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Biomedical subjects

J S Cheng

Publications and source records attributed to J S Cheng.

At least 91 records · Page 5Linked to original sources
PubMed1996

Gallbladder function and recurrent stones of the biliary tract in patients after endoscopic sphincterotomy.

BACKGROUND: Change in gallbladder function may occur in patients with an intact gallbladder after endoscopic sphincterotomy (EST). This study was designed to evaluate the factors influencing gallbladder filling after EST and the correlation between gallbladder function and stone recurrence. METHODS: Sixty Chinese patients with symptomatic choledocholithiasis and an intact gallbladder received EST to clear the bile ducts. They were further investigated with sphincter of Oddi manometry (SOM), quantitative cholescintigraphy (QC), and long-term clinical follow-up. RESULTS: Fifty-six of the 60 patients in the study group were confirmed to have a loss of sphincteric function by SOM. QC showed normal gallbladder filling in 35 of these patients and delayed or non-filling in 21 patients. A significantly higher incidence of normal gallbladder filling occurred in patients with juxtapapillary diverticulum than in those without (P < 0.02), but preexisting cholecystolithiasis had no effect on it. During the follow-up period (median, 32 months: range, 9-54 months) 10 of 56 patients developed recurrent choledocholithiasis. There was no correlation between the status of gallbladder filling, preexisting cholecystolithiasis, and recurrent stones, but 9 of the 10 patients with recurrent stones had a juxtapapillary diverticulum. Repeated endoscopic treatment was satisfactory in eight patients, and only two patients received cholecystectomy. CONCLUSIONS: EST does not alter gallbladder function in most patients. Juxtapapillary diverticulum may facilitate gallbladder filling after EST, but it is also a possible factor for recurrent choledocholithiasis.

Aged↗
PubMed1996

Ultrastructural calcification of glomerular immune complexes.

We report a previously undescribed ultrastructural calcification of glomerular immune complex depositions in a patient with lupus nephritis. Such processes give rise to a distinctive ultrastructural calcified microspheriol in electron-dense immune deposits, and were associated with hypercalcemia and nephrocalcinosis. The cause of hypercalcemia in this patient was uncertain, but related to a granulomatous inflammation and abscess of the breast. Whereas ultrastructural microcalcification was associated with hypercalcemia, its distribution in the segmental glomerular lesions suggests that an inflammatory process was contributory. The clinical follow-up indicates that the microcalcifications of immune complexes have not affected the outcome of nephritis and renal function.

Adolescent↗
PubMed1996

The efficacy of endoscopic sphincterotomy in patients with sphincter of Oddi dysfunction.

BACKGROUND: Dysfunction of the sphincter of Oddi (SOD) is one of the causes of postcholecystectomy syndrome and biliary pain. Endoscopic sphincterotomy (EST) is recommended in some patients refractory to conservative treatment. This study was designed to evaluate the efficacy of, and complications from EST in patients with SOD. METHODS: Between 1990 and 1993, 24 patients clinically diagnosed as having papillary stenosis were treated by endoscopic sphincterotomy. All patients had dilated common bile duct (CBD) in addition to 1) elevation of transaminases and alkaline phosphatase (n = 13); 2) elevation of transaminases and serum amylase (n = 4); 3) normal liver enzymes but delayed biliary emptying on quantitative hepatobiliary scintigraphy (QHS) (n = 7). No CBD stones, organic obstruction or other disorders were found in these patients. RESULTS: EST was successfully performed in 24 patients. One patient had minor hemorrhage and one patient developed pancreatitis after EST. Twenty-two of the 24 patients (91.7%) were symptomatically improved before discharge. Twenty-one patients were regularly followed over a median period of 18 months (range 5-36) after EST. Two patients with symptom had recurrence at five and eight month follow up because of restenosis of papilla; another two patients with recurrent biliary symptoms, but the sphincter of Oddi remained wide open. Seventeen of 21 regularly followed patients were symptom free after the median 18-month follow up. CONCLUSIONS: EST is an effective and safe modality for treatment of sphincter of Oddi dysfunction.

Adult↗
PubMed1996

Experience with transjugular intrahepatic portosystemic shunts for gastroesophageal variceal bleeding.

BACKGROUND: Variceal bleeding is a major life-threatening complication of cirrhosis of the liver. Transjugular intrahepatic portosystemic shunts (TIPS) have been accepted as an effective method for portal decompression. Experiences here with the use of TIPS for control of gastroesophageal variceal bleeding is presented. METHODS: Sixteen TIPS procedures were performed for 15 patients who suffered from intractable gastroesophageal variceal bleeding. Nine cases (60%) were hepatitis-related cirrhosis of liver, four (27%) were alcoholic liver cirrhosis and two were cryptogenic in origin. Liver function tests revealed four patients were Child-Pugh's classification A, five were B and six, C. Twelve cases had received failed endoscopic management of varices; and one patient had recurrent variceal bleeding after devascularization. TIPS procedure was performed electively in nine cases and, as an emergency in six cases. RESULTS: Fifteen of the 16 TIPS procedures attempted were successfully performed. The technically successful rate was 94% (15/16), but two cases with successful TIPS procedure expired at the end of the procedure from hypovolemic shock and acute respiratory distress, respectively; thus the completely successful rate was 81% (13/16), The initial bleeding control rate was 83% (5/6) for the six patients with active bleeding. Portal venous pressure was significantly decreased from 30.8 +/- 5.8 mmHg before TIPS to 21.7 +/- 6.0 mmHg after the procedure (P < 0.01) and the porto-systemic pressure gradient also significantly decreased from 23.0 +/- 3.6 mmHg to 11.9 +/- 2.7 mmHg after TIPS (P < 0.01). Recurrent variceal bleeding was noted in four patients (33%) and that was managed by percutaneous transluminal angioplasty (PTA) of shunt, placement of additional stent, second TIPS procedure and a devascularization operation. Hepatic encephalopathy was noted in three patients (25%) after TIPS. CONCLUSIONS: TIPS is an effective method to control variceal bleeding caused by portal hypertension, especially when endoscopic or surgical management has failed or is contraindicated.

Adult↗
PubMed1996

Inhibitory effects of dextromethorphan on c-fos protein expression during focal cerebral ischemia in rats.

AIM: To study the effect of dextromethorphan (DM) in focal cerebral ischemia. METHODS: The c-fos protein was detected immunohistochemically in the brain of rats after focal cerebral ischemia (induced by placing a nylon thread in the lumen of the internal carotid artery) with and without treatment with DM. RESULTS: Focal cerebral ischemia induced c-fos protein expression outside the core territory of the middle cerebral artery (MCA) and neuronal damage in the core territory of the MCA. There was an evident expression of c-fos protein in the ipsilateral regions outside the MCA territory (e.g. cingulate cortices, piriform cortices and entorhinal cortices), and in the contralateral regions of hippocampus after 4-h reperfusion following 1-h MCA occlusion. But morphological results showed severe edema and neuronal damage in the core territory and the ipsilateral hippocampus. DM blocked both the c-fos protein induction and neuronal damage in all regions. CONCLUSION: DM reduced c-fos protein expression and blocked the neuronal damage after focal cerebral ischemia.

Animals↗
PubMed1995

Factors influencing the success rates of endoscopic nasobiliary drainage in treatment of obstructive jaundice.

BACKGROUND: Endoscopic nasobiliary drainage (ENBD) is a safe and effective modality which has been well documented for obstructive jaundice. However, factors predicting success rate of ENBD remain inconclusively. This study analyses those factors and discusses the outcome of patients with obstructive jaundice. METHODS: One hundred and sixteen patients (male 99, female 17; mean age 68.2 years) with obstructive jaundice received ENBD after endoscopic retrograde cholangiogram (ERC) by Olympus JF-lT20 endoscope and 7F Wilson-Cook nasobiliary catheter from Sep. 1990 to Oct. 1993. Bile output (QD), serum bilirubin (BIW), liver biochemistry (QW), bile culture (next day), blood culture (if BT > 38.5 degrees C) were checked until definite treatment or death. Adequate drainage was defined as a daily output of bile more than 200cc, a gradual drop in serum bilirubin and no signs of cholangitis. Factors such as causes of jaundice, obstruction level, serum bilirubin, albumin, juxtapapillary diverticulum (JPD), bacteremia, fever before ERCP and ascites were analyzed. RESULTS: The success rate was 86.2% (100/116) in ERC and 78% (78/100) in ENBD. Adequate biliary drainage was 82.1% (64/78), and serum bilirubin was reduced from 14.3 +/- 8.5 mg% to 7.5 +/- 5.6 mg% within one week. In patients with non-cancerous causes, higher success rate and adequate drainage rate were obtained compared with those with cancerous causes (94.3% vs. 69.2%, p < 0.01 and 88.6% vs. 50.8%, p < 0.01, respectively). In all patients, a higher success rate was achieved at the obstruction level at the common bile duct (CBD) compared with periampullary and hilar levels (90.7% vs 69.2%, p < 0.05 and 90.7% vs 28.6%, p < 0.001, respectively). In patients with cancer as a cause, higher success rate was achieved at CBD level than at hilar level (85% vs 28.6%, p < 0.05). Those patients with cancer and serum bilirubin above 15 mg/dl had a higher failure rate in ENBD. Success rate of ENBD was not related to the presence of JPD, bacteremia or fever before ERCP and serum albumin level. CONCLUSIONS: Factors decreasing the success rates of ENBD were underlying cancerous causes, obstruction level at hilum or periampullary region and serum bilirubin level more than 15 mg%.

