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Biomedical subjects

W Y Chang

Publications and source records attributed to W Y Chang.

At least 127 records · Page 7Linked to original sources
PubMed1991

[Primary treatment of contaminated syringes and needles in a ward].

Body fluid transmitted viruses become the major enemies of human health. These viruses have been reported as occupational hazards for health care personnel, and they may become environmental hazards as well. We conducted this study to examine the primary treatment of used syringes and needles in a ward, and to evaluate the effects of re-education. For questions such as "The used syringes with bloody contamination should isolated from those without" and "The cover of used needles should not be put back on", we recorded error rates during the 1st one-week observation. A lecture about the standard treatment methods of discarding instruments was given to all nurses in this ward after the 1st observation. The 2nd and 3rd one-week observations were repeated one day and one month after the lecture, respectively. The misclassification rates of discarded syringes were 4.4% (33/758), 1.4% (9/661) and 3.9% (18/616). There was a significant decrease between the 1st and 2nd observations (p less than 0.05), but no significant difference between the 1st and 3rd observations (p greater than 0.05). The rates of covered discarded needles were 50.4% (287/569), 44.3% (198/447) and 38.5% (269/699), respectively. These rates showed a trend to decrease (p less than 0.05). The misclassification rates of discarded syringes were low. Although re-education achieved only temporary effects, self-protective education on not re-covering used needles was effective. However, about 40% of all discarded syringes were still being covered after use. Based on our finding, some improvements have been made in this ward.

Medical Waste↗
PubMed1991

Effects of hepatitis B virus, alcohol drinking, cigarette smoking and familial tendency on hepatocellular carcinoma.

Independent and interactive effects related to the development of hepatocellular carcinoma were assessed using a community-based case-control study for hepatitis B virus, habitual alcohol drinking, cigarette smoking, peanut consumption and history of hepatocellular carcinoma among the immediate family. All 200 male newly diagnosed hepatocellular carcinoma patients were recruited consecutively through the period of study as the case group from two teaching medical centers in northern and southern Taiwan. Healthy community residents matched one-to-one with cases on age, sex, ethnic group and residential area were selected as the control group. The carrier status of HBsAg and HBeAg was determined by blind radioimmunoassays, and other risk factors were obtained through standardized interviews according to a structured questionnaire. Conditional logistic regression analysis showed a significant association between hepatocellular carcinoma and the carrier status of HBsAg and HBeAg with an odds ratio of 16.7 and 56.5, respectively, for carriers of HBsAg alone and for carriers of both HBsAg and HBeAg. There was a dose-response relationship between cigarette smoking and hepatocellular carcinoma with an odds ratio of 1.1, 1.5 and 2.6, respectively, for those who smoked 1 to 10, 11 to 20 and more than 20 cigarettes a day. A significant association with hepatocellular carcinoma was also observed for the habitual alcohol consumer with an odds ratio of 3.4. Those whose immediate family had a history of hepatocellular carcinoma were more likely to have the disease develop, with an odds ratio of 4.6. However, the frequency of peanut consumption was not significantly associated with hepatocellular carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Natural killer cell activity in patients with hepatocellular carcinoma relative to early development and tumor invasion.

To evaluate the significance of natural killer (NK) cell activity in the clinical assessment of patients with hepatocellular carcinoma (HCC), 32 patients combined with liver cirrhosis (LC) and HCC, and 29 LC patients were studied. The NK cell activity was markedly decreased in HCC patients and the LC group as compared with the control group, but there was no statistical difference between the NK cell activity of the HCC group and the LC group. The depression of NK cell activity in HCC patients was inversely correlated with the patient's age, and the HCC patients with venous invasion or with both lobes involved had lower NK cell activity. These results suggest that the decreased NK cell activity in HCC patients might be related to the coexistent liver disease, and marked decrease in NK cell activity might be one of the causes for the early development and invasion of HCC.

Adult↗
PubMed1990

Immunoglobulin and hepatitis B surface antigen-specific circulating immune complexes in chronic hepatitis with hepatitis delta virus infection.

