Biomedical subjects

F Y Chang

Publications and source records attributed to F Y Chang.

At least 163 records · Page 9Linked to original sources

PubMed1998

Staphylococcus aureus nasal colonization and association with infections in liver transplant recipients.

BACKGROUND: Staphylococcus aureus has emerged as a leading cause of bacterial infections after liver transplantation. However, the role of nasal colonization in the development of S aureus infections has never been explored in liver transplant recipients. The objectives of this study were to determine whether nasal carriage of S aureus was a risk factor for S aureus infections in liver transplant recipients. METHODS: Over a 2-year period, 30 consecutive liver transplant recipients were studied. Beginning when the recipients were transplant candidates, nasal cultures were performed at each admission and monthly thereafter until discharge or death. RESULTS: Overall, 67% (20/30) of the patients were nasal carriers, 70% of the carriers had methicillin-resistant S aureus (MRSA), 15% had methicillin-sensitive S aureus, and 15% had both MRSA and methicillin-sensitive S aureus. Infections were significantly associated with the carrier state; 100% (9/9) of the infected patients were carriers as compared with 50% (11/21) of the noninfected patients (P=0.01). All infections were a result of MRSA, and 56% (5/9) of the infections were bacteremia. Median time to the onset of S aureus infections was 16 days after transplant. Pulse field gel electrophoresis (with digestion of S aureus with SmaI restriction enzyme) in seven infected patients demonstrated that the isolates from the anterior nares matched the invasive isolates in all cases. A total of 43% (3/7) of these infected patients shared the same restriction pattern. CONCLUSION: MRSA colonization of the anterior nares was a significant predictor of MRSA infections in liver transplant recipients. Infections occurred only in those colonized with MRSA and were a result of the endogenously colonizing S aureus strains in all cases.

Adult↗

PubMed1998

Quantitative measurement of serum HCV RNA in patients with chronic hepatitis C: comparison between Amplicor HCV monitor system and branched DNA signal amplification assay.

Quantitative measurement of serum hepatitis C virus (HCV) RNA is important in predicting and monitoring the therapeutic effects of interferon in treating patients with chronic hepatitis C. We compared two commercial available assays, Roche Amplicor HCV Monitor test kits and Chiron branched DNA signal amplification (bDNA) assay, in quantitative measurement of serum HCV RNA in 74 patients with chronic hepatitis C. The serum HCV RNA of each of these patients was qualitatively positive by conventional reverse transcription-nested polymerase chain reaction. Serum HCV RNA was detected positive by the Amplicor test kits in 63 (85%) patients and by the bDNA assay in 58 (78%) patients (P > 0.05). The quantitative results of HCV RNA detected by both assays showed a good linear correlation (r = 0.56, P < 0.001). Amplicor test kits detected 5 patients with low viremia which were below the detection limit of the bDNA assay (2.0 x 10(5) genome equivalents/ml). However, the mean HCV RNA values detected by the Amplicor test kits was 1.26 log lower than that of the bDNA assay. The Amplicor test kits detected only 5 samples (8%) with a HCV RNA value greater than 5 x 10(6) copies/ml, while the bDNA assay detected 23 samples (40%) with a HCV RNA value greater than 5 x 10(6) genome equivalents/ml (P < 0.01). HCV genotype did not affect the positive rate of HCV RNA measurement detected by both assays. However, a significantly higher mean serum HCV RNA value was noted in HCV genotype 1b as compared with the other genotypes. We concluded that the Roche Amplicor HCV Monitor test kits and the Chiron branched DNA signal amplification assay are equally sensitive in the quantitative measurement of serum HCV RNA in patients with chronic hepatitis C and can be reliably used in measuring HCV viremia clinically.

Female↗

PubMed1998

Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis.

