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Biomedical subjects

X Z Lin

Publications and source records attributed to X Z Lin.

At least 73 records · Page 4Linked to original sources
PubMed1994

Intrafamilial transmission of hepatitis C virus: the important role of inapparent transmission.

To evaluate the intrafamilial transmission of hepatitis C virus (HCV) 104 index patients with type C chronic liver disease and their 307 family contacts were interviewed. After a questionnaire on the risk factors of parenteral exposure, blood samples were obtained and tested for liver biochemistry and anti-HCV antibody by enzyme-linked immunosorbent assay (Abbott II). Overall, 52 family contacts (17%) were positive for anti-HCV, indicating a higher anti-HCV prevalence among family contacts than among the general population in Taiwan. The anti-HCV prevalences in parents, spouses, children, and other contacts of the patients were 54% (14/26), 28% (25/91), 6.9% (10/143), and 6.4% (3/47), respectively. The contacts of index patients had increasingly greater risk of HCV infection when they became older and had lived longer with index patients. All family contacts were divided into two groups categorized by whether the index patients had or did not have a history of parenteral exposure. Among 126 family contacts of the 42 patients without parenteral exposure, blood transfusion and surgery were the factors significantly associated with HCV infection in these family contacts (odds ratio = 7.26, 95% confidence interval = 2.32-32.67; odds ratio = 3.95, 95% CI = 1.29-12.11, respectively). Risk factors were not significantly associated with HCV infection among 181 family contacts of the 62 index patients with parenteral exposure. It is concluded that the index patients without parenteral exposure appeared to have acquired the disease from HCV-infected family members with risk factors. Most of the index patients had a history of parenteral exposure and in turn served as the source of the disease for family members.

Adult↗
PubMed1994

Gas in hepatic veins: a rare and critical presentation of emphysematous pyelonephritis.

Although emphysematous pyelonephritis has been recognized for more than a hundred years, the actual etiology is still unknown. Glucose fermentation has been implicated as a mechanism of gas formation. We report a case of emphysematous pyelonephritis in which real-time ultrasonography demonstrated intravascular gas bubbles originating in the involved kidney, and passing into the inferior vena cava and hepatic veins. Gas from the affected kidney was analyzed by chromatography; the result showed hydrogen 10.5%, carbon dioxide 39%, nitrogen 49.6% and oxygen 0.8%. The clinical presentation and the results of gas analysis implicate a critical condition that bacteria proliferated rapidly by mixed acid fermentation of glucose. Additionally, the finding of gas production and transportation could explain the previous hypothesis of gas transport. In this critical situation immediate drainage with medical intervention is indicated to treat this life threatening condition.

Adult↗
PubMed1994

Bleeding peptic ulcer--risk factors for rebleeding and sequential changes in endoscopic findings.

From September 1991 to December 1992, a prospective study was conducted to determine the risk factors and residual risk of rebleeding, and the evolutionary endoscopic changes in peptic ulcers that rebled. Emergency endoscopies were performed on 452 patients with haematemesis or a melaena, or both within 24 hours of admission. If the lesions were actively bleeding, then the patients were treated with injection sclerotherapy. A multivariate analysis of clinical, laboratory, and endoscopic variables of 204 patients with ulcer bleeding showed that hypovolaemic shock, a non-bleeding visible vessel, and an adherent clot on the ulcer base were independently significant in predicting rebleeding (p < 0.05). Considering these three factors according to the estimates of their regression coefficients showed that a non-bleeding visible vessel was the strongest predictor of rebleeding. The study of the residual risk of rebleeding after admission showed that most rebleeding episodes (94.1%), including all associated with hypovolaemic shock, surgical treatment, and death, occurred within 96 hours of admission. After this time, the residual risk of rebleeding was less than 1%. Study of the changes in endoscopic findings before and after rebleeding illustrated that all ulcers with a visible vessel or adherent clot showed at follow up endoscopy were derived from ulcers with initial major stigmata. It is concluded that hypovolaemic shock, a non-bleeding visible vessel, and an adherent clot on an ulcer base are of independent significance in predicting rebleeding. Observation for 96 hours is sufficient to detect most rebleeding episodes after an initial bleed from peptic ulcer.

