Biomedical subjects

I S Sheen

Publications and source records attributed to I S Sheen.

At least 73 records · Page 4Linked to original sources

PubMed1992

Role of hepatitis C virus infection in spontaneous hepatitis B surface antigen clearance during chronic hepatitis B virus infection.

To examine the role of hepatitis C virus (HCV) infection in spontaneous hepatitis B surface antigen (HBsAg) clearance during the course of chronic hepatitis B virus (HBV) infection, serum specimens from 32 asymptomatic HBsAg carriers and 22 patients with chronic hepatitis type B who underwent spontaneous HBsAg clearance were studied for antibody to HCV (anti-HCV) using commercial EIAs. The results were compared with those of control groups matched for age, sex, hepatitis B e antigen, antibody to hepatitis delta virus, and cirrhosis. Eight (25%) of the asymptomatic carriers and 9 (41%) of the patients with chronic hepatitis were seropositive for anti-HCV in contrast to 1.6% and 9.1% of their respective control groups (P less than .01). Serum alanine aminotransferase level was persistently abnormal after HBsAg clearance in one asymptomatic carrier and in four patients with chronic hepatitis. These patients were seropositive for anti-HCV and at least one of them was negative for HBV-DNA by polymerase chain reaction. The data suggest that HCV superinfection may not only suppress HBV or terminate the HBsAg carrier state but may also assume the role of HBV as the cause of persistent hepatitis or transaminase elevation.

Adult↗

PubMed1992

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases.

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Adult↗

PubMed1992

[A clinicopathological study in primary biliary cirrhosis].

Twenty-two patients with clinical, biochemical, immunological and pathological characteristics compatible with primary biliary cirrhosis were studied. There were 17 women and 5 men with a mean age of 57.4 +/- 15.2 years and a mean follow-up of 24.1 +/- 20.1 months. Four of them expired during the follow-up and eighteen patients now survive. The most common complaints were fatigue (63.6%) and itching (59.1%). Only one case (4.5%) was asymptomatic in this series. The major physical findings were jaundice (50%) and hepatomegaly (50%). The significant laboratory findings were: elevation of alkaline phosphatase (91% of the cases greater than 3 times the upper limit of normal), gamma-glutamyl transpeptidase (100% of the cases greater than 4 times the upper limit of normal), aspartate transaminase (95%) and alanine transaminase (100%), presence of anti-mitochondrial antibodies (91%), antinuclear antibodies (73%) and the elevation of IgM (88%). One case was associated with ulcerative colitis. Pathological staging in this series revealed 57.9% of stage II, 26% of stage III, 10% of stage IV and 5.3% of stage I. All patients with granuloma survived but 4 of the 5 patients with cholestasis died during follow-up. The results show that the features in this series of PBC were similar to those observed in western countries. The very high ALP and gamma-GT level as well as only one asymptomatic case in this series, suggest that our patients were diagnosed at a late stage. The reason(s) for the higher positivity of ANA, particularly the speckled type and a lower rate of associated auto-immune disease requires further study. Liver biopsy in predicting a prognosis is valuable.

Adult↗

PubMed1992

Gastric adenocarcinoma simulating benign gastric ulcer.

The pathologic features and prognosis of patient in whom gastric cancer simulates at endoscopy as a benign gastric ulcer has been poorly characterized. We performed a retrospective study with particular reference to the long term prognosis on 191 patients treated for gastric adenocarcinoma over the period 1980-1986. In 176 of these 191 patients (92.2%), the endoscopic findings suggested cancers, while in the remaining 15 patients (7.8%), the endoscopic appearance suggested benign ulcer. Comparing gastric cancers masquerading as benign gastric ulcers with those appeared malignant endoscopically, the former had higher resectability rate (100% vs 77.3%), higher incidence of early gastric cancer (73.3% vs 6.25%), less poorly differentiated carcinoma (33.3% vs 65.4%), less lymph node metastasis (13% vs 69.5%) and a higher five-year survival rate (86.6% vs 24.8%) (p less than 0.05 in all). Our study indicated that gastric adenocarcinomas simulated benign gastric ulcers at endoscopy are mostly early gastric cancers that carry a much better prognosis.

Adenocarcinoma↗

PubMed1992

A prospective randomized controlled trial of sandostatin and vasopressin in the management of acute bleeding esophageal varices.

To study the hemostatic effect of Sandostatin, a long-acting analogue of somatostatin, in acute variceal bleeding, a prospective randomized controlled trial comparing it with Vasopressin was conducted in 41 cirrhotic patients with esophageal variceal bleeding. Initial hemostasis was achieved within 6 hours in 75% of patients treated with Sandostatin and in 61.9% treated with Vasopressin. Recurrent bleed developed in 20% of patients in Sandostatin group and 46.2% in Vasopressin group following initial hemostasis. Complete control of bleeding for 24 hours was attained in 60% of the Sandostatin group and in 33.3% of the Vasopressin group. There was no statistically significant difference in both the rate of initial hemostasis and complete bleeding control. Hospital mortality was also similar in both groups. However, transfusion requirements were less (P less than 0.05) and side effects tended to be milder in patients treated with Sandostatin. In conclusion, Sandostatin is at least as effective as Vasopressin in the treatment of acute variceal bleeding, and carries less severe complications than Vasopressin does.

Adult↗

PubMed1991

Hepatitis C virus infection in patients with chronic liver diseases in an endemic area for hepatitis B virus infection.

Taiwan is an endemic area for hepatitis B virus (HBV) infection, which is responsible for up to 80% of chronic liver diseases there. In contrast to an HBV carrier rate of 15-20% in the general population, only 1% of its population are seropositive for anti-HCV. To evaluate the role of HCV infection in chronic liver diseases in Taiwan, serum anti-HCV was studied using an enzyme immunoassay in 123 "healthy" administration staff of the hospital, 724 hepatitis B surface antigen (HBsAg)-positive and 157 HBsAg-negative patients with chronic liver disease. The prevalence of anti-HCV was 0.8% in the hospital staff, 24.3% in HBsAg-positive and 80.9% in HBsAg-negative patients with chronic liver diseases. Anti-HCV was positive in 10 (9.6%) of 104 HBsAg-positive and 31 (77.5%) of 40 HBsAg-negative patients with inactive chronic hepatitis; 94 (27.2%) of 346 HBsAg-positive and 53 (85.5%) of 62 HBsAg-negative patients with active chronic hepatitis; 49 (26.1%) of 181 HBsAg-positive and 33 (86.8%) of 38 HBsAg-negative patients with cirrhosis; 23 (26.7%) pf 86 HBsAg-positive and 10 (58.8%) of 17 HBsAg-negative patients with hepatocellular carcinoma. In HCV infected HBsAg-positive patients, the optical density was usually lower, and anti-HCV became negative in 27% on follow-up. HCV infection tends to occur more frequently in older, HBeAg-negative and anti-HD-positive patients with chronic HBV infection. It is concluded that HCV not only is the major agent for non-B chronic liver diseases but also plays a significant role in HBsAg-positive chronic liver diseases in Taiwan.

Chronic Disease↗

PubMed1991

Prednisolone withdrawal followed by recombinant alfa-interferon in chronic non-A, non-B hepatitis: interim results of a randomized controlled trial.

To determine the effect of a recombinant alpha interferon 2b (Intron-A) and possible benefit of prednisolone pretreatment in chronic non-A, non-B hepatitis, 75 Chinese patients with clinico-histologically proven chronic hepatitis were randomly allocated to one of the following regimens: (A) 3 million units of Intron-A trice weekly for 6 months; (B) dose titration according to ALT-AST values; (C) prednisolone withdrawal followed by regimen A; (D) control group: no treatment for 6 months but followed by alternating treatment with 3 million units of Intron-A trice weekly for 2 weeks followed by 2 weeks no treatment for 6 months. Up to September 30, 1990, 67 patients have been followed for a minimum of 2 months. At the end of the second month, complete response (normal ALT) was achieved in 71% of group A, 50% of group B, 50% of group C and 0% of group D. At the end of the 6th month, the complete response rate was 62%, 47% and 64% respectively in groups A, B and C. The response rates in groups A and C were significantly better than the 7% in the control group. Complete response usually (91%) occurred within 2 months after the first dose of interferon. Relapse occurred in 40% of the complete responders, usually within 2 months of the last dose. The cumulative relapse rate was significantly lower in responders of group C (11% vs 43% in group A and 86% in group B during a period of 6 months). Only mild adverse effects were reported though two patients withdrew because of intolerable fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗

PubMed1991

Why most patients with hepatitis delta virus infection are seronegative for hepatitis B e antigen. A prospective controlled study.

A prospective age/sex matched control and follow-up study was conducted to explore the reason(s) for the association of hepatitis delta virus (HDV) infection with hepatitis B e antigen (HBeAg) negative hepatitis B surface antigen (HBsAg) carrier state. Over a 3-year period, a total of 110 patients (104 males and six females) with acute HDV superinfection were documented in our unit. Twenty-four (21.8%) of them were HBeAg positive at the onset of acute HDV infection. In the control study, 110 age- and sex-matched asymptomatic HBsAg carriers with normal serum transaminase, as well as 110 age- and sex-matched patients with chronic type B hepatitis were randomly selected from the computer files of the same 3-year period of entry. The prevalence of serum HBeAg in patients with HDV infection was similar to that of asymptomatic HBsAg carriers (20.9%), but significantly lower than that of the patients with chronic type B hepatitis (72.7%). In a follow-up study of 16 HBeAg-positive patients with HDV infection, eight (50%) cleared HBeAg and three (18.8%) seroconverted to anti-HBe within 3 months. The HBeAg clearance rate was significantly higher than for chronic type B hepatitis and asymptomatic carriers (p less than 0.01). The results suggest that the low prevalence of serum HBeAg in HDV infection simply reflects the HBeAg/anti-HBe status of the asymptomatic HBsAg carriers in the population under study. Also in some patients HDV superinfection may itself suppress HBV and thus clear HBeAg.

Adolescent↗

PubMed1991

Bacteremia in patients with cirrhosis of the liver.

Infections are frequent in patients with liver cirrhosis, as their defenses against infectious agents are altered. But bacteremia occurring in cirrhotic patients has seldom been reported in the literature. From 1981 to 1986, we collected 197 cases with 228 episodes of bacteremia for this retrospective study. The incidence of bacteremia in cirrhotic patients was 8.8%; no significant difference was noted between cirrhotic patients with variant etiologies of HBV(+), HBV(-) and alcohol. But the incidence increased with the severity of the disease (1%, 4.8%, 17.1% in Child's A, B, C groups, respectively). Gram-negative bacteria were the predominant microorganisms of bacteremia (75.6%). Among them, Escherichia coli, Klebsiella pneumoniae and Aeromonas hydrophilia were the three most commonly detected microorganisms. Gram-positive bacterias were detected in 21.2% of patients with bacteremia, with predominance of the Streptococcus group and Staphylococcus aureus. In about 26.3% of cases the infectious sources were the same by bacteria cultures as from blood. The most common sources were spontaneous bacterial peritonitis, urinary tract infection, pneumonia and biliary tree infection. In cirrhotic patients with and without bacteremia, the mortality rate increased significantly in the bacteremia group (54.8% vs 23.2%, P less than 0.05). By Child's classification, the mortality of patients with classes B and C increased significantly after onset of bacteremia. There was no significant difference in mortality between bacteremic patients in the HBV(+), HBV(-) and alcohol groups. In conclusion, bacteremia is a severe complication of liver cirrhosis and a sign of a poor prognosis.

Bacteremia↗

PubMed1991

Prevalence of antibodies to hepatitis C virus in the hemodialysis unit.

An enzyme immunoassay was used to detect antibodies to hepatitis C virus (anti-HCV) in 261 patients and 69 staff members of a hemodialysis unit. The prevalence of anti-HCV was 46.7% in patients and 2.9% in staff members (p less than 0.001). The prevalence of anti-HCV increased significantly with increasing duration of hemodialysis (p less than 0.001), but was not related to age, sex, history of blood transfusion, status of hepatitis B or hepatitis A virus infection, or serum ALT. Patients with hepatitis episode increased with increasing duration of hemodialysis and showed a significantly higher prevalence of anti-HCV than those without (63.1 vs. 34.7%, p less than 0.001). The prevalence of anti-HCV in patients with hepatitis also increased with increasing duration of hemodialysis (p = 0.05). Thus, HCV appears to be the major cause of hepatitis in hemodialysis patients. Besides strict infection control measures, further studies are needed to determine the mode of HCV infection and its prevention in the hemodialysis unit.

Female↗

PubMed1991

Incidence, determinants and significance of delayed clearance of serum HBsAg in chronic hepatitis B virus infection: a prospective study.

To investigate the incidence, determinants and significance of delayed clearance of serum HBsAg in chronic hepatitis B virus infection, a prospective follow-up study was conducted in two consecutive groups of patients. Group I consisted of 984 patients (859 men and 125 women) with biopsy-proven chronic type B hepatitis, whereas group II consisted of 1,598 asymptomatic chronic carriers (998 men and 600 women) with normal serum aminotransferase activity. During a mean follow-up period of 4.0 +/- 2.3 yr, 19 patients (1.9%) of group I cleared HBsAg from their serum, whereas 35 patients (2.2%) in group II did so in a mean follow-up period of 2.7 +/- 1.4 yr. The annual incidence of delayed serum HBsAg clearance was 0.5% in group I and 0.8% in group II (p less than 0.02). The cumulative probability of HBsAg clearance was also higher in group II than in group I (p less than 0.007). Antibodies to HBsAg developed in 9 patients (47.4%) with chronic hepatitis and in 11 (31.4%) asymptomatic carriers who cleared serum HBsAg. Those who were HBeAg negative and those older than 40 at entry and those who exhibited cirrhosis during follow-up had a higher incidence of delayed HBsAg clearance. Gender, initial histological changes and hepatitis delta virus infection did not influence the occurrence of HBsAg clearance. Serum HBV DNA was not detectable by slot-blot hybridization but was still detectable by polymerase chain reaction in serum specimens collected within 1 yr of HBsAg clearance. Liver biopsy performed later in 10 patients showed no significant hepatitis activity or tissue HBV DNA, HBsAg or HBcAg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Intrahepatic expression of HBcAg and delta antigen in anti-HBe positive HBsAg carriers with acute exacerbation or chronic active liver disease.

Intrahepatic expression of HBcAg and hepatitis delta antigen (HDAg) was studied in 43 patients with acute exacerbation AE and 37 with chronic active liver disease CALD, in order to evaluate the role of hepatitis B virus (HBV) replication and hepatitis delta virus (HDV) superinfection in development of AE or CALD in anti-HBe positive HBsAg carriers in Taiwan, and the results were compared with 37 patients with only minor hepatitic activity. Only 8.1% of patients with minor hepatitic activity were HBcAg positive, and none were HDAg positive. In contrast, 41.8% and 32.6% of patients with AE were positive for HBcAg and HDAg, respectively, and the other 25.6% were negative for both. The clinical features of AE showed no difference in relation to HBcAg and HDAg activity in the liver except that patients without HBcAg and HDAg were predominantly older adults. These patients might be supposed to have non-A, non-B hepatitis (NANB) virus superinfection, as many reports have shown a predominance of older patients in acute NANB hepatitis. Of the patients with CALD, 40.5% were HBcAg positive, 27.0% were HDAg positive, and 32.5% were positive for neither. Histological features of CALD were identified in 83.3% and 100% of patients with HBcAg and HDAg activity, respectively, but only in 26.1% of those without HBcAg and HDAg. The etiology of CALD in the latter group remains unclear. Furthermore, some of the anti-delta seropositive patients with AE or CALD expressed HBcAg rather than HDAg in the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Heterosexual transmission of hepatitis delta virus in the general population of an area endemic for hepatitis B virus infection: a prospective study.

A prospective study was conducted in 268 consecutive patients with overt hepatitis to examine the transmission of hepatitis delta virus (HDV) in the general population of an area hyperendemic for hepatitis B virus (HBV) infection. The patients were interviewed extensively for potential risk factors associated with transmission. Of the 203 patients with type B hepatitis, 34 (30 men, 4 women) showed serologic evidence of acute HDV infection (HDV+ group), while the other 169 did not (HDV- group). Of the 30 HDV+ men, 27 (90%) had had sexual intercourse with prostitutes within 3 months of admission, while only 31 (22.7%) of the 136 HDV- men, 8 (17.4%) of the 46 men with non-A, non-B hepatitis and 5 (8.3%) of the 60 control men had done so (P less than .001). Of the 4 HDV+ women, 1 was a prostitute and another was the wife of a patient with active HDV infection. There was no significant difference in exposure to other risk factors among these groups of patients. The results suggest that heterosexual exposure, particularly prostitute contact, is the most important route of HDV transmission in the general population of this area endemic for HBV infection.

Adolescent↗

PubMed1990

Retroperitoneal neurilemoma: clinical features in 10 cases.

Neurilemoma is a rare tumor in the retroperitoneal cavity. Up to 1984, less than 50 cases had been reported in the English literature. We observed 10 cases of retroperitoneal neurilemoma with histologic proof at our hospital. The major symptoms were abdominal pain (80%) and body weight loss (40%). Physically palpable abdominal masses were found in 90% of the cases. The laboratory data were all within normal limits, except for a mild elevation of the eosinophil count in 4 cases. Radiologic examination demonstrated the tumor in most cases. Abdominal ultrasonography was very effective in the detection of these tumors. Surgical resection was the treatment of choice. Some patients suffered from leg numbness after the operation. Recurrent rate was high, up to 20% therefore, long-term follow-up is mandatory.

Adult↗

PubMed1990

Ultrasonographic difficulties and pitfalls in diagnosing primary carcinoma of the gallbladder.

In order to more specifically define gallbladder carcinoma with real-time ultrasonography, a retrospective study was performed involving 29 sonographically false-negative and 22 sonographically false-positive cases of gallbladder carcinoma. Among the false negative cases, 18 (62.1%) were diagnosed as gallbladder stone only, 6 cases (20.7%) were incorrectly diagnosed as either acute or chronic cholecystitis, 2 cases (6.9%) were diagnosed as bile sludge, 2 cases (6.9%) were diagnosed as polyps, and 1 case (3.4%) was diagnosed as liver tumor. In false-positive cases, 8 (31.8%) were erroneously diagnosed as liver tumor. In false-positive cases, 7 (31.8%) were erroneously diagnosed as a mass projecting from the gallbladder wall but were pathologically proven to be polyps (4 cases) or bile sludge (3 cases); 8 cases (36.4%) were incorrectly diagnosed due to irregular thickening of the gallbladder wall but histology revealed them to be acute (3 cases) or chronic (5 cases) cholecystitis. Seven cases (31.8%) had a solid mass in porta hepatis, indicating gallbladder carcinoma; of these, 2 cases were lumps of bile sludge and 5 cases were acute cholecystitis with empyema. The differentiation of gallbladder carcinoma from cholecystitis (acute or chronic), polyps, and bile sludge is sometimes very difficult. With an understanding of the sonographic pitfalls and difficulties in the diagnosis of gallbladder carcinoma, a more specific diagnosis may be made.

Carcinoma↗

PubMed1989

[Hyperlipoproteinemia associated acute pancreatitis complicating with pregnancy--a case report].

Hyperlipoproteinemia associated with acute pancreatitis is a rare complication during pregnancy. Acute pancreatitis may occur when physiologic hyperlipoproteinemia of pregnancy superimposes on primary or secondary hyperlipoproteinemia. In the meantime, acute pancreatitis may unmask hyperlipoproteinemia and the pattern of lipoprotein electrophoresis may evolve from Fredrickson type III to type IV or type V during acute pancreatitis. We reported a case and reviewed the literature. A 28 years old woman, G4P3, was admitted to our hospital in the sixth month of pregnancy because of epigastralgia and vomiting for 10 days and respiratory distress for one day. Laboratory examination revealed amylase 551 U/L, lipase 1073 U/L, blood sugar 873 g/dl, triglyceride 1298 mg/dl and cholesterol 1044 mg/dl. Abdominal sonogram revealed diffuse edematous change of the pancreas and minimal ascites. The symptoms and signs subsided gradually after supportive treatment that included nothing per os, fluid and electrolyte balance, antacid and analgesics. Unfortunately , intrauterine fetal death was found on the twentieth day after admission. The blood levels of triglyceride and sugar were still elevated 3 weeks after discharge. The most important observation was a broad beta lipoprotein band found in lipoprotein electrophoresis in the acute stage of this case. The broad beta band disappeared and Fredrickson type IV was found in the late stage of pancreatitis. The pattern of lipoprotein electrophoresis changed to Fredrickson type V 3 weeks later.

Acute Disease↗

PubMed1989

The prevalence and incidence of cholecystolithiasis in patients with chronic liver diseases: a prospective study.

To investigate the prevalence and incidence of cholecystolithiasis in hepatitis B surface antigen-positive chronic liver diseases, a prospective study using hepatobiliary ultrasonography was conducted in 933 "healthy" persons and four groups of HBsAg-positive patients: 226 asymptomatic carriers, 73 patients with chronic active hepatitis, 77 patients with early liver cirrhosis and 124 patients with advanced liver cirrhosis. Patients with hepatocellular carcinoma or alcoholism were excluded. The prevalences of cholecystolithiasis increased along with the increasing duration and severity of chronic liver diseases, with a significant linear trend (p less than 0.001). The prevalences of cholecystolithiasis in patients with liver cirrhosis (18.5% in males, 31.2% in females) were 4 to 5.5 times higher than that of the healthy population (p less than 0.005). In addition, the linear trend of increasing prevalence with increasing age in the healthy population was not observed in patients with chronic liver diseases. On the other hand, five of the 69 patients with early liver cirrhosis were found to develop cholecystolithiasis during a mean follow-up period of 32 months. The calculated annual incidence of cholecystolithiasis was 2.6%. The results suggest that chronic liver disease, particularly liver cirrhosis, is a risk factor for cholecystolithiasis.

Age Factors↗

PubMed1989

Randomized controlled study of propranolol for prevention of recurrent esophageal varices bleeding in patients with cirrhosis.

A randomized controlled trial of propranolol was conducted in 36 adult cirrhotic patients after active esophageal variceal hemorrhage had been controlled. Seventy-eight percent of the 18 patients on propranolol and 72% of the patients on a placebo were of Pugh's class A. Of the patients treated with propranolol, 94%, 87%, 68% and 57% were free from rebleeding 6, 12, 18 and 24 months after entry, respectively. The corresponding figures in control patients were 81%, 59%, 30% and 15%, respectively. The percentages of patients free from rebleeding were significantly higher in the propranolol group than in the control group (P less than 0.05). No significant adverse effect was observed during the study, except for a patient who developed hepatic decompensation 14 months after propranolol therapy. It was concluded that propranolol was a safe and effective drug for the prevention of variceal rebleeding in patients with good liver functional reserve.

Adult↗