peptic ulcer. Of 193 patients suffering from peptic ulcer bleeding identified by emergency gastrointestinoscopy, 52 patients were found to have bleeding gastric ulcer (spurt 5, active oozing 9, fresh clot 11, black clot 17, protruding vessel 4, and clear base without stigmata 6); the other 141 had bleeding duodenal ulcer (spurt 5, active oozing 26, fresh clot 43, black clot 23, protruding vessel 15, and clear base without stigmata 31). Patient with continuous bleeding or rebleeding was grouped as unstable bleeders. The rate of unstable bleeders was 39.1% (continuous bleeding 23.9% and rebleeding 15.2%) in patients with gastric ulcer, compared to 9.0% (4.5% and 4.5%) in duodenal ulcer (P less than 0.001). The unstable bleeder rate of ulcers with spurt, active oozing, clot, and protruding vessel was 80%, 44%, 35.7%, and 0%, respectively, in patients with bleeding gastric ulcer; and 33.3%, 19.2%, 6%, and 0%, respectively, in patients with bleeding duodenal ulcer. The data suggest that the stigmata of recent hemorrhage, excluding protruding vessel, has prognostic significance in bleeding gastric ulcer but less in bleeding duodenal ulcer.

Duodenal Ulcer↗
PubMed1987

Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreatography? A prospective study.

Previous observations indicate that juxtapapillary diverticula (JD) of the duodenum have made cannulation of the papilla of Vater difficult in endoscopic retrograde cholangiopancreatography. This prospective study of 1,243 cases that underwent ERCP shows that 153 patients with JD had the same failure rate as the 1,090 patients without JD (8.49% vs. 8.99%). The incidence of JD increases with age, but the incidence of biliary calculi or cholangitis is not different between the JD group and the nondiverticulum group.

Adult↗
PubMed1987

Controlled trial of protease inhibitor gabexelate mesilate (FOY) in the treatment of acute pancreatitis.

A controlled trial with synthetic protease inhibitor gabexelate mesilate (FOY) in the treatment of acute pancreatitis was conducted in a total of 42 patients. The age, sex, etiology of pancreatitis, initial serum amylase level, and amylase creatinine clearance ratio were comparable between FOY-treated and control groups. FOY did not alter the course of the disease, but there was a weak trend toward lower morbidity and mortality in the FOY-treated patients. These results may justify further, larger scale studies or evaluation of alternate dosage or route of administration.

Acute Disease↗
PubMed1987

Hepatocellular carcinoma associated with second primary malignancy.

In a consecutive series of 562 patients with pathologically documented hepatocellular carcinoma (HCC), 12 patients (2.1%) were found to have a second primary malignancy elsewhere. Of these, eight were male, four female, with ages ranging from 49 to 76 years (mean 60.7 +/- 9.3 years). The associated cancers included eight cases of gastric cancers, an esophageal cancer, a stump cancer, a case of myelocytic leukemia and a histiocytic lymphoma. Eight cases had both malignancies diagnosed at the same admission. In the other four, HCC were detected after an interval of 4, 10, 12 and 39 months. Two had received previous chemotherapy or radiotherapy. Fifty percent of the 12 patients were hepatitis B surface antigen (HBsAg) positive. Their liver function tests and alpha-fetoprotein levels were consistent with those of patients with HCC alone. The results suggest that the occurrence of HCC concomitant with or arising after another primary malignancy in Taiwan is not rare.

Aged↗
PubMed1984

Hepatocellular carcinoma in noncirrhotic patients. A laparoscopic study of 92 cases in Taiwan.

Clinical and laboratory findings of 92 cases of pathologically verified noncirrhotic primary hepatocellular carcinoma (HCC) were analyzed and compared with that of 174 cases of cirrhotic HCC during the same period. Ninety-two cases of noncirrhotic HCC constitute one third of all the cases of HCC. They comprised 74 men (80.4%) and 18 women (19.6%) with a male:female ratio of 4.1. The mean age was 52.0 +/- 14.5 years. Among them, 17.4% had a history of hepatitis; 65.2% were HBsAg positive. Compared with cirrhotic HCC, patients with noncirrhotic HCC had less frequent past history of hepatitis, lower positive rate for HBsAg, higher albumin/globulin ratio, and lower frequency in the elevation of serum alpha-fetoprotein. The results might imply that noncirrhotic and cirrhotic HCC have different pathogenetic backgrounds.

Adolescent↗