Blood Vessels↗
PubMed1994

Hepatitis B and hepatitis C virus infection among chronic alcoholic patients with liver disease in Taiwan.

The prevalence of the anti-hepatitis C virus (anti-HCV) antibody and hepatitis B surface antigen (HBsAg) among 123 alcoholic patients with liver disease from our hospital and 44 alcoholic subjects from the local community was evaluated. By radio-immunoassay HBsAg was detected in 30.1% of alcoholic patients with liver disease, compared with 11.4% of alcoholic subjects from the local community (p < 0.05). The prevalence of HBsAg was 40.7% (11/27) in patients with cirrhosis and hepatocellular carcinoma (HCC), 31.5% (17/54) in patients with cirrhosis only, and 29.4% (5/17) in patients with other liver diseases. By enzyme-linked immunosorbent assay, anti-HCV antibody was detected in 30.9% of alcoholic patients with liver disease, compared with 2.3% of alcoholic subjects from the local community (p < 0.0005). The prevalence of anti-HCV antibody was 44.4% in alcoholic patients with cirrhosis and HCC, 29.6% in alcoholic patients with cirrhosis only, and 17.6% in alcoholic patients with other liver diseases. As the degree of liver damage advanced, the prevalence of either HBsAg or anti-HCV antibody, or both, being detected in these alcoholic patients increased significantly (p < 0.05). The serum ALT level was higher among alcoholic patients who had either HBsAg or anti-HCV antibody than those having neither (151 +/- 204 vs 62 +/- 47 IU/L; p < 0.005). All three alcoholic patients with chronic hepatitis had positive HBsAg or anti-HCV antibody. Histologic findings, except cells within sinusoids, were comparable between the alcoholic patients with or without superimposed hepatitis viruses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Active, bleeding marginal ulcer of Billroth II gastric resection: a clinical experience of 18 patients.

OBJECTIVES: From July 1988 to April 1993, 18 patients with active, marginal ulcer bleeding were investigated for their clinical presentation, endoscopic findings, and successful rate of therapeutic endoscopy. METHODS: Through endoscopic survey, data on the ulcer number, ulcer location, and prevalence rate of each major stigmata of recent hemorrhage were obtained. Therapeutic methods used include heater probe thermocoagulation and local injection with diluted epinephrine (0.01%) or 95% alcohol through the endoscope. RESULTS: All patients were male with a mean age of 65.3 years. Tarry stool passage (15/18; 83.3%) was the most common clinical presentation. Fifteen patients (15/18; 83.3%) had single marginal ulcer. Ulcerations were located in the jejunal site (12/18; 66.6%) and gastro-jejunal anastomosis (5/18; 27.7%). There were two patients with spurting artery, six with nonbleeding visible vessel, two with blood clot adhesion, four with oozing, three with visible vessel-associated oozing and three, with blood clot adhesion accompanying oozing. The rate of therapeutic endoscopy to successfully stop bleeding or prevent rebleeding was 94.4% (17/18). Sixteen cases (16/17) received one session of endoscopic therapy, and one patient (1/17) accepted two sessions. One patient with multiple underlying diseases died of persistent bleeding after three sessions of therapy. No complication was found to be related to the endoscopic procedure. CONCLUSIONS: Marginal ulcer bleeding exhibits the same endoscopic findings as peptic ulcer hemorrhage. Most marginal ulcers are single and located at the saddle area of the jejunal site. Endoscopy can be useful in diagnosing marginal ulcer, and it is safe and effective in managing active marginal ulcer bleeding.

Aged↗
PubMed1994

[Study on effect of emodin on the isolated intestinal smooth muscle of guinea-pigs].

