[The effects of Saussurea polysaccharide on isolated rat uteri].
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Animals↗
Biomedical subjects
X Z Lin
Publications and source records attributed to X Z Lin.
Endoscopic nasobiliary drainage for acute suppurative cholangitis: a sonographically guided method.
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Acute Disease↗
The natural history (fading time) of stigmata of recent hemorrhage in peptic ulcer disease.
From October 1991 to December 1992, 144 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were included in a study designed to investigate, by means of endoscopic examinations repeated at 2-day intervals, the evolutionary development of stigmata of recent hemorrhage, such as visible vessels, and to determine the time required for each type of stigma to fade. Eighty-five patients underwent endoscopic follow-up until the stigmata had disappeared. A visible vessel takes about 4.1 +/- 2.1 days to disappear, requiring significantly more time than an adherent clot or an old stigma, which take 2.4 +/- 0.8 days and 2.4 +/- 1.3 days, respectively (p < .05). Bleeding does not recur after stigmata disappear. Time required for stigmata to fade is not affected by age, sex, smoking, history of peptic ulcer, ulcer location, severe bleeding, underlying systemic disease, or endoscopic local therapy. While healing, stigmata of recent hemorrhage evolve through a sequence of phases: a visible vessel may or may not appear as an adherent clot and then as a red or black flat spot before disappearing.
Endoscopy, Gastrointestinal↗
Choledocholithiasis treated by ethylenediaminetetraacetic acid infusion through an endoscopic nasobiliary catheter.
A 64 year old man was admitted to the National Cheng Kung University Hospital for obstructive jaundice. He had received cholecystectomy 5 years previously. Sonography revealed common bile duct stones. He was treated with endoscopic nasobiliary drainage (ENBD) for 5 days for concomitant cholangitis. The muddy pigment stones disappeared completely after 10 days of infusion of ethylenediaminetetraacetic acid (EDTA) via the ENBD tube. There were no adverse effects, and he was stone-free 4 months later.
Catheters, Indwelling↗
Emergency endoscopic nasobiliary drainage for acute calculous suppurative cholangitis and its potential use in chemical dissolution.
Acute suppurative cholangitis is one of the common causes of acute abdomen in Taiwan. Emergency decompression is a life-saving procedure if patients fail to respond to antibiotic treatment. From July 1988 to June 1991, 224 patients were encountered with concomitant bile duct stones and cholangitis; 40 were brought to the emergency service with shock or mental confusion or responded poorly to antibiotic treatment. The patients consisted of 20 males and 20 females aged 21-81 years (mean age 64 years); 55% had intrahepatic duct stones, 50% had positive blood culture, 38% had undergone previous biliary surgery, 25% had concomitant medical illnesses and 20% presented with mental confusion. Emergent endoscopic nasobiliary drainage (ENBD) was performed within 48 h of each patient's arrival in the emergency room. In 3 days all the patients exhibited significant improvement as defined by body temperature, vital signs, white blood cell count, serum bilirubin and alkaline phosphates levels. When their condition had stabilized, 21 patients underwent elective surgery. Six patients received ethylenediaminetetraacetic acid infusion through an ENBD tube. Two of the patients' stones dissolved completely. Six patients received papillotomy with stone removal. The remaining patients refused further treatment. There was no hospital mortality. It is therefore concluded that ENBD offers an effective treatment for acute calculus suppurative cholangitis and it is a potential route of administration for the chemical dissolution of bile duct stones.
Abdomen, Acute↗
Chemical dissolution of gallstones in Taiwan: an in vitro study.
To evaluate the potential for the chemical dissolution of gallstones, 480 stones from 214 patients were studied. The stones were obtained via surgery or endoscopically. They were classified into cholesterol-rich mixed stones, brown pigment stones and black stones. The composition of bilirubin and cholesterol was determined by Fourier transformed infrared spectroscopy. Two per cent tetrasodium ethylenediamine acetate (EDTA), dimethylsulfoxide (DMSO) or methyl-tert-butyl-ethylene (MTBE) were used to dissolve the stones. To enhance solubility, surfactant polysorbate-20 was used to mix two of the individual three solvents. Methyl-tert-butyl-ethylene was found to have the best dissolution ability (by dry weight) 94, 13.4 and 20% for mixed, brown and black stones, respectively. Dimethylsulfoxide resulted in 13, 14 and 25% dissolution and EDTA 9.5, 13 and 16.5%. In contrast, pure water dissolved 4, 6 and 10.4% of the stones, respectively. A combination of the dissolution agents did not enhance the dissolution rate. In fact, the combination of solvents unexpectedly reduced the solubility of the stones: EDTA/MTBE was 17.5, 6.7 and 16.0%; DMSO/MTBE 43.2, 21.9 and 18.0%; DMSO/EDTA 9.1, 7.0 and 9.6%. In conclusion, cholesterol-rich mixed stones were able to be dissolved using MTBE but results of contact dissolution for gallstones are still far from satisfactory.
