Biomedical subjects

C S Changchien

Publications and source records attributed to C S Changchien.

At least 19 recordsLinked to original sources

PubMed2001

Endosonographic appearances of Brunner's gland hamartomas.

Brunner's gland hamartoma is an uncommon intestinal tumor, most frequently located in the duodenal bulb. We report the endoscopic sonographic (EUS) appearances in 2 cases of Brunner's gland hamartoma. In 1 case, EUS revealed a heterogeneous hypoechoic pedunculated mass, 1.7 cm in diameter, arising from the mucosal and submucosal layers of the wall of the duodenal bulb. Multiple anechoic large and small cystic areas were demonstrated in the tumor. In the other case, EUS revealed a 1.4- x 0.9-cm pedunculated mass with an echogenicity higher than that of the muscular layer and lower than that of the mucosa, arising from the submucosal layer of the duodenal bulb wall. Multiple small anechoic areas were demonstrated in the tumor. We believe that both EUS patterns are typical for Brunner's gland hamartomas.

Brunner Glands↗

PubMed2001

Liver abscess in patients with cirrhosis of the liver: a 12-year experience.

PURPOSE: Liver abscess is rare in patients with cirrhosis of the liver. The aim of this retrospective study was to investigate the incidence, clinical presentation, causal pathogens, and outcome of liver abscess in cirrhotic patients. METHODS: We collected 21 liver abscess specimens (from 14 male patients and 7 female patients; Child A: B: C, 4: 7: 10) from 22,731 admissions of 6450 cirrhotic patients, from 1986 through 1998. RESULTS: The common clinical symptoms and signs included fever, chills, and abdominal tenderness. The major predisposing factors were biliary tract disease (52%) and diabetes mellitus (48%). The diagnosis rate with abdominal ultrasonography was 79%. Gram-negative aerobes were the predominant pathogens (Klebsiella pneumoniae, 66.7%; Escherichia coli, 23.8%), and occurred in 80% and 69% of blood and pus cultures, respectively, while 38% of cases showed polymicrobial pathogens. The location of the abscess was predominantly in the right lobe (71.4%), and 47.6% of patients had multiple abscesses. Six patients died (all with Child C cirrhosis). The overall mortality rate was 28.6% (6/21). CONCLUSIONS: The incidence of liver abscess in the cirrhotic patients was low, at 0.09% (21/22,731 admissions). The clinical presentations and pathogens were not different from those in noncirrhotic patients, except that in our cirrhotic patients, there was no significant difference in mortality between those with monomicrobial and those with polymicrobial abscess: nor was there a significant difference in mortality between those with single and those with multiple abscesses. The Child C patients were the high-risk group.

Adult↗

PubMed2001

Endoscopic and radiological features of intramural esophageal dissection.

A 41-year-old woman was admitted to our hospital complaining of chest pain, dysphagia, and odynophagia after an upper respiratory tract infection and nasogastric tube insertion. An upper endoscopy showed a large submucosal bulge along the posterior wall from the upper esophagus with mucosal tears and bridge formation, extending down to the lower esophagus. A barium esophagogram revealed a "double-barreled" esophagus, and chest computed tomography (CT) scan showed eccentric thickening of the esophageal wall. The diagnosis of intramural esophageal dissection (IED) was made and the patient was managed conservatively with nothing by mouth and intravenous hydration. The clinical course was uneventful; the patient was discharged later and up to the time of writing has been completely asymptomatic, with normal swallowing function.

Adult↗

PubMed2001

Clinical characteristics of double pylorus.

