Biomedical subjects

S J Hwang

Publications and source records attributed to S J Hwang.

At least 55 records · Page 3Linked to original sources

PubMed2001

Clinical, virologic, and pathologic significance of elevated serum alpha-fetoprotein levels in patients with chronic hepatitis C.

Elevated serum alpha-fetoprotein (AFP) in patients with chronic hepatitis C is not uncommonly seen, but the pathogenesis of this phenomenon remains unclear. The aims of this study were to assess the prevalence of elevated serum AFP in patients with chronic hepatitis C and to evaluate the clinical, virologic, and histopathologic significance of this phenomenon. One hundred and fifteen Chinese patients with a histologic diagnosis of chronic hepatitis C were enrolled. None had evidence of hepatocellular carcinoma by image study at enrollment and for at least 2 years' follow-up. Of the 115 patients, 33 (29%) had elevated serum AFP (more than 12 ng/mL). There was a significantly lower mean serum albumin (4.0 +/- 0.1 vs. 4.3 +/- 0.1 gm/dL, p <0.001) and higher mean scores for periportal necroinflammation (3.3 +/- 0.3 vs. 2.3 +/- 0.2, p = 0.007) and fibrosis (2.3 +/- 0.2 vs. 1.1 +/- 0.1, p < 0.001) in patients with elevated serum AFP when compared with patients without elevated serum AFP. Patients with elevated serum AFP had significantly more incidences of genotype 1b infection when compared with patients without elevated serum AFP (77% vs. 51%, p = 0.021). Mean serum hepatitis C virus (HCV) RNA titer showed no significant difference between the two groups. Multivariate logistic regression analysis showed that as serum albumin of less than 4.2 gm/dL, a histology fibrotic score of more than 3, and HCV genotype 1b infection were significantly independent predictors associated with elevated serum AFP. In conclusion, elevated serum AFP levels were significantly correlated with lower serum albumin levels, advanced fibrosis/cirrhosis, and genotype 1b infection in patients with chronic hepatitis C.

Hepatitis C, Chronic↗

PubMed2001

Protein-losing enteropathy: diagnosis with (99m)Tc-labeled human serum albumin scintigraphy.

PURPOSE: To investigate the diagnostic value of technetium 99m-labeled human serum albumin (HSA) scintigraphy in a group of patients suspected of having protein-losing enteropathy (PLE). MATERIALS AND METHODS: After intravenous injection of 740 MBq of freshly prepared (99m)Tc HSA, serial images of the abdomen were obtained from 10 minutes until 24 hours after injection. A (99m)Tc HSA scan was considered positive for PLE if there was visible tracer exudation in the gut. The diagnosis was established on the basis of standard clinical and biopsy findings. RESULTS: Thirty-nine scans were obtained: 27 scans in 26 suspected cases of PLE and 12 scans in control subjects with no known gastrointestinal disease. Twenty-five of the 26 studies in patients suspected of having PLE showed (99m)Tc HSA activity in the bowel. Among the 25 studies with positive findings, seven demonstrated PLE only on images obtained 24 hours after injection. In the control subjects, no activity was seen in the bowel. CONCLUSION: (99m)Tc HSA with serial scanning for up to 24 hours is reliable and useful for imaging PLE. Sites of protein loss may also be demonstrated. This imaging method is convenient, easy to perform, and yields results within 24 hours.

Adult↗

PubMed2001

Tuberculosis in maintenance dialysis patients.

