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Biomedical subjects

Eric M Yoshida

Publications and source records attributed to Eric M Yoshida.

At least 37 records · Page 2Linked to original sources
PubMed2005

Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community.

BACKGROUND: Hepatitis B (HBV) is endemic and a leading cause of morbidity and mortality in Asia. British Columbia has the highest proportion of Chinese and Southeast Asians among all Canadian provinces. The present study was designed to evaluate the degree of concern for and knowledge of HBV in this high-risk community. METHODS: Unselected patrons of two large Asian commercial centres in Richmond, British Columbia were surveyed. The variables studied were population demographics, concern for HBV, level of HBV knowledge and awareness of HBV-related cirrhosis or hepatocellular carcinoma (HCC). Associations were assessed using c2 testing and multiple logistic regression analysis. RESULTS: A total of 1008 individuals participated in the survey. Fifteen incomplete surveys were excluded. Only 7.7% felt that HBV was not a concern for the community. Only 13% of respondents felt that HBV education was adequate in the community. The main sources of community health education were their doctor's office (56.3%) and media (49.1%). A high number stated they were "aware" of HBV (68%) but over 60% were unaware that HBV could cause HCC or cirrhosis and only 61.3% scored a 'reasonable' level of HBV knowledge. Higher HBV knowledge was significantly associated with increasing age (P<0.001), higher education (P<0.001) and the use of media for health education (P<0.001). Awareness that HBV may cause HCC and cirrhosis was significantly associated with age (P<0.001), education (P=0.006) and birthplace (P=0.001). INTERPRETATION: HBV education is necessary in this local Asian community. Programs should target younger, less educated adults and elaborate on the potential serious health consequences of HBV. Vehicles for public education should include the physicians' offices and local media.

Adult↗
PubMed2005

Treatment of chronic hepatitis C in Canadian prison inmates.

PURPOSE: To assess sustained viral response rate and adherence to standard interferon alpha-2b and ribavirin therapy in inmates with chronic hepatitis C (HCV) in Canadian penitentiaries in the Pacific region. METHODS: A retrospective chart review of all inmates with chronic HCV who were treated with standard interferon alpha-2b and ribavirin therapy between March 2001 and October 2002. RESULTS: A total of 90 male inmates were treated. The mean age at time of treatment was 40 years. There were 49 inmates with HCV genotype 1, 11 with HCV genotype 2 and 30 with HCV genotype 3. Eight inmates discontinued treatment because of intolerance to side effects. Nine inmates were stopped by the physician because of nonresponse at an average of 27 weeks. All inmates achieved at least 80% adherence of interferon and ribavirin therapy. The overall sustained virological response (SVR) was 55.9%. SVR was 31.6% for genotype 1, 100% for genotype 2 and 71.4% for genotype 3. CONCLUSION: There was excellent SVR and adherence to treatment with interferon and ribavirin. This experience highlights an important opportunity to treat a population with a high prevalence of HCV-positive persons who may otherwise not seek treatment.

Adult↗
PubMed2005

Parvovirus B19 in an immunocompetent adult patient with acute liver failure: an underdiagnosed cause of acute non-A-E viral hepatitis.

There are occasional pediatric reports of parvovirus B19-associated transient acute hepatitis and hepatic failure. A case of a 34-year-old immunocompetent woman who developed severe and prolonged but self-limited acute hepatitis and myelosuppression following acute parvovirus B19 infection is reported. Parvovirus B19 may be the causative agent in some adult cases of acute non-A-E viral hepatitis and acute liver failure.

Acute Disease↗
PubMed2004

Effects of upper extremity exercise training on peak aerobic and anaerobic fitness in patients after transplantation.

We found that patients with transplants, regardless of transplant type, and sedentary control subjects experience significant increases in aerobic fitness after 10 weeks of Dragon boat training. However, the magnitude of improvement in aerobic fitness depends on the transplant type, with patients having cardiac transplant experiencing greater relative changes in response to training than patients with noncardiac transplant. It also appears that patients with cardiac and noncardiac transplants have an increased reliance on anaerobic energy systems during exercise conditions compared with healthy control subjects.

Adult↗
PubMed2004

Liver injury associated with the beta-interferons for MS: a comparison between the three products.

A population-based retrospective chart review of the biochemical liver tests of 844 patients with multiple sclerosis prescribed a beta-interferon (IFNbeta) product in British Columbia, Canada was performed between 1995 and 2001. Overall, 36.9% (243/659) of patients developed new elevations of alanine aminotransferase. All the IFNbetas caused elevated aminotransferase levels compared with pretreatment levels (p < 0.005) and were higher than reported in clinical trials. Their relative effect on aminotransferases can be approximated as IFNbeta-1b(subcutaneous [SC]) = IFNbeta-1a(SC) > IFNbeta-1a(IM).

