Right-sided aorta with Kommerell's diverticulum.
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Aorta, Thoracic↗
Biomedical subjects
Jaw-Town Lin
Publications and source records attributed to Jaw-Town Lin.
Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy.
BACKGROUND: Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury. METHODS: Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded. OBSERVATIONS: All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff. CONCLUSIONS: EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.
Adult↗
Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus-associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4 counts.
BACKGROUND AND AIMS: The role of Helicobacter pylori infection in gastroduodenal lesions might be different between the general population and AIDS patients. The aim of the present study was to compare the prevalence of H. pylori and cytomegalovirus (CMV) infection in AIDS patients and HIV-negative controls. The impact of CD4 lymphocyte counts on H. pylori and CMV infection in the same subjects was also assessed. METHODS: One hundred and fifty-six patients (52 HIV-positive, 104 HIV-negative) with gastrointestinal symptoms were evaluated with upper gastrointestinal endoscopy and biopsy. Comparison of the prevalence of H. pylori and CMV infection was made by dividing AIDS patients into two groups: those with CD4 counts >100/mm3 and those with CD4 counts <100/mm3, and ulcer and non-ulcer patients. RESULTS: In comparison with HIV-negative controls, AIDS patients had a lower prevalence of H. pylori infection (P < 0.0001) but a higher prevalence of CMV infection (P < 0.0001). Cytomegalovirus infection was frequently found in AIDS patients with CD4 count <100/mm3, in comparison with those with a CD4 count >100/mm3. In AIDS patients, CMV was more frequently detected in subjects with peptic ulcers (P = 0.0125). Conversely, the prevalence of H. pylori infection in AIDS patients was not different between those with and without peptic ulcers. CONCLUSIONS: The low prevalence of H. pylori infection and peptic ulcer in AIDS patients suggests a different role of H. pylori infection in peptic ulcer or even a different mechanism of peptic ulcerogenesis in HIV-positive subjects. Cytomegalovirus, rather than H. pylori, may be the main causative pathogen of peptic ulcers in AIDS patients.
AIDS-Related Opportunistic Infections↗
Relationship between Helicobacter pylori infection and erosive gastroesophageal reflux disease.
BACKGROUND AND PURPOSE: The role of Helicobacter pylori in the pathogenesis of gastroesophageal reflux disease remains controversial. The aims of the study were to assess the factors that influence the severity of erosive esophagitis in Taiwanese and to determine the prevalence of H. pylori infection in symptomatic patents. METHODS: Patients with erosive esophagitis confirmed by upper endoscopy from January 2002 to December 2002 at National Taiwan University Hospital were enrolled. The severity of erosive esophagitis was graded endoscopically according to the Los Angeles classification. H. pylori infection was determined by pathology and culture of biopsies at the gastric body and/or antrum. A sex-matched control was selected to determine the prevalence of H. pylori infection. RESULTS: A total of 104 patients were recruited for the study, 3 of whom were excluded due to previous eradication of H. pylori infection. The prevalence of H. pylori infection in the 101 eligible patients with erosive esophagitis was 34.7%, which was significantly lower than the 64.9% prevalence in the control group (p < 0.001). Age and hiatal hernia were significantly associated with the severe erosive esophagitis (odds ratio, 1.05 and 4.44, respectively). H. pylori infection status, gender, smoking, alcohol drinking, and coexistent systemic diseases such as diabetes and hypertension were not correlated with the severity of erosive esophagitis. CONCLUSIONS: The overall prevalence of H. pylori infection was significantly lower in symptomatic patients with erosive esophagitis than in controls. Age and hiatal hernia were significantly associated with the severity of erosive esophagitis. H. pylori infection was inversely correlated with the occurrence of erosive esophagitis, but was not correlated with its severity.