In this investigation, we tried to find the incidence and characteristics of tuberculosis (TB) in dialysis patients previously found only in a small number of cases. We collected the cases of newly diagnosed TB patients in Taiwan during 1997. Simultaneously, all dialysis patients were collected and matched with the TB cases to identify the dialysis patients who had also contracted TB. The annual incidence of the dialysis population was 493.4/100,000, 6.9 times that of the general population (71.1/100,000). The annual incidence for the male dialysis population was 573.3, the incidence was 479.2 for the female dialysis population. The incidence for the general population was 97.1 and 43.7/100,000, respectively. Although the 1-year mortality rate due to TB (1.7 vs. 1.9%, p > 0.05) was similar in both populations, the non-TB mortality was much higher in the dialysis population than that in the general population (25.6 vs. 11.1%, p < 0.05). Finally, the 1-year mortality rate of dialysis patients with TB is 3.3 times higher than that in dialysis patients without TB (27.3 vs. 8.3%, p < 0.05). The findings suggest that uremia modifies the behavior of TB, jeopardizes female and younger dialysis patients, poses a higher risk of extrapulmonary dissemination, and predicts a higher overall mortality.

Age Factors↗

PubMed2001

Tinnitus caused by traumatic posterior auricular artery--internal jugular vein fistula.

A patient with an arteriovenous fistula that developed after a traffic accident was recently treated. The patient noticed pulsatile tinnitus in the right orbital region two months after the accident. On the first visit, the preliminary clinical impression of this case was a carotid-cavernous fistula, but angiography showed a fistula between the posterior auricular artery and the internal jugular vein. Although rare, this arteriovenous fistula should be included in the differential diagnosis of pusatile tinnitus in the orbit region. The fistula was controlled by embolization with a platinum coil. This is the first report of an arteriovenous fistula between the posterior auricular artery and internal jugular vein.

Adult↗

PubMed2001

Evaluation of acupuncture effect to chronic myofascial pain syndrome in the cervical and upper back regions by the concept of Meridians.

Myofascial pain syndrome (MPS) in the cervical and upper back regions is a common medical problem. The involved muscles include trapezius, multifidi, splenius cervicis, levator scapulae, supraspinatus or infraspinatus. Acupuncture is a well-known method for relief of chronic pain. In this study, we evaluated the effect of acupuncture in MPS and its durability by using the concept of meridians. Twenty-nine patients with chronic MPS in the upper back and cervical regions received acupuncture 2 times per week for 3 weeks. According to the pathways of the meridians, we chose acupuncture points by the pain regions located in which parts of meridian passing (i.e. "Where the meridian passes, where to treat the disease."). We evaluated the intensity of pain by visual analog scales (VAS) and active range of motion (ROM) of neck before and after therapy. After receiving acupuncture for 3 weeks, VAS of pain fell significantly from 9.0+/-1.0 to 4.9+/-2.5 and active ROM of neck significantly increased from 35.8+/-10.2 degrees to 61.3+/-9.4 degrees (p<0.05). The onset of symptom relief was gradual and duration of symptom relief after a course of acupuncture was average 5.3+/-1.2 days. In conclusion, acupuncture is a somewhat effective method for pain relief of patients with chronic MPS in the cervical and upper back regions. However, the effect of acupuncture with the concept of meridians on MPS is insidious and the duration of the relief is not long enough.

Acupuncture↗

PubMed2001

Cationic polymers for gene delivery: designs for overcoming barriers to systemic administration.

Cationic, polymer-based delivery systems have faced limitations in the systemic delivery of therapeutic gene drugs due to difficulties in formulation, in vivo stabilization, toxicity and low transfection efficiencies. Strategies for overcoming some of these barriers have utilized knowledge gained from the fields of colloidal stabilization and protein trafficking. This review highlights recent efforts in polycation preparations that include the development of new polymers for gene delivery, the modification of traditional polycations with hydrophilic polymers for salt and serum stability and the addition of bioactive functionalities to polymers for enhanced intracellular trafficking. These studies have resulted in polymer/DNA composites with increased stability and delivery efficiencies.

Active Transport, Cell Nucleus↗

PubMed2001

Hepatitis C viral genotype influences the clinical outcome of patients with acute posttransfusion hepatitis C.