Cholelithiasis↗
A clinical study of 130 patients with biliary tract cancers and periampullary tumors.
A retrospective review of 130 patients with peripheral-type cholangiocarcinomas (PTCC), hilar-type cholangiocarcinomas (HTCC), extrahepatic cholangiocarcinomas (EHCC), gallbladder cancers (GBCA), and periampullary cancers (PACA), seen at National Cheng Kung University Hospital and Tainan Municipal Hospital from June 1987 to July 1993 was performed. There were 47 (36%) HTCC, 32 (25%) PACA, 24 (19%) PTCC, 17 (13%) GBCA, and 10 (8%) EHCC patients. The distribution is completely different from that reported in western countries. These cancers mainly occur in elderly patients. HTCC and GBCA were predominantly noted in female patients. Biliary cancers in Taiwan were not related to liver fluke infestation, inflammatory bowel disease or hepatitis B virus infection. However, a close association with biliary lithiasis was found. The incidence of gallstones was 67, 39, 20, 29 and 19% for PTCC, HTCC, EHCC, GBCA and PACA, respectively. The most common presentation for PTCC and GBCA was abdominal pain, or jaundice for HTCC, EHCC and PACA. These symptoms correlate well with the location of the tumors. Among serum tumor markers, the elevation of CA19-9 was most frequent, occurring in 86% of the patients while CA125 and CEA occurred in 47% and 30% of the patients, respectively. During the course of disease, infection developed in 61% of the patients and was the main cause of death in 25%. Biliary tract infection and sepsis were the two leading manifestations and occurred in 49% and 32% of the patients, respectively. Overall survival was poor except in patients whose tumor could be completely resected.
Adult↗
Percutaneous endoscopic gastrostomy in a patient with subtotal gastrectomy.
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Gastrectomy↗
Cardiac biopsy of stomach may improve the detection of H. pylori after dual therapy.
BACKGROUND/AIMS: To determine whether gastric cardia biopsy may improve the detection of Helicobacter pylori (H. pylori) before and after eradication therapy. METHODOLOGY: A total of 150 dyspeptic patients with H. pylori infection completing a 2-week course of dual therapy (amoxicillin plus omeprazole) were studied. Endoscopy was carried out at the initial stage and 4 weeks after the completion of dual therapy. During each endoscopy, gastric biopsies were sampled in order from cardia, lower body, and antrum and stored separately to survey the distribution of H. pylori by histology. RESULTS: Before treatment, 88% (132/150) of the study cases had H. pylori found in antrum and 3.3% (5/150) of cases presented with bacteria only in cardia. After treatment, 38 cases had failure of dual therapy. The detection rates of H. pylori by biopsies without cardia decreased after the dual therapy (by antrum only: 88% to 60.5%, p < 0.05; antrum and body: 96.7% to 81.6%, p < 0.05). In contrast, the incidence of patients with only cardia involvement by H. pylori significantly increased from 3.3% (5/150) before to 18.4% (7/38) after treatment (p < 0.01). Among the 7 patients with H. pylori only in cardia after dual therapy, 3 cases had recurrent dyspepsia during follow-up because of no further anti-H. pylori therapy. Two of these 3 cases disclosed diffuse bacterial involvement in antrum and body besides cardia; the last case later had a positive result of urea breath test. CONCLUSIONS: Biopsy obtained from gastric cardia can improve the detection rate of H. pylori especially after dual therapy, which encounters antibiotics with possible sanctuary sites here. Thus, it will be useful to prevent over diagnosis of H. pylori eradication.
Adult↗
Enhanced dissolution of gallstone by combining ethanol with two commonly used cholelitholytic solvents.
