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Chiung-Yu Chen

Publications and source records attributed to Chiung-Yu Chen.

15 recordsLinked to original sources
PubMed2006

Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis.

BACKGROUND: The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated appendicitis for predicting the recurrence of appendicitis. METHODS: Thirty-five patients with nonoperated perforated appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. RESULTS: Both of the 2 patients who had a past history of appendicitis suffered recurrent appendicitis (the recurrence versus the nonrecurrence group, P<.05). The only CT imaging relating to the recurrence of appendicitis is the presence of calcified appendicolith (the recurrence versus the nonrecurrence group, P<.001). CONCLUSIONS: It is most likely that appendicitis will recur if a calcified appendicolith on CT imaging or a past history of appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent appendicitis.

Adult↗
PubMed2005

The value of biliary amylase and Hepatocarcinoma-Intestine-Pancreas/Pancreatitis-associated Protein I (HIP/PAP-I) in diagnosing biliary malignancies.

BACKGROUND/OBJECTIVES: Elevated concentrations of Hepatocarcinoma-Intestine-Pancreas/Pancreatitis-associated Protein I (HIP/PAP-I) in pancreatic juice have been reported in patients with pancreatic adenocarcinoma and have been considered as a promising tumor marker. This study was conducted to investigate whether biliary HIP/PAP-I can be used in the differential diagnosis of the cause of biliary obstruction. METHODS: Bile was obtained from patients with bile duct obstruction on the day of biliary drainage. The etiology of biliary obstruction included gallstones (n = 131), pancreatic cancer (n = 32), cholangiocarcinoma (n = 47), papilla Vater cancer (n = 13), hepatocellular carcinoma (n = 4) and metastatic cancer (n = 16). In addition to HIP/PAP-I, the samples were analyzed for amylase to check for the presence of pancreaticobiliary reflux. RESULTS: The biliary concentration of HIP/PAP-I was not statistically different between patients with gallstones (median, 9.70 ng/mL; interquartile range [IQR] 1.80-45.75) and cancers (median, 12.70 ng/mL; IQR, 3.85-36.75), P > 0.05. However, the amylase activity in the bile was markedly elevated in patients with gallstones (median, 228 U/L; IQR, 40-1965), compared to those with cancer (median, 32 U/L; IQR; 30-176), P < 0.001. The area under the ROC curve of amylase was 0.751 (95% CI: 0.69 to 0.81). At a cut-off value of 46 U/L, the biliary amylase distinguished patients with malignant obstruction from those with benign obstruction with a sensitivity of 66% and a specificity of 74%. CONCLUSIONS: Our data suggest that the biliary HIP/PAP-I measurement is not useful for differentiating causes of biliary obstruction. The divergent extent and duration of biliary obstruction caused by neoplasm and gallstones may contribute to the significant difference in the amylase activity in bile. Thus, amylase in bile represents a candidate marker in the differential diagnosis of the cause of biliary obstruction.

Amylases↗
PubMed2005

Single-session alcohol-retention sclerotherapy for simple renal cysts: comparison of 2- and 4-hr retention techniques.

OBJECTIVE: The objectives of our study were to evaluate the feasibility of ethanol sclerotherapy in treating simple renal cysts with prolonged ethanol retention and to compare the therapeutic results of 2- and 4-hr retention techniques. MATERIALS AND METHODS: We retrospectively reviewed 36 renal cysts in 33 patients treated by ethanol sclerotherapy with a single-session single-injection technique during the past 6 years. After complete aspiration of the cystic fluid, 95% ethanol was injected into the cyst and was retained for 4 hr in 14 cysts (group 1) and for 2 hr in 22 cysts (group 2). The average maximal diameter and aspirated volume of the cysts were 8.3 cm and 223 mL in group 1 patients and 7.9 cm and 167 mL in group 2, respectively. The ablated cysts were followed up regularly by sonography, CT, or both at 3- to 6-month intervals for at least 1 year. The nonparametric Mann-Whitney U test was used to compare differences in characteristics, treatment results, and laboratory data of the subjects in the two groups. The level of statistical significance was set at a p value of less than 0.05. RESULTS: Technically, all the patients tolerated the procedures. One patient had gross hematuria 10 days after the procedure. She underwent surgical deroofing treatment and was excluded in the later statistical analysis. After sclerotherapy, 14 cysts disappeared completely and 16 cysts showed marked regression with residual maximal diameter of less than 3 cm. The overall volume reduction rate was 97.6% in all 35 cysts. The mean residual longest diameters and average volume reduction rates of the treated cysts were 1.9 cm and 97.9% in group 1 patients and 1.1 cm and 97.3% in group 2 patients, respectively, which showed no statistical significance of volume reduction rate with a p value 0.149. CONCLUSION: The single-session prolonged ethanol-retention technique is safe and efficacious for the treatment of renal cysts. There is no statistical difference in therapeutic efficacy between 2- and 4-hr ethanol-retention techniques.

Adult↗
PubMed2005

Metallic stent placement for treating peripheral outflow lesions in native arteriovenous fistula hemodialysis patients after insufficient balloon dilatation.

OBJECTIVE: The purpose of this study was to report our experience with metallic stent placement in the peripheral outflow veins in native arteriovenous fistula (A-V fistula) hemodialysis patients after insufficient balloon dilatation. MATERIALS AND METHODS: During the past 4 years, 12 A-V fistula dialysis patients in our hospital underwent metallic stent placement in the peripheral outflow veins to restore vascular access. The indications for metallic stent placement in our study included (1) recoil stenosis of outflow vein in six patients; (2) outflow venous rupture in two patients and dissection in one patient; and (3) large residual adherent thrombus in outflow aneurysms in three patients with thrombosed (arteriovenous) access. Self-expandable Wallstent or Jostent (Jomed, Abbott Laboratories) of appropriate size (6-10 mm in diameter) was chosen for use in these patients. Kaplan-Meier survival analysis was used to calculate the access patency rates. RESULTS: Twelve patients received stents. Eleven patients (92%) underwent successful dialysis after the procedure. One patient experienced complications due to incorrect positioning of the stent at the anastomotic site, causing flow compromise. The primary patency (+/- standard error) of the vascular access at 3, 6, 12, and 24 months was 92% +/- 8%, 81% +/- 12%, 31% +/- 17%, and 31% +/- 17%, respectively. The secondary patency of the vascular access at 3 months was 92% +/- 8%, and 82% +/- 12% at 6, 12, and 24 months each. CONCLUSION: Metallic stent placement is safe and effective in treating peripheral venous lesions in native A-V fistula hemodialysis patients after unsatisfactory balloon dilatation.

Adult↗
PubMed2004

Rapid detection of K-ras mutations in bile by peptide nucleic acid-mediated PCR clamping and melting curve analysis: comparison with restriction fragment length polymorphism analysis.

BACKGROUND: Current methods for detection of K-ras gene mutations are time-consuming. We aimed to develop a one-step PCR technique using fluorescent hybridization probes and competing peptide nucleic acid oligomers to detect K-ras mutations in bile and to compare the efficacy with restriction fragment length polymorphism (RFLP) analysis. METHODS: Bile samples were obtained from 116 patients with biliary obstruction, including gallstones (n = 64), benign biliary strictures (n = 6), pancreatic cancer (n = 20), and cholangiocarcinoma (n = 26). The DNA was extracted and subjected to K-ras mutation analysis by real-time PCR and RFLP analysis. Mutations were confirmed by direct sequencing. The sensitivity and specificity were calculated according to the clinical results. RESULTS: The analysis time for real-time PCR was <1 h, whereas RFLP analysis took more than 2 days. With the sensor probe designed for the GAT (G12D) mutant in codon 12 of the K-ras gene, the real-time PCR method also detected the GTT (G12V) mutant. In contrast, a specific sensor probe for the TGT (G12C) mutant detected GAT (G12D), AGT (G12S), and GTT (G12V) mutants in addition to the TGT mutant. The real-time PCR assay allowed the detection of mutation in a 3000-fold excess of wild-type bile DNA. In bile, K-ras codon 12 mutations were detected in 16 of 46 malignant cases by real-time PCR with the TGT probe and 15 by RFLP analysis. All benign cases were wild type. CONCLUSION: Real-time PCR with a cysteine-specific (TGT) sensor probe can rapidly detect K-ras gene mutations in bile and diagnose malignant biliary obstruction with high specificity.

Aged↗
PubMed2004

MRI of gallstones with different compositions.