Emodin is an active principle of Rheum palmatum. It is reported that emodin possesses antibiotic and antineoplastic functions. The effect of emodin action on the isolated intestinal smooth muscle of guinea-pigs were dose dependent. When the dose of emodin was less than 29.6 mumol/L, the contraction effect enhanced obviously with increasing dosage; but whenever the dose increased to more than 29.6 mumol/L, on the contrary, the effect decreased gradually and ceased finally. Emodin with appropriate concentration (14.8 mumol/L) strengthened the effect of acetylcholine (Ach) on the isolated ileum and large intestine of guinea-pigs (P < 0.05 and P < 0.01). But high concentration of emodin could reduce even completely antagonize the effect of Ach. Under such condition, CaCl2 could restore the effect of Ach on the smooth muscle. It is suggested that emodin has biphasic regulatory effect on the intestinal smooth muscle, and its effect is related to calcium ion.

Animals↗
PubMed1994

Endoscopic removal of a large intragastric foreign body with an overtube: a case report.

After amphetamine ingestion, a 39-year-old male attempted suicide by swallowing glass trifles, cigarette lighter and razor blades. All foreign bodies ingested were evacuated spontaneously and smoothly within one week, except for the 10-cm long lighter, which was removed by endoscopy via supplementary overtube with moderate difficulty. The subsequent clinical course was uncomplicated. More than 80% of the ingested foreign bodies which reach the stomach can be eliminated uneventfully through the gastrointestinal tract. The remainder may cause complications such as obstruction, perforation and hemorrhage. Usually the locations of obstruction are over the three anatomic narrowings of the esophagus, the pyloric ring and ileocecal valve. Perforation occurs with ingestion of long, sharp, metallic pointed objects or animal bones, and is more frequent among those who had previous abdominal surgery or intestinal diseases. Endoscopic removal as soon as possible is suggested for high risk groups, with use of the overtube method to prevent complications.

Adult↗
PubMed1994

Gallstone images on plain film and endoscopic retrograde cholangiopancreatography.

Different compositions of gallstone merit different treatments if a non-surgical method is chosen for these patients. In this study, gallstones collected from 125 patients were classified into cholesterol (pure, combination, mixed N = 28), brown (N = 64) and black (N = 41) stones by the Gallstone Classification of the Japanese Study Group (1986). Plain film and endoscopic retrograde cholangiopancreatography (ERCP) were reviewed in an attempt to predict the composition of the stones. We found that shape and location were highly correlated with stone composition. Most of the sandy stones were black stones (15/19, 79%); and 48% (10/21) of the irregular stones were brown stones; 70% (14) of facet stones were brown stones, 30% cholesterol stones. Stones in the gallbladder tended to be of the cholesterol type (47%, 13/28), 64% (51/81) of the bile duct stones were brown stones and 69% (11/16) of the gallbladder and bile duct stones were brown stones. We therefore conclude that imaging studies using plain film and ERCP is a fairly accurate means of predicting the composition of gallstone.

Bile Duct Diseases↗
PubMed1993

Pyogenic liver abscess in Taiwan: emphasis on gas-forming liver abscess in diabetics.

Ninety-seven cases of pyogenic liver abscesses in a 4-yr period were studied: 27.8% (27 cases) were associated with biliary tract stone, 5.2% (five cases) were associated with biliary tract cancer, and there were two cases of diabetes (2.1%) associated with anal infection, but 63.9% (63 cases) were diagnosed as cryptogenic. Forty patients (64.5%) in the cryptogenic group had diabetes mellitus, and 23 of them (23/40, 57.5%) had gas-forming infection. All patients received parenteral antibiotics therapy, percutaneous aspiration, drainage, or operation. The overall mortality was 16.5%. Diabetes mellitus alone, without demonstrable infectious foci, was an important predisposing factor for pyogenic liver infection. Furthermore, to evaluate the clinical importance of gas-forming pyogenic liver infections, we separated these 42 diabetic patients into gas-forming and non-gas-forming groups, after sonography and CT scan. Klebsiella pneumoniae was the major pathogen in both groups. There was no significant difference in the clinical manifestations, complication, bacterial culture, or laboratory data between these two groups, except that the AST level was higher in the gas-forming group. However, the gas-forming group had higher mortality rate (30.4% vs. 5.3%). Gas-forming liver abscesses were common among the diabetics. Early and adequate drainage for pyogenic liver abscesses with parenteral antibiotics are crucial in their management.