The incidence of delayed hepatitis B surface antigen (HBsAg) clearance in the natural history of chronic hepatitis B virus (HBV)-infected patients was low. Previous studies regarding the prognosis in such patients were controversial. Among 1,355 chronic carriers from 1985 to 1997, spontaneous HBsAg clearance was observed in 55 patients. During a mean follow-up period of 23 months, 18 (32.7%; all were male subjects) developed serious complications, including 11 with hepatocellular carcinoma (HCC) (9 of them underwent surgical resection), 6 with cirrhosis, and 1 with subfulminant liver failure. The overall cumulative probability of complications was 29.8% at 4 years, and it was higher in males (P = .044) and patients aged 45 years or more (P = .006); the latter carried an 8.6-fold increased risk (95% CI: 1.2-64.6; P = .037) of adverse events. Histories of acute or chronic infection by hepatitis A virus, C virus (HCV), or D virus (HDV) were present in 42% of patients. Patients seropositive for antibodies against HCV (anti-HCV) or HDV (anti-HDV) had higher alanine transaminase (ALT) levels (>40 U/L; P = .008) after sero-clearance. HBV DNA was detectable in 31% of 51 subjects, in 20% of 20 with antibodies against HBsAg, in 40% of 20 with anti-HCV or anti-HDV, and also in an HCC patient's serum and tumor. Staining of liver HBsAg was positive in 30% of 10 HCC patients. In conclusion, our results demonstrated that hepatitis B viremia may persist, and adverse complications were not rare in HBsAg-clearance patients. All such patients should be closely monitored, which may allow for earlier detection of HCC.

Adult↗

PubMed1998

The relationship of Helicobacter pylori colonization, the serum pepsinogen A level, and gastric resection.

The serum levels of pepsinogen A (PGA) were measured in patients who underwent various forms of gastric resection to assess whether Helicobacter pylori (HP) colonization has any influence. Included in this study were 48 patients who underwent subtotal gastrectomy for a peptic ulcer (SGPU), 36 who underwent radical subtotal gastrectomy for gastric carcinoma (SGGC), 16 who underwent truncal vagotomy plus antrectomy (TV + AE), 24 with recurrent ulcer (RU) and 27 who underwent total gastrectomy (TG). The mean serum PGA levels in these five groups and in 40 healthy controls were 49.1 +/- 30.4 ng/ml, 30.0 +/- 14.8 ng/ml, 44.8 +/- 21.7 ng/ml, 66.4 +/- 42.8 ng/ml, 8.7 +/- 3.0 ng/ml, and 94.7 +/- 27.9 ng/ml, respectively. All patients except those with RU showed a diminished PGA level. The HP colonization rates of the patients who underwent partial resection were 45.8%, 22.2%, 50%, and 54.2%, respectively (P < 0.05). Age, gender, smoking, the type of gastroenterostomy, and underlying disease did not exert any influence on the measured PGA levels. However, higher PGA levels were observed in HP-colonized patients who either underwent SGPU or had RU. We conclude that various forms of distal gastrectomy, but not RU, elicit an indistinguishable acid secretory ability while HP colonization is responsible for the higher serum PGA levels in some patients following peptic ulcer surgery.

Aged↗

PubMed1998

Sequential variceal pressure measurement by endoscopic needle puncture during maintenance sclerotherapy: the correlation between variceal pressure and variceal rebleeding.

BACKGROUND/AIMS: The risk factors for esophageal variceal rebleeding are little known. Variceal pressure is one of the major determinants of variceal rupture, but the relationship between variceal pressure and variceal rebleeding during maintenance sclerotherapy has not been determined. This study was undertaken to evaluate the relationship between variceal pressure/gradient change and variceal rebleeding during maintenance sclerotherapy. METHODS: Patients with liver cirrhosis and recent esophageal variceal hemorrhage underwent consecutive variceal pressure measurements by direct puncture of the varices before each elective sclerotherapy. RESULTS: In 46 patients, the initial variceal pressure was no different regardless of age, sex, underlying etiology or hepatic reserve. Variceal pressure was higher in large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. A larger volume of sclerosant was required to eradicate large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. There was a positive correlation between initial variceal pressure and total amount of sclerosant (r=0.485, p=0.001). Initial variceal pressure was not related to rebleeding. Variceal pressure increased more in patients with rebleeding from varices per se (n=7) than in those without rebleeding (n= 24). There was no difference in pressure change between patients without rebleeding (n=24) and those with rebleeding from variceal ulcers (n=7). CONCLUSIONS: Large varices, severe red color signs and slow reduction in variceal size were associated with higher initial variceal pressure, and more sclerosant was required to eradicate the varices. An increase in variceal pressure during maintenance sclerotherapy indicates a higher risk of variceal rebleeding, but not of variceal ulcer rebleeding.