BACKGROUND: Double pylorus can occur as either a congenital abnormality or an acquired complication of peptic ulcer disease. There has been no report of long-term follow-up of a large series of patients treated for double pylorus. The objective of this study was to determine the course of double pylorus in 20 patients by serial endoscopic examination. METHODS: Among 102,958 endoscopic examinations conducted from 1987 to 1999, a diagnosis of double pylorus was made in 20 patients, 18 of whom were followed from 2 months to 10 years. The demographics, clinical presentations, and outcome, as well as endoscopic patterns of double pylorus, were retrospectively reviewed. The rates of ulcer recurrence and symptoms were estimated and compared. RESULTS: Most fistulous rings were located on the lesser curve of the gastric antrum (75%). Evolution from an original ulcer to fistula was observed in 9 patients. The fistula disappeared in 1 patient, remained open in 12, and converged with the normal pyloric ring in 5 patients. One or more associated systemic diseases and extensive treatment with various drugs were noted in 12 patients. Eradication of Helicobacter pylori in infected patients resulted in a lower percentage of patients with symptoms (36% vs. 100%) and ulcer recurrence (55% vs. 100%) compared with uninfected patients, but the differences were not statistically significant. CONCLUSION: In this study, fistula closure did not occur in the majority of patients. Associated systemic diseases and extensive use of medications might be important factors in persistence of double pylorus. Eradication of Helicobacter pylori was not beneficial in terms of relief of symptoms, prevention of ulcer recurrence, and fistula closure. Surgical intervention should be considered for patients with refractory symptoms, recurrent ulcers, and other complications.

Duodenal Diseases↗

PubMed2001

Famotidine versus omeprazole, in combination with amoxycillin and tinidazole, for eradication of Helicobacter pylori infection.

BACKGROUND: Eradication regimens combining two antibiotics with a proton pump inhibitor have been studied intensively. In contrast, only a few studies have focused on the possible role of H2-receptor antagonists in eradication therapy. The mechanism involved in the synergy between antibiotics and proton pump inhibitors is still controversial. OBJECTIVES: To compare the results of two triple-therapy regimens, different only in the antisecretory drugs used, in patients with Helicobacter pylori infection, and to assess the impact of primary resistance to metronidazole on treatment outcome. METHODS: A total of 120 patients with peptic ulcer and non-ulcer dyspepsia were randomly assigned to a 2-week course of either: famotidine 40 mg twice a day, amoxycillin 1 g twice a day and tinidazole 500 mg twice a day (FAT group; n = 60); or omeprazole 20 mg twice a day, amoxycillin 1 g twice a day and tinidazole 500 mg twice a day (OAT group; n = 60). Upper endoscopy was performed prior to treatment and at least 4 weeks after completion of treatment and discontinuation of the antisecretory therapy. H. pylori status was assessed by a biopsy urease test, histology and culture. RESULTS: In the intention-to-treat analysis, eradication of H. pylori was achieved in 48 of the 60 patients (80%; 95% confidence interval: 70-90%) in the FAT group, compared to 50 of the 60 patients (83.3%; 95% confidence interval: 74-93%) in the OAT group. In the per protocol analysis, eradication therapy was achieved in 48 out of 53 patients (90.6%; 95% confidence interval: 83-98%) treated with FAT and 50 out of 57 patients (87.7%; 95% confidence interval: 79-96%) treated with OAT (not significant). The primary metronidazole resistance was present in 28.8% of strains. Overall, per protocol eradication rates in strains resistant and susceptible to metronidazole were 83.3% and 91.3% respectively (P > 0.05). CONCLUSIONS: Two-week courses of either high-dose famotidine or omeprazole, both combined with amoxycillin and tinidazole, are equally effective for eradication of H. pylori infection. In a 2-week triple therapy, metronidazole resistance has no significant impact on eradication rates.

Adolescent↗

PubMed2001

Flash echo gray scale imaging with subtraction in assessment of small hepatocellular carcinoma treated with percutaneous ethanol injection: preliminary report.