Adult↗
PubMed2004

Remission of multiple sclerosis post-liver transplantation.

BACKGROUND: The effect of liver transplantation on pre-existing multiple sclerosis (MS) has never been reported. We report the three year post-transplant neurological outcome of a patient with MS. CASE REPORT: A Caucasian woman with MS received an urgent liver transplant for fulminant liver failure at the age of 59. Her Extended Disability Scale Score (EDSS) pretransplant was 5.0 and clinically she had cerebellar and brainstem dysfunction. Post-transplant immunosuppression consisted of tacrolimus, mycophenolate mofetil and tapering corticosteroids that were discontinued after 1.5 years. Post-transplant her EDSS decreased to 2.0 and after three years she is clinically asymptomatic with only very mild dysarthria on neurologic examination. Long-term maintenance immunosuppression consists of low dose tacrolimus. CONCLUSIONS: Combination immunosuppression with tacrolimus may have a beneficial effect on MS although an effect of donor allograft itself can not be excluded.

Female↗
PubMed2004

Regression of cirrhosis associated with hepatitis B e (HBe) antigen-negative chronic hepatitis B infection with prolonged lamivudine therapy.

In theory, hepatic fibrosis should be a dynamic process with the potential for remodelling after the injury-provoking stimulus has been removed. Clinically, there has been an accumulation of a small number of cases, including hepatitis B e (HBe) antigen-positive chronic hepatitis B infection, in which cirrhosis regressed after successful treatment. We report a 42-year-old HBe antigen-negative Chinese man with detectable serum hepatitis B virus DNA and histologically established cirrhosis (Ludwig score 4) who, after 4 years of successful lamivudine therapy, was found to have regression of cirrhosis on repeat liver biopsy. The repeat biopsy revealed normal liver architecture with fibrosis confined to the portal tracts and short fibrosis septae extending into the lobule without bridging (Ludwig score 1-2). Although cirrhosis may take many years to develop, our experience suggests that successful treatment may reverse the process within a relatively short time.

Adult↗
PubMed2004

Advanced colon cancer before the age of 20 years: a case for extension of the current colonoscopy surveillance guidelines in hereditary nonpolyposis colorectal cancer syndrome.

BACKGROUND: Hereditary nonpolyposis colorectal cancer (HNPCC) currently accounts for between 2% to 6% of all colorectal adenocarcinomas. Controversies exist regarding the current guidelines for colonoscopic screening for colon cancer. CASE REPORT: A case of colon cancer in a young Japanese man with a family history of colon cancer that did not meet the criteria for HNPCC is reported. A malignant pelvic mass discovered shortly before his 20th birthday prompted a colonoscopy. The findings at colonoscopy determined that the patient and his family fulfilled the criteria of HNPCC. CONCLUSION: Before finding a pelvic mass metastatic from adenocarcinoma of the ascending colon, this patient was clearly outside of the current guidelines for HNPCC screening. It is suggested that in similar patients, even if they do not fulfill all the criteria for HNPCC, it would be appropriate to consider screening well before the recommended lower age.

Adenocarcinoma↗
PubMed2004

Management of polycystic liver disease.

Polycystic liver disease (PCLD) is characterized by multiple cysts throughout the liver. Patients may develop chronic intractable symptoms that may be debilitating. Others may develop medical complications that necessitate intervention. There is a variety of nonsurgical and surgical treatment options for symptomatic or complicated PCLD, which range from cyst aspiration and fenestration to liver transplantation. Studies have described variable efficacy and morbidity. Currently, there are no guidelines for the management of PCLD patients and the optimal intervention is controversial. This article reviews the pathogenesis, classification and spectrum of treatment options for PCLD.

Cysts↗
PubMed2003

Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a canadian cancer center.

PURPOSE: Differences in stage-stratified survival have been reported between Asian and Western populations with gastric cancer. This study examines differences in presentation and outcomes among Asian and non-Asian patients evaluated and treated at a Canadian institution. PATIENTS AND METHODS: We reviewed 2,043 patients (159 Asians and 1,884 non-Asians) with gastric adenocarcinoma treated between 1978 and 1997. Overall survival was examined by the Kaplan-Meier method, and multivariable analysis by Cox proportional hazards was used to identify whether Asian ethnicity had independent prognostic significance for survival. RESULTS: Median survival was 13.1 months for Asians and 11.1 months for non-Asians (P =.0016). Asian patients were younger and had a greater proportion of signet ring cell histology but were less likely to have proximal disease. Signet ring cell histology did not adversely affect survival. By multivariable analysis, proximal location, poor differentiation, and extent of disease were independently associated with worse survival. Survival was improved with curative resection, palliative resection, and palliative chemotherapy. Asian ethnicity was not independently associated with survival (hazard ratio, 0.89; 95% confidence interval, 0.74 to 1.08). Although a similar proportion of patients underwent curative resection, an interaction was observed between Asian ethnicity and efficacy of resection, with Asians achieving a greater benefit as compared with non-Asians even when adjusted for age and location. CONCLUSION: The disparity between Eastern and Western gastric cancer survival is not explained by the hypothesis of ethnicity-related differences in tumor biology. Although it is not an independent predictor of survival, Asian ethnicity is associated with distinct characteristics at presentation and more favorable outcomes after curative surgery.