IgM, IgG, and HBsAg containing circulating immune complexes (CIC) were determined, by conglutinin (K) and C1q assays, for assessing the role of CIC in hepatitis delta virus (HDV) infection in 54 HBsAg-negative controls and 85 HBsAg-positive patients with chronic hepatitis. The prevalence of HDV markers (HDV antigen and anti-HD) was 24.70% (21/85). CIC were a common feature of HDV infection with 95.24% of patients having at least one abnormal test result. The prevalence of elevated IgM-K, IgG-K, IgM-C1q, and IgG-C1q CIC were 85.71, 85.71, 57.14, and 85.71%, respectively. The prevalence of IgM class CIC were statistically higher in patients with HDV infection than in those without (P = .001 for the K assay and P = .023 for the C1q assay). There was no difference in the prevalence of IgG class CIC. Patients with HDV infection also have significantly higher median levels of IgM K-CIC (P = .002), IgG K-CIC (P = .049), and IgG C1q-CIC (P = .008). In patients with HDV infection, there was positive correlation between IgM C1q-CIC and transaminase levels (r = .519, P = .016 for AST; r = .500, P = .021 for ALT). There was no difference in the prevalence of HBsAg containing CIC between patients with HDV infection (76.19%) and those without (74.60%). In conclusion, IgM class CIC are the major CIC and correlate with disease activity in HDV infection. CIC may play a role in the pathogenesis of HDV infection.

Adult↗
PubMed1990

Relationship of serum alpha-fetoprotein to circulating immune complexes and complements in patients with hepatitis B surface antigen-positive hepatocellular carcinoma.

Circulating immune complexes (CIC), complement and alpha-fetoprotein (AFP) were detected in 93 hepatitis B surface antigen (HBsAg)-positive patients with hepatocellular carcinoma (HCC), 16 patients with liver cirrhosis (LC) and 54 healthy controls. The CIC and complements were significantly higher in HCC patients than in LC patients. The complement and polyethylene glycol(PEG)-CIC in HCC patients with LC were higher than those in LC only (P less than 0.0001). The complement levels in LC patients were significantly lower than in controls. There was no difference in C3 and C4 between HCC patients and controls, while the C3 proactivator was higher in HCC patients (P less than 0.02). The C1q-CIC was higher in HCC and LC patients when compared to controls (P less than 0.0001). In patients with HCC, there was no difference in the CIC and complement levels between patients with cirrhosis and those without. There were inverse correlations between C1q-CIC and C3 (P less than 0.05), C1q-CIC and C4 (P less than 0.04). The mean level of 3% PEG-CIC and C1q-CIC increased significantly as AFP elevated, but decreased as AFP was higher than 1599 ng/ml (P less than 0.05). These results imply that CIC increase with tumor growth but further tumor burden may result in a fall in CIC, there was a shifting of CIC from complement-fixing to non-complement-fixing as AFP increased gradually.

Antigen-Antibody Complex↗
PubMed1990

Ureteral obstruction associated with prostate cancer: the outcome after percutaneous nephrostomy.

We retrospectively reviewed the outcome of 37 prostate cancer patients with ureteral obstruction treated by percutaneous nephrostomy. The over-all survival was 57% at 1 year and 29% at 2 years (median survival time 21 months). The 1 and 2-year survival rates of 15 patients with no prior hormonal therapy were 73 and 47%, respectively, while those of patients who had previously received hormonal therapy were 48 and 19%, respectively. Median survival times of these groups were 24 months and 12 months, respectively. Of 12 patients who had severe renal failure before percutaneous nephrostomy (serum creatinine greater than or equal to 6.9 mg. per dl.) 9 had an adequate return of renal function (serum creatinine less than 3 mg. per dl.) after drainage and 58% survived more than 1 year (median survival time 22 months). Percutaneous nephrostomy is safe and effective in relieving ureteral obstruction and reasonable survival can be achieved even in patients with renal failure. Percutaneous nephrostomy should be considered strongly in these patients.

Aged↗
PubMed1990

Risk factors for gallstones among Chinese in Taiwan. A community sonographic survey.