OBJECTIVE: To assess the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma by using a flash echo imaging system, a newly developed technique for detecting echoes from microbubble contrast agents more efficiently. METHODS: Six patients with 7 small nodular hepatocellular carcinomas, proved by fine-needle aspiration cytologic or pathologic examination, were included. Percutaneous ethanol injection was performed until there was no intratumoral color signal on conventional color and power Doppler ultrasonography. A bubble contrast agent was then injected, and flash echo imaging in the subtraction mode was performed for assessment of the therapeutic effect. Dynamic computed tomography, magnetic resonance imaging, and hepatic angiography were also used for evaluation of the therapeutic effect. RESULTS: Five tumors had perfusion defects that were equal in size to or larger than the tumors. No tumor stain was shown on hepatic angiography. Two tumors had partial perfusion defects. Viable tumors were confirmed by tumor resection in 1 case and cytologic examination in the other. CONCLUSIONS: Our preliminary results show that flash echo imaging with subtraction has potential value in evaluation of the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma.

Adult↗

PubMed2001

Differentiation of benign and malignant gastric stromal tumors using endoscopic ultrasonography.

BACKGROUND: Endoscopic ultrasonography (EUS) is a useful modality to show the sonographic features of gastric stromal tumors (GST) which originate from the gastric wall, but it is difficult to distinguish benign from malignant tumors. This study tried to discriminate between them by their EUS patterns. METHODS: EUS patterns were obtained from 52 histologically proved GST. The tumor size, echo patterns and irregular margin were analyzed. RESULTS: Of 52 GST, 11 were leiomyosarcoma and 41 were leiomyoma. The mean sizes of the leiomyoma and leiomyosarcoma were 3.3 +/- 1.1 cm and 7.1 +/- 2.2 cm (p < 0.01). Using a tumor size > or = 5 cm as a criterion for malignancy resulted in a sensitivity of 72.7% and a specificity of 85.4%. A sonolucent area inside the tumor, resulted in a sensitivity and specificity of 81.8% and 80.5%. With an irregular tumor margin, the sensitivity and specificity were 90.9% and 90.2%. A combination of all 3 criteria, resulted in a sensitivity and specificity of 72.7% and 90.2%. For benign tumors, the criteria of tumor < 5 cm, no sonolucent areas and no irregular margin had a sensitivity of 80.5% and a specificity of 100%. CONCLUSION: Tumor size is not a sensitive criterion of malignancy. An irregular margin and sonolucent areas in the tumor have better sensitivity and specificity for the diagnosis of malignant GST. On the contrary, a GST smaller than 5 cm in size with neither a sonolucent area nor an irregular tumor margin strongly suggests a benign lesion.

Endosonography↗

PubMed2000

Changes in portal venous hemodynamics in patients with severe acute hepatitis over one year.

PURPOSE: A wide range of portal vein blood flow velocity (PVV) values can be found in acute hepatitis. We studied course and medical significance of PVV changes in patients with severe acute hepatitis over a 1-year period. METHODS: Portal venous hemodynamics were studied by Doppler sonography in 90 patients at study enrollment and 3, 6, and 12 months following an episode of severe acute hepatitis. RESULTS: Forty-one survivors who had a maximum PVV at enrollment greater than or equal to the value measured at the third month were classified as the "declining PVV" group. Thirty-six survivors who had a maximum PVV at enrollment less than the value measured at the third month were classified as the "rising PVV" group. Thirteen patients died of acute hepatic failure and were classified as the fatality group. The fatality group had significantly lower maximum PVV, worse liver biochemical test results, and a higher prevalence of ascites at enrollment. In contrast, the declining PVV group showed significantly better liver biochemical test results and a lower prevalence of ascites. There was no significant difference in portal vein blood flow between the rising and declining PVV groups since portal vein diameter increased while PVV decreased. CONCLUSIONS: An initially decreased PVV can be found in some patients with severe acute hepatitis and is inversely correlated with the severity of liver damage.

Acute Disease↗

PubMed2000

Demonstration of gastric submucosal lesions by high-resolution transabdominal sonography.