Adult↗
Effect of interleukin-1beta and glutathione S-transferase genotypes on the development of gastric mucosa-associated lymphoid tissue lymphoma.
e tested whether polymorphic variations in glutathione S-transferase genes (GSTM1, GSTT1, GSTP1) and interleukin-1 (IL-1beta and IL-1RN) genes confer susceptibility to mucosa-associated lymphoid tissue lymphomas (MALT) in a Chinese population. The rates of GSTM1, GSTP1, IL-1beta and IL-1RN genotypes did not differ between patients and controls. However, GSTT1 null genotypes were significantly more common in patients with MALT lymphomas (43/75 vs. 138/321, p=0.029; OR=1.8, 95% CI: 1.1-3.0) than in controls. Our results suggest that a glutathione S-transferase defect plays a role in MALT lymphoma.
China↗
Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit.
OBJECTIVE: To investigate the sources of hemorrhage and use of endoscopic hemostasis in patients with clinically significant upper gastrointestinal (UGI) hemorrhage after admission to the intensive care unit (ICU). DESIGN AND SETTING: Prospective study, 123 beds of ICU in a 1,629-bed medical center. MEASUREMENTS AND RESULTS: Of the 9,512 consecutive admissions over a 2-year period 105 UGI hemorrhage patients underwent urgent bedside UGI endoscopy. We compared two groups of these patients, one receiving and the other not receiving endoscopic hemostasis. Ulcers with profusely bleeding stigmata occurred in 31 patients (29.5%), ulcers with clean bases or firmly adherent blood clots in 27 (25.7%), stress-related mucosal diseases in 23 (21.9%), esophageal varices in 5 (4.8%), malignancy in 4 (3.8%), and no detectable bleeding site in 15 (14.3%). Endoscopic hemostasis was attempted in 34 patients (32.4%). Primary hemostasis for them was achieved in 67.6% and the rebleeding rate was 30.4%. In-hospital mortality rate was 77.1% and death related to hemorrhage 6.2%. Length of ICU stay before endoscopic diagnosis was significantly shorter in those who underwent endoscopic hemostasis than those who did not (28.2+/-26.3 vs. 41.2+/-57.5 days). CONCLUSIONS: Endoscopic hemostasis may be more beneficial when the period between ICU admission and development of hemorrhage is shorter. Bleeders can be more readily identified and controlled endoscopically in such patients. A significant proportion of bleeding sites cannot be identified by UGI endoscopy. It may indicate higher risk of small bowel hemorrhage in these critically ill patients.
Adolescent↗
Interleukin-10 genotypes associate with the risk of gastric carcinoma in Taiwanese Chinese.
The association of cytokine genotypes with gastric carcinoma (GC) may be influenced by environmental factors and varies among different populations. Few studies have addressed the impact of different cytokine genotypes on the development and progression of GC. We analyzed 11 functional polymorphisms in tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, IL-4 and IL-10 genes in 220 Taiwanese Chinese with GC and in 230 healthy controls. The risk of genotypes was adjusted with confounding environmental risks. Our results revealed that the frequency of Helicobacter pylori infection [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.19-2.56], cigarette smoking (OR 2.02, 95% CI 1.38-2.95) and high IL-10 producer genotype (OR 2.67, 95% CI 1.29-5.50) was significantly increased in the entire GC patients. Among different subtypes of GC, a higher risk of developing diffuse type (OR 1.64, 95% CI 1.01-2.67) or cardia cancer (OR 2.44, 95% CI 1.13-2.67) was observed for the CT/CC genotype of IL-4 at the position -590, whereas the high IL-10 producer genotype was significantly linked with the risk of cardia cancer (OR 3.21, 95% CI 1.06-9.73) or advanced stage (OR 2.29, 95% CI 1.12-4.64). No association was noted between GC and controls in the distribution of IL-1 and TNF-alpha genotypes. Logistic regression analyses revealed that H. pylori infection (OR 1.7, 95% CI 1.14-2.52), cigarette smoking (OR 1.87, 95% CI 1.27--2.96) and IL-10 genotype (OR 2.54, 95% CI 1.24-5.61) are independent risks for GC. Independent effects of IL-10 genotype, H. pylori infection and cigarette smoking indicate that carcinogenesis of GC is influenced by a variety of host and environmental factors.
China↗
Simplified 13C-urea breath test with a new infrared spectrometer for diagnosis of Helicobacter pylori infection.
