PubMed Health⌕ Search

Biomedical subjects

J H Chiang

Publications and source records attributed to J H Chiang.

At least 73 records · Page 4Linked to original sources
PubMed1993

Hepatic actinomycosis with portal vein thrombosis mimicking hepatocellular carcinoma: a case report.

A fatal case of hepatic actinomycosis with portal vein thrombosis is reported. The diagnosis of actinomycosis was delayed because of its rarity in Taiwan. This 63-year-old man was admitted due to body weight loss and poor appetite. No fever was noted before admission. Liver biochemical test showed a decreased serum albumin level with elevated serum levels of globulin and alkaline phosphatase. He was not a hepatitis B carrier and his serum level of alfafetoprotein was within normal range. Image studies (abdominal sonography and computed tomography) showed a hepatic mass over the medial segment of the left lobe with involvement of right lobe of the liver. Main portal vein thrombosis was also seen. Because of profound cachexia, he died of aspiration pneumonia and disseminated intravascular coagulation on the 11th day after admission. An autopsy revealed hepatic actinomycosis. High index of suspicion for early diagnosis and treatment is emphasized.

Actinomycosis↗
PubMed1992

Radionuclide hysterosalpingography with technetium-99m-pertechnetate: application and radiation dose to the ovaries.

Although radionuclide hysterosalpingography (RNHSG) has been suggested as an efficient procedure for assessing function of fallopian tubes, the radiation dose to the ovaries was addressed as an important issue to be taken into consideration. We describe a modified method of RNHSG, calculating the radiation dose to the ovaries. A small dose of approximately 18.5 MBq (0.5 mCi) of [99mTc]pertechnetate was administered directly into the uterine cavity without overpressure. The accuracy of the method was 84.5% as compared with the contrast hysterosalpingography. The estimated average dose to the ovaries was 0.057 mGy/MBq (0.21 rad/mCi) or 1.08 mGy (108 mrad) per study. RNHSG is an accurate method for functional study of fallopian tube patency with low radiation dose.

Adult↗
PubMed1992

[Computed tomography for evaluation of hepatocellular carcinoma after treatment with transarterial chemoembolization].

Totally 135 series of computed tomography (CT) and angiographic examination were performed in 53 patients with proved hepatoma treated by TAE. CT examination was performed four to six weeks after TAE, and a comparative angiographic examination was performed within three weeks after CT examination. The pictures of CT scanning were read to determine 1). the grading of lipiodol retention inside the tumor, 2). the presence/absence of filling defect in the tumor margins coated by lipiodol, 3). the presence/absence of residual tumor tissue within or surrounding the main tumor, and 4). the presence/absence of developed satellite nodules. In comparison with angiographic findings, CT demonstrated 96.3% specificity and 58.2% sensitivity in the grading of lipiodol filling, and 96.3% specificity and 65.7% sensitivity in the tumor margins of lipiodol coating. However, it was difficult for CT to detect small nodules, especially those less than 1 cm in diameter. We find no statistically significant association between newly developed satellite nodules and grading of lipiodol retention inside the tumor or tumor margins of lipiodol coating. Therefore, when CT pictures reveal filling defect over the margins of the tumor coated by lipiodol or less-than-50% lipiodol filling inside the tumor, repeated angiography and further treatment with TAE are suggested.

Adult↗
PubMed1992

[Acute abdomen with intraperitoneal bowel perforation-demonstration by CT scan].

Ninety-eight cases of surgically proved bowel perforation in VGH-Kaohsiung within one year were reviewed. Among them, 25 patients received abdominal CT scans before operation. Free gas or fluid could be demonstrated with CT scan in 80% of cases though sometimes the fluid was too scanty to be well recognized. Local abscess formation with or without tumor mass lesion (n = 3), local fluid accumulation (n = 1) and negative CT findings (n = 1) constituted the remaining 20% of cases. The recognition of perforation sites depended on direct evidences of perforation such as ulceration, abscess formation and tumor mass lesion (32%), or indirect evidences including hematoma formation, dependent extraluminal gas accumulation and phlegmonous reaction (12%). An inexplicable localized extraluminal fluid accumulation might also suggest a possibility of hollow organ perforation and lead to the recognition of perforation site in the absence of free gas (4%). Absence of extraluminal fluid or gas can not completely rule out the possibility of hollow organ perforation (4%). Massive free air, especially with an air-fluid level, suggested a possibility of upper abdominal perforation. The perforation hole located at the anterior wall of stomach produced more free gas than that located at posterior wall. Air-fluid levels could never be identified in the cases of lower gastrointestinal perforations. Local bowel wall thickening and the distribution of free gas contributed little to the recognition of perforation site. Extravasation of oral contrast media sometimes led to the diagnosis of gastrointestinal perforation but was not necessary to be noted around the perforation hole and did little contribution to the perforation site recognition.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1992

Adrenal hemangioma: computed tomogram and angiogram appearances.