PURPOSE: We evaluated the accuracy of high-resolution transabdominal sonography (TAUS) in identifying and characterizing gastric submucosal masses previously detected by endoscopy. METHODS: Patients given endoscopy for suspected submucosal gastric lesions and 2 patients with gastric wall cysts were enrolled. Patients underwent TAUS and then endoscopic sonography (EUS) on the same day, and the sonographic results were compared with endoscopic and histologic findings. RESULTS: Among 101 patients with gastric submucosal masses on endoscopy, TAUS revealed a mass in 94 (93%); of these 94 patients, 60 underwent EUS. The final diagnoses were 31 leiomyomas, 10 leiomyosarcomas, 13 ectopic pancreases, 2 cysts, and 1 glomus tumor, 1 carcinoid tumor, 1 lipoma, and 1 fibroma. Leiomyomas (mean size, 3.2 cm) and leiomyosarcomas (mean size, 7.1 cm) were shown sonographically to originate from the muscular layer. Ectopic pancreases (mean size, 1.2 cm) were shown to originate from the submucosal layer and had a homogeneously echogenic pattern. Gastric cysts were found in the submucosal layer and were anechoic. The glomus tumor and the carcinoid tumor were found in the muscular layer and were hypoechoic. The lipoma and the fibroma were located in the submucosal layer and were echogenic on TAUS. CONCLUSIONS: TAUS had a detection rate of 93% in visualizing submucosal gastric masses previously identified by endoscopy. TAUS is less invasive than EUS and can be used to follow submucosal gastric masses that are not excised.

Adolescent↗

PubMed2000

Aortoduodenal fistula presenting as acute massive gastrointestinal bleeding and recurrent syncope: case report.

Aortoenteric fistula is a rare condition that may cause death in patients due to gastrointestinal bleeding. The duodenum is the most frequently involved site, at 78.5% of 191 cases by Nagy and Marshall's meta-analysis. It is characterized by the clinical triad of abdominal pain, gastrointestinal bleeding, and an abdominal mass. Abdominal computed tomography is the most useful tool in detecting an aortoenteric fistula. To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. Herein, we report a 60-year-old man who suffered from acute gastrointestinal bleeding, recurrent syncope, and impending shock. Abdominal computed tomography revealed a 6 cm longitudinal aneurysm in the infrarenal aorta. Emergency laparotomy was performed and revealed an aortoduodenal fistula in the fourth portion of the duodenum causing acute duodenal bleeding. The patient survived and has undergone 2 years worth of regular follow-up in our outpatient department.

Aortic Diseases↗

PubMed2000

Adult intussusception: a 12-year experience, with emphasis on etiology and analysis of risk factors.

BACKGROUND: To determine the incidence, causes, and associated risk factors of adult intussusception. METHODS: Forty-five cases of adult intussusception proven by surgery were collected from 58,000 surgeries performed from December 1986 through December 1998. The condition leading to intussusception, imaging studies, and clinical risk factors were analyzed. RESULTS: Nineteen men and 26 women, 18 to 83 years of age (mean, 52.6 years), experienced intussusception. The incidence of adult intussusception was 0.08% of abdominal surgeries and 3.0% of intestinal obstructions. A benign process was diagnosed in 25 cases (55.6%), malignancy in 16 cases (35.6%), surgery-related intussusception in 1 case (2.2%), and an idiopathic condition existed in 3 cases (6.6%). The major cause of adult intussusception due to benign lesions was polyps (12/25) and for malignancy, it was colonic adenocarcinoma (14/16). The diagnostic imaging rates were 52% for computed tomography, 41% for barium studies and 32% for abdominal ultrasound. There was no mortality due to intussusception; 4 patients (8.9%) died of colon cancer with liver metastasis. No definite risk factor was identified, but leukocytosis and a shorter preoperative duration tended to increase the risk of complications (p = 0.084, 0.082 respectively). CONCLUSION: Malignancy was the major cause of colonic intussusception, as was a benign process the primary cause of intestinal intussusception. These adult patients with intussusception received adequate surgical care and had a good prognosis except for those with colon cancer and liver metastasis.