BACKGROUND AND AIM: Infrared spectrometry has correlated excellently with mass spectrometry in detecting the ratio of 13CO(2) to 12CO(2) in breath samples. The present study aimed to evaluate the accuracy of the 13C-urea breath test (13C-UBT) using a new model of infrared analyzer. METHODS: A total of 600 patients who were undergoing upper endoscopy without receiving eradication therapy were entered into the study. Culture, histology, and rapid urease test on biopsies from the antrum and corpus of the stomach were used for the determination of Helicobacter pylori infection. Breath samples were collected before and 20 min after drinking 100 mg 13C-urea in 100 mL water. The optimal cutoff value was determined by the receiver operating characteristic curve. RESULTS: Of the 586 patients who were eligible for analysis, 369 were positive for H. pylori infection, 185 were negative for H. pylori infection, and 32 were indeterminate. When the appropriate cutoff value was set at 3.5 per thousand, a sensitivity of 97.8%, a specificity of 96.8% and an accuracy of 97.5% were obtained using the 13C-UBT. The accuracy of the 13C-UBT decreased when CO(2) concentration in the breath sample was <2%, as compared with > or = 2% (93.6%vs 97.7%), mainly because of a decrease in specificity (81.8%vs 97.7%). There were 2.7% of patients with Delta13CO(2) values that fell between 3.0-4.5 per thousand, in whom the risk of error was 47%. CONCLUSIONS: The 13C-UBT performed with infrared spectrometry is a highly sensitive, specific, and non-invasive method for the detection of H. pylori infection. The immediate availability of the test result and technical simplicity make it particularly effective in routine clinical practice.
Adult↗
CagA tyrosine phosphorylation in gastric epithelial cells caused by Helicobacter pylori in patients with gastric adenocarcinoma.
BACKGROUND: Tyrosine phosphorylation of Helicobacter pylori cytotoxin-associated protein of in gastric epithelial cells is reported. The goals of this study are first to examine the occurrence of CagA tyrosine phosphorylation in H. pylori strains isolated from patients with gastric adenocarcinoma and gastritis, and second to clarify the relationship between the diversity of tyrosine phosphorylation motifs and the presence of CagA tyrosine phosphorylation. METHODS: Fifty-eight clinical isolates of H. pylori from patients with gastric adenocarcinoma (29 cases) and gastritis (29 cases) were studied for CagA tyrosine phosphorylation by Western blotting. Sequence diversity of tyrosine phosphorylation motifs was analysed among positive- or negative-CagA tyrosine phosphorylation isolates. RESULTS: Positive CagA tyrosine phosphorylation was found in 93.1% (27 of 29) of strains from gastric adenocarcinoma patients and 51.7% (15 of 29) of strains from gastritis patients (p < 0.001). Intact motifs were found in H. pylori isolates with CagA tyrosine phosphorylation. Of the 16 negative CagA tyrosine phosphorylation isolates, intact tyrosine phosphorylation motifs were found in 15 isolates. CONCLUSIONS: CagA tyrosine phosphorylation, which is significantly greater in strains from gastric adenocarcinoma patients, may play a role in gastric carcinogenesis, and could be a better marker of more virulent strains than the cag pathogenicity island in Asia, where the cag pathogenicity island is present in nearly all H. pylori strains. Sequence diversity of tyrosine phosphorylation motifs on CagA was not related to the presence of tyrosine phosphorylation. The absence of tyrosine phosphorylation motif might result in negative tyrosine phosphorylation phenotypes, but such motifs are not the sole factors associated with CagA tyrosine phosphorylation.
Adenocarcinoma↗
Superior mesenteric artery occlusion.
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Female↗
Limited value of typical gastroesophageal reflux disease symptoms to screen for erosive esophagitis in Taiwanese.
