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Biomedical subjects

P C Sheen

Publications and source records attributed to P C Sheen.

At least 37 records · Page 2Linked to original sources
PubMed1993

Elevation of carcinoembryonic antigen related to biliary malignancy in hepatolithiasis.

Bile duct neoplasms occur relatively often in patients with hepatolithiasis in Taiwan. In this study, 49 patients with a positive immunoperoxidase stain for carcinoembryonic antigen (CEA) in the bile duct glands were examined in relation to the concentration of CEA in serum and bile. The bile concentrations of CEA in 15 control patients, 16 patients with hepatolithiasis only, 7 with hepatolithiasis and bile duct carcinoma, and 11 with bile duct carcinoma only were 4.09 +/- 4.12, 70.49 +/- 81.62, 137.73 +/- 66.15, and 144.3 +/- 117.31 ng/ml (mean +/- SD), respectively. A positive CEA stain from the bile duct was seen in 13.33%, 81.23%, 85.71%, and 90.91% of each group, respectively. No strongly positive staining, (2+ or 3+) was found in the control group, but it was found frequently in the hepatolithiasis and bile duct carcinoma groups. The findings of this study therefore suggest the probability of a combined neoplasm in patients with hepatolithiasis if the CEA value is unusually elevated in the serum or bile.

Bile↗
PubMed1993

[Strategics of medical centers and regional hospitals in response to new labour insurance fee schedule].

The purpose of this paper is to evaluate the medical centers and regional hospitals, strategic response to the implementation of new labour insurance fee schedule. This survey selects fifty-one medical centers and regional hospitals, with the response rate of 92.73%. This questionnaire was developed and evaluated by the authors and mailed to the questionnaire response by hospital's director or relative department director. We have selected Shortell et al. (1985) theory as the framework for evaluating and explaining hospital response to regulation environment (ex: change in the reimbursement system) at institutional-level response (ex: hospital association activity aimed at influencing regulation), managerial-level response (ex: increased physician participation in hospital-wide decision making; starting or expanding a planning department) and technical-level response (ex: shared clinical services such as lab., X-ray, pharmacy). The result found that hospitals with the characteristics as non-public ownership, medical centers, bigger size, and more administrative staff are more inclined to adopt institutional-level response. And a technical-level response occurs to hospital when market competibility becomes more intense which leads to higher reimbursement resource dependency.

Fee Schedules↗
PubMed1993

Extracorporeal shockwave lithotripsy for treatment of intrahepatic stones: in vitro and in vivo studies.

In vitro, bile duct stones, mostly comprising calcium bilirubinate, are readily fragmented by extracorporeal shockwave lithotripsy (ESWL). In the case of intrahepatic stones, ESWL is effective if the stones float freely in the bile, but if the stones completely fill, or are impacted within, the hepatic duct or bile duct, attempts at fragmentation will end in failure. Three patients with intrahepatic stones were treated with ESWL, and effectively fragmented. The stone fragments passed out spontaneously through T-tube sinus tract, PTDC sinus tract and the sphincter of Oddi as shown in the second cholangiogram. No specific complication was noted in our experimental and clinical experience. We believe that ESWL for fragmentation of biliary stones is technically reliable. The problem of the passage of these fragmented stones is considered; if necessary, it can be overcome by endoscopic means.

Adult↗
PubMed1992

[The management of obstructive jaundice caused by pancreatic head carcinoma and periampullary carcinoma].

