Chiung-yu Chen - Academia.edu (original) (raw)

Papers by Chiung-yu Chen

Research paper thumbnail of Increasing Incidence and Lifetime Risk of Inflammatory Bowel Disease in Taiwan

Inflammatory Bowel Diseases, 2013

The incidence of inflammatory bowel disease is increasing worldwide, but data of epidemiological ... more The incidence of inflammatory bowel disease is increasing worldwide, but data of epidemiological trends from low-endemic area are limited. As one of the low-endemic countries, we describe the trends of this disease in Taiwan over time. This study was based on data obtained from the Catastrophic Illnesses Registration in the National Health Insurance Research Database, which covers more than 98% of the people in Taiwan. Every certificate of catastrophic illness must be approved by 2 expert gastroenterologists. Thirteen years (1998-2010) of data were analyzed for the trends of Crohn's disease (CD) and ulcerative colitis (UC). A total of 2915 incident cases (1818 men and 1097 women) were identified, including 2357 cases of UC and 558 cases of CD. The mean annual incidence rates were 0.80 for UC and 0.19 for CD per 100,000 inhabitants, with lifetime risks for those 20 to 79 years of age of 0.066% and 0.013%, respectively. The mean annual prevalence was 4.59 for UC and 1.05 for CD per 100,000 inhabitants. Poisson regression showed significantly increased trends during the observation period for both diseases, with a men/women ratio of 1.50 in UC and 2.14 in CD (P < 0.01). The mean age of individuals at diagnosis was higher for UC as compared with CD (44.7 versus 37.9, P < 0.001). Inflammatory bowel diseases are still relatively uncommon in Taiwan, but the incidence and prevalence rates are increasing.

Research paper thumbnail of P-229 Sequential changes of bile contents in patients with obstructive jaundice from different etiologies — bile from drainage catheter

Research paper thumbnail of The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma - The influence of sampling time and hepatolithiasis

Hepato-gastroenterology

This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled ... more This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled in different situations for the diagnosis of cholangiocarcinoma. Bile was obtained from patients with bile duct obstruction on the day of biliary drainage and 3 days later separately. The etiology of biliary obstruction included choledocholithiasis (N = 51), hepatolithiasis (N = 19) and cholangiocarcinoma (N = 28). Patients of the former two conditions were all complicated with cholangitis. The sensitivity of biliary CEA, CA 19-9 and CA 125, whenever checked were all less than 70%. The biliary CEA and CA 19-9 were elevated in the presence of cholangitis. In addition, the biliary CEA was also increased in the patients with hepatolithiasis. The specificity of CA 125 was better than those of CEA and CA 19-9 (75.7% vs. 33.3% and 60%, respectively) on the day of biliary drainage. The diagnostic efficiency was slightly improved when combining biliary CA 125 and CEA. As the biliary CA 125 was less affected by inflammation and hepatolithiasis, it is more useful than CEA and CA 19-9 in the diagnosis of cholangiocarcinoma. The single tumor marker test of CA 125 or combined tumor marker test of CEA and CA 125 may be used as a useful complement to other investigative methods to differentiate benign from malignant causes of the bile duct obstruction.

Research paper thumbnail of Chen, CY, Liu, HS and Lin, XZ. Hydrodynamics-based gene delivery to the liver by bile duct injection of plasmid DNA-the impact of lasting biliary obstruction and injection volume. Hepatogastroenterology 52: 25-28

Hepato-gastroenterology

ABSTRACT

Research paper thumbnail of Su1464 Features Associated With Interval Progression of Small Pancreatic Cystic Lesions - A Retrospective Study

Research paper thumbnail of Spontaneous Rupture of Hepatocellular Carcinoma: A Review of 141 Taiwanese Cases and Comparison with Nonrupture Cases

Journal of Clinical Gastroenterology

ABSTRACT

Research paper thumbnail of Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma

World Journal of Gastroenterology

To identify factors that were related to the short term effectiveness of percutaneous transhepati... more To identify factors that were related to the short term effectiveness of percutaneous transhepatic biliary drainage in cholangiocarcinoma patients and to evaluate the impact of palliative drainage on their survival. Seventy-four patients with hilar cholangiocarcinoma who underwent percutaneous biliary drainage were enrolled in the study. The demographic and laboratory data as well as the imaging characteristics were retrospectively analyzed to correlate with the bile output and reduction rate of serum bilirubin 1 wk after drainage. Patients with more bile duct visualized on percutaneous transhepatic cholangiography or absence of multiple liver metastases on imaging studies had more bile output after biliary drainage [odds ratio (OR): 8.471, P = 0.010 and OR: 1.959, P = 0.022, respectively]. Patients with prolonged prothrombin time had a slow decrease in serum bilirubin (OR: 0.437, P = 0.005). The median survival time was not significantly different in patients with low or high bile ...

Research paper thumbnail of Development of biodegradable radiopaque microsphere for arterial embolization-a pig study

World journal of radiology, Jan 28, 2015

To develop a new type of calibrated, biodegradable, and imaging detectable microsphere and evalua... more To develop a new type of calibrated, biodegradable, and imaging detectable microsphere and evaluated its embolization safety and efficacy on pig's liver and spleen. Six kinds of pharmaceutical excipient were combined and atomized to form our microsphere. Twenty-four male Lanyu pigs weighing 25-30 kg were used. The arteries of spleen and liver were embolized with Gelfoam, Embosphere, or our microsphere. The serum biochemical tests, computed tomography (CT), liver perfusion scan, and tissue microscopy examination were done to evaluate the safety and efficacy of embolization. Radiopaque microspheres with a size ranging from 300 to 400 μm were produced. Embolization of hepatic and splenic artery of pigs with our microsphere significantly reduced the blood flow of liver and resulted in splenic infarction. The follow-up CT imaging and the microscopic examination showed intraarterial degradation of Gelfoam and microsphere. The blood tests demonstrated insignificant changes with regards...

Research paper thumbnail of Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study

The Kaohsiung journal of medical sciences, 2014

The management of acute cholecystitis is still based on clinical expertise. This study aims to in... more The management of acute cholecystitis is still based on clinical expertise. This study aims to investigate whether the outcome of acute cholecystitis can be related to the severity criteria of the Tokyo guidelines and additional clinical comorbidities. A total of 103 patients with acute cholecystitis were retrospectively enrolled and their medical records were reviewed. They were all classified according to therapeutic modality, including early cholecystectomy and antibiotic treatment with or without percutaneous cholecystostomy. The impact of the Tokyo guidelines and the presence of comorbidities on clinical outcome were assessed by univariate and multivariate regression analyses. According to Tokyo severity grading, 48 patients were Grade I, 31 patients were Grade II, and 24 patients were Grade III. The Grade III patients had a longer hospital stay than Grade II and Grade I patients (15.2 days, 9.2 days, and 7.3 days, respectively, p < 0.05). According to multivariate analysis,...

Research paper thumbnail of Hydrodynamics-based gene delivery to the liver by bile duct injection of plasmid DNA--the impact of lasting biliary obstruction and injection volume

Hepato-gastroenterology

Increased biliary pressure may mediate an opening of intrahepatic tight junctions. The biliary pr... more Increased biliary pressure may mediate an opening of intrahepatic tight junctions. The biliary pressure is related to the duration of biliary obstruction and the injected volume. Their effects on the efficiency of gene delivery to the liver were studied. The luciferase gene with a volume of 0.5, 1.0, 1.5 or 2.0mL was injected into the bile duct of Sprague-Dawley rats. After the injection, the bile ducts were occluded in some of the rats, while left to drain in the others. The activity of luciferase was the highest in rats that received 2.0mL of DNA injection and biliary occlusion, while the lowest in the rats that received 0.5mL of DNA only. The bile duct can be an efficient route for gene delivery to the liver depending on the volume of injected DNA. Biliary occlusion can enhance the expression of genes but it may induce a certain degree of liver injury, which should be taken into concern.