Adult↗
PubMed1995

Neuroprotective effects of dextromethorphan against transient cerebral ischemia/reperfusion injury in gerbils.

AIM: To study the neuroprotective effects of dextromethorphan against transient cerebral ischemia/reperfusion injury. METHODS: Transient cerebral ischemia/reperfusion injury in gerbils was produced by temporarily clamping the common carotid arteries (CCA) for 10 min. RESULTS: Intrahippocampal (ih) injection of 2.0 microL dextromethorphan (DM, 100 mumol.L-1) 5 min before ischemia quickened the recovery of EEG changes, the total power spectra of EEG, and the power of dominant frequency following reperfusion. The total power of EEG was increased to 92 +/- 30 (P < 0.01) at 240 min following reperfusion. DM substantially reduced the severe ischemic neuronal damage (SIND) after 10 min of cerebral ischemia and 24 h of reperfusion. CONCLUSION: DM has neuroprotective effects against transient cerebral ischemia and reperfusion injury in gerbils.

Animals↗
PubMed1995

A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices.

We conducted a prospective, randomized trial comparing sclerotherapy and ligation in 120 patients with acute bleeding of esophageal varices. All the patients were cirrhotic, 59 received sclerotherapy, and 61 received ligation. Treatment was repeated regularly until the varices were obliterated. The mean follow-up period was 295 +/- 120 days and 310 +/- 105 days for the sclerotherapy and ligation groups, respectively. The control of active bleeding was 12/15 (80%) in the sclerotherapy group and 18/19 (94%) in the ligation group (P = .23). The numbers of treatment sessions required to achieve variceal obliteration were 6.5 +/- 1.2 in the sclerotherapy group and 3.8 +/- 0.4 in the ligation group (P < .001). Recurrent bleeding from the gastrointestinal tract was 51% in the sclerotherapy group compared with 33% in the ligation group (P < .05). Recurrent bleeding from esophageal varices was 36% in the sclerotherapy group and 11% in the ligation group (P < .01). However, bleeding from ectopic varices and congestive gastropathy was less common in the sclerotherapy group (7%) than in the ligation group (18%) (P = .05). Significant complications were encountered in 19% of the sclerotherapy group and in 3.3% of the ligation group (P < .01). Comparison of Kaplan-Meier estimates of time to death of both groups showed a significantly lower mortality in the ligation group (P = .011). Both sclerotherapy and ligation can effectively arrest active bleeding from esophageal varices. However, ligation is more effective than sclerotherapy in decreasing the risk of rebleeding from esophageal varices with fewer complications. Ligation can also achieve obliteration of esophageal varices more rapidly than sclerotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Biliary motility following endoscopic sphincterotomy for recurrent common bile duct stones.

BACKGROUND: Recurrent common bile duct (CBD) stones after cholecystectomy are a common biliary tract disease. The role of biliary emptying in the formation of these stones is not yet well defined. METHODS: Cholescintigraphy was used to evaluate the biliary motility in 50 cholecystectomized patients with recurrent CBD stones after endoscopic sphincterotomy (EST) with stone extraction. Complete clearance of the CBD stones was confirmed in all patients by endoscopic retrograde cholangiopancreatography. Absence of sphincter of Oddi (SO) pressure after EST was determined by means of biliary manometry, and 99mTc-diisopropyl iminodiacetic acid (DISIDA) cholescintigraphy was performed four to six weeks after recovery from sphincterotomy. RESULTS: Complete clearance of the radioisotopes from the bile duct within 1, and more than 1 hour, was observed in 3 (6%) and 47 (94%) of the patients, respectively. When a cutoff value of 2 hours indicating abnormal biliary motility was employed, 31 out of the 50 patients (62%) had delayed biliary emptying. In comparing the clinical parameters between the two groups, patients with delayed biliary emptying time demonstrated an increase in CBD size greater than those of the normals (11.7 +/- 0.5 vs 9.2 +/- 0.4 mm, p < 0.05), while the presence of juxtapapillary diverticula and length of time for recurrence of CBD stones after cholecystectomy were not significant. Follow-up study showed that repeated recurrence rate of CBD stones appeared to be higher in the patients associated with delayed (12.9%) rather than normal (5.3%) biliary emptying. CONCLUSIONS: These results suggested that, in the absence of a functioning SO, abnormal biliary motility in cholecystectomized patients is one of the clinical factors involved in the pathogenesis of recurrent CBD stones.

Adult↗
PubMed1994

Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect?

Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomized to receive endoscopic injection therapy with either 1:10,000 epinephrine in water (Group I) or distilled water (Group II). Twenty-five out of 27 patients in group I, versus 22 out of 25 patients in group II, achieved initial hemostasis after endoscopic injection therapy (p > 0.05). Five patients who did not respond to local injection had bleeding controlled by heater probe thermocoagulation or surgical intervention. Three patients in each group developed rebleeding after initial hemostasis. Four of these patients had bleeding controlled by surgical intervention, while the other two died of underlying diseases. No change in systemic blood pressure, but a significant drop in the pulse rate were noted in both groups after injection therapy. Patients with shock at admission or ulcer size greater than 2 cm had a significantly higher rebleeding rate after initial hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05). No serious complications were observed after injection therapy, and no significant difference in the amounts of solution required for successful hemostasis was noted between the two groups. We conclude that a local tamponade with distilled water is as effective and safe as diluted epinephrine solution for endoscopic injection therapy.

Double-Blind Method↗
PubMed1994

[Alteration of dynorphin1-8 and leu-enkephalin in rat hippocampus during seizure and electroacupuncture].

Immunocytochemical technics were used to evaluate the influence of penicillin-induced seizure and electroacupuncture treatment on dynorphin1-8 and leu-enkephalin immunoreactivity in hippocampus. It was found that 3 h after beginning of seizure there started a dramatic decrease in dynorphin1-8 in hilus, mossy fiber of hippocampus but an increase in hilus, mossy fiber of hippocampus but an increase in leu-enkephalin in subiculum, CA1 area of hippocampus and some other limbic structures. Electroacupuncture treatment decreased the leu-enkephalin immunoreactivity in the nuclei mentioned above and increased dynorphin1-8 immunoreactivity in hippocampus. The results show that epileptiform activity and electroacupuncture inhibitory effect on seizure may be related to the alteration of dynorphin1-8 and leu-enkephalin in the brain.

Animals↗
PubMed1994

Serum and ascitic concentration of C3, C4 and protein in cirrhotic patients with spontaneous bacterial peritonitis.

BACKGROUND: Lower concentration of ascitic or serum complement (C3, C4) or protein has been reported to participate in the development of spontaneous bacterial peritonitis (SBP). In Taiwan, the etiology of hepatic cirrhosis is mainly post-hepatic and SBP is the common complication. This study aims to determine the role of protein and complements in the pathogenesis of SBP. METHODS: 119 cirrhotic patients were divided into two groups, 30 SBP and 89 non-SBP. The concentrations of ascitic and serum complement and protein were measured for comparison. RESULTS: The ascitic and serum C3, C4 and protein levels were significantly lower (P < 0.05) in patients with SBP than in non-SBP patients. No significant differences were noted in the ascites/serum ratio of C3, C4 and protein in patient with or without SBP. CONCLUSIONS: Low levels of ascitic and serum protein and complements, C3 and C4, may be prone to develop SBP in our patients mostly with post-hepatitic cirrhosis.

Aged↗
PubMed1994

[C-fos expression in rat brain during seizure and electroacupuncture].

C-fos proteins were visualized immunohistochemically in the brain of rats after seizures induced by injecting penicillin into hippocampus and by penicillin+electroacupuncture treatment. Three hours following seizures there was an evident expression of c-fos proteins in the hippocampus (CA1 area), dentate gyrus, piriform cortex, dorsal part of entorhinal cortex, and amygdaloid nucleus, and there was a dramatic increase of c-fos proteins in CA3 area and the areas mentioned above except the CA1 area where c-fos proteins apparently decreased after electroacupuncture treatment. The results showed that seizures can induce c-fos proteins in some nuclei related with seizure and that electroacupuncture can also regulates the c-fos expression after seizure.

Animals↗
PubMed1975

Insulin control of hepatic glucose production.

Insluin injected intravenously caused a rapid, marked decrease in hepatic glucose secretion in the rabbit, as determined by an isotope-dilution procedure. This was associated with a decrease in the concentrations of gluconeogenic intermediates from phosphoenolpyruvate to triose phosphates, inclusive, compatible with inhibition of gluconeogenesis at phosphoenolpyruvate carboxykinase. The concentration of glucose 6-phosphate was unaltered but that of hepatic glucose was reduced. The specific activities of the hexose phosphates, relative to that of liver glucose, were the same in control and insulin-treated animals. These observations can be explained by a decrease in the activity of glucose-6-phosphatase. It is concluded that this enzyme is a control point for hepatic glucose production and is inhibited by insulin. In the rat, insulin produced a rapid fall in blood sugar. The hepatic glucose output remained normal despite a fall in hepatic glucose 6-phosphate concentration during the initial period of insulin action. This suggests that glucose-6-phosphate returned to normal with no change in the rate of glucose production. The data suggest that in the rat, insulin produces a transient increase in glucose-6-phosphatase activity.

Adenine Nucleotides↗