Adolescent↗

PubMed2000

Endoscopic ultrasonographic classification of gastric aberrant pancreas.

BACKGROUND: Gastric aberrant pancreas (GAP) can be demonstrated by its characteristic patterns on endoscopic ultrasonography (EUS). We tried to classify the EUS figures of GAP to provide a useful EUS pattern for diagnosing this disease. METHODS: Among 68 cases of GAP suspected by EUS, 13 patients who were proven to have GAP by histology from surgical specimens (4 cases), mucosectomy (6 cases), and biopsy (3 cases) were enrolled. EUS was performed under a standard procedure using an Olympus EU-M3 machine with a 7.5/12 MHz inter-changeable transducer. The essential histological finding of GAP is pancreatic tissue in specimens. RESULTS: Among 13 patients with GAP (size from 0.7 to 1.6 cm in diameter), 11 tumors were located in the antrum, and 2 were located at the lower body. All 13 tumors arose from the third layer of the gastric wall with an echogenicity higher than the fourth hypoechoic layer. We classified EUS figures of these 13 GAP into 3 types based on the change of the muscular (fourth) layer below the tumor: Type 1 (6 cases), the fourth layer is intact and has a normal thickness; Type 2 (4 cases), the fourth layer has thickened; and Type 3 (3 cases), the fourth layer has thickened, and there are some hyperechoic densities (tubular-like structures) within the fourth layer. Mucosectomy was performed without any complication in 6 cases (four type 1 and two type 2). CONCLUSION: EUS figures of our 13 cases of GAP were classified into 3 types which will be helpful in the EUS diagnosis of GAP and can provide information on selecting patients for mucosectomy.

Adolescent↗

PubMed1999

Age, gender, and local geographic variations of viral etiology of hepatocellular carcinoma in a hyperendemic area for hepatitis B virus infection.

BACKGROUND: There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV-endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. METHODS: The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. RESULTS: The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 +/- 12.3 vs. 61.3 +/- 11.2 years) (P < 0.05). The male-to-female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti-HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti-HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti-HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi-based HCC patients, 55.4% were anti-HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV-related disease. CONCLUSIONS: The mean age of patients with HBV-related HCC was significantly lower than that of patients with non-HBV-related HCC. The male-to-female ratio for patients with HBV-related HCC was significantly higher than that of patients with HCV-related HCC. The authors identified an area of Taiwan in which HCV-related HCC was prevalent.

Age Factors↗

PubMed1999

Ileal aberrant pancreas induces intussusception and gastrointestinal bleeding in an adult woman--case report.

Aberrant pancreas is a congenital anomaly. In surgical series, its incidence varied from 0.2 to 0.8%. About 70% of aberrant pancreas occur in the gastrointestinal tract. Eighty percent of them locate in the stomach and duodenum, and only 0.2% in the ileum. We report on a 25-year-old woman with ileal aberrant pancreas who suffered from ileal intussusception and recurrent gastrointestinal bleeding. The diagnosis was confirmed by surgery and histology. She is symptom-free after surgery.

Adult↗

PubMed1999

Replication of hepatitis B virus in first-degree relatives of patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) may occur in family clusters. No genetic mechanism has been identified as responsible for this familial tendency. We suspected that a longer hepatitis B virus (HBV) replication phase might be the reason for a higher risk of HCC in families with this disease. We performed liver biochemical tests, test for viral hepatitis markers and hepatitis B e antigen (HBeAg), and liver ultrasonography in relatives of patients with HCC. A total of 1,885 first-degree relatives from 688 families participated in this study. Seven hundred fifty-two relatives were found to be carriers of hepatitis B surface antigen (HBsAg) and 675 of them were tested for HBeAg. The prevalence of HBeAg was 27.4% in relatives of those with HCC and 20% in asymptomatic HBsAg carriers. The HBeAg prevalence rate was higher in relatives of those with HCC > or = 40 years old than in asymptomatic HBsAg carriers. Moreover, HBeAg was more likely to persist in men than in women > or = 40 years old. We conclude that families with HCC showed a prolonged HBV replication phase that may be one of the cofactors for a familial tendency for HCC.