Aged↗

PubMed1998

Effects of high dose octreotide on retrograde bile salt-induced pancreatitis in rats.

The effects of somatostatin and octreotide (a long acting somatostatin analogue) in acute pancreatitis are inconclusive. This study examined the prophylactic and therapeutic effects of different doses of octreotide on retrograde sodium taurodeoxycholate-induced acute necrotizing pancreatitis in rats. The rats were divided into 4 groups receiving subcutaneous injection of saline, octreotide 10 microg/kg, 20 microg/kg at 0, 8 and 16 h and octreotide 20 microg/kg at 5, 13 and 21 h, separately. The serum levels of amylase and lipase, pancreatic histopathology, mortality and hemodynamics were examined. Octreotide significantly reduced serum levels of amylase and lipase at 12 h and the degree of pancreatic edema, necrosis and hemorrhage at 18-24 h as compared to the control group. Prophylactic octreotide 10 microg/kg significantly decreased the 24-h mortality from 100% to 44.4% (p < 0.05). The 24-h mortality further reduced to 12.5% and 10% with prophylactic and therapeutic octreotide 20 microg/kg, respectively. The decrease of mean arterial pressure at 12 h was significantly lower in octreotide groups than in the control group. We conclude that octreotide improves pancreatic histopathology and survival in acute necrotizing pancreatitis in rats.

Amylases↗

PubMed1998

Abnormal vagal cholinergic function and psychological behaviors in irritable bowel syndrome patients: a hospital-based Oriental study.

Irritable bowel syndrome (IBS) patients in Western countries usually manifest autonomic nerve dysfunctions and abnormal psychological behaviors. The purpose of this study was to assess whether Oriental IBS patients with predominant bowel symptoms also exhibited similar abnormalities. We enrolled 40 IBS patients from the outpatient clinic and 20 controls with normal daily bowel habit for study. The IBS patients were further divided according to their predominant bowel habit: 20 were constipation-predominant and 20 were diarrhea-predominant. Sympathetic function was evaluated by sympathetic skin response (SSR) while vagal cholinergic function was determined by measuring R-R interval variation (RRIV) in electrocardiography during rest and deep breathing. Psychological parameters were assessed by scales of the Minnesota Multiphasic Personality Inventory (MMPI) and the Hopkins Symptom Checklist (HSCL-90). IBS patients, despite their bowel habit, showed normal SSR response. RRIV during deep breathing was significantly lower in constipation-predominant IBS patients than in controls or diarrhea-predominant IBS patients (16.5+/-3.1% vs 20.5+/-4.8% and 21.5+/-4.6%, P < 0.001). IBS patients also exhibited abnormal MMPI measuring scores on depression, hysteria, paranoia, and masculinity/femininity scales. In addition, they also had more severe psychological distress in the items of HSCL-90 measurement. In conclusion, vagal dysfunction characterizes Oriental constipation-predominant IBS patients seeking medical help. Abnormal psychoneurotic profiles also exist in these IBS patients, irrespective of their bowel habits.

Attitude to Health↗

PubMed1998

Inhibition of gastric emptying and intestinal transit by amphetamine through a mechanism involving an increased secretion of CCK in male rats.