OBJECTIVE: Gallstones are usually recognized on MRI as filling defects of hypointensity. However, they sometimes may appear as hyperintensities on T1-weighted imaging. This study investigated how gallstones appear on MRI and how their appearance influences the detection of gallstones. MATERIALS AND METHODS: Gallstones from 24 patients who had MRI performed before the removal of the gallstones were collected for study. The gallstones were classified either as cholesterol gallstone (n = 4) or as pigment gallstone (n = 20) according to their gross appearance and based on analysis by Fourier transform infrared spectroscopy. MRI included three sequences: single-shot fast spin-echo T2-weighted imaging, 3D fast spoiled gradient-echo T1-weighted imaging, and in-phase fast spoiled gradient-echo T1-weighted imaging. The signal intensity and the detection rate of gallstones on MRI were further correlated with the character of the gallstones. RESULTS: On T1-weighted 3D fast spoiled gradient-echo images, most of the pigment gallstones (18/20) were hyperintense and all the cholesterol gallstones (4/4) were hypointense. The mean ratio of the signal intensity of gallstone to bile was (+/- standard deviation) 3.36 +/- 1.88 for pigment gallstone and 0.24 +/- 0.10 for cholesterol gallstone on the 3D fast spoiled gradient-echo sequence (p < 0.001). Combining the 3D fast spoiled gradient-echo and single-shot fast spin-echo sequences achieved the highest gallstone detection rate (96.4%). CONCLUSION: Based on the differences of signal intensity of gallstones, the 3D fast spoiled gradient-echo T1-weighted imaging was able to diagnose the composition of gallstones. Adding the 3D fast spoiled gradient-echo imaging to the single-shot fast spin-echo T2-weighted sequence can further improve the detection rate of gallstones.

Adult↗
PubMed2003

Metallic stenting for treatment of central venous obstruction in hemodialysis patients.

BACKGROUND: Central venous obstruction is a serious and common complication in hemodialysis patients. The recurrence rate is high after balloon dilation, while surgical repair is hazardous in these chronically ill patients. The aim of this study was to evaluate the efficacy of primary Wallstent placement for treatment of hemodialysis-related central venous obstructions. METHODS: Eighteen hemodialysis patients with symptomatic shunt dysfunction and arm swelling due to subclavian (n = 3) or innominate (n = 15) venous obstructions were treated at Kaohsiung Veterans General Hospital with primary Wallstent placement from November 1998 to August 2001. Technical success and complications were reported. Primary and secondary patency rates of stent and hemodialysis access were calculated by survival analysis with Kaplan-Meier method. RESULTS: A total of twenty-five Wallstents were deployed for central venous stenosis (n = 18) and occlusion (n = 7) in these 18 hemodialysis patients. The initial technical success rate was 100%. Fourteen episodes of re-obstruction developed during the observation period. Of them, seven episodes occurred within the stent, four episodes outside of but abutting to the peripheral end of the stent, and another three episodes of re-obstruction were attributed to delayed shortening of the Wallstent. Six of the 14 episodes were treated percutaneously with angioplasty alone, while seven episodes necessitated additional stent placement. No stent migration or other complications were encountered. Primary patency rates of stent and hemodialysis access at 3, 6, 12 and 18 months were 100 and 89%, 73 and 68%, 49 and 42%, and 16 and 0%, respectively. Secondary patency rates of stent and hemodialysis access each were both 100% after 3 months, 93 and 100% after 6 months, 85 and 91% after 12 months and, 68 and 72% after 24 months. CONCLUSIONS: Wallstents are safe to deploy, with excellent technical success for hemodialysis-related central venous obstructions. The Wallstent provides continued use of a hemodialysis access for a substantial period. However, repeated interventions may be necessary to maintain the patency.

Aged↗
PubMed2002

The role of bacterial virulence and host factors in patients with Escherichia coli bacteremia who have acute cholangitis or upper urinary tract infection.

We studied the pathogenic role of host and Escherichia coli virulence factors in the development of E. coli bacteremia in patients with acute cholangitis (AC) or upper urinary tract infection (UTI). Isolates recovered from 75 adult patients consecutively admitted to the hospital with E. coli bacteremia caused by AC (n=24) or upper UTI (n=51) were evaluated, as were 30 fecal strains isolated from healthy control individuals. Virulence genes of E. coli were detected by polymerase chain reaction analysis, including papG genes (classes I-III), sfa/foc, fimH, afa, hlyA, cnf1, and iutA. Our results show that biliary tract obstruction and urinary tract obstruction are important host factors for the development of E. coli bacteremia in patients with AC and upper UTI, respectively. With regard to E. coli virulence factors, the papG class II gene might play a more important role in the development of E. coli bacteremia in patients with upper UTI than in those with AC.

Acute Disease↗
PubMedDate not supplied

Computed tomography demonstration of immediate and delayed complications of computed tomography-guided transthoracic percutaneous ethanol injection of hepatocellular carcinoma at the liver dome.

OBJECTIVE: We conducted this study to correlate computed tomography (CT) images with the complications induced by CT-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). METHODS: Twenty-two patients with ultrasonographically unreachable HCC were treated with CT-guided transthoracic PEI. The procedures and the CT findings were recorded to correlate with the various complications of PEI. RESULTS: After the ethanol injection, 3 patterns of CT images were identified according to the distribution of ethanol (ie, intratumoral, extrahepatic, and intrahepatic patterns). The intrahepatic pattern was further classified as the branch, tubular, and infiltrative types. During the follow-up period, 3 patients developed biliary stricture, portal vein thrombosis, or tumor seeding. The tubular type was associated with the development of biliary stricture, whereas the branch type was related to the occurrence of portal vein thrombosis. These complications were considered to be caused by a greater amount of ethanol leakage into bile ducts or portal veins than in cases without complications (median = 17 mL vs. 0 mL, P = 0.002). CONCLUSIONS: Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.

