[Nd-YAG laser endoscopy for the treatment of upper gastrointestinal bleeding].
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Biomedical subjects
Publications and source records attributed to D Y Lin.
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A 60-mo longitudinal study has been undertaken in 99 HBeAg-positive patients with clinicopathologically verified chronic hepatitis. Hepatitis B e antigen clearance occurred in 30 patients at a rate of approximately 17% per year. A phenomenon of abrupt elevation of serum glutamic pyruvic transaminase (greater than 300 IU/L) with histological changes compatible with chronic lobular hepatitis was observed in 13 of 20 patients (65%) preceding spontaneous HBeAg clearance. In contrast, 8 of 10 patients on immunosuppressive or antiviral therapy, or both, had uneventful HBeAg clearance. It was concluded that HBeAg clearance can occur in patients with varying immunologic status. The mechanism responsible for HBeAg clearance awaits further study.
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A series of 80 patients with chronic lobular hepatitis (CLH) was reviewed clinically and histologically to demonstrate etiology, clinical presentation, course, and prognosis of this disorder. Data from our study indicate that CLH in Taiwan is a disease of viral origin, mostly hepatitis B (67.5%) and some non-A, non-B. It occurs predominantly in young males (81.3%); frequently commences as acute viral hepatitis (57.5%); and has clinical and laboratory features similar to convalescent viral hepatitis or even indistinguishable from full-blown acute viral hepatitis. Clinical and histological follow-up study indicate that CLH may extend for several years with remissions and relapses. No evidence of progression to cirrhosis was observed at least in a 4 1/2-year period of follow-up. It is concluded that CLH is a persistent but nonprogressive disease although the number of non-A, non-B CLH is too small to ascertain its nonprogressive course. The prognosis is generally good, and no specific therapy is required.
Hepatitis B e antigen (HBeAg) and antibody (anti-HBe) were studied by radioimmunoassay in consecutive series of 145 asymptomatic hepatitis B surface antigen (HBsAg) carriers, 389 patients with HBsAg-positive chronic liver disease and 194 patients with HBsAg-positive hepatocellular carcinoma, and compared between male and female subjects. The male to female ratio increased from 1.2 in asymptomatic carriers to 6.3 in chronic liver disease and 9.8 in hepatocellular carcinoma. Abnormal SGPT was much more frequently seen in male carriers than in females (p less than 0.01). Contrary to female patients with chronic liver disease, the positive rate for HBeAg in males is lower and tended to decrease with increasing age. It is postulated that male patients with chronic hepatis B virus infection might have higher HBeAg clearance ability that resulted in more frequent hepatitis B virus DNA integration and subsequent development of hepatocellular carcinoma. However, the ultimate mechanism regulating this difference awaits further study.
To examine the period between disappearance of hepatitis B e antigen (HBeAg) and appearance of anti-HBe, 48 patients with clinicopathologically verified chronic B hepatitis were followed every 1 to 3 months after HBeAg clearance. Sera were tested by radioimmunoassay for HBeAg and anti-HBe. Anti-HBe appeared in days to years, mostly (78.7%) within 1 year, after disappearance of HBeAg. Only 40.5% of patients had an "e-window" shorter than 1 month. Clinical and histological exacerbation preceding HBeAg clearance precipitated or accelerated appearance of anti-HBe. Since the patients in the "e-window" period were positive for DNA polymerase, it is suggested that the "e-window" reflects relative insensitivity of the radioimmunoassay rather than absence of HBeAg/anti-HBe. Therefore, HBeAg can reappear and clinical activity can relapse particularly during immunosuppressive therapy.