Biomedical subjects

Long-Bin Jeng

Publications and source records attributed to Long-Bin Jeng.

28 records · Page 2Linked to original sources

PubMedDate not supplied

Laboratory tests in patients with acute appendicitis.

BACKGROUND: Laboratory measurements such as leucocyte count, neutrophil percentage and C-reactive protein (CRP) concentration are commonly used as diagnostic aids in patients with suspected acute appendicitis. The present study aimed to clarify the role of these laboratory tests in diagnosing acute appendicitis. METHODS: The medical records of 897 patients who underwent appendicectomy for suspected acute appendicitis during a 30-month period were retrospectively reviewed. The laboratory findings were correlated with the histopathology of the excised appendices. Data were analysed to calculate the sensitivity and specificity of the individual tests, as well as the test combinations. RESULTS: Histologically verified appendicitis was found in 740 of the 897 patients (82.5%). The rise in leucocyte count and neutrophil percentage correlated with the degree of appendiceal inflammation. The median CRP level was much higher in the patients with ruptured appendicitis compared with that in patients with a normal appendix (96.8 vs 39.6 mg/L, P < 0.001). However, patients with uncomplicated appendicitis had a lower median CRP concentration than those with a normal appendix, although the difference was not statistically significant (24.1 vs 39.6 mg/L, P = 0.079). The sensitivity of leucocyte count, neutrophil percentage and CRP in diagnosing acute appendicitis was 85.8, 87.2 and 76.5%, respectively, whereas the specificity was 31.9, 33.1 and 26.1%, respectively. Of the 740 patients with acute appendicitis, only six had all three tests simultaneously within the reference interval. CONCLUSIONS: Abnormal laboratory findings cannot reliably deliver a diagnosis of acute appendicitis. However, acute appendicitis is very unlikely when leucocyte count, neutrophil percentage and CRP level are simultaneously normal.

Acute Disease↗

PubMedDate not supplied

C-reactive protein and gallium scintigraphy in patients after abdominal surgery.

BACKGROUND/AIMS: Early detection of post-surgical infection is important to decrease mortality in patients after operation. Both C-reactive protein test and gallium-67 scan (gallium scan) are sensitive examinations in the detection of infection. In this study, we compared the diagnostic accuracy of the two modalities in the detection of infection after abdominal surgery. METHODOLOGY: Forty-six patients undergoing abdominal surgery were enrolled in this study. All patients received blood examination for C-reactive protein test and were referred to our department for gallium scan because of unknown fever after surgery. RESULTS: Of the 46 patients with abdominal surgery, 22 (47.8%) were diagnosed to have infection including 6 intra-abdominal abscesses, 8 wound infection and 8 with both intra-abdominal abscesses and wound infection. To achieve better diagnostic results, C-reactive protein value of 2.8 mg/dL was chosen as cut-off value. The diagnostic sensitivities for both gallium scan and C-reactive protein test were 100%. The diagnostic specificity of gallium scan was superior to C-reactive protein test (83.3% vs. 54.2%). The overall diagnostic accuracy of gallium scan and C-reactive protein test were 92.6% and 76%, respectively. CONCLUSIONS: Both C-reactive protein test and gallium scan have good sensitivity in the detection of infection after abdominal surgery. Gallium scan has better diagnostic specificity than the C-reactive protein test.

Abdominal Abscess↗

PubMedDate not supplied

The usefulness of technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan to differentiate periappendiceal abscess from acute appendicitis--a preliminary report.

BACKGROUND/AIMS: The purpose of this study is to assess the usefulness of Tc-HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cells abdomen scan to differentiate acute appendicitis from periappendiceal abscess. METHODOLOGY: Forty-five patients with atypical symptoms and signs of appendicitis were included in this preliminary study. At 4 hours after an intravenous injection of Tc-HMPAO labeled white blood cells, static images over the anterior abdomen were obtained using a gamma camera. Two regions of interest were selected, one was over the lumbar spine and the other was over the appendiceal area. The mean count ratio of the appendiceal area over the mean pixel count of the lumbar spine was calculated. Sixteen patients were diagnosed with acute appendicitis and 19 patients with periappendiceal abscess by final operative findings. Meanwhile, the other 10 patients with acute abdomen but with no appendicitis served as controls. RESULTS: The mean count ratio of controls, acute appendicitis and periappendiceal abscess was 0.65 +/- 0.05, 0.82 +/- 0.07, and 1.25 +/- 0.11, respectively. If the mean count ratio > or = 1.00 was defined as the cutoff value to diagnose periappendiceal abscess, the specificity and the positive predictive value was 100%. CONCLUSIONS: We concluded that Tc-HMPAO white blood cells abdomen scan should be a potential tool to differentiate periappendiceal abscess from acute appendicitis.

Abdominal Abscess↗

PubMedDate not supplied

Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in children with an atypical clinical presentation.