1. The effect of amphetamine on gastrointestinal (GI) transit and the plasma levels of cholecystokinin (CCK) were studied in male rats. 2. Gastric emptying was inhibited both acutely and chronically by the administration of amphetamine. GI transit was decreased by the acute administration of amphetamine but not affected by the chronic administration of amphetamine. 3. Plasma CCK levels were increased dose-dependently by amphetamine. 4. Proglumide, a CCK receptor antagonist, prevented amphetamine-induced inhibition of gastric emptying and the decrease in GI transit in male rats. 5. The selective CCK(A) receptor antagonist, lorglumide, dose-dependently attenuated the amphetamine-induced inhibition of gastric emptying in male rats. In contrast, the selective CCK(B) receptor antagonist, PD 135,158, did not reverse the effect of amphetamine on gastric emptying. 6. Both lorglumide and PD 135,158 reversed the inhibitory effect of amphetamine on GI transit in male rats. 7. These results suggest that amphetamine-induced inhibition of gastric emptying and intestinal transit is due in part to a mechanism associated with the hypersecretion of endogenous CCK.

Amphetamines↗

PubMed1998

Chronic administration of octreotide ameliorates portal hypertension and portal hypertensive gastropathy in rats with cirrhosis.

1. Portal hypertension and hyperdynamic circulation have been postulated to play a role in the pathogenesis of portal hypertensive gastropathy. Administration of octreotide to portal hypertensive rats has been shown to reduce portal pressure and ameliorate hyperdynamic circulation. 2. This study investigated the effects of chronic administration of octreotide on systemic and portal haemodynamics and the development of portal hypertensive gastropathy in carbon tetrachloride-induced cirrhotic rats. 3. After 12 weeks of carbon tetrachloride induction, cirrhotic rats were randomly assigned to receive either placebo (5% dextrose in water) or octreotide (65 micrograms/kg in 5% dextrose in water) subcutaneously twice daily for 10 days. Haemodynamic studies with a thermodilution technique and gastric morphometric analyses were performed at 10 days after treatment. 4. In cirrhotic rats, octreotide treatment induced a significant increase in systemic vascular resistance (2.7 +/- 0.2 versus 3.4 +/- 0.2 mmHg/ml.min-1.100 g-1, P < 0.05) and decrease in portal pressure (12.5 +/- 1.2 versus 9.9 +/- 0.5 mmHg, P < 0.05) compared with placebo-treated rats. In addition, octreotide treatment significantly reduced the mean cross-sectional area of gastric mucosal vessels (2290 +/- 145 versus 1810 +/- 101 micron 2, P < 0.05). 5. This study shows that chronic octreotide treatment ameliorates the development of portal hypertensive gastropathy in cirrhotic rats. The effect of octreotide on portal hypertensive gastropathy may, at least partly, be due to the alleviation of portal hypertension and hyperdynamic circulation.

Animals↗

PubMed1998

Effect of long-term octreotide and isosorbide dinitrate on haemodynamics in rats with portal vein stenosis.

1. Both octreotide and isosorbide dinitrate have been shown to have portal hypotensive effects in animals with portal hypertension. Moreover, in both animals and humans with portal hypertension, the reduction of portal pressure was enhanced when nitrovasodilators were combined with propranolol or vasopressin. The present study was undertaken to evaluate the effect of long-term administration of octreotide and isosorbide dinitrate on haemodynamics in rats with portal vein stenosis. 2. Portal hypertension was induced by portal vein stenosis. Portal hypertensive rats were allocated into one of four groups (eight rats in each group): vehicle group, octreotide group (100 micrograms/kg via subcutaneous injection every 12 h), isosorbide dinitrate group (5 mg/kg via gastric gavage every 12 h) and combined treatment group. Drug was given for eight consecutive days, starting 1 day before surgery. Haemodynamic values were measured using a radioactive microsphere technique. 3. Long-term octreotide treatment decreased portal pressure and improved the hyperdynamic circulation. In contrast, long-term administration of isosorbide dinitrate reduced portal pressure but did not ameliorate vasodilatation. A combination of octreotide and isosorbide dinitrate improved the hyperdynamic circulation with a reduction of portal pressure. In addition, the mean value of portal pressure after combination treatment was significantly lower than in rats receiving octreotide alone. 4. These results showed that, in rats with portal hypertension, long-term combined administration of octreotide and isosorbide dinitrate improved the hyperdynamic circulation together with a more profound reduction of portal pressure than rats receiving octreotide alone.