Adrenal hemangiomas are rare. To our knowledge, about 22 cases have been reported in the literature, of which 13 cases were surgically removed. We report probably the first case of CT and angiographically diagnosed and surgically confirmed adrenal hemangioma in Taiwan. We concluded that characteristic appearances on computed tomogram and angiogram associated with phlebolith-like calcification in the tumor may allow the radiologists to make correct preoperative diagnosis.

Adrenal Gland Neoplasms↗
PubMed1991

Hepatic microabscesses caused by Escherichia coli--US and CT appearance.

Hepatic microabscesses have been described in immunosuppressed patients. However, there has been no previous report concerning hepatic microabscesses caused by Escherichia coli (E. coli). Recently, we experienced a 75-year-old male patient who had suffered from fever and upper abdominal pain for 4 days. His laboratory tests revealed an increased erythrocyte sedimentation rate (55 mm/hr), the white cell count was 7500/cumm with 82% segmented leukocytes, minimally elevated serum alkaline phosphatase and serum glutamic-pyruvic transaminase. Ultrasonography (US) showed multiple tiny hypo- or nearly anechoic lesions (3-8mm) diffusely scattered in both hepatic lobes. Some lesions were too small to be demonstrated and only distal acoustic enhancement posterior to the lesions could be noted. Contrast-enhanced computed tomography (CT) scan subsequently demonstrated the tiny hypodense and cystic lesions and confirmed the US diagnosis of microabscesses. Cultures of blood and liver aspirates showed E. coli. Although US and CT appearance of hepatic microabscesses caused by E. coli may be characteristic, it is not specific. Differential diagnosis should include multiple biliary hamartomas, and definite diagnosis should be made by needle aspiration.

Aged↗
PubMed1991

Hamartoma of spleen: a case report.

Hamartoma of the spleen is a rare benign tumor. Only about 105 cases in English-writing literature were reported after first description by Rokitansky in 1861. We reported one case of asymptomatic splenic hamartoma in Taiwan which was found incidentally by ultrasonographic examination. Ultrasonography of abdomen revealed a slightly hypoechoic and nearly isoechoic tumor mass in the spleen. Computed tomography of the abdomen revealed a well-defined, low-attenuation mass in the spleen, which became isodense after contrast injection. Celiac arteriography and superselective splenic arteriography revealed a hypervascular mass with fine tumor vessels and tumor stains in the spleen. Splenectomy was performed and the microscopic examinations revealed typical red-pulp type hamartoma of the spleen.

Adult↗
PubMed1991

Lung deposits of lipiodol in normal and cirrhotic rats.

The distribution of Lipiodol in the liver and lungs following arterial or portal injection was studied in normal (n = 55) and cirrhotic rats (n = 20). Using magnified xeroradiography and radioisotope labeled tracers, it was found that Lipiodol was deposited mainly in the liver and lung after either arterial or portal administration. In control rats after arterial injection, deposits in the lung peaked after 2 hours and gradually declined over 48 hours; whereas after portal injection, the deposit steadily increased for 48 hours. Twenty-five percent of cirrhotic rats demonstrated a Lipiodol-induced military pattern in the lung. An increased number of portosystemic shunts in cirrhotic rats was also noted. These results suggest that cirrhosis of the liver may be a potential risk factor for developing pulmonary complications after Lipiodol administration.

Animals↗
PubMed1990

Focal hepatic fatty infiltration as a cause of pseudotumors: ultrasonographic patterns and clinical differentiation.

Focal hepatic fatty infiltration may be mistaken for hepatic neoplasm on ultrasonography. A sonographic feature mimicking "space occupying lesions" was identified in 41 cases with focal fatty liver, which led to the recognition of four sonographic patterns: (1) Ten patients in whom the livers were characterized by irregular configurations of hyperechoic and hypoechoic areas. Although confusing to inexperienced sonographers, all of them were properly interpreted by experienced sonographers. (2) One patient in whom the hepatic sonography revealed a hyperechoic nodule, but which was correctly diagnosed by computed tomography (CT) scan. (3) Six patients in whom the livers were characterized by multiple confluent hyperechoic lesions, which were all misinterpreted by sonographers and misinterpreted following CT scans in 4 cases and angiography in 3 cases. (4) Twenty-four patients in whom the livers revealed focal spared areas, which was misdiagnosed by sonographers in 14 cases, but correctly diagnosed by CT scan in all 24 cases.

Adult↗
PubMed1990

Radionuclide transit studies for esophageal function before and after esophageal transection and devascularization.