BACKGROUND/AIMS: Diagnosing acute appendicitis in children with equivocal signs and symptoms is usually difficult. The usual approach to the patient is hospital observation and frequent reexamination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. The aim of this study is to assess and compare the value of the Tc-99m HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cell abdomen scan and abdominal sonography in the diagnosis of acute appendicitis in children with an atypical clinical presentation. METHODOLOGY: Forty children with acute abdomen and possible acute appendicitis but atypical findings were included in this study. After an intravenous injection of Tc-99m HMPAO white blood cells, serial anterior abdomen scans at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images. RESULTS: Thirty-three children received operation for surgical and pathological diagnoses. The other 17 children did not receive operation but follow-up of at least a one-month period. The overall sensitivity, specificity, and accuracy of Tc-99m HMPAO white blood cell scan to diagnose acute appendicitis in children with atypical findings is 96.7%, 80.0%, and 90.0%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography is 86.6%, 90.0%, and 88.0%, respectively. CONCLUSIONS: The Tc-99m HMPAO white blood cell abdomen scan provides a more sensitive and accurate method for the diagnosis of appendicitis in children with atypical clinical presentation when compared with abdominal sonography.

Abdomen↗

PubMedDate not supplied

A trial of single photon emission computed tomography of the liver with technetium-99m tetrofosmin to detect hepatocellular carcinoma.

Technetium-99m Tetrofosmin (Tc-TF) has been shown to be useful in identifying several types of tumors, such as breast, lung and thyroid cancers. However, there are no reports in the literature about the usefulness of Tc-TF liver imaging in detecting hepatocellular carcinoma (HCC). Twenty-two patients with HCC were enrolled in this study. Tc-TF liver single photon emission computed tomography (SPECT) images were performed 10 minutes after intravenous injection of 20mCi Tc-TF. All patients were pathologically investigated by liver biopsy or surgery within one week after Tc-TF liver SPECT imaging. Among the Tc-TF liver SPECT images, 20 out of 22 (90.9%) patients showed negative results without significant Tc-TF uptake in HCC, whereas only 2 (9.1%) patients showed positive results with significant Tc-TF uptake in HCC. No significant correlation between Tc-TF liver SPECT findings and sex, age, serum alpha feto-protein level, differentiation of the tumor, or status of hepatitis virus infection was found. In this preliminary report, Tc-TF liver SPECT imaging is not a sensitive method to detect HCC. However, further studies are necessary to analyze the correlation of Tc-TF liver imaging findings and the MDR gene Pgp expression in HCC.

Adult↗

PubMedDate not supplied

Limited value of 18F-2-deoxyglucose positron emission tomography to detect hepatocellular carcinoma in hepatitis B virus carriers.

BACKGROUND/AIMS: The differentiation of hepatocellular carcinoma from benign liver diseases in hepatitis B virus carriers by imaging studies based upon morphological aspects can be difficult. METHODOLOGY: FDG-PET (18F-2-deoxyglucose positron emission tomographies) were performed in 48 hepatitis B virus carriers to detect hepatocellular carcinoma and differentiate other benign liver diseases. In each patient, the focal liver lesion was visible by ultrasound and an elevated serum alpha-fetoprotein level was noted. Definite diagnosis was established after ultrasound-guided liver biopsy followed by histopathological examination. RESULTS: The histopathological examination revealed hepatocellular carcinoma in 36 patients and benign liver diseases in the remaining 12 patients. Twenty of 36 hepatocellular carcinomas were detectable by FDG-PET and none of 12 benign liver diseases were visualized by FDG-PET. The detection sensitivity of FDG-PET was not related to the echogenicity and size of hepatocellular carcinoma. CONCLUSIONS: FDG-PET is not sensitive to but is more specific than ultrasound and serum alpha-feto-protein level to detect hepatocellular carcinoma and differentiate from other benign liver diseases in hepatitis B virus carriers.

Adult↗

PubMedDate not supplied

Hepatic resection for hepatocellular carcinoma in elderly patients.

BACKGROUND/AIMS: We present the clinical features and outcome of 34 patients with hepatocellular carcinoma older than 70 years of age who underwent hepatic resection (elderly-HCC). Nowadays, hepatic surgeons unavoidably have to perform hepatic resection on elderly patients with hepatocellular carcinoma due to increasing life expectancy. However, the outcome of hepatic resection on elderly patients with hepatocellular carcinoma varies in each series, and the exact role of surgery in the management of hepatocellular carcinoma in the elderly remains to be clarified. METHODOLOGY: From 1986 to 1998, the clinical features of 34 surgically treated cases of elderly-HCC were reviewed. Factors that may influence the outcome were also analyzed. Clinical features and outcome of 398 patients with hepatocellular carcinoma younger than 70 years old (younger-HCC) were also summarized for comparison. RESULTS: Of 432 surgically resected hepatocellular carcinomas, 34 (7.9%) were elderly-HCC. More underlying diabetes mellitus association, higher hepatitis C infection, and lower hepatitis B infection were observed in the elderly-HCC group. More blood loss, larger tumor size, less capsule formation, and more recurrence were significantly prominent in the patients in the younger-HCC group compared with the elderly-HCC group. The patients in the elderly-HCC group had a favorable disease-free survival rate compared with the younger-HCC group, although not statistically significant. The 1- and 5-year survival rates of elderly-HCC patients were 85.3% and 39.6%, respectively. No significant difference in survival or mortality rate was found between elderly-HCC and younger-HCC groups. CONCLUSIONS: We present the clinical features and outcomes of 34 elderly patients with hepatocellular carcinoma who underwent hepatic resection. The results seem to indicate that hepatic resection is safe and feasible in the elderly with hepatocellular carcinoma with or without cirrhosis. The prognosis after hepatic resection is as comparable as that of the younger patients with hepatocellular carcinoma.