Research paper thumbnail of The value of biliary fibronectin for diagnosis of cholangiocarcinoma

Hepato-gastroenterology

The fibronectin in various body fluids was reported to be useful in the differential diagnosis of... more The fibronectin in various body fluids was reported to be useful in the differential diagnosis of benign and malignant diseases. We conducted this study to assess the diagnostic value of biliary fibronectin. Bile was collected from patients with gallstones (n = 62), benign biliary stricture (n = 5) and cholangiocarcinoma (n = 28). All patients with gallstones were complicated with cholangitis. The absolute biliary level of fibronectin was determined by an immunoenzymatric assay and divided by the biliary concentration of bile acids to calculate the relative concentration. The relative concentration of biliary fibronectin was significantly different among the patients with benign biliary obstruction, gallstone and cholangiocarcinoma (7.1 +/- 14.3 vs. 350.5 +/- 1535.4 vs. 180592.6 +/- 917236.2, p < 0.05). With a cut-off value of 40 ng/mumol, its sensitivity for diagnosing cholangiocarcinoma was 0.57, and specificity, 0.79. As bile may be concentrated or diluted to a various extent ...

Research paper thumbnail of Expression of oncogene products HER2/Neu and Ras and fibrosis-related growth factors bFGF, TGF-beta, and PDGF in bile from biliary malignancies and inflammatory disorders

Digestive diseases and sciences, 2001

The expression of several growth factors and K-ras gene mutation in bile were studied to better u... more The expression of several growth factors and K-ras gene mutation in bile were studied to better understand the pathogenesis and improve early diagnosis of bile duct cancers. Bile samples were collected from 12 cholangiocarcinomas (CLC), 10 ampullary cancers (APC), 3 gallbladder cancers (GBC), 7 pancreatic cancers (PNC), 9 biliary tract infection (BTI), 8 biliary stone disease (ST), and 5 normal controls (NC). The highest mean value of TGF-beta in bile was in patients with BTI; the mean levels of bFGF and PDGF were highest in CLC, and patients with APC and CLC had higher expression of HER2/Neu than other groups. In bile, a K-ras gene codon 12 mutation was found in 5 of 6 (83%) cases of CLC by the PCR-RFLP method. The results suggest overexpression of bFGF, PDGF, and HER2/Neu and the presence of K-ras mutation are important for carcinogenesis of bile duct cancers, and detection of the above abnormalities in bile is helpful for early diagnosis.

Research paper thumbnail of Protective effect of melatonin on renal injury of rats induced by bile duct ligation

Digestive diseases and sciences, 2001

Oxygen radicals have been implicated in the pathogenesis of renal injury induced by extrahepatic ... more Oxygen radicals have been implicated in the pathogenesis of renal injury induced by extrahepatic cholestasis. We conduct this study to investigate whether melatonin can have a protective effect against such injury. Either normal saline or gentamicin with or without melatonin was injected into rats that received either a bile duct ligation or a sham operation. The serum levels of malondialdehyde and total antioxidative activity were measured. The kidney was fixed for histologic scoring of renal injury. The serum malondialdehyde level was highest in the rats that received both bile duct ligation and gentamicin injection. Treatment with melatonin significantly increased the serum total antioxidative activity and reduced the serum malondialdehyde concentration. The mean score of renal injury, highest in the rats receiving bile duct ligation and gentamicin injection, was significantly reduced with melatonin treatment. By reducing the systemic oxygen radicals, supplementation with antioxi...