Adenocarcinoma↗
PubMed2003

Hepatology and the Canadian gastroenterologist: interest, attitudes and patterns of practice: results of a national survey from the Canadian Association of Gastroenterology.

BACKGROUND: Hepatology has emerged as a subspecialty distinct from gastroenterology. Despite this, there is no formal certification examination or accredited training program, and training remains combined with gastroenterology. AIM: To determine attitudes, perceptions and patterns of practice with respect to liver disease among Canadian gastroenterologists. METHODS: A survey questionnaire was distributed to clinician gastroenterologists who are members of the Canadian Association of Gastroenterology. The responses of subgroups of respondents were compared by univariate and multivariate statistical techniques. RESULTS: Hepatologists constituted 20 of 201 respondents, the rest identifying themselves as gastroenterologists. Among gastroenterologists, liver disease constituted 10% of in- and out-patient practice. Despite this, 85% of gastroenterologists maintain an interest in hepatology, 49% perform liver biopsies, 60% treat hepatitis C, and 54% treat hepatitis B. In all of these areas, university-based gastroenterologists were consistently less likely than community-based gastroenterologists to maintain an interest and practice in hepatology, a finding that remained statistically significant on multivariate analysis. With regard to hepatology training, 90% of hepatologists and 94% of gastroenterologists felt that hepatology training should remain combined with gastroenterology, although 55% of hepatologists felt that current training was adequate compared with 79% of gastroenterologists, who were satisfied with the status quo. CONCLUSIONS: Hepatology remains relevant and important to Canadian gastroenterologists, especially those who have community-based practices. Canadian gastroenterologists and hepatologists are not in favour of separating hepatology training from existing gastroenterology training programs, although hepatologists feel that the current level of training is suboptimal.

Attitude of Health Personnel↗
PubMed2003

Abdominal pain as the initial and sole clinical presenting feature of systemic lupus erythematosus.

Classically, a diagnosis of systemic lupus erythematosus (SLE) is dependent on renal, rheumatological, cutaneous and neurological target organ damage with supporting serological markers. A previously healthy 26-year-old Japanese woman whose only manifestation of otherwise occult SLE was severe abdominal pain is reported. A computed tomographic scan of the abdomen revealed thickened loops of small bowel, endoscopic findings were nonspecific and jejunal biopsy revealed a nonspecific enteritis. Laboratory studies revealed lymphopenia, hypocomplementemia, a positive antinuclear antibody, a weakly positive anti-Smith and a strongly positive anti-double stranded DNA. There was a prompt symptomatic recovery with immunosuppressive therapy. The authors' experiences, and a review of the literature suggest that a diagnosis of SLE should be considered in young Asian women who present with significant but clinically enigmatic gastrointestinal illness.

Abdominal Pain↗
PubMed2003

Peginterferon alpha-2a (40kD) [Pegasys] improves HR-QOL outcomes compared with unmodified interferon alpha-2a [Roferon-A]: in patients with chronic hepatitis C.

BACKGROUND: Use of unmodified interferon alpha-2a in chronic hepatitis C is associated with impaired health-related quality of life during therapy. Treatment with peginterferon alpha-2a (40kD) provides an improved sustained response over unmodified interferon alpha-2a. OBJECTIVES: To compare health-related quality of life during treatment for patients receiving peginterferon alpha-2a (40kD) [Pegasys] versus unmodified interferon alpha-2a [Roferon]. DESIGN: A randomised, international, multicentre, open-label, parallel group study. SETTING: 36 centres worldwide. PATIENTS: Interferon-naïve patients (n = 531) with chronic hepatitis C. INTERVENTIONS: Peginterferon alpha-2a (40kD) 180 mirog once a week (n = 267) for 48 weeks or unmodified interferon alpha-2a 6 million IU three times a week for 12 weeks followed by 36 weeks of 3 million IU three times a week (n = 264). MEASUREMENTS: Fatigue Severity Scale and 36-item Short-Form Health Survey (SF-36). RESULTS: At weeks 2 and 12, differences favouring peginterferon alpha-2a (40kD) were seen on seven of eight domains and both summary scores of the SF-36 (p < 0.05 to p < 0.01). At weeks 2, 12 and 24, patients receiving peginterferon alpha-2a (40kD) had less disabling fatigue (p < 0.01) than those receiving unmodified interferon alpha-2a. CONCLUSION: Treatment with peginterferon alpha-2a (40kD) is associated with less disabling fatigue and less impairment in patient functioning and well-being during treatment than unmodified interferon alpha-2a. In addition to safety and efficacy, the impact on health-related quality of life may be an important consideration for physicians when selecting an optimal treatment regimen.