Aged↗

PubMedDate not supplied

Arginine and proline alleles of the p53 gene are associated with different locations of gastric cancer.

BACKGROUND/AIMS: Abnormal function of gene p53 is associated with the formation of various cancers including gastric cancer. Recently, p53 codon 72 polymorphism was extensively studied to determine the risk factors responsible for cancer formation using the concept of single nucleotide polymorphism. In this study, we evaluated the risk factors associated with p53 codon 72 polymorphism and gastric cancer carcinogenesis. METHODOLOGY: This study consisted of 51 patients and 59 control subjects. We then evaluated the patient's age, sex, smoking and alcohol consumption habits, tumor location, cell differentiation, lymph node involvement, distant metastasis and tumor stage. Finally the p53 gene codon 72 polymorphism was analyzed by polymerase chain reaction (PCR). The results of polymorphic genotype were stratified with the above risk factors and the associations were analyzed. RESULTS: There was no significant difference between the polymorphic genotypes and the two study groups. However, when the genotypes were further stratified with co-factors, the results revealed a significant association with tumor location. The proline homozygote was more frequent in the patients with gastric cancer at the cardia than in those with cancer at the antral or corpus locations. (55.56% of cardia vs. 14.28% of corpus and antrum, p=0.024). The arginine allele was associated with antral and corpus location of gastric cancer and the proline allele was associated with cardial location (OR=3.25, p=0.026). Also, these polymorphisms do not seem to be associated with age, sex, smoking and alcohol consumption, cell differentiation, lymph node involvement, tumor stage and distant metastasis. CONCLUSIONS: The proline allele at p53 codon 72 is associated with adenocarcinoma of the gastric cardia, and the arginine allele is associated with cancer of the antral and corpus locations. These findings suggest that different genotypes of the p53 gene in different locations of stomach might implicate a different cause of tumor growth.

Alcohol Drinking↗

PubMedDate not supplied

Long-term survival following resection of peritoneal implantation from hepatocellular carcinoma: a case report.

This study presents a rare case of long-term survival following the resection of peritoneal implantation from hepatocellular carcinoma (HCC). A 33-year-old female patient with hepatitis B infection presented with a huge pedunculated HCC and underwent left lateral segmentectomy in 1995. She received regular follow-up and peritoneal implantation was diagnosed 30 months after hepatic resection using abdominal computed tomography due to elevated alpha-fetoprotein (AFP). Subsequently, the patient received segmental resection of jejunum and a solitary peritoneal implantation from HCC in the mesentery of the jejunum. No peritoneal carcinomatosis, direct invasion of the surrounding tissue, or lymph node involvement existed and the postoperative course was uneventful. Meanwhile, histopathological examination of the resected nodule revealed metastatic hepatocellular carcinoma. With regular follow-up with AFP, abdominal ultrasonography, and or computed tomography, no intrahepatic tumor recurrence or extrahepatic metastasis was observed. The patient survived for 90 months following hepatic resection, and survived disease free for 60 months after resection of peritoneal implantation from HCC.

Adult↗

PubMedDate not supplied

Glutathione S-transferase M1 gene null genotype and gastric cancer risk in Taiwan.

BACKGROUND/AIMS: Glutathione S-transferases (GST) are involved in the detoxification of many potential carcinogens and appear to play an important role in the protection from carcinogens. The association between different GSTM1 genotypes and gastric cancer risk is still controversial. The aim of this study was to determine the association between the GSTM1-null genotype and gastric cancer risk. METHODOLOGY: A retrospective, hospital-based case-control study of 123 primary gastric cancer patients and 121 healthy controls was conducted to evaluate the presence or absence of the GSTM1 gene from peripheral blood samples by a PCR-based method. RESULTS: The frequency of the GSTM1-null was 59.3% in the gastric cancer group and 45.5% in the control group. An increase in risk for gastric cancer was found among carriers of GSTM1-null genotype. The odds ratio (OR) was 1.752, with 95% confidence interval (CI) = 2.963 approximately 1.035. CONCLUSIONS: GSTM1-null polymorphism was associated with genetic susceptibility of gastric cancer in Taiwan.

Adult↗