A health survey of adults aged 30 years or more was carried out in southwest Taiwan to determine the prevalence of gallstones and to study risk factors associated with gallstones. Blood samples were collected and abdominal sonographic examination and anthropometric measurements were performed on a total of 923 people. The 40 gallstone cases detected resulted in a prevalence of 4.3%. The risk factors explored included age, sex, hepatitis, obesity, hyperlipidemia, and diabetes mellitus (DM). Age and DM were the only significant factors associated with gallstones in our study. With a reference group of 30-39-year-olds as a comparison, multiple logistic regression analysis showed a trend effect with odds ratios of 1.73, 3.74, and 6.32 for age groups of 40-49, 50-59, and 60 or above, respectively. The odds ratio for DM was as high as 2.59. However, sex, body weight index, chronic hepatitis B, and hyperlipidemia were not significantly associated with gallstones.

Adult↗
PubMed1990

Hepatitis delta virus superinfection among patients with chronic hepatitis B in southern Taiwan.

To study the prevalence of hepatitis delta virus (HDV) superinfection among patients with chronic hepatitis in southern Taiwan, total and IgM anti-delta antibody (anti-HD) and delta antigen (HDAg) were determined in 85 histology-proven patients with chronic hepatitis. There were 12/85 (14.1%) cases with total anti-HD; 3 of them were also positive for IgM anti-HD. Another 9 (10.6%) cases were positive for HDAg. Thus, the prevalence of HDV superinfection was 21/85 (24.7%), which was significantly higher than previous reports in southern Taiwan. The difference was not seen if anti-HD was used as the only detector. It is concluded that, when other methods are used than previously, HDV infection is more common than previously thought and there is no difference between different parts of Taiwan.

Adult↗
PubMed1990

Serum B protein in hepatocellular carcinoma and liver cirrhosis.

The present studt was completed to assess the clinical utility of B protein, as a tumor marker of hepatocellular carcinoma. The association of B protein and liver cirrhosis was also evaluated because hepatocellular carcinoma is usually combined with cirrhosis. The serum levels of B protein were studied by a Latex-agglutination test. One hundred and twenty-nine patients including 23 hepatocellular carcinoma, 50 hepatocellular carcinoma combined with liver cirrhosis, 40 liver cirrhosis, and 16 chronic hepatitis were tested. The positive rates of B protein in various diseases were as follows: 30.4% (7/23) in patients with hepatocellular carcinoma; 68.6% (35/50) in patients with hepatocellular carcinoma combined with cirrhosis; 82.5% (33/40) in patients with cirrhosis; and 62.5% (10/16) in patients with chronic hepatitis. When B protein was used as a tumor marker of hepatocellular carcinoma, the sensitivity (57.5%) and specificity (25%) were very low. Furthermore, patients with hepatocellular carcinoma, usually combined with cirrhosis; which carried the highest positive rate on B protein determination. This also limited clinical utilization of B protein as a tumor marker of hepatocellular carcinoma. Moreover, there was no correlation of B protein with the serum alpha-fetoprotein level or tumor size. On the contrary, positive correlation of the B protein level with Child's staging (Tau-c value = 0.392, p = 0.008), and death during follow-up (Tau-c value = 0.456, p = 0.021), were discovered in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The outcome of hepatocellular carcinoma treated with transcatheter arterial chemoembolization.

Transcatheter arterial embolization (TAE) has now been widely accepted in the treatment of hepatocellular carcinoma (HCC). Forty-five patients with tissue proven HCC received TAE and were followed up for more than 6 months; 28 of them were followed for more than one year and 13 for 2 years. The embolic materials used were Lipiodol 0.1-0.2 ml/cm2 (tumor area of its maximal diameter), which was prepared by pumping with contrast agent at a ratio of 1:2 and mixed with anticancer drugs (Mitomycin C: 8-10 mg or Adriamycin 40-50 mg), gelform particles 1-2 mm in size were subsequently embolized. The postembolization syndrome: abdominal pain, fever, nausea and vomiting usually subsided within 1-3 weeks. The overall cumulative half-year, 1-year and 2-year survival rates were 77.8%, 57.1% and 46.2%, respectively. Cases with regular follow-up and those with massive type without satellites, esp. when tumor size less than 5 cm, had better survival rates. In contrast, portal vein thrombosis and big tumors (especially with satellites) indicated poor prognosis. In addition, actively treated coexisting peptic ulcer and/or esophageal varices in HCC patients also improved TAE results.