Research paper thumbnail of The effects of bile duct obstruction on the biliary secretion of ciprofloxacin in piglets

The American journal of gastroenterology, 1999

The aim of this study was to evaluate the effect of bile duct obstruction on biliary secretion of... more The aim of this study was to evaluate the effect of bile duct obstruction on biliary secretion of ciprofloxacin and to look for useful parameters to guide clinical use of antibiotics in patients with acute cholangitis. Twenty-five Landrace piglets were used in this study. Their common bile ducts were ligated, with a duration ranging from 1 to 7 days. The changes of liver biochemical tests, intrabiliary pressure, diameter of common bile duct, and concentration of ciprofloxacin in bile were compared among the piglets with different severity of bile duct obstruction. The bile-to-serum ratio of the ciprofloxacin concentration was 586.4% +/- 140.3% before the ligation of bile duct and was reduced significantly to 94.5% +/- 118.0% after 1-day obstruction. The biliary secretion of ciprofloxacin was greatly affected by the intrabiliary pressure in that the bile-to-serum ratio of ciprofloxacin concentration was reduced to 12.2% +/- 14.8% when the intrabiliary pressure reached to 32 cm H2O. T...

Research paper thumbnail of Biliary sludge and pigment stone formation in bile duct-ligated guinea pigs

Digestive diseases and sciences, 1999

We studied the effects of bile stasis in a guinea pig model of pigment gallstone. The common bile... more We studied the effects of bile stasis in a guinea pig model of pigment gallstone. The common bile ducts of guinea pigs were partially ligated, and the guinea pigs killed one or two weeks later. Biliary sludge or stones were examined with the Fourier transform infrared spectroscopy and the scanning electromicroscopy. The bile was analyzed for pH, free calcium, bile acids and bilirubin fractions, and the activities of both bacterial and endogenous beta-glucuronidase. After bile duct ligation, calcium bilirubinate precipitates or stones formed in all except one of the animals studied. The bile pH and the proportion of unconjugated bilirubin rose after bile duct ligation, with a concomitant fall of bilirubin monoglucuronide. The activity of bacterial beta-glucuronidase decreased after ligation, while the activity of endogenous beta-glucuronidase rose at week 2. Our results imply that precipitation of calcium bilirubinate in this animal model was induced by an increased bile pH and the n...

Research paper thumbnail of Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma ≤ 3 cm: A preliminary report

Advances in Digestive Medicine, 2014

ABSTRACT Background Conventional monopolar radiofrequency ablation (RFA) bears the risks of incom... more ABSTRACT Background Conventional monopolar radiofrequency ablation (RFA) bears the risks of incomplete ablation and tumor seeding. This study aimed to evaluate the effectiveness and safety of multipolar RFA with non-touch technique for hepatocellular carcinoma (HCC) ≤ 3 cm. Methods Fifteen cirrhotic patients (9 men, 6 women; age 51–83 years, mean 64.4 years, Child-Pugh score: A = 10 and B = 5) with 17 HCCs of ≤ 3 cm (mean: 26 mm), which were diagnosed based on typical radiologic findings were enrolled. Two or three Celon Prosurge Bipolar electrodes with 3-cm active tip were deployed with non-touch technique via percutaneous approach under ultrasound guidance. Results Complete ablation was achieved in all 17 lesions. This is defined as no enhanced part around the ablated index tumors according to dynamic computed tomography or magnetic resonance imaging at least 1 month after ablation. No local tumor progression was detected at follow-up (range, 3–21.5 months; mean, 10 months). No track seeding was observed. There was one distant recurrence 15.4 months after ablation. One patient had procedure-related biliary stricture and died of pneumonia 3.5 months after tumor ablation. Conclusion Multipolar RFA with non-touch technique is an effective method to achieve complete tumor ablation and an adequate safety margin. This method has low complication rate and bears minimal risk of tumor seeding.

Research paper thumbnail of Spontaneous Rupture of Hepatocellular Carcinoma: A Review of 141 Taiwanese Cases and Comparison with Nonrupture Cases

Journal of Clinical Gastroenterology, 1995

ABSTRACT

Research paper thumbnail of Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis

The American Journal of Surgery, 2006

The purpose of this study was to study the clinical symptoms, laboratory data, and the characteri... more The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated appendicitis for predicting the recurrence of appendicitis. Thirty-five patients with nonoperated perforated appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. Both of the 2 patients who had a past history of appendicitis suffered recurrent appendicitis (the recurrence versus the nonrecurrence group, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The only CT imