Biomedical subjects

Full-Young Chang

Publications and source records attributed to Full-Young Chang.

115 records · Page 7Linked to original sources

PubMedDate not supplied

Clinical characteristics and prognosis of hepatocellular carcinoma patients with paraneoplastic syndromes.

BACKGROUND/AIMS: Hepatocellular carcinoma patients with paraneoplastic syndromes usually have a larger tumor volume and a higher serum alpha-fetoprotein. Whether the presence of paraneoplastic syndromes, such as hypercholesterolemia, hypoglycemia, hypercalcemia, and erythrocytosis in hepatocellular carcinoma patients is a significant prognostic factor in patients' survival is of clinical interest. METHODOLOGY: We evaluated the occurrence of paraneoplastic syndromes in 903 hepatocellular carcinoma patients; 179 (20%) patients developed paraneoplastic syndromes either upon diagnosis or during follow-up, 179 age-sex-tumor volume-matched hepatocellular carcinoma patients without paraneoplastic syndromes were selected as controls. Serum liver biochemistry, alpha-fetoprotein, clinical Child-Pugh's score, tumor image studies, histological features, accessibility to treatment, and survival were recorded and compared between patients with and without paraneoplastic syndromes. Prognostic factors in patients' survival were analyzed. The clinical course and survival of hepatocellular carcinoma patients with different paraneoplastic syndromes were also compared. RESULTS: Multivariate Cox regression analysis revealed Child-Pugh's grade C, ineligibility for active treatment, serum alpha-fetoprotein > 10,000 ng/mL, main portal vein tumor thrombosis, and the presence of paraneoplastic syndromes were all independent unfavorable prognostic factors for survival. The median survival from the occurrence of paraneoplastic manifestation to death was only 36 days. Patients with different paraneoplastic syndromes had similar clinical characteristics in Child-Pugh's score, serum alpha-fetoprotein level, tumor volume, prevalence of main portal vein tumor thrombosis, and accessibility for active treatment upon diagnosis. However, erythrocytosis and hypercholesterolemia usually developed earlier in the clinical course, whilst hypoglycemia and hypercalcemia were usually terminal events. Hepatocellular carcinoma patients with erythrocytosis tended to have a longer survival than patients with other paraneoplastic syndromes. CONCLUSIONS: The presence of paraneoplastic syndromes in hepatocellular carcinoma patients is an unfavorable prognostic factor, excluding the occurrence of erythrocytosis.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Poor responders to intravenous omeprazole in patients with peptic ulcer bleeding.

BACKGROUND/AIMS: Although proton pump inhibitors are highly effective in raising intragastric pH, there still remains a small group of patients who resist acid suppression. A high dose of omeprazole has been shown to reduce rebleeding rate in patients with bleeding peptic ulcers after endoscopic therapy. The primary objective of this study was to assess the incidence of peptic ulcer bleeding patients who were resistant to intravenous omeprazole. The secondary objective was to evaluate the relationship between intragastric pH and rebleeding rate in studied patients after successful endoscopic therapy. METHODOLOGY: Between Oct. 1996 and Aug. 1999, 88 bleeding peptic ulcer patients who had obtained initial hemostasis with endoscopic therapy were enrolled in this study. In these patients, 40 mg of omeprazole was given as intravenous bolus followed by 40 mg intravenously every 6 h for 3 days. Thereafter, omeprazole was given 20 mg orally once daily for 2 months. The intragastric pH was recorded for 24 hours after the first dose of omeprazole. The occurrence of rebleeding was observed for 14 days. RESULTS: The mean intragastric pH value of these 88 patients was 6.07, (95% CI: 5.91-6.23). Four patients (5%) were found to have omeprazole resistance (pH < 4.0, 50% of the time). By the 3rd days after entering the study, more patients with a mean pH < 6 rebled (5/25 vs. 3/63, p<0.05). CONCLUSIONS: About five percent of patients with peptic ulcer bleeding respond poorly to intravenous omeprazole. Rebleeding rate is higher in patients with a mean intragastric pH of less than 6.

Aged↗

PubMedDate not supplied

Undisturbed water gastric emptying in patients of stomach cancer.

BACKGROUND/AIMS: Gastric cancer is an infiltrative disease involving deep layers of the stomach. It is of interest whether the stomach motility in gastric cancer patients may be altered. We employed a homemade applied potential tomographic system to study the features of water gastric emptying in gastric cancer patients. METHODOLOGY: Twelve electrodes were placed in a circular array around the upper abdomen of studied subjects. After drinking 500 mL of test water, paired electrodes injected an electrical current and another 9 paired electrodes recorded signals. This procedure was processed in a rotated order for 50 min while the serial changes in altered resistivity were constructed to display water gastric emptying curve. Before surgery, 27 histologically confirmed gastric cancer patients were enrolled to measure their gastric emptying parameters including half emptying time (T1/2) and area under the curve (AUC). Consequently, tumor parameters were obtained from their resected specimens. In addition, 28 healthy controls were recruited to compare water gastric emptying. RESULTS: The half emptying times of gastric cancer patients and controls were 15.51 +/- 2.21 (SE) and 16.82 +/- 2.13 min, respectively (NS). While their measured areas under the curve were also comparable (1719.5 +/- 169.4 vs. 1896.0 +/- 143.6 arbitrary unit, NS). Regarding with various patient factors to influence water gastric emptying among gastric cancer patients, those patients presenting nausea (T1/2: 8.3 +/- 1.44 vs. 18.5 +/- 2.8 min, P<0.05) or free of regional lymph node metastasis (9.98 +/- 2.53 vs. 22.7 +/- 3.84 min, P<0.05) had a rapid water gastric emptying. Other demographic and tumor characteristics including gender, age, smoking, body size, serum levels of tumor markers, cancer location/size, invasion layer, Helicobacter pylori colonization and histological subtype did not influence water gastric emptying. CONCLUSIONS: Water gastric emptying in non-obstructive gastric cancer patients is mainly undisturbed. However, some obvious dyspeptic symptom or tumor nature appears leading to a rapid water gastric emptying.

Aged↗

PubMedDate not supplied

The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach.

BACKGROUND/AIMS: Intra-gastric bacterial proliferation is frequent in patients with hypochlohydria. However, status of gastric bacterial infection in patients receiving proton pump inhibitor or H2-receptor antagonist remains controversial. The purpose of this study was to investigate the microbial condition of the stomach in patients who received H2-receptor antagonist or proton pump inhibitor. METHODOLOGY: Between November 2000 and January 2002, 102 patients were enrolled in this study. Of these, 52 did not receive any treatment (group I), 26 received H2-receptor antagonist (group II), and 24 received proton pump inhibitor (group III). Ten mL of gastric juice were aspirated for culture during endoscopic examination. The aerobic and anaerobic bacterial and fungal cultures were performed immediately. A glass pH meter measured the pH of the gastric juice. RESULTS: The intra-gastric pH was 2.91+/-2.06 (mean +/- SD), 4.12+/-2.83, and 5.11+/-2.47 for groups I, II, and III, respectively (p=0.001 between groups I and III, p>0.05 between groups I and II, and groups II and III). The positive bacterial culture rates were 66.7% (16/24) in group III, 46.2% (12/26) in group II, and 28.8% (15/52) in group I (p=0.007 between groups III and I,p>0.05 between groups I and II, and groups II and III). The positive candidal culture rates were 12.5% (3/24) in group III, 11.5% (3/26) in group II, and 17.3% (9/52) in group I (p>0.05). CONCLUSIONS: Patients who received proton pump inhibitor had more acid suppression and intra-gastric bacterial infection than those of the control group. The intra-gastric candidal infection was not related to intra-gastric pH or anti-secretory medication in this study.

Adult↗

PubMedDate not supplied

Rapid urease test from non-ulcer part of stomach is superior to histology from ulcer in detection of Helicobacter pylori infection in patients with gastric ulcer.

BACKGROUND/AIMS: Helicobacter pylori is the major pathogenesis of peptic ulcer disease. It is important for the endoscopists to detect H. pylori infection during endoscopy. Only one endoscopic diagnostic method can be used due to the limitation of health insurance payments in Taiwan. Most endoscopists use the tissue obtained from the ulcer margins for histopathological examination and detection of H. pylori infection in patients with gastric ulcer. Whether this is suitable deserves study. METHODOLOGY: A total of 103 consecutive subjects with gastric ulcer were recruited. Biopsy specimens from the margins of gastric ulcer were sent for histological examination with modified Giemsa stain. Two biopsy specimens from the antrum and greater curvature site of mid body were embedded in rapid urease test (CLOtest). A patient was classified as H. pylori positive if either CLOtest or histology were positive. RESULTS: 57 patients had H. pylori infection. The detection rate of rapid urease test and histological examination was 96.5% (55/57) and 59.6% (35/57), respectively. Of the 3 patients who had positive histological examinations and negative urease test, only one was confirmed again to have H. pylori infection. The detection rates of rapid urease test and histological examination in different locations of ulcer (antrum/angularis/proximal stomach) were 92.6%/100%/100% and 81.5%/42.1%/36.4%, respectively. CONCLUSIONS: Our study shows that rapid urease test has higher detection rate than histological examination of the biopsy specimens obtained from the margins of gastric ulcer in diagnosis of H. pylori infection. Under the consideration of the health insurance payments limitation and elimination of false-negative detection rate of H. pylori infection, we strongly recommend the rapid urease test from the antrum and body specimens rather than from the ulcer margins for detection of the bacteria in patients with gastric ulcer disease.

Adult↗

PubMedDate not supplied

The clinical experience of Chinese patients with Wilson's disease.

BACKGROUND/AIMS: Wilson's disease has protean presentations. Most patients manifested as either hepatic or neurologic symptoms and signs initially. No study has investigated the predictor of presentation and differences in laboratory tests and survival between patients presented with hepatic or neurological disease so far. METHODOLOGY: Forty-one patients with Wilson's disease were diagnosed between 1981 and 2002 at our hospital. Their clinical features at presentation and laboratory findings were retrospectively collected. Survival was calculated using the Kaplan-Meier analysis. RESULTS: Twelve patients initially presented with hepatic symptoms including chronic hepatitis, complications of cirrhosis, and fulminant hepatic failure. Twenty-nine patients presented with neurological symptoms including tremor, dysarthria, ataxia, and psychiatric diseases. No specific factor identified could predict the initial presentations. Compared to patients with neurological symptoms, patients with hepatic disease had significantly higher serum levels of aminotransferase, ceruloplasmin, copper, and 24-hour urine copper excretion. There was no significant difference in survival between these two groups. Among the patients who died, the most common causes of death were fulminant hepatic failure and complications of cirrhosis. CONCLUSIONS: Our results suggested that the overall survival did not differ significantly according to the initial presentations. There was no predictor found that could foretell the clinical course of Wilson's disease.

Adolescent↗

PubMedDate not supplied

Polymorphism of T-cell receptor gamma short tandem repeats as a susceptibility risk factor of hepatocellular carcinoma.

BACKGROUND: T-cells play a critical role in the immunological surveillance network against cancer formation. The activation of T-cells is initiated by binding of T-cell receptors (TCR) with antigen epitopes. Polymorphisms of TCR-gamma microsatellite (short tandem repeats, STR) marker has been associated with early-onset colorectal cancer. The aim of this study was to test the relationship of TCR-gamma STR genetic polymorphisms and hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 225 chronic hepatitis B- or C-related HCC and liver cirrhosis patients were enrolled in this study. The other 225 sex-matched cirrhotic patients without HCC were recruited as controls. Their TCR-ygammaSTR polymorphisms at loci D7S1818 and D7S2206 were measured by polymerase chain reaction. Dietary habits and other possible risk factors for HCC were also assessed by a structured questionnaire. RESULTS: Compared to controls, the HCC patients were older in age (64.9 +/- 10.3 vs. 53.5 +/- 10.1 years, p < 0.001) and had a higher percentage of family history of HCC (13.3% vs. 7.6%, p = 0.045) and habitual alcohol use (23.1% vs. 15.6%, p= 0.042). A total of 20 genotypes of TCR-gamma D7S1818 STR were detected. Of these, the genotype 16 (13/14 of repeat number of GA A) had a higher percentage in the HCC groups than in the controls (13.8% vs. 6.7%, p = 0.013). After adjustment for age, family history of HCC and habitual alcohol use, the TCR-gamma genotype 16 remained a significant risk factor for HCC (OR: 2.18, 95% CI: 1.02-4.65, p= 0.045). CONCLUSION: The TCR-gamma STR polymorphism may be associated with HCC susceptibility.

Aged↗