We had treated 115 patients with malignant obstructive jaundice, including 69 pancreatic head carcinoma and 46 periampullary carcinoma during the period between 1982 and 1991. In the 115 jaundiced patients 33 had undergone pancreaticoduodenectomy, 50 had bypass operation and the remaining 32 patients undergone percutaneous transhepatic biliary drainage (PTBD) only. No operative mortality happened for the 33 pancreaticoduodenectomies. Postoperative complications occurred in 12 patients. Leakage from the choledochojejunostomy was the most often occurred complications, it was found in 7 patients (21.2%). Intraabdominal abscesses happened in six patients (18.2%) which recovered by treating with ultrasound-guided catheteral drainage. Leakage from pancreaticojejunostomy was also found in five patients (15.2%), the complication recovered uneventfully after administration of total parenteral nutrition and good abdominal drainage. Twenty-two out 33 patients with pancreaticoduodenectomy received preoperative biliary drainage. However, despite preoperative biliary drainage, 10 of 22 patients (45.5%) still suffered postoperative complications. It implied that hyperbilirubinemia would trend to carry a high postoperative morbility. The prognosis for our patients with pancreatic head carcinoma was extremely poor. The mean survival period for all of them was not exceeding 12 months. Those who had PTBD as the sole treatment had the shortest survival period, which was 3.4 +/- 3.1 months only. On the other hand, the mean survival period for those who had periampullary cancer and had pancreaticoduodenectomy was 35.5 +/- 27.2 months, while it was 13.3 +/- 10.1 and 11.8 +/- 10.0 months for those having bypass operation and PTBD respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Choledochoscopic heat-probe therapy: an adjunctive palliative treatment for intrahepatic cholangiocarcinoma with hepatolithiasis.

From 1983 to 1988, 20 out of 440 patients undergoing surgery for hepatolithiasis were discovered to have proximal bile duct adenocarcinomas, an incidence of 4.54%. Pre- and intra-operative diagnosis in all patients was hepatolithiasis. Four patients had left lateral segmentectomies and were found to have intrahepatic cholangiocarcinoma on subsequent histopathologic studies. In 16 patients, choledocholithotomy and biliary drainage were performed requiring post-operative choledochoscopy for removal of residual intrahepatic stones. Follow-up choledochoscopies revealed bile duct cancers in the biopsy specimens obtained. All patients refused any form of reoperation, eight patients accepted heat-probe therapy as an alternative, and were classified under group A. Group B patients (n = 8) refused any form of treatment whatsoever and agreed to periodic follow-ups and maintenance of external biliary drainage. At the half year follow-up, group A had a survival rate of 100%, whereas group B had a survival rate of 62.5%. At the end of one year, there was one survivor in group B, while group A has 2, 3 and 4 year survival rates of 50%, 37.5% and 12.5% respectively. This study has shown that gross and histological documentation of unsuspected proximal biliary cancers in hepatolithiasis patients are possible with the use of the flexible choledochoscope. Furthermore, we believe that choledochoscopic cauterization of tumors with the heat-probe is a reasonable palliative that can lead to appreciably longer survival rates.

Adenoma, Bile Duct↗
PubMed1990

Percutaneous post-operative choledochofiberscopic lithotripsy for residual biliary stones.

A total of 5,116 post-operative percutaneous choledochofiberscopy (POC) sessions were performed on 739 patients with residual bile duct stones between 1980 and 1988. These residual stones were detected and removed by choledochoscopy. The success rate of non-surgical stone removal using POC was 100% for residual common duct stones and required 414 treatment sessions in this group of 168 patients. The success rate was 92.2% (525/569) for patients with residual intrahepatic stones; in this group a total of 4,694 treatment sessions were needed. Two patients with residual cystic duct stones were also successfully treated with POC. The distribution of residual intrahepatic stones was as follows: 166 (29.2%) in the right hepatic duct, 255 (44.8%) in the left hepatic duct and 148 (26.0%) in both hepatic ducts. Complications after POC were minimal and subsided after conservative treatment except in 2 patients. One patient had hemobilia and another a large subphrenic abscess, which required surgical drainage. Choledochofiberscopic electrohydraulic shock-wave lithotripsy was effective treatment for large stones and was well tolerated. Residual stones in Oriental gallstone disease are not preventable, and we believe that POC should be the first choice for these patients. Many of the problems associated with residual stones can be overcome by this method and good results achieved.

Adult↗
PubMed1989

The ultrasound survey of gallstone diseases of patients infected with Clonorchis sinensis in southern Taiwan.

Ultrasonography was used to evaluate the relationship between the gallstone diseases and infection with Clonorchis sinensis. One thousand and ninety-one Hakkanese in southern Taiwan were examined in the past 2 years. Among the 947 cases infected with clonorchiasis, 89 cases were found to have gallstone diseases, which included gallbladder stones (85 cases), common bile duct stones (three cases) and one case of intrahepatic duct stone, indicating a prevalence of 8.97, 0.32 and 0.11% respectively. The overall prevalence of gallstones in the infected group was 9.39%. In the other 144 cases without clonorchiasis infection, eight patients were found to have gallstone disease, which included gallbladder stone (six cases) and intrahepatic duct stone (two cases), indicating an incidence of gallstone of 4.16 and 1.39% respectively. The overall prevalence of gallstones in the non-infected group was 5.56%. A comparison between the infected and non-infected groups was made and showed no significant relationship between gallstone disease and clonorchiasis.

Adolescent↗
PubMed1989

A comparative study of cefotaxime sodium versus a combination of cefapirin and gentamicin in the prophylactic treatment of patients undergoing cholecystectomy.

This was a randomized open evaluation of claforan vs. combination treatment of cefapirin + gentamicin. Patients taking part in the study were randomized in 3 parallel groups: 3 x 1 g claforan given during a period of 24 h (regimen I) was compared to 1 x 1 g claforan given at the time of incision (regimen II) and to a combination of cefapirin + gentamicin given in divided doses for 5 days (regimen III). Sixty-five patients (31 males and 34 females) aged between 23 and 76 years, who underwent cholecystectomy, were included in the study. There were no significant differences between the study groups in terms of sex, age, height, weight, diagnosis, aggravating factors and clinical condition of patients. Sixty of sixty-five patients noted "cholelithiasis" as diagnosis. The majority of patients documented an acute exacerbation of chronic condition. Twenty-three patients documented concomitant diseases/conditions or aggravating factors. The most frequent were: Diabetes mellitus, jaundice and clonorchiasis. During the study no additional administration of antibiotics or other concurrent treatment was recorded. Tolerance of the test substances was noted as "good" by 63 patients and satisfactory in 2 patients. In 3 patients (one patient in each treatment group) a postoperative wound infection was documented. One patient from regimen II with wound infection, therefore, received more than 1 g claforan. Postoperative hemoglobin decreased in all 3 groups (p less than 0.05). BUN decreased in the regimen group I (p less than 0.05) and increased together with creatinine in the group of regimen III (p less than 0.05). No side effects were documented in any treatment groups. The use of a single or three doses of claforan was more convenient and simple than the combination regimen. Less laboratory adverse effects (renal function) were also noted in claforan treated patients than the combination of cefapirin + gentamicin group.

Adult↗
PubMed1989

A study of CEA, CA 19-9 and CA 125 in biliary tract diseases.

Sixty-six patients were classified into three groups; control group A was (n = 24), group B those with hepatolithiasis (n = 24) and group C those with the bile duct carcinoma (n = 18). All patients had accepted operation and the patients bile and serum were send for determination with radioimmuno assay. The positive rate of serum CEA were 4.17%, 37.5% and 66.67% for the control, hepatolithiasis and bile duct carcinoma groups respectively. The positive rate of serum CA 19-9 were 8.33%, 25% and 61.11% for the control, hepatolithiasis and bile duct carcinoma respectively. The positive rate of serum CA 125 were 5%, 0% and 31.25% for control, hepatolithiasis and bile duct carcinoma groups respectively. The sensitivity level of serum CEA, CA 19-9 and CA 125 for the bile duct carcinoma group was 66.67%, 61.11% and 31.25% respectively. The diagnostic accuracy for bile duct carcinoma with regard to bile CEA was 94.44% but the accuracy ratio was only 45.24%. The bile concentration of CA 19-9 level of more than 1200 ng/ml were 75% and 61.11% for the hepatolithiasis and bile duct carcinoma group and none in control group. The bile concentration of CA 125 more than 200 ng/ml was 43.75% in the bile duct carcinoma and none in control or hepatolithiasis group. Finally, the concentration of CA 19-9 will be effected not only by tumor itself but also by severe infection in the hepatolithiasis patients. The sensitivity of CA 125 was low but accuracy was high for the diagnosis of the bile duct carcinoma.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1988

Physicochemical basis of increased bioavailability of a poorly water-soluble drug following oral administration as organic solutions.