Adult↗
PubMed1990

Prediction of fatty liver from serum triglyceride levels and body weight indexes.

Fatty liver is a common disease in Taiwan. In this study, we tried to evaluate the validity of predicting the presence of fatty liver from clinical data instead of liver biopsy or sonography. From a community survey in Putai, a total of 873 adults older than 30 years and quantified as to triglyceride level, body height, body weight, and the results of the oral glucose tolerance test and upper abdominal sonography were recruited for analysis. Using a receiver operating characteristic (ROC) curve, the best 'cutoff values' for determination of fatty liver were predicted from body weight index and serum triglyceride level in 8 clusters grouped by sex, age and presence or absence of diabetes mellitus. The best cutoff values of triglyceride in the 8 clusters varied from 100 to 170 mg/dl with worse validity. Most of the values were 130 and 140 mg/dl. The cutoff values of body weight index were constant in all clusters and showed greater validity than those for triglyceride. They were 115% or 120%. Their accuracy for the prediction of fatty liver was positively correlated with its prevalence. However, their accuracy was lower than 70% in non-diabetic females. We conclude that body weight index is a good parameter for prediction of fatty liver especially in the high risk groups and we recommend that health-determining cutoff values of serum triglyceride and body weight index should be set at 130 mg/dl and 115%, respectively.

Adult↗
PubMed1990

Sequential changes of serum transaminase and abdominal sonography in patients with suspected dengue fever.

Southern Taiwan experienced a dengue (type 1) outbreak in the autumn of 1988. One hundred and thirteen febrile patients suspected as having dengue infection were seen in the emergency room of the Kaohsiung Medical College Hospital. These patients were recruited for this study. Two hundred and eighty-six sequential serum aspartate transaminase (AST) and alanine transaminase (ALT) data from these patients were analyzed. Data analysis showed serum AST had increased daily and all data were out of normal range from day 6 of the illness. Compared to the AST level on the first day of the illness, the AST level was noted to elevate to an average of 9.25 folds on day 6. The sequential changes of AST were as follows: AST had elevated since the third ill-day in most cases and reached a peak on the 7th or 8th ill-day. It then declined gradually from the 8th ill-day and became normal about 3 weeks later. The changes of ALT level were about the same as AST but had later onset and lower peak. Abdominal sonographic examinations showed thickening of the gall bladder wall, splenomegaly and ascites in some patients during acute stage of the illness and recovered completely after patients recovered from the dengue attack. The sequential change of serum transaminase levels and sonographic findings were compatible. These findings may be used as a reference for the differential diagnosis among dengue fever, acute hepatitis and acute cholecystitis.

Abdomen↗
PubMed1990

The effect of pitressin and glypressin in variceal bleeding--a preliminary clinical trial.

Effects of hemostatic and various side effects were compared between glypressin and pitressin. Fifty-five episodes of esophageal variceal bleeding in 29 patients were studied. Although the glypressin group included more patients in Pugh's classification C than the pitressin group, the result of hemostasis was not influenced. The effect of hemostasis was evaluated in 24 episodes receiving either glypressin or pitressin. The hemostatic effects of glypressin and pitressin were 6/11, 54.5% and 7/13, 53.8% respectively. Eighteen episodes in six patients, with multiple episodes, were used to observe the effect of these two drugs in the same person. No difference was observed. The number of side effects in the glypressin group and the pitressin group were 5 and 10 respectively. Although the side effects of glypressin might be fewer than those of pitressin, chest pain was observed in patients receiving glypressin treatment. The use of glypressin in the patients with cardiac diseases should be studied further. Glypressin is more convenient in clinical use. However, pitressin doses is easily modified. Both drugs might be selected in the control of variceal bleeding.

Adult↗
PubMed1990

Abdominal sonographic screening in a single community.

A health survey, on adults aged 30 years or more, was carried out at 3 villages on the southwest coast of Taiwan. A total of 923 cases (42.6%) of the 2,166 population participated in the survey. The estimated total population prevalence rates were as follows: no gross lesion (60.5%), fatty liver (25.2%), biliary stone (5.2%), gall bladder polyp (1.9%), hepatic hemangioma (1.4%), liver cyst (0.9%) and renal cyst (2.9%). The prevalence rates of gall bladder polyp and renal cyst were higher in men, while that of fatty liver was higher in women. There was an increase in the prevalence with age for fatty liver in females. The results might be a reference about the above findings among Chinese in Taiwan.