BACKGROUND/AIMS: Contact dissolution therapy is one of the non-surgical treatments for patients with gallstone. Among the various solvents, methyl tert-butyl ether (MTBE) is used for cholesterol gallstone, while tetrasodium ethyl-dimethyl tetraacetate (EDTA-4Na) solution is used to dissolve calcium bilirubinate stones. However, the contents of gallstone cannot be precisely predicted while they are still present in the human body. This study was designed to test if the MTBE and EDTA can be mixed together and to test the solubility of different kinds of gallstone in each original solution and mixture. METHODOLOGY: Each 0.1 gm of mixed cholesterol stone, brown stone and pigment stone from 18 patients was used. Pure ethanol was chosen to enhance the miscibility between the organic phase of MTBE and the aqueous phase of EDTA. The contents of gallstone after dissolution were examined with scanning electromicroscopy. RESULTS: We found the mixture of ethanol, MTBE and EDTA to be the most efficient solvent in gallstone dissolution in comparison with the other two original solvents. The mixture reached a dissolution percentage of 97.96 +/- 1.00, 88.96 +/- 6.51 and 67.75 +/- 14.26 for cholesterol, brown and black pigment gallstone, respectively. CONCLUSIONS: We concluded that ethanol can be used to mix the MTBE and EDTA with good preservation in their litholytic effects on gallstone. The ethanol-MTBE-EDTA solvent is, therefore, a promising universal cholelitholytic agent which deserves further tests for its safety and efficacy in the in vivo study.
Cholagogues and Choleretics↗
Liver, spleen and tumor volume measured by personal computer.
BACKGROUND/AIMS: Computed tomography (CT) scans are common examinations for patients with chronic liver diseases. To quantitate the organ or tumor volume from the scans and to accomplish the task in an efficient way with the most economic equipment, we developed a system based on a personal computer. METHODOLOGY: We used color-markers and transparency to sketch the edges of liver, hepatoma, and spleen. Each organ or tumor of interest is marked out by fine-point markers on pieces of transparency. The sketch was scanned into a digitized image format on a personal computer (Pentium 133). The calculation involves edge detection, three-dimensional reconstruction, and voxel counting. By using summation-of-the-area and trapezoid approximation technique, the voxels of each structure are counted. In this study, we illustrate the potential application in the management of a hepatic cancer patient. RESULTS: After digitalization, the data size of CT images is about 1 to 1.5 megabytes. It takes less than 5 min to complete volume calculation. CONCLUSIONS: By this method, tumor load before and after chemotherapy can be estimated easily and accurately. This would be helpful in clinical practice.
Carcinoma, Hepatocellular↗
Quantitative result of 13C urea breath test at 15 minutes may correlate with the bacterial density of H. pylori in the stomach.
BACKGROUND/AIMS: We tried to test the diagnostic efficacy of a new 13C-labeled urea agent made in Taiwan for urea breath test (UBT) of H. pylori infection, and to assess the correlation between the bacterial load of H. pylori in the stomach and the results of UBT from different timings. METHODOLOGY: One hundred and ninety-six dyspeptic patients without usage of antibiotics and proton pump inhibitors in the last 4 weeks were recruited for endoscopy, which included CLO test and H. pylori culture. Three additional bits of gastric biopsy (each one from antrum, body, and cardia) were taken for histology to assess the H. pylori density (HPD, range 0-5) in each specimen and the total bacterial density (TBD, a sum of HPD from three sites, range 0-15). Every study patient had been assigned to complete the UBT protocol. The gas samplings of UBT at baseline, 15 min and 30 min after ingestion of 100 mg 13C-labeled urea (INER-Hp 13C-tester, Taiwan) were collected for the ratio of 13CO2/12CO2 and labeled A, B, and C respectively. Both delta15 (B minus A) & delta30 (C minus A) were recorded to express the excess delta13CO2 per milliliter. During the 30 min period of UBT, the patient was scheduled to change lying positions every 5 minutes for even coating of the stomach with test agent. RESULTS: Based on two positive results of three invasive methods (CLO test, culture, and histology), 91 cases were confirmed to have H. pylori infection. The diagnostic efficacy of UBT was quite good with 96.7% sensitivity for both delta15 and delta30, and with 97.1% and 96.2% specificity for delta15 and delta30 respectively. Both delta15 and delta30 of UBT were well correlated with the TBD of H. pylori in histology (delta15: r=0.7574; delta30: r=0.7432, p<0.0001). CONCLUSIONS: The new C13-labeled urea for UBT can achieve a high diagnostic yield for H. pylori infection. Furthermore, the density of H. pylori in the stomach can be assessed indirectly by UBT by applying 15-minute gas sampling.
Adult↗
Percutaneous and endoscopic management of bile leak following endoscopic stone retrieval--a case report.