Causality↗
PubMed1993

[Prophylactic and therapeutic effect of jiawei zhigancao tang injection on experimental arrhythmia in rats].

The antiarrhythmic effect of Jiawei Zhigancao Tang injection (JZTI) was studied in experimental arrhythmia induced by aconitine or by CaCl2 in anesthetized rats. The prophylactic dose of JZTI (5g/kg, i.v.) reduced the incidence rate of premature ventricular complexes, ventricular tachycardia (P < 0.01), delayed the onset time of arrhythmia induced by CaCl2 (P < 0.01), and the recovery time of sinus rhythm occurred earlier than that of control group (P < 0.01). The therapeutic dose of JZTI (10g/kg, i.v.) raised the rate of aconitine-induced arrhythmia to sinus rhythm conversion (P < 0.05). The results showed that JZTI could significantly antagonize arrhythmia induced by aconitine or by Cacl2 in rats.

Aconitine↗
PubMed1992

Detection of HCV RNA in saliva, urine, seminal fluid, and ascites.

Approximately half of the patients with type C hepatitis do not have a history of parenteral exposure. The route of nonparenteral infection remains unknown. To evaluate the possible role of body fluids, the existence of hepatitis C virus (HCV) RNA in saliva, urine, seminal fluid, and ascites was examined by "nested" polymerase chain reaction (PCR). Amplification of the HCV 5' noncoding sequences was carried out. The amplified product was confirmed by Southern blot hybridization and restriction endonuclease digestion. Among 34 patients with chronic liver disease who were positive for anti-HCV and serum HCV RNA, the prevalence of HCV RNA in body fluids was 100% (7/7) in ascites, 48% (15/31) in saliva, 24% (4/17) in seminal fluid, and 7% (2/29) in urine. The body fluids collected from 3 healthy subjects and 5 patients with chronic liver disease who were positive for anti-HCV but negative for serum HCV RNA were all negative for HCV RNA. Hence, the potential infectivity of body fluids in patients testing negative for serum HCV RNA can probably be discounted. Conversely, the presence of HCV RNA in saliva and seminal fluid of patients positive for serum HCV RNA suggests sexual and household contact as likely modes of nonparenteral transmission of type C hepatitis. Furthermore, the high prevalence of HCV RNA in ascites and saliva may have important implications in medical and dental practice.

Ascitic Fluid↗
PubMed1992

Pancreas divisum with early pancreatic cancer--presenting as chronic obstructive pancreatitis.

A 61-year-old man experienced four bouts of pancreatitis in 1 year. Detailed history taking and a series of examinations, including sonography, computed tomography scan, and endoscopic retrograde cholangiopancreatography (ERCP), revealed pancreas divisum on the first admission. He was treated conservatively. However, repeated ERCP on the fourth admission, 1 year later, showed a small filling defect in the tail of the pancreatic duct. A distal pancreatectomy was carried out. Pathological studies revealed a small papillary adenocarcinoma (1.5 x 1.0 x 0.5 cm) confined to the pancreatic duct grossly with minimal parenchymal invasion microscopically. He has been free from cancer and pancreatitis for 13 months since the operation.

Adenocarcinoma↗
PubMed1992

Caroli's disease and congenital hepatic fibrosis associated with polycystic kidney disease. A case presenting with acute focal bacterial nephritis.

Congenital cystic dilatation of the intrahepatic biliary ducts (Caroli's disease), until recently, has been infrequently recognized. It is often associated with autosomal recessive polycystic kidney disease (ARPKD) and congenital hepatic fibrosis (CHF). We hereby report a case with Caroli's disease, polycystic kidney disease (PKD), and CHF: This 24-year-old female patient initially presented with acute bacterial nephritis (ABN). Renal ultrasonography revealed bilateral enlarged kidneys with multiple cysts. Because her parents showed no renal cyst on ultrasonographic examination, she received further studies. Abdominal ultrasonography showed cystic dilatation of the biliary tree. Computed tomography (CT) with meglumine lotroxinate (biliscopin) infusion study and hepatobiliary scintigraphy confirmed the diagnosis of Caroli's disease. Liver biopsy revealed CHF: The radiographic and scintigraphic pictures are hereby illustrated and CT with biliscopin infusion study is emphasized. We conclude that if radiologic evidence of renal cystic lesions is absent in the parents of patients with PKD, the coexistence of Caroli's disease and CHF should be considered. The clinical pictures of ABN in this patient are also discussed. As far as we know, this is the first reported case of ABN in a patient with PKD and Caroli's disease, and it showed good response to antibiotic therapy.