Abdomen↗
PubMed1989

Lymphocyte transformation in patients with HBsAg-positive chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma.

To evaluate cellular immunity, mitogen-induced lymphocyte transformation was assessed in 146 patients with chronic hepatitis B virus (HBV) infection, including 63 patients with chronic hepatitis (CH), 34 with liver cirrhosis (LC), and 49 patients combined with liver cirrhosis and hepatocellular carcinoma (HCC). The PHA-induced transformation indices (TI) were lower in patients with chronic HBV infection, especially in the LC and the HCC groups. The Con A-induced TI were also diminished in patients with chronic HBV infection. The mitogen-induced TI in patients with CH showed no significant difference in regards to different histological patterns, HBeAg/anti-HBe statuses, sex groups, age distributions, and SGPT levels. However, the mitogen-induced TI were substantially higher in CH patients with elevated serum AFP levels, especially in the group with AFP levels over 100 ng/ml. From these data, we conclude that: (1) impaired PHA-induced TI in patients with LC may partly explain the high risk factor of LC in the occurrence of HCC; (2) the reduction in TI induced by optimal concentration of Con A reflects the defective suppressor cell activity in patients with chronic HBV infection, even in patients with HCC; (3) no significant difference among the control group and patients with chronic HBV infection in PWM-induced TI implies that the response of B cells may be normal in patients with chronic HBV infection; (4) elevated mitogen-induced TI in CH patients with high AFP levels indicate that the activation of lymphocyte may contribute to the severity of inflammation and tissue damage.

Adult↗
PubMed1989

Factor analysis for the presence of serum HBV DNA in chronic hepatitis B virus infection.

To elucidate the role of HBeAg and other influential factors for the presence of serum HBV DNA and their interactions, serum HBV DNA was examined in 68 patients with chronic HBV infections and 23 HBsAg negative persons by molecular hybridization. Based on the univariate analysis, the positive rate of HBV DNA was higher in patients with HBeAg (31/43, 72.1%) than in patients with anti-HBe (5/22, 22.7%) with an odd ratio of 8.78. The positive rates of HBV DNA between men and women were not significantly different, and the positive rates of HBV DNA were not related to the SGPT levels. The mean age of patients without HBV DNA was higher than that of patients with HBV DNA (p value less than 0.025), and the positive rate and concentration of HBV DNA were decreased with increasing age (p value less than 0.005). The positive rates of serum HBV DNA among different histological changes were not statistically different. However, the discordance of HBV DNA and HBeAg/anti-HBe was increased when the liver parenchymal damage became severe (p less than 0.05). Only 5 patients were anti-D positive and 3 of them had serum HBV DNA. To exclude interactions of the influential factors, multivariate analysis was also performed. HBeAg was the only significant factor for the presence of serum HBV DNA when logistic regression was used (p less than 0.001). The age was an important factor when the concentration of serum HBV DNA was considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

A case-control study of primary hepatocellular carcinoma in Taiwan.

A case-control study was carried out to explore possible risk factors of primary hepatocellular carcinoma (PHC) in Taiwan. One hundred thirty-one PHC patients and 207 hospital control patients were interviewed and blood samples were collected for blood type and hepatitis B virus (HBV) infection marker tests. Eighty-three percent of the PHC patients were found to be hepatitis B surface antigen (HBsAg) positive as compared with 21.0% of the control patients with an odds ratio (OR) of 21.5. Hepatitis B e antigen (HBeAg) positive status increased the risk of PHC. No significant association was observed between erythrocyte genetic markers and PHC, except c of the Rh system, which was significantly lower in the PHC cases. As compared with the control patients, the PHC patients had a higher proportion with a history of liver diseases and more siblings affected with liver diseases. However, the variables such as cigarette smoking, alcohol drinking, peanut consumption, frequent intake of raw fish, heart diseases, peptic ulcer, malaria, hypertension, diabetes, color blindness, G-6-PD deficiency, surgical operation, blood transfusion, and liver diseases of parents and children were not found to be associated with PHC.

Adult↗