Endoscopic sphincterotomy with stone removal is the method of choice for the treatment of choledocholithiasis. The main complications of this procedure are bleeding, pancreatitis, intestinal perforation and cholangitis. Herein, we report on a case of bile peritonitis in a patient who underwent sphincterotomy and stone retrieval. The literature regarding the etiology and management of bile peritonitis is also reviewed.
Aged↗
A three-day course of intravenous omeprazole plus antibiotics for H. pylori-positive bleeding duodenal ulcer.
BACKGROUND/AIMS: This prospective trial aimed to test the efficacy of 3-day intravenous omeprazole plus antibiotics for Helicobacter pylori (H. pylori) eradication rate, and to see whether individualized response to omeprazole in intragastric pH elevation will alter the success of eradication. METHODOLOGY: One hundred and thirty-eight cases with H. pylori-positive duodenal ulcer bleeding were randomized into four therapy groups: Group 1 (n = 32) received a 3-day course of intravenous omeprazole (80 mg loading then 40 mg q 9 am & 9 pm) plus ampicillin/salbactum (1.5 gm i.v. loading then 750 mg q 9 am, 3 pm, & 9 pm); Group 2 (n = 35) followed protocol as for Group 1 except the antibiotics were metronidazole and erythromycin (both 500 mg i.v. q 9 am, 3 pm, & 9 pm). Group 3 (n = 31) followed protocol as for Group 1 and further added with erythromycin (both 500 mg i.v. q 9 am, 3 pm, & 9 pm). Group 4 served as a control group (n = 40) receiving oral dual therapy after leaving the emergency room (omeprazole 20 mg and amoxycillin 1 g bid x 2 weeks). In each case, three gastric biopsies were done for total histologic density of H. pylori (THPD) (range: 0-15) before, 1 day and 6 weeks after completion of therapy. Except for the control group, the 24-hour ambulatory intragastric pH meter (MIC Inc, Gastrograph Spark III, Swiss) was inserted as possible on the 2nd day of therapy. RESULTS: The 3-day intravenous regimens achieved high clearance rates of H. pylori (Group 1: 93.8%; Group 2: 93.9%; Group 3: 100%). The eradication rates of H. pylori in Groups 1-4 were 43.8%, 57.1%, 58.1%, and 72.8%, respectively. In Groups 1-3, the H. pylori-eradicated cases had lower pre-treatment THPD than non-eradicated cases (6.01 vs. 9.24, p < 0.001). Among 72 cases with pH meter insertion, the percentage of intragastric pH > 5.3 during 24-hour was not different among 35 H. pylori non-eradicated and 37 eradicated cases (78.7 vs. 76.7%, p > 0.05). CONCLUSIONS: The 3-day intravenous regimens may achieve clearance of H. pylori quickly. However, they were not so effective for eradication, especially in cases with higher bacterial loads. The interindividual response to omeprazole in intragastric pH elevation under the study dosage had insignificant variations to alter the success of eradication.
Adult↗
Hepatofugal flow on computed tomography of arterial portography: its correlation with esophageal varices bleeding.
BACKGROUND/AIMS: To study the portal flow patterns from CTAP (computed tomography of arterial portography), then to predict the existence of esophageal varices bleeding clinically. METHODOLOGY: 192 patients who underwent CTAP from superior mesenteric artery infusion were recruited in this study. The obtained images were classified according to our proposed criteria. Stage 0: hepatopetal flow, when all the contrast medium from the superior mesenteric vein entered the portal vein. Stage 1: when the contrast medium opacified the splenic vein or the other collateral vessels. Stage II: when the contrast medium opacified the paraesophageal vessels without entering the inner wall of the esophagus. Stage III: when the contrast medium opacified the collaterals up to the inner wall of the esophagus. RESULTS: The incidence of bleeding esophageal varices was correlated to the different stages of collateral flows pattern obtained. The esophageal varices bleeding rates were 0/137, 1/16, 1/14, 16/25 for stage 0, I, II and III, respectively. The incidence of bleeding esophageal varices was significantly higher in stage III group than in the other groups (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of stage III patients in regard to the occurrence of bleeding esophageal varices were estimated as 80.0%, 98.8%, 88.9%, 94.8%, and 94.3%, respectively. CONCLUSIONS: Our results show that CTAP demonstrates the portal flow patterns and collateral veins clearly, which can serve as an excellent imaging modality to predict the risk of esophageal varices bleeding.
Adolescent↗
Electrochemical therapy--comparison with other local treatment methods on rat model.