Most patients with an acute infection of hepatitis C virus (HCV) will develop chronic hepatitis, and only about 15-20% of the cases will resolve spontaneously. The mechanism for the different outcomes in patients with acute HCV infection remains unclear. HCV genotype has been recognized as an important factor affecting the clinical course and outcome of chronic hepatitis C patients. In order to evaluate the role of HCV genotype in the clinical course and outcome of acute posttransfusion hepatitis C, 67 patients with acute posttransfusion hepatitis C from a prospective study of posttransfusion non-A, non-B hepatitis were enrolled. Thirty-nine patients (58.2%) were HCV genotype 1b. Among the 67 patients with acute posttransfusion hepatitis C, 53 (79.1%) progressed to chronic hepatitis. Significantly more patients with genotype 1b than non-1b genotypes developed chronic hepatitis (89.7% vs. 64.3%; P = 0.019). There was no significant difference in gender, mean age, amount of transfused blood, hepatitis symptoms, jaundice, incubation period, peak serum alanine transaminase, or serum HCV RNA titer between patients with HCV genotype 1b and non-1b infections. Patients who developed chronic hepatitis had a significantly greater incidence of genotype 1b infection (66.0% vs. 28.6%; P = 0.013) and a longer incubation period (7.3 weeks vs. 5.4 weeks; P = 0.052) than patients whose infection was resolved. Patients with a genotype 1b infection that resolved itself spontaneously all had an incubation period of less than 6 weeks. Multivariate logistic regression analysis revealed that genotype 1b and an incubation period > or = 6 weeks were significant predictive factors for the development of chronic hepatitis. Therefore, the HCV genotype can influence the outcome of patients with acute HCV infection.

Acute Disease↗

PubMed2001

Inadvertent hypothermia causes pulseless electrical activity in a patient during cervical spine surgery--a case report.

Recent studies have shown that hypothermia triples the incidence of major cardiac events. We present a happening in which a 71-year-old patient developed pulseless electrical activity (PEA) while he was undergoing cervical laminectomy for spinal stenosis in the sitting position. Thromboembolism or venous air embolism and acute myocardial infarction were respectively excluded by transesophageal echocardiography and cardiac enzymes analysis to be the causes of the cardiac event. The abnormal finding that stood out was low nasopharyngeal temperature (31 degrees C) during the procedure, which was thought to contribute to the development of the PEA episode.

Aged↗

PubMed2001

Colorectal cancer in patients 20 years old or less in Taiwan.

BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of the elderly population, but it sometimes occurs in young patients. The diagnosis of CRC in youngsters is often overlooked by physicians or presentation may be delayed. METHODS: With assistance from the cancer registry center of Taipei Veterans General Hospital, we collected data on all types of colorectal malignancy, including carcinoma, adenocarcinoma, or lymphoma in patients aged 20 or younger. All available medical charts and pathologic specimens were reviewed in detail. RESULTS: A total of 28 cases were analyzed. The leading presenting symptom was abdominal pain (92%). The locations of the primary tumors were evenly distributed, and the major histologic type was predominantly adenocarcinoma. However, the proportion of mucinous adenocarcinoma was higher than that in the older population. Most of the cases were advanced (11 tumors were classified as Dukes stage C and another 11 as Dukes stage D). The overall 5-year survival rate was 21%. CONCLUSIONS: Despite the rarity of CRC during the first two decades of life, physicians need to be aware of the possibility and to evaluate suggestive signs and symptoms by colonoscopy or barium enema. Family history of CRC, inflammatory bowel disease, previous polyps, or familial polyposis did not play a crucial role in this group of young patients.

Abdominal Pain↗

PubMed2001

Hepatitis C virus infection: an overview.