Administration, Cutaneous↗
PubMedDate not supplied

Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation.

OBJECTIVE: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients. MATERIALS AND METHODS: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10 mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis. RESULTS: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (+/-standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%+/-9 and 88%+/-6, 41%+/-10 and 88%+/-6, 30%+/-10 and 77%+/-10, and 12%+/-8 and 61%+/-13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively. CONCLUSION: Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

Aged↗
PubMedDate not supplied

The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma--the influence of sampling time and hepatolithiasis.

BACKGROUND/AIMS: This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled in different situations for the diagnosis of cholangiocarcinoma. METHODOLOGY: Bile was obtained from patients with bile duct obstruction on the day of biliary drainage and 3 days later separately. The etiology of biliary obstruction included choledocholithiasis (N = 51), hepatolithiasis (N = 19) and cholangiocarcinoma (N = 28). Patients of the former two conditions were all complicated with cholangitis. RESULTS: The sensitivity of biliary CEA, CA 19-9 and CA 125, whenever checked were all less than 70%. The biliary CEA and CA 19-9 were elevated in the presence of cholangitis. In addition, the biliary CEA was also increased in the patients with hepatolithiasis. The specificity of CA 125 was better than those of CEA and CA 19-9 (75.7% vs. 33.3% and 60%, respectively) on the day of biliary drainage. The diagnostic efficiency was slightly improved when combining biliary CA 125 and CEA. CONCLUSIONS: As the biliary CA 125 was less affected by inflammation and hepatolithiasis, it is more useful than CEA and CA 19-9 in the diagnosis of cholangiocarcinoma. The single tumor marker test of CA 125 or combined tumor marker test of CEA and CA 125 may be used as a useful complement to other investigative methods to differentiate benign from malignant causes of the bile duct obstruction.

Aged↗
PubMedDate not supplied

The value of biliary fibronectin for diagnosis of cholangiocarcinoma.

BACKGROUND/AIMS: The fibronectin in various body fluids was reported to be useful in the differential diagnosis of benign and malignant diseases. We conducted this study to assess the diagnostic value of biliary fibronectin. METHODOLOGY: Bile was collected from patients with gallstones (n = 62), benign biliary stricture (n = 5) and cholangiocarcinoma (n = 28). All patients with gallstones were complicated with cholangitis. The absolute biliary level of fibronectin was determined by an immunoenzymatric assay and divided by the biliary concentration of bile acids to calculate the relative concentration. RESULTS: The relative concentration of biliary fibronectin was significantly different among the patients with benign biliary obstruction, gallstone and cholangiocarcinoma (7.1 +/- 14.3 vs. 350.5 +/- 1535.4 vs. 180592.6 +/- 917236.2, p < 0.05). With a cut-off value of 40 ng/mumol, its sensitivity for diagnosing cholangiocarcinoma was 0.57, and specificity, 0.79. CONCLUSIONS: As bile may be concentrated or diluted to a various extent after biliary obstruction, the relative concentration of biliary fibronectin is more useful than the absolute concentration in differentiating the causes of biliary obstruction. In addition to the presence of biliary cancer, biliary fibronectin was also increased in response to biliary inflammation, which limits its use as a tumor marker of cholangiocarcinoma.

Aged↗
PubMedDate not supplied

Hydrodynamics-based gene delivery to the liver by bile duct injection of plasmid DNA--the impact of lasting biliary obstruction and injection volume.

BACKGROUND/AIMS: Increased biliary pressure may mediate an opening of intrahepatic tight junctions. The biliary pressure is related to the duration of biliary obstruction and the injected volume. Their effects on the efficiency of gene delivery to the liver were studied. METHODOLOGY: The luciferase gene with a volume of 0.5, 1.0, 1.5 or 2.0mL was injected into the bile duct of Sprague-Dawley rats. After the injection, the bile ducts were occluded in some of the rats, while left to drain in the others. RESULTS: The activity of luciferase was the highest in rats that received 2.0mL of DNA injection and biliary occlusion, while the lowest in the rats that received 0.5mL of DNA only. CONCLUSIONS: The bile duct can be an efficient route for gene delivery to the liver depending on the volume of injected DNA. Biliary occlusion can enhance the expression of genes but it may induce a certain degree of liver injury, which should be taken into concern.

Animals↗