Animals↗

PubMed1998

Aminoguanidine ameliorates splanchnic hyposensitivity to glypressin in a haemorrhage-transfused rat model of portal hypertension.

1. Hyposensitivity to vasopressin is a well-documented phenomenon in animals with portal hypertension and patients with cirrhosis subjected to haemorrhage. Excessive formation of nitric oxide is at least partly responsible for the vascular hyporesponsiveness to vasoconstrictors observed in experimental portal hypertension or in rats with haemorrhagic shock. This study investigated whether addition of aminoguanidine, a preferential inducible nitric oxide synthase inhibitor, to glypressin (a long-acting vasopressin analogue) could enhance its portal hypotensive effect in portal-hypertensive rats with bleeding.2. Portal hypertension was induced by partial portal vein ligation. Fourteen days after operation, systemic and portal haemodynamics were measured in stable or bleeding portal vein-ligated rats receiving intravenous glypressin (0.07 mg/kg) or aminoguanidine (70 mg/kg) followed by glypressin infusion. In rats with a hypotensive haemorrhage, 4.5 ml of blood was withdrawn and 50% of the withdrawn blood was reinfused before the administration of glypressin or aminoguanidine.3. Glypressin resulted in a significantly greater decrease in portal pressure in portal vein-ligated rats without bleeding than in those with bleeding (P<0.001). In contrast, glypressin induced similar changes in mean arterial pressure between the two groups (P>0.05). The addition of aminoguanidine significantly potentiated the portal-hypotensive effect of glypressin in bleeding portal vein-ligated rats (P<0.005) without an effect on the changes in mean arterial pressure induced by glypressin infusion (P>0.05).4. Splanchnic hyposensitivity to glypressin exists in a haemorrhage-transfused rat model of portal hypertension. This hyposensitivity can be ameliorated by the administration of aminoguanidine.

Animals↗

PubMed1998

Nizatidine in combination with amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection.

BACKGROUND: The efficacy of H2-antagonists in combination with antibiotics in curing Helicobacter pylori infection remains controversial, and it is uncertain whether double dose H2-antagonist therapy is superior to standard dose. AIM: To determine the efficacy of two doses of nizatidine in combination with two antibiotics in the treatment of H. pylori. METHODS: A randomized controlled trial was conducted in 160 patients comparing nizatidine 150 mg with 300 mg b.d. (standard vs. double dose), in combination with clarithromycin (500 mg) and amoxycillin (1000 mg) b.d. for 14 days, in Australia and Taiwan. Compliance was based on a clinical assessment and pill count. H. pylori status was determined by histology (antrum and corpus) and CLO-test. RESULTS: Baseline clinical and endoscopic findings were similar in both arms of the study. Based on an intention-to-treat analysis, cure of H. pylori was achieved in 78% (95% CI: 70.4-85.4%) in the standard nizatidine dose arm and 70% (95% CI: 61.6-78.2%) in the double dose arm (P=0.2). Similar cure rates were observed in ulcer and non-ulcer patient groups. Compliance was excellent in the single and double dose arms (85 and 91%, respectively). CONCLUSIONS: The combination of nizatidine in standard or double dose with clarithromycin and amoxycillin is similarly efficacious in curing H. pylori infection.

Adult↗

PubMed1998

Infective endocarditis in solid organ transplant recipients.