Adolescent↗

PubMed1999

Pseudomyxoma peritonei with high serum CA19-9: report of three cases.

Pseudomyxoma peritonei (PMP) is an unusual form of intraabdominal neoplasm that produces a large amount of extracellular mucin. It is often associated with mucinous tumors of gastrointestinal tract or ovary. Herein, we report 3 patients with pseudomyxoma peritonei with high serum carbohydrate antigen 19-9 (CA19-9) levels. The first patient, who had a CA19-9 level of 1132 U/ml, had well-differentiated rectal cancer and died of chemotherapy complications, pneumonia and septic shock; one month after admission. The other 2 cases with CA19-9 levels of 2520 U/ml and 679 U/ml had tumors of unknown origins and had survived more than 1 year and 3 months after treatment, respectively. Usually, elevated serum CA19-9 levels are found in patients with pancreatic, biliary, colorectal, gastric or liver cancers. However, many studies have shown high serum CA19-9 levels are associated with mucinous carcinoma. Immunochemical studies also showed positive staining of CA19-9 in mucinous tumors. PMP is composed of large amounts of mucin, therefore, we suggest that serum and ascites CA19-9 levels should be routinely checked in patients with PMP.

Aged↗

PubMed1999

Brunner's gland hamartomas: report of three cases.

Brunner's gland hamartoma is a rare duodenal tumor, which grew larger than 2 cm in diameter in a very limited number of cases. Since the first description in a patient with fatal duodenal intussusception by Cruveilhier in 1835, approximately 143 cases have been reported in the English literature, and only 25 cases had tumor growth to more than 2 cm in diameter. To the best of our knowledge, only 4 cases have been reported in Taiwan. We present three of Brunner's gland hamartomas. In one patient the tumor was located on the secondary portion of the duodenum, which presented with massive tumor bleeding and measured 3.0 cm in diameter. The other two were both located on the duodenal bulb, which presented with abdominal pain and measured 2.0 and 1.3 cm in diameter, respectively. One of the patients received endoscopic ultrasonography which showed specific findings. Two patients received laparotomy and tumor excision; the other one received endoscopic polypectomy. All 3 patients recovered well without any complications.

Brunner Glands↗

PubMed1999

Sequential sonographic changes of the gallbladder in hemobilia: case report of a patient with intrahepatic duct stones.

The sonographic features of hemobilia in the gallbladder have been reported with variation, including an echogenic mass, hypoechoic mass, and scattered intraluminal echoes. The sequential sonographic changes of hemobilia in the gallbladder were observed in a 59-year-old male patient with bilateral intrahepatic duct stones. The sonograms of hemobilia in the distended gallbladder initially showed a hyperechoic, homogeneous, movable mass-like lesion, 36 hours before the onset of upper gastrointestinal (UGI) bleeding. A hypoechoic mass-like lesion with a hyperechoic ring was found 5 days after the onset of UGI bleeding. A faint hypoechoic mass-like lesion was found 7 days after the onset of UGI bleeding (the day of no further bleeding). Scattered echoic densities were found 9 days after the onset of UGI bleeding, then disappearance of the lesion was noted 12 days after the onset of UGI bleeding. The sonographic patterns of hemobilia in the gallbladder vary depending on the timing of lysis of the blood clot. It should be differentiated from gallbladder cancer, a stone, a polyp, sludge, acute gangrenous cholecystitis, and gallbladder empyema.

Bile Ducts, Intrahepatic↗