BACKGROUND/AIMS: Electrochemical therapy is an alternative to treat hepatoma. We compare this method with the other local injection methods on rat liver. METHODOLOGY: Five groups of Wister rats (24 in each) were anaesthetized. Electrochemical therapy was set under direct current, 6 volts, electrodes were 0.5 cm apart, 0.5 cm deep into exposed parenchyma for 10 min. Local injection was done with 50 microL of 95% alcohol, 30 microL of 20% acetic acid, 30 microL of 35% hydrochloric acid, and 30 microL of 20% sodium hydroxide via a 27-gauge needle under direct vision into each rat. Rats and their livers were examined postmortem on day 1, 3, 7 and 14. RESULTS: In electrochemical therapy, the treated area showed coagulation necrosis and without blood cells on day 1; then the margin became blurred. Mononuclear cell infiltration, reperfusion and fibrous band formation were prominent from day 3 through day 14. In local injection groups, the necrosis is quite irregular and unpredictable. The regeneration went under similar process. CONCLUSIONS: To destroy tissue locally, electrochemical therapy is unique for its predictability in destructive area and the recovery process and is as effective as the other injection methods. Therefore, it has great potential for hepatoma treatment.
Acetic Acid↗
Multiple mucosal lesions in the duodenum: exploring the potential clinical backgrounds and concurrent diseases.
BACKGROUND/AIMS: Multiple mucosal lesions of the duodenum (MMLD), presenting with multiple mucosal redness and ulcers with or without blood clots in the proximal duodenum, may be occasionally discovered during gastroduodenal endoscopy. This study was undertaken to investigate the clinical implications of MMLD. METHODOLOGY: Endoscopic pictures and charts of patients with MMLD were retrospectively reviewed. The endoscopic features of MMLD were recorded for both location and severity. The endoscopic severity of MMLD was defined as follows: Grade I: multiple mucosal redness; Grade II: multiple ulcers with clear base; Grade III: multiple ulcers with reddish base or fresh blood clot coating. RESULTS: A total of 229 (1.08%) MMLD events in 207 patients were identified out of a total of 21,223 upper gastrointestinal endoscopies. Common backgrounds of patients with MMLD included diabetes, hypertension, and some chemical exposure, such as cigarettes, alcohol, nonsteroidal anti-inflammatory drugs and anti-Helicobacter pyloric regimens. Common concurrent diseases included peptic disease, sepsis, malignancy, renal insufficiency, and portal hypertension. MMLD associated with sepsis usually involved only the second portion of the duodenum, but when associated with nonsteroidal anti-inflammatory drugs was less often only involved with the second portion. MMLD with renal insufficiency was less prone to involve the bulb alone. Diabetes-related MMLD tended to present with mild severity as defined by Grade I, H. pylori infection with Grade II, and renal insufficiency and portal hypertension with higher severity such as Grade III. Nine patients had fatal outcomes due to uncontrolled concurrent diseases, other than MMLD. CONCLUSIONS: MMLD, an uncommon occurrence in endoscopy, can develop from several clinical settings. When encountering MMLD while performing endoscopy, the best policy is to search and correct the concurrent diseases as early as possible.
Adult↗
Prognostic significance of ferritin expression in colorectal adenocarcinoma.
In recent years, there has been considerable interest in ferritin as an oncofetal protein. However, the clinical significance of ferritin expression in cancer tissues remains unknown. We performed an immunohistochemical study to examine the expression of ferritin in colorectal adenocarcinoma (n = 104). A total of 95 out of 104 (91.3%) colon cancers were positive for ferritin expression. The degree of immunoreactivity has no significant correlation with tumor grade (p = 0.964), size (p = 0.659), serosal invasion (p = 0.331), nodal metastasis (p = 0.955), distant metastasis (p = 0.354) and DNA ploidy status (p = 0.126), but there was a strong association between ferritin expression of tumor cells and stromal mononuclear cell infiltration (p = 0.004). In terms of prognostic significance, multivariate analysis showed that nodal metastasis (p = 0.0123) and distant metastasis (p = 0.0237) were independent poor prognostic factors. However, there was no significant difference in survival between patients with weak and strong ferritin expression in cancer tissues (p = 0.3766). The results indicate that the majority of colorectal adenocarcinomas exhibit ferritin expression. The grade of ferritin expression is strongly associated with stromal mononuclear cell infiltration, but has no significant correlation with any staging parameters or the survival of cancer patients.
Adenocarcinoma↗