Infective endocarditis, defined as pathologically or clinically definite by the Duke criteria, was observed in 14 transplant recipients at our institutions. In addition, we reviewed 32 previously reported cases in solid organ transplant recipients. The spectrum of organisms causing infective endocarditis was clearly different in transplant recipients than in the general population; 50% of the infections were due to Aspergillus fumigatus or Staphylococcus aureus, but only 4% were due to viridans streptococci. Fungal infections predominated early (accounting for six of 10 cases of endocarditis within 30 days of transplantation), while bacterial infections caused most cases (80%) after this time. In 80% (37) of the 46 cases in transplant recipients, there was no underlying valvular disease. Seventy-four percent (34) of the 46 cases were associated with previous hospital-acquired infection, notably venous access device and wound infections. Three patients with S. aureus endocarditis had had an episode of S. aureus bacteremia > 3 weeks prior to the diagnosis of endocarditis and had received treatment for the initial bacteremia of < 14 days' duration. The overall mortality rate was 57% (26 of 46 patients died), with 58% (15) of the 26 fatal cases not being suspected during life. Endocarditis is an underappreciated sequela of hospital-acquired infection in transplant recipients.

Adult↗

PubMed1998

Fever in liver transplant recipients: changing spectrum of etiologic agents.

Febrile episodes in liver transplants were prospectively evaluated. Fever was due to infections in 78% of the episodes (35 of 45) and due to noninfectious causes in 22% (10 of 45). The predominant sources of fever were bacterial infections (62%; 28 of 45) and viral infections (6%; 7 of 45), whereas rejection accounted for only 4% of the episodes (2 of 45). Forty percent of the infections were unaccompanied by fever; fungal infections were significantly less likely to be associated with fever than were viral or bacterial infections (P = .001). Eighty-six percent (6) of the 7 febrile viral infections were due to viruses other than cytomegalovirus, of which human herpesvirus-6 was the predominant pathogen (71%; 5 of 7). Eighty percent (four) of the five febrile episodes with leukopenia were due to human herpesvirus-6. Episodes of fever were most likely to occur within 12 weeks (58%) or 1 year (29%) after transplantation; 100% of the latter episodes were in patients with recurrent hepatitis due to hepatitis C virus, malignancy, or chronic hemodialysis. In conclusion, cytomegalovirus and rejection were no longer the predominant etiologies of fever in liver transplant recipients, and viruses other than cytomegalovirus (e.g., human herpesvirus-6) are emerging as a significant cause of febrile viral illnesses in these patients.

Adult↗

PubMed1998

Staphylococcus aureus nasal colonization in patients with cirrhosis: prospective assessment of association with infection.

OBJECTIVE: To determine if Staphylococcus aureus colonization of the anterior nares was a risk factor for S aureus infection in patients with cirrhosis and to determine the predictors of S aureus infection in colonized patients. DESIGN: Prospective cohort study. PATIENTS: 84 consecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center. RESULTS: Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MRSA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSSA). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carriers within 1 month, and 7 acquired MRSA carriage more than a month later. Higher Child-Pugh score was independently associated with MRSA carriage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3). S aureus nasal carriers (9 [23%] of 39) were significantly more likely to develop S aureus infections than noncarriers (2 [4%] of 45; P=.02). Central venous catheter use was associated independently with S aureus infections in the carriers (OR, 4.1; CI95 2.8-6.1). Mortality was significantly higher in carriers who developed S aureus infections as compared to those who did not (57% vs 13%; P=.022); S aureus infection was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8). CONCLUSIONS: Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhosis.

Adult↗

PubMed1998

Age is one of the risk factors in developing gallstone disease in Taiwan.