Hepatitis C virus is an RNA virus belonging to the Flaviviridae family. The diagnosis of hepatitis C virus infection was based on the detection of serum antibody to hepatitis C virus (anti-HCV) using immunoassay or recombinant immunoblot assay, or the direct detection of serum hepatitis C virus RNA using polymerase chain reaction. The anti-HCV positive rate in the general population or healthy blood donors is 0.5% to 4% worldwide. Parenteral transmission was the major route of hepatitis C virus infection. High-risk groups for hepatitis C virus infection included recipients of blood transfusion of which the blood donors were not screened for anti-HCV, intravenous drug abusers, hemophiliacs, and patients who have received hemodialysis. More than 80% of patients with hepatitis C virus infection progressed into chronicity, 20% to 30% of patients with chronic hepatitis C progressed to cirrhosis after 10 to 20 years of follow-up, and some developed hepatocellular carcinoma. Hepatitis C virus was the most common cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma in Western countries and in Japan, where hepatitis B virus is not endemic. Interferon therapy at a dosage of 3 MU and subcutaneous injection 3 times per week for 6 months normalized serum transaminase in 50% of patients with chronic hepatitis C at the end of treatment. However, the relapse rate was high and only 20% to 25% of patients sustained response 1 year after discontinuing therapy. Prolonged interferon therapy up to 12 to 18 months has been suggested to improve interferon efficacy by decreasing the relapse rate and thus increasing the sustained response rate. New interferon preparation such as consensus interferon and long-acting pegylated-interferon has recently shown better treatment response than the traditional interferon regimen. The combined regimen of interferon and ribavirin was shown to have better efficacy than interferon alone in treating patients with chronic hepatitis C.

Hepacivirus↗

PubMed2000

Sulfation and attrition of calcium sorbent in a bubbling fluidized bed.

A bubbling fluidized bed reactor was used as a desulfurization apparatus in this study. The height of the bed was 2.5m, and the inner diameter was 9cm. The bed materials were calcium sorbent and silica sand. The effects of the operating parameters of the flue gas desulfurization including relative humidity, temperature, superficial gas velocity, and the particle size of calcium sorbent on SO2 removal efficiency and calcium sorbent conversion and attrition rate in the fluidized bed were investigated. It was found that the temperature effect in our system was negligible from 40 to 65 degrees C. A higher relative humidity had a higher calcium conversion and a higher sulfur dioxide removal efficiency. Moreover, a smaller particle size of calcium sorbent had a lower calcium conversion in the cyclone but a higher sulfur dioxide removal efficiency. A lower superficial gas velocity resulted in a higher sulfur dioxide removal efficiency and a higher calcium conversion, thus, the total volume of the flue gas treated was maximum near the minimum fluidization velocity. Finally, an attrition rate model proposed in this study could predict the elutriation rate satisfactorily.

Air Pollutants↗

PubMed2000

Fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients.

Clinical outcome of dialysis patients after eating star fruit (Averrhoa carambola) varies, but it may be fatal. In the past 10 years, 20 such patients were treated in our hospital when they developed clinical symptoms after eating the fruit or drinking star fruit juice. Their initial presentations included sudden-onset limb numbness, muscle weakness, intractable hiccups, consciousness disturbance of various degrees, and seizure. No other major events that might be responsible for these symptoms could be identified. Eight patients died, including one patient with a serum creatinine level of 6.4 mg/dL who had not yet begun dialysis. The clinical manifestations of the survivors were similar to those who died except for consciousness disturbance and seizure. Death occurred within 5 days despite emergent hemodialysis and intensive medical care. The survivors' symptoms usually became less severe after supportive treatment, and these patients subsequently recovered without obvious sequelae. The purpose of this article is to report that patients with renal failure who ingest star fruit may develop neurological symptoms and also run the risk for death in severe cases. Mortality may also occur in patients with chronic renal failure not yet undergoing dialysis.

Adult↗

PubMed2000

Evaluation of gallbladder motility in patients with liver cirrhosis: relationship to gallstone formation.