BACKGROUND AND PURPOSE: The predictive value of gastroesophageal reflux disease (GERD) symptoms for erosive esophagitis is controversial. This study evaluated the sensitivity of heartburn and acid regurgitation as indicators of erosive esophagitis in Taiwanese. METHODS: Data collected from 521 consecutive health check-up participants who received panendoscopy and completed a self-administered questionnaire for GERD were analyzed. A classification system was used based on the presence of typical symptoms (heartburn or acid regurgitation) experienced 1 or more times per week (I), less than once per week, but more than once per month (II), and in the past (III), and in subjects free of typical symptoms, comprised those with atypical symptoms (IV), extraesophageal symptoms (V), both atypical and extraesophageal symptoms (VI), and lack of all of the above symptoms (VII). The Los Angeles classification was used for the endoscopic assessment of erosive esophagitis. RESULTS: The sensitivity, positive predictive value (PPV), and specificity of criteria I+II were 30.5%, 32%, and 78.9%, respectively, for erosive esophagitis in Taiwanese. Inclusion of symptoms in category III increased sensitivity by 13.3%. Combined symptoms in categories IV+V+VI had the highest negative predictive value of 85.5% and a fair specificity of 73.8% for those free of typical symptoms. In the overall classification system, the combination of symptoms in categories IV+V+VI increased sensitivity by 17.9 to 61.7%, and decreased specificity by 26.3 to 40.4%. The most specific indicator was symptoms in category I (with a PPV of 45% for erosive esophagitis in symptomatic patients). About two-fifths (38.3%) of patients with erosive esophagitis had none of the symptoms in the classification system. CONCLUSIONS: Heartburn and acid regurgitation are insensitive predictors of erosive esophagitis in Taiwanese. Step-wise addition of previous typical symptoms, currently atypical and extraesophageal symptoms to the "heartburn and acid regurgitation" criterion can greatly increase sensitivity, but endoscopy remains the method of choice to detect erosive esophagitis.
Adolescent↗
Genetic alterations and polymorphisms in gastric cancer.
The etiology of gastric cancer (GC) is multifactorial, and is likely to involve the actions of genes at multiple levels along the multistage carcinogenesis process. This article reviews the considerable progress that has been achieved in understanding the genetics of GC. The genetic effects consist of inherited genetic factors that predispose to GC, and the genetic targets of neoplastic progression that confer altered growth capacity to neoplastic cells. Inherited genotypes include germline mutations of high-penetrance genes directly associated with hereditary GC syndromes and genetic polymorphisms that indirectly affect the susceptibility to GC after exposure to carcinogens or Helicobacter pylori infection. Based on accumulation of different oncogenes or tumor suppressor genes alterations, 2 broad classes of genetic pathways called suppressor and mutator phenotypes are defined that participate in the development and progression of GC. Examples of genes involved in pathogenesis of GC include p53, adenomatous polyposis coli (APC), beta-catenin, E-cadherin, transforming growth factor (TGF)-betaRII, and hMLH1. Delineating genes involved in different subtypes of GC can reflect the heterogeneity and biologic characteristics of GC. Elucidation of the role of inherited genotypes and genetic alterations at different stages of gastrocarcinogenesis may provide a more coherent picture of the mechanism of this devastating disease and facilitate the development of novel approaches to effective prevention and intervention. Advances in high throughput technologies and functional genomics have rapidly increased our understanding of gene structure and function and its role in disease.
Disease Progression↗
Association of the -160 C --> a promoter polymorphism of E-cadherin gene with gastric carcinoma risk.
BACKGROUND: A -160 C --> A polymorphism in the promoter region of E-cadherin has been shown to decrease gene transcription. This allelic variation might be a potential genetic marker for identifying individuals at risk for cancer. There remains no report regarding the polymorphism of E-cadherin in gastric carcinoma (GC). METHODS: A hospital-based case-control study, including 201 GC cases and 196 unaffected controls, was performed. DNA from peripheral blood samples was examined by polymerase chain reaction-restriction fragment length polymorphism. Logistic regression analyses were used to compute odds ratio (OR) and 95% confidence interval (CI) after adjusted for Helicobacter pylori infection, smoking, and other relevant factors. RESULTS: In 196 healthy Taiwanese, the distribution of genotype C/C was 42.3%, C/A was 48.0%, and A/A was 9.7%. The frequency of variant A/A genotype in GC case (4 of 201, 2%) was significantly lower than that of controls (19 of 196, 9.7%) (P < 0.005), conferring a 5-fold decrease in the risk of GC (OR, 0.20; 95% CI, 0.06-0.56) compared with the C/C genotype. Stratification of the GC cases according to their location (cardia and noncardia), histology (intestinal and diffuse), tumor stage (early and advanced), and lymph node metastasis (positive and negative) failed to reveal any heterogeneity with respect to E-cadherin genotype. CONCLUSIONS: The authors' data suggest that individuals with E-cadherin -160 A/A genotype have a decreased risk of GC. Further work is mandatory to clarify the functional relevance of the A allele in vivo and to confirm the inverse association of the A/A genotype with GC in large epidemiologic studies.