OBJECTIVES: To assess the prevalence and risk factors of gallstone disease (GSD) in Taiwan. DESIGN: Descriptive and cross-sectional. METHODS: A prospective ultrasonographic study of GSD was conducted in 3647 Chinese subjects who received a paid hospital physical check-up. Their demographic characteristics and biochemical parameters were recorded and compared. Ultrasonographic diagnosis revealed 2946 (M/F: 1838/1108) with normal gallbladder, 286 (M/F: 196/90) with gallbladder stones, 100 (M/F: 56/44) with previous cholecystectomy for gallstones, 243 (M/F: 174/69) with gallbladder polyps, 17 (M/F: 10/7) with mixed gallbladder stones/polyps and 35 as 'miscellaneous'. We enrolled subjects showing either gallbladder stones or cholecystectomy for gallstones in the GSD group. RESULTS: Excluding those subjects with mixed gallbladder stones/polyps, the overall prevalence of GSD in the studied group was 10.7%. The studied factors manifesting an increase in risk for the development of GSD were age (P<0.05), high body mass index (P< 0.05), diabetes mellitus (adjusted odds ratio: 1.998; P< 0.05) and glucose intolerance (adjusted odds ratio: 2.056; P<0.05) by multivariate analysis. Other demographic characteristics and biochemical parameters, such as body height, ABO blood type, cigarette smoking, alcohol consumption, blood pressure, lipid profiles, hepatitis B virus infection, liver function and multiparity did not show any correlation to GSD. CONCLUSIONS: Age, high body mass index, diabetes mellitus and glucose intolerance are the risk factors for developing GSD in Taiwan.

Adult↗

PubMed1998

Predictive factors for rebleeding in patients with peptic ulcer bleeding after multipolar electrocoagulation: a retrospective analysis.

The role of endoscopic therapy for peptic ulcer bleeding is well-documented. Nevertheless, rebleeding occurs in 10% to 30% of patients, and such patients are at high risk for death without early retreatment or definitive surgery. The aim of our study was to predict which patients would rebleed within 1 month after successful multipolar electrocoagulation of 100 patients with active peptic ulcer bleeding (spurting, oozing, or nonbleeding visible vessel). We had achieved initial hemostasis in 97 patients and carried out univariate and multivariate analyses to predict which patients would rebleed. Rebleeding occurred within 1 month in 17 (17.5%) patients. we correlated 20 clinical and endoscopic factors with rebleeding episodes. With univariate analysis, blood transfusion of 500 ml or more at entry (p < 0.0001) and use of cimetidine (p = 0.01) were statistically significant for rebleeding. With multivariate analysis, use of omeprazole was an independent factor for preventing rebleeding (odds ratio, 7.68; 95% confidence interval, 1.642-35.929). We suggest that omeprazole may help to prevent rebleeding in patients who have had hemostasis with multipolar electrocoagulation.

Anti-Ulcer Agents↗

PubMed1998

Diagnostic value of anti-hepatitis D virus (HDV) antibodies revisited: a study of total and IgM anti-HDV compared with detection of HDV-RNA by polymerase chain reaction.

A high serum titre (> or = 1000 or > or = 5000) of total antibody to hepatitis D virus (anti-HDV) and positive for immunoglobulin (Ig)M anti-HDV have been used to represent HDV replication, while reverse transcription-polymerase chain reaction (RT-PCR) is currently the most sensitive assay for detecting HDV viraemia. The aim of the present study was to re-evaluate the correlation of total anti-HDV and IgM anti-HDV with HDV viraemia based on RT-PCR and to assess the clinical significance of these markers in acute and chronic HDV superinfection. Chronic HDV infection was defined as positive HDV-RNA by RT-PCR for more than 6 months, while total anti-HDV titre was defined by serial dilution. Of 178 hepatitis B virus (HBV) carrier patients studied, 119 cases had been anti-HDV positive for more than 6 months. Two-thirds (79/119) were positive for HDV viraemia by RT-PCR. Only half the chronic HDV viraemic patients had a high titre (> or = 1000) of total anti-HDV, and there was only moderate agreement (kappa = 0.41) between total anti-HDV titre/IgM anti-HDV and HDV-RNA and chronic HDV viraemia. Based on cross-sectional and longitudinal follow-up analyses, serum total anti-HDV titres > or = 100 appeared to be an excellent cut-off titre (kappa = 0.91) in differentiating chronic from acute HDV infection among viraemic patients. In summary, IgM and a high titre total of anti-HDV are not good markers of HDV viraemia, but an anti-HDV titre of > or = 100 appears to be an excellent marker for the differentiation of acute from chronic HDV superinfection.

Acute Disease↗