To investigate the postprandial gallbladder motility, including emptying and refilling, in cirrhotic patients and to evaluate the relationship to the presence of gallstones and various humoral mediators, 82 patients with liver cirrhosis and 40 age- and sex-matched healthy subjects were enrolled into this study. Postprandial gallbladder volumes were measured with ultrasonography every 15 min for 2 hr. Plasma levels of estradiol, testosterone, substance P, and nitrate/nitrite were also measured. Cirrhotic patients showed a higher prevalence of gallstones than healthy subjects (41% vs 15%, P = 0.003), and the prevalence increased with the progression of liver cirrhosis (Child-Pugh class A: 26%, B: 44%, and C: 65%, P = 0.02). Plasma levels of estradiol, testosterone, and substance P, and nitrate/nitrite and estradiol/testosterone ratios were not different between cirrhotic patients with and without gallstones. However, postprandial refilling of the gallbladders was significantly impaired in patients with cirrhosis, especially in those combined with gallstones. There was no significant difference in the postprandial gallbladder motility between cirrhotic patients with and without elevated plasma levels of estradiol, testosterone, and substance P and nitrate/nitrite, and estradiol/testosterone ratios. Gallstones were common in patients with liver cirrhosis and the prevalence increased with the progression of liver diseases. Sex hormones, substance P, and nitrate/nitrite did not play major roles in the formation of gallstones in cirrhotic patients. Refilling of the gallbladder was significantly impaired in patients with liver cirrhosis, especially in those with gallstones, and may play an important role in the pathogenesis of gallstones.

Aged↗

PubMed2000

Detection and viral nucleotide sequence analysis of transfusion-transmitted virus infection in acute fulminant and non-fulminant hepatitis.

The impact of transfusion-transmitted virus (TTV) infection on acute fulminant and non-fulminant hepatitis is unclear. In this study, serum samples from 164 patients with acute hepatitis of various aetiologies, from 34 asymptomatic hepatitis B virus carriers and from 202 healthy adults were tested for TTV DNA by the semiconserved nested polymerase chain reaction. TTV viraemia was prevalent in patients with acute hepatitis C, in patients with acute hepatitis D virus superinfection and in patients with non-A-E hepatitis (27-30%) but the incidence was not significantly different from that of healthy controls (31 of 202, 15.3%). There were no significant differences in gender, age, presence of hepatitis G virus, the occurrence of fulminant hepatitis, or in serum albumin, bilirubin or alanine aminotransferase levels (9/30 vs 35/134) between patients with or without TTV viraemia. Seven of the nine TTV-positive patients with fulminant hepatitis were co-infected with hepatitis C, D or E. TTV clones from 18 subjects, with or without fulminant hepatitis, were sequenced and analysed phylogenetically. Eleven (61. 1%) belonged to TTV group 1, six (33.3%) to TTV group 2 and one to TTV group 3. No particular strain of TTV was associated with fulminant hepatitis. In summary, in Taiwan, TTV is prevalent in the general population as well as in patients with liver diseases. TTV plays an insignificant role in acute fulminant and non-fulminant hepatitis. Its influence on outcome requires a longitudinal study.

Acute Disease↗

PubMed2000

Autoimmune cholangitis with features of autoimmune hepatitis: successful treatment with immunosuppressive agents and ursodeoxycholic acid.

We report a 42-year-old Chinese female with elevated serum levels of liver aminotransferases, alkaline phosphatase, gamma-glutamyl transpeptidase, cholesterol and immunoglobulin M. Serum antimitochondrial antibody was negative, but antinuclear antibody was strongly positive. Liver histology showed features of both autoimmune cholangitis and autoimmune hepatitis. Combination therapy with immunosuppressive (prednisone and azathioprine) and choleuretic agents (ursodeoxycholic acid) was given. Serum aminotransferases and biliary enzymes showed much improvement after treatment. A follow-up liver biopsy showed improvement of both hepatic necroinflammation and bile duct damage. Biliary enzymes rose after withdrawal of the immunosuppressive agents and declined again with reinstitution of prednisone. This case demonstrates that a combination of immunosuppressive agents and ursodeoxycholic acid may effectively treat patients with features of both autoimmune cholangitis and autoimmune hepatitis.

Adult↗

PubMed2000

Seroprevalence of GB virus C/hepatitis G virus-RNA and anti-envelope antibody in high-risk populations in Taiwan.