Adult↗
PubMed2002

Post-liver transplant Crohn's disease: graft tolerance but not self-tolerance?

Inflammatory bowel disease (IBD) rarely occurs de novo after liver transplantation, and when it does usually presents as ulcerative colitis in patients transplanted for primary sclerosing cholangitis. We present two patients who developed de novo Crohn's colitis two and three years after liver transplant for primary biliary cirrhosis (PBC) and chronic hepatitis B infection, respectively. Both were on maintenance immunosuppression with a calcineurin inhibitor and azathioprine with no evidence of allograft rejection. Investigations for enteric and opportunistic infection were negative. In the nontransplant setting, the development of IBD is likely multifactorial with an immune origin. In our cases, the immunosuppression was titrated to minimal levels when IBD developed. Clearly, although a significant degree of allograft tolerance can occur, autoimmune diseases can still develop elsewhere, suggesting selective immune tolerance.

Colon↗
PubMed2002

Post-liver transplantation diabetes mellitus: an association with hepatitis C.

A retrospective study was performed on all liver transplant recipients from British Columbia from 1989 to March 2000 to determine the prevalence and predictive factors of diabetes mellitus (DM) post-liver transplantation. DM was defined as hyperglycemia requiring treatment with insulin or oral hypoglycemic agents. Patient characteristics, cause of liver disease at transplantation, and immunosuppression regimen were considered. Both univariate and multiple logistic regression analyses were performed. Posttransplantation DM (PTDM) occurred in 43 of 177 transplant recipients (24%). Of these, 13 transplant recipients had DM pretransplantation, whereas 30 patients developed de novo PTDM. The majority of patients were treated with insulin (80%). In univariate analysis, transplantation for hepatitis C virus (HCV) liver disease was associated with a greater incidence of PTDM (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.46 to 6.23) and de novo PTDM (OR, 5.20; 95% CI, 2.25 to 11.99). Patients administered tacrolimus had a greater incidence of PTDM (OR, 2.04; 95% CI, 1.01 to 4.13), and there was a trend toward increased PTDM in older patients (mean age, 49 years). Recipient sex, steroid dosage, and acute rejection were not predictive of PTDM. The incidence of graft loss and death rates were similar between the two groups. On logistic regression, HCV was the only independent predictor of PTDM (OR, 4.12; 95% CI, 1.91 to 8.90) and de novo PTDM (OR, 6.02; 95% CI, 2.55 to 14.20). In conclusion, DM post-liver transplantation is a common occurrence and is associated with HCV.

Adult↗
PubMed2002

Late acute rejection after liver transplantation: the Western Canada experience.

Acute rejection usually occurs within 3 months posttransplantation. Most centers reduce immunosuppression over 6 to 12 months to minimize opportunistic infection, malignancy, and drug toxicity. Pretransplant disease and low immunosuppression have been reported in association with late acute rejection (LAR). The objective of this study was to determine the incidence, predictive factors, and outcomes of LAR via retrospective review of adult liver transplant recipients in Western Canada from 1989 to 2000. LAR was defined as biopsy-proven acute rejection occurring more than 180 days posttransplantation. Patient characteristics, immunosuppression, and outcome were determined. Both a univariate and multiple logistic regression analysis were performed. LAR occurred in 97 (23%) of 415 patients more than 180 days posttransplantation. Median follow-up was 402 days (range, 180 to 3137 days); 79% of LAR episodes were graded mild. At the time of LAR, 33% were on a steroid taper. A total of 73% of LAR episodes were treated with pulse intravenous steroids, and 5% were steroid-resistant. In the univariate analysis, patients undergoing transplantation for viral etiologies and older age were associated with less LAR. Immunosuppression was significant in a multiple logistic regression model, but not with a proportional hazards model. On multivariate analysis, only patients undergoing transplantation for viral etiologies remained resistant to LAR (hazard ratio, 0.52; range, 0.34 to 0.93, P = .02). There was a trend toward increased chronic rejection in patients who developed LAR (P = .04). LAR is common and occurs after more than 1 year posttransplantation. Patients undergoing transplantation for viral etiologies seem to have a lower risk of LAR. There may be an increased risk of chronic rejection in those developing LAR.

Acute Disease↗