Adenocarcinoma↗
Genetic polymorphisms of cytochrome p450 2E1, glutathione S-transferase M1 and T1, and susceptibility to gastric carcinoma in Taiwan.
BACKGROUND AND AIMS: Cytochrome p450 (CYP) and glutathione S-transferase (GST) enzymes are involved in activation and detoxification of many potential carcinogens. Genetic polymorphisms in these enzymes have been found to influence interindividual and interethnic susceptibility to cancer. Although CYP and GST enzymes are involved in the activation and detoxification of N-nitrosamines and related compound, studies on the relationship between genetic polymorphisms of CYP2E1, GSTT1, and GSTM1 and the risk of gastric carcinoma (GC) are few, and the results have been conflicting. PATIENTS AND METHODS: We conducted a hospital-based case-control study to investigate whether such variations affect the risk of developing GC. Subjects included 356 GC patients and 278 unaffected controls. Peripheral white blood cell DNA was obtained from all subjects. Genotyping of CYP2E1 was performed using a PCR-based restriction fragment length polymorphism assay. Deletion of GSTT1 and GSTM1 genes was assessed by multiplex PCR. RESULTS: The distribution of c2/c2 genotype of CYP2E1, detected by PstI or RsaI digestion, differed significantly between GC patients and controls; the odds ratio was 2.9. It remained significant after adjustment with gender, histological subtypes (diffuse, intestinal, mixed), location (cardia, body, antrum/angle), and stage (early, advanced). In contrast, the prevalence of CYP2E1 DraI polymorphism and GSTT1 and GSTM1 null genotype was similar in controls and GC patients. CONCLUSION: Our findings suggest that the CYP2E1 genotype is a determinant of GC risk in Taiwan.
Adenocarcinoma↗
Color Doppler sonography for preoperative diagnosis of an aneurysm of the ileal branch of the superior mesenteric artery.
Aneurysms of the superior mesenteric artery are uncommon, and aneurysms of its branches occur even less frequently. We report the case of a 60-year-old man with an aneurysm of the ileal branch of the superior mesenteric artery whose initial symptom was abdominal pain. Gray-scale and color Doppler sonography provided noninvasive, accurate preoperative identification of the aneurysm despite its uncommon location, a small branch of the superior mesenteric artery. CT and conventional and magnetic resonance angiography confirmed the sonographic diagnosis. The aneurysm was resected successfully, and the patient's postoperative course was uneventful. Although angiography is required for a definitive diagnosis and for surgical planning, sonography is a useful tool for preoperative evaluation and diagnosis of such aneurysms.
Aneurysm↗
Synchronous triple cancers at middle and lower esophagus and stomach with different histological features and genetic alterations.
Synchronous multiple primary malignancies are relatively unusual. We describe a case of synchronous triple cancers located at the middle and lower esophagus and the stomach in a 59-year-old Taiwanese man who presented with progressive dysphagia, epigastralgia, and bodyweight loss in 1 month. Endoscopic and histological features, microsatellite instability status of genomic DNA, and immunohistochemical staining of p53, MUC2, Fhit, c-erbB-2 and E-cadherin of all three cancers were demonstrated. We noted that these three cancers arose from different clones and that p53 mutation, instead of microsatellite instability, may play a major role in the development of multiple primary malignancies in this patient.
Adenocarcinoma↗