The physicochemical basis of improvement of the bioavailability of a poorly water-soluble drug [REV 5901; alpha-pentyl-3-(2-quinolinylmethoxy)benzenemethanol; 1] after oral administration as organic solutions was investigated. The drug, which exists in solid and metastable liquid forms, had a pKa value of 3.7 and a solubility of approximately 0.002 mg/mL in water (pH approximately 6) at 37 degrees C. It had appreciable aqueous solubility only at pH values less than 2. The dissolution rate of 1 at pH values greater than 3 was practically zero. On dilution of the water-miscible organic solutions (polyethylene glycol 400 and polysorbate 80) of 1 with aqueous media, the drug instantaneously formed saturated solutions and the excess drug separated as emulsified oily globules. The dispersibility of the globules improved in the presence of surfactants. The average globule size of the oily form of 1 was 1.6 micron or less, as compared with a particle size of 5-10 microns for the solids. Thus, a high surface area of 1 was obtained after oral intake of water-miscible organic solutions. Although 1 was practically insoluble under intestinal pH conditions, its solubility was greatly increased in the presence of bile salts, lecithin, and lipid-digestion mixtures. The high surface area of 1 separating from organic solutions would facilitate its dissolution rate in the presence of biological surfactants and lipids and, therefore, would increase its bioavailability.

Administration, Oral↗
PubMed1988

Effect of vehicle amphiphilicity on the dissolution and bioavailability of a poorly water-soluble drug from solid dispersions.

Solid dispersions of a poorly water-soluble drug [REV 5901; alpha-pentyl-3-(2-quinolinylmethoxy)benzenemethanol; 1] in an amphiphilic vehicle [Gelucire 44/14; 2] and in polyethylene glycol (PEG) 1000, PEG 1450, and PEG 8000 were prepared. The vehicle 2 was a mixture of hydrogenated fatty acid esters with a mp of 44 degrees C, and had a HLB value of 14. Compound 1 was dissolved or dispersed in molten vehicles at elevated temperatures. The pulverization and compression of solid dispersions were avoided by encapsulating the hot solutions directly into hard gelatin capsules. At room temperature, the dispersions solidified forming plugs inside the capsules. On storage, greater than 180 mg of 1 remained dissolved per gram of vehicle, while the excess drug formed fine crystals (less than 20 micron). When mixed with water, the dissolved drug separated as a metastable liquid. Due to the surfactant property of 2, the oily form of 1 that separated from this vehicle formed an emulsified system with a globular size of less than 1 micron, while greater than 80% of 1 that separated from the other three formulations coalesced to form large oily masses. As a result of the large difference in surface area, the dissolution rate of 1 in simulated gastric fluid from capsules containing 2 was much higher than that of a PEG-based formulation. The bioavailability (AUC) of 1 in dogs from capsules containing 2 was also higher than that from PEG 1000-based capsules.

Administration, Oral↗
PubMed1987

Common ion effect on solubility and dissolution rate of the sodium salt of an organic acid.

The solubility and the dissolution rate of the sodium salt of an acidic drug (REV 3164; 7-chloro-5-propyl-1H,4H-[1,2,4]triazolo[4,3-alpha]quinoxaline-1,4-dione) decreased by the effect of common ion present in aqueous media. The solubility of the sodium salt of REV 3164 in a buffered medium was much lower than that in an unbuffered medium. Also, the presence of NaCl decreased its solubility in water. The apparent solubility product (K'sp) of the salt, however, did not remain constant when the concentration of NaCl was changed. A decrease in K'sp value with the increase in NaCl concentration was observed; for example, the K'sp values at 0 and 1 M NaCl were 7.84 X 10(-4) and 3.94 X 10(-4) M2, respectively. Even when corrected for the effect of ionic strength, the solubility product decreased. This decrease in the solubility product in the presence of NaCl indicated a decrease in the degree of self-association (increase in activity coefficient) of the drug in aqueous media.

Acids↗