Adult↗
PubMed1989

Serum amylase, isoamylase, and lipase in the acute abdomen. Their diagnostic value for acute pancreatitis.

We evaluated the diagnostic value of serum amylase, isoamylase, and lipase for the diagnosis of acute pancreatitis from sera of patients with acute abdominal pain. Comparison was first made in condition A between 32 patients with image-proven pancreatitis and 414 patients with nonpancreatic acute abdomen (the control group), then in condition B, between 62 pancreatitis patients with or without image proof and the control group. We found (a) that patients with image-proven pancreatitis suffer a more severe clinical course than those without; (b) that the sensitivity, positive predictive value, and accuracy in condition B are higher than in condition A at any cutoff level; (c) that none of the enzyme assays is specific at the upper reference limit, but their diagnostic yields are much improved by raising cutoff levels to about three or four times the upper limit; and (d) that at these selected cutoff levels, amylase had a diagnostic value similar to p-isoamylase or lipase in both conditions (sensitivity 84% and 92% for amylase in conditions A and B, respectively; specificity 98% and 98%; positive predictive value 75% and 90%; negative predictive value 99% and 99%; accuracy 91% and 97%). In conclusion, at an appropriately selected cutoff level, amylase can be effectively used as the first-line test and isoamylase or lipase as adjunct tests for acute abdominal conditions.

Abdomen, Acute↗
PubMed1988

Pancreatic enzymes in uremic patients with or without dialysis.

One hundred thirty blood samples from 87 patients with renal failure, but without abdominal pain, were analyzed for blood urea nitrogen (BUN), creatinine, amylase, p-isoamylase, and lipase simultaneously. We found that 74, 78, and 80% of the patients had hyperamylasemia, hyperisoamylasemia, and hyperlipasemia. None had amylase higher than five times the upper limit. A few patients (2.3%) had lipase elevated to more than 10 times the upper limit. No significant change of pancreatic enzyme level was noted as a result of hemodialysis, but a significant amount of amylase was removed from the circulation in patients receiving intermittent peritoneal dialysis. Significantly lower pancreatic enzyme levels were observed in patients with less impairment of renal function. We conclude that elevation of pancreatic enzymes in uremic patients is more frequent and more extensive than most articles indicate, and that the extent of increase is related more to renal function than to the modalities of dialysis the patients received.

Adult↗
PubMed1988

Clinical significance of ultrasonography, computed tomography, and biochemical tests in the rapid diagnosis of gallstone-related pancreatitis: a prospective study.

Real-time ultrasonography (US), computed tomography (CT), and biochemical tests were prospectively performed to detect gallstones in 88 consecutive patients immediately after the onset of an attack of acute pancreatitis. The sensitivity of biochemical tests was 84.6% when the patients had three or more positives of five parameters [including serum bilirubin, alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), alanine transaminase (ALT), and alanine transaminase-aspartate transaminase (ALT-AST) ratio]. The sensitivity, specificity, and accuracy were 71.8, 98.0, and 86.4% for US, and 52.9%, 100%, and 79.5% for CT. The sensitivity, specificity, and accuracy were improved to 82.1, 100, and 93.2% by the combination of US and CT, and 94.9, 100, and 97.7% by the combination of US and biochemical tests. Adding CT to the combination of US and biochemical tests resulted in only a slight improvement in sensitivity and accuracy. In conclusion, a combination of US and biochemical tests can provide the best noninvasive method in rapidly detecting gallstones as an etiological factor in acute pancreatitis. Computed tomography is not cost-effective. A positive result of biochemical tests despite a negative finding in US calls for an intensive search for gallstones by further investigation with endoscopic retrograde cholangiography or repeated US examinations.

Acute Disease↗