Nonobstructive swallowing disturbance is a common complication following esophageal transection and devascularization to control bleeding from esophageal varices. From July 1983 to July 1984, 12 patients underwent both a radionuclide esophageal transit study (RETS) and a barium swallowing fluoroscopic study (BSFS) before and after surgery to evaluate esophageal function. Before surgery, 9 of the 12 patients had no swallowing disturbance and the RETS was normal in 8 cases, and the BSFS was normal in all cases. Three patients who received sclerotherapy on more than 3 occasions suffered from swallowing disturbances and both the RETS and BSFS detected their defective passage. The average distal 1/3 segmental and total esophagus transit times were 11.5 +/- 9.9 seconds and 13.0 +/- 10.6 seconds among symptom-free patients; and 24.8 +/- 11.8 seconds and 30.1 +/- 14.6 seconds among swallowing-disturbance patients. The time prolongation was significant (p less than 0.005). After surgery, 5 of 9 preoperative symptom-free patients suffered from swallowing disturbances for 10 days and then became symptom free. Their serial follow-up RETS and BSFS at 1 month, 3 months and 6 months all showed normal results. One preoperative symptom-free patient suffered from a mild swallowing disturbance for 2 months. However, only RETS, but not BSFS, demonstrated the prolonged proximal segmental esophageal transit time at 1 month postoperatively. The remaining 6 patients suffered from prominent swallowing disturbances and their initial postoperative RETS demonstrated prolonged defective transit or the presence of gastroesophageal (GE) reflux. All these events were confirmed by both tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Pyeloduodenal fistula: report of 2 cases.

Pyeloduodenal fistula is a rare event, which can occur spontaneously or be caused by trauma. We present two such cases, of which, one was complicated by percutaneous nephrolithotomy for a right renal stone and the other occurred spontaneously from right renal and perirenal abscesses. Its etiology, pathogenesis, clinical manifestations, diagnosis and treatment are discussed. We emphasize that with the increasing use of interventional uroradiologic procedures, particularly percutaneous nephrolithotomy, we may encounter more traumatic pyeloduodenal fistulae.

Abscess↗
PubMed1990

Angiographic arterio-venous shunt and venous thrombosis in the prognosis of hepatoma.

Angiograms and clinical data for 249 patients with hepatoma were evaluated, with particular attention paid to the arteriovenous (A-V) shunt and venous thrombosis (including occlusion). There were 43 cases (17.3%) with A-V shunt and 140 cases (56.2%) with venous thrombosis. A statistically significant difference in survival was noted among the unresectable patients with and without these vascular changes. Furthermore, in the resectable patients, presence of venous thrombosis also showed a poor prognosis. A-V shunt did not influence the survival in the unresectable patients with venous thrombosis, and 93.0% of A-V shunt was associated with venous thrombosis. This seemed to imply that these two vascular changes might be the same entity. In the presence of either A-V shunt or venous thrombosis, the survival rate in the surgical group was still better than that of medical groups treated by either transarterial embolization (TAE) or conservative methods. Most of the A-V shunt (81.4%) and venous thrombosis (56.4%) occurred in the diffuse type of hepatoma, and the prognosis for unresectable patients was the worst in this type, with a mean survival time of 3 months. Since A-V shunt and venous thrombosis are factors in poor prognosis and occur frequently, careful preoperative evaluation of these vascular changes is mandatory. However, in patients with localized tumor, coexisting with such vascular involvement, surgical resection is still recommended.

Arteriovenous Fistula↗
PubMed1990

Report of a pilot study of intra-arterial injection of I-131 lipiodol for the treatment of hepatoma.

This pilot study in 10 hepatoma patients investigated the feasibility of using selective targeting of radioisotope (I-131) lipiodol in the treatment of hepatoma patients. Lipiodol is a contrast medium that selectively goes to hepatoma and remains there for a long period as compared with that in normal liver and other tissues. Lipiodol was labelled with I-131 and infused into the hepatoma via the hepatic artery. Selective targeting of I-131 to hepatoma was demonstrated with a radiation dose ratio (hepatoma to normal liver) of up to 25 to 1. The biodistribution data of I-131-lipiodol in this study also confirmed the selective targeting of the radioisotope (I-131) to the hepatoma. Tumor radiation dose up to 26,000 rads can be delivered by this method. The treatment results were encouraging. About 70% of hepatoma patients had response to the treatment with reduction of alpha-fetoprotein and decrease of hepatoma sizes. The overall median survival was 9 months (range 2-17 months). This treatment was simple, safe, effective, non-expensive and well tolerated by all patients without major side effects. The optimal dose, schedule, duration of this treatment are still under investigation.

Adult↗
PubMed1988

Mass screening of primary hepatocellular carcinoma by alpha-fetoprotein in a rural area of Taiwan--a dried blood spot method.

A prospective survey of primary hepatocellular carcinoma (PHC) was conducted in a rural area of Taiwan using a two-site enzyme immunoassay for alpha-fetoprotein (AFP) in dried blood samples collected on filter paper. Of 1894 men over 40 years of age who were tested, 20 (1%) had AFP levels of greater than 20 ng/ml of blood on screening. Nineteen of these men received ultrasound examinations, and small PHCs were detected in 4 (21%). The remaining 15 cases had other types of hepatobiliary tract diseases, and 6 (40%) were also serum HBsAg positive. They should all be closely followed up by AFP determination and ultrasound examination of the liver. In contrast to the low resection rate of PHC in symptomatic patients who were admitted through the outpatient clinic during the period of this survey, the four cases with small PHC discovered by AFP screening had their tumors successfully removed (5/57 vs. 4/4, p less than 0.005). Our preliminary results showed that this method is a simple, sensitive and convenient assay for AFP and may be used as a first-line screening test in mass population surveillance programs for PHC, particularly in areas where PHC is highly prevalent.

Adult↗