BACKGROUND: GB Virus C (GBV-C)/hepatitis G virus (HGV) was identified in 1995-1996 as a transfusion-transmissible virus. The diagnosis of GBV-C/HGV infection is based on the detection of GBV-C/HGV-RNA by using polymerase chain reaction. Recently, an enzyme immunoassay detecting the antibodies to the viral protein, E2 envelope protein (anti-envelope) of GBV-C/HGV, has been developed. METHODS: Serum GBV-C/HGV-RNA and anti-envelope antibody were determined in 76 cases of intravenous drug users (IVDU), 76 patients with regular hemodialysis and in 80 prostitutes to evaluate the GBV-C/HGV infection rate among high-risk populations in Taiwan. Seventy-six healthy blood donors were randomly selected and were used as a control group. RESULTS: The prevalence of GBV-C/HGV-RNA in high-risk populations was 33% for IVDU, 16% for patients with hemodialysis and 13% for prostitutes, which was significantly higher than the 3% obtained in the control group (P < 0.05 for all groups). The prevalence of anti-envelope antibody was 13% for IVDU, 21% for patients with hemodialysis and 23% for prostitutes, which was not significantly different from the control group (11%). Among the 99 subjects who had positive GBV-C/HGV markers, 97 were tested for exclusive positivity for either GBV-C/HGV-RNA or anti-envelope antibody. CONCLUSIONS: The presence of serum anti-envelope antibody usually indicates the clearance of serum GBV-C/HGV-RNA in patients infected with GBV-C/HGV. GBVirus-C/HGV infection in high-risk populations, determined by the presence of serum GBV-C/HGV-RNA, may underestimate the true level of past and present infection.

Adult↗

PubMed2000

The role of a posteriorly inclined condylar neck in condylar resorption after orthognathic surgery.

Recently, it has been reported that a posteriorly inclined condylar neck is associated with condylar resorption following orthognathic surgery, although its role in resorption remains unknown. By cephalometric screening of 240 patients with Angle Class II occlusion 2 years after orthognathic surgery, 11 patients with postoperative condylar resorption were identified. The preoperative posterior inclination of the condylar neck and the surgical risk factors mentioned in the literature, particularly surgically induced counterclockwise rotation of the mandibular proximal segment were evaluated. In all 11 cases, the condylar neck was clearly inclined posteriorly. Counterclockwise rotation of the proximal segment was also observed in all cases, and it amounted to 6.7 degrees (2.5-12 degrees) on average. The contributing role of a posteriorly inclined condylar neck in connection with surgical mandibular movement in postoperative condylar resorption is discussed.

Adolescent↗

PubMed2000

Surgical risk factors for condylar resorption after orthognathic surgery.

OBJECTIVE: The purpose of this study was to look for surgical risk factors for condylar resorption after orthognathic surgery. STUDY DESIGN: Seventeen patients of a group of 452 patients who had undergone orthognathic surgery consecutively and who were in accordance with the inclusion criteria of this study showed postoperative condylar resorption (group I). Preoperative cephalometric characteristics and surgically induced movements of this group were compared with a control group of 17 of 452 patients (group II) in whom postoperative condylar resorption and skeletal relapse did not develop, despite mandibular retrognathism (ANB angle >4 degrees) and high mandibular plane angle (>40 degrees). RESULTS: The kind of osteosynthesis used was not significantly different between the 2 groups. The amount of surgical advancements and the vertical movements of the jaws were not significantly different between the 2 groups. However, the distal (P =.005) and proximal (P =.007) mandibular segments were rotated significantly further counterclockwise in group I. Surgically induced posterior condylar displacement occurred significantly more frequently (P =.007) in group I. CONCLUSIONS: Counterclockwise rotation of the distal and proximal mandibular segments and surgically induced posterior condylar displacement seem to be important surgical risk factors for postoperative condylar resorption. Therefore, these movements seem to be contraindicated in patients who are at high risk.

Adolescent↗