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Publications and source records attributed to Mei-Hwei Chang.
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Hepatocyte transplantation has been proposed as an alternative for rescuing patients with acute hepatic failure. However, portal hemodynamic changes and issues of safety after hepatocyte transplantation in acute hepatic failure have not been systemically evaluated because of the lack of a suitable experimentation system. In this study, we created a novel spring-guidewire introducer needle to simplify the technique for long-term portal cannulation in F-344 rats. The portal cannula was capable of being used for blood sampling, infusion of hepatocytes, and measurement of portal hemodynamic changes. One week after portal cannulation, rats were injected with D-galactosamine (1.35 g/kg, i.p.) to induce hepatic failure. Hepatocytes (2 x 10(7)) were infused intraportally 24-26 h after induction of liver injury. Portal pressures were recorded for up to 60 min after hepatocyte transplantation. Intraportal infusion of 2 x 10(7) hepatocytes caused an instantaneous onset of portal hypertension. The magnitude of the rise in portal pressure was similar in both normal rats and rats with acute hepatic failure (33.0 +/- 7.1 vs. 37.7 +/- 0.5 mm Hg; p = 0.23). However, the resolution rate of portal hypertension was remarkably delayed in rats with acute hepatic failure, and the portal pressure was significantly higher than that in normal rats 60 min after hepatocyte transplantation (25.0 +/- 2.8 vs. 14.5 +/- 2.4 mm Hg; p = 0.007). In conclusion, we have established a simple new technique for long-term portal cannulation of rats. Our studies provide critical insights into the delayed resolution of portal hemodynamics after hepatocyte transplantation in subjects with acute hepatic failure.
To facilitate making a diagnosis of cholestatic liver disease in Taiwan, we have established reference ranges for serum gamma-glutamyl transpeptidase (gamma-GT) activity and bile acids in normal Taiwanese infants. The serum level of gamma-GT activity was assayed in 90 normal Taiwanese infants and children aged between 2 days and 2 years old. These data were analyzed in twenty-three 0-3-month-old, twenty-four 4-6-month-old, and forty-three 7-24-month-old infants. The mean values of serum gamma-GT activity were 47.4 +/- 26.6, 21.5 +/- 7.3, and 14.0 +/- 3.2 IU/L for the respective age groups. The highest reference gamma-GT values were 99.5, 35.8, and 20.3 IU/L for the respective age groups. The mean values of serum gamma-GT activity were highest in infants younger than 3 months, and these gradually decreased to the adult level with age (p < 0.01). Serum bile acids were measured in 24 premature and 56 full-term infants. The mean values of serum bile acids were 34.5 +/- 34.5 mumol/L in preterm infants and 18.7 +/- 21.9 mumol/L in full-term babies. The bile acid levels of preterm infants were higher than those in full-term babies (p < 0.01).
Constipation is a common gastrointestinal complication in type I neurofibromatosis (NF-1). We present a 4-year-8-month-old boy with NF-1 bothered by chronic episodic constipation and diarrhea since early childhood. Rectal suction biopsy confirmed the diagnosis of intestinal neuronal dysplasia. To our knowledge, this is the first Chinese child reported to have such association.
The aim of this study was to evaluate the family clustering in symptomatic children and to better understand possible transmission routes of Helicobacter pylori (H. pylori) infection. From September 1998 to March 2000, totally 112 children with upper gastrointestinal symptoms (M:F = 59:53, mean age 11.4 +/- 1.5 years, range from 0.9 to 15.3 years old) were enrolled. All of them underwent upper endoscopic examination. Their parents and siblings were recruited to check the serum anti-H. pylori. The results showed 58 of 112 (51.7%) children were injected with H. pylori, while the remaining 54 children were not. To compare the H. pylori (+) and H. pylori (-) groups, we found differences in anti-H. pylori seropositive rates between their fathers (80.7% vs. 79.3%, p = 1.000), mothers (84.7% vs. 70.1%, p = 0.093) and siblings (47.0% vs. 23.0%, p = 0.259) were not statistically significant. In conclusion, the H. pylori seroprevalences between the families of H. pylori-infected and non-infected children were not different. A relatively high H. pylori seroprevalence in the background population may mask the difference. We might need a revised seroepidemiologic study in the future to further clarify this issue.
Primary sclerosing cholangitis (PSC) happens mainly in middle-aged men and is seldom diagnosed in children. Childhood PSC undergoing liver transplantation is rarely reported. Here we present a 12-year-old girl who was admitted with a 6-day history of fever, abdominal pain, fatigue, jaundice, and splenomegaly. Liver histological examination revealed the destroyed bile ducts and bridging fibrosis. Endoscopic retrograde cholangiopancreatography (ERCP) showed beaded appearance of right intrahepatic ducts and absent left intrahepatic ducts. PSC was diagnosed. Because of decompensated liver function, she received a living-related orthotopic liver transplantation (OLT). The post-transplantation course was uneventful during the 12-month follow-up. She experienced neither additional episode of cholangitis nor recurrence of liver cirrhosis after OLT.
Biliary atresia is a severe progressive cholangiopathy which leads to early liver cirrhosis and is uniformly fatal. Early surgical intervention (the Kasai procedure) is needed for an improved outcome. However, early recognition and diagnosis is not easy during the neonatal period because of the high incidence of neonatal jaundice, ill-informed and less than urgent appraisal of the clinical manifestations among jaundiced neonates. A mass screening program for biliary atresia using a stool color card was conducted in Taiwan from March 2002 (in 49 hospitals and clinics) to December 2003 (in 95 hospitals and clinics). The stool color card for infants has proved to be a sensitive and specific screening method for biliary atresia in infants younger than two months of age.
BACKGROUND: The purpose of this study was to delineate the long-term prognosis and factors we have noted in our 25 years of experience treating patients suffering from biliary atresia (BA) who have undergone Kasai's operation. METHODS: We studied 141 patients (69 male and 72 female infants) who underwent Kasai's operation at the National Taiwan University Hospital between 1976 and 2000. Factors analyzed included age at time of surgery, postoperative bile flow, frequency of cholangitis, prophylactic long-term oral antibiotics given, and intrahepatic biliary cyst formation. RESULTS: The 5-year and 10-year survival rates for native liver patients were 34.8% (49/141) and 30.5% (43/141). If surgery was performed before the patient was 60 days old, the results were 44.8% (26/58) and 39.7% (23/58). Good bile flow occurred in 115 patients (81.6%) and 88 (62.4%) became jaundice-free. Cholangitis was encountered in 77 patients (54.6%) within the first two postoperative years. Prophylactic oral antibiotics lowered the rate of recurrent cholangitis (p = 0.011). Multiple intrahepatic biliary cysts occurred in 11.3% (16/141) of patients, who had a higher mortality rate when compared with the other patients (p = 0.037). The factors that had a positive effect include: (1) less than 60 days of age at time of surgery, (2) good bile flow, (3) low frequency of cholangitis, (4) long-term prophylactic antibiotics, and (5) no multiple intrahepatic cyst formation. CONCLUSION: The long-term survival rate can be improved if Kasai's operation is performed early, there is a detailed dissection producing good bile flow, and long-term prophylactic antibiotics are given to prevent recurrent cholangitis and formation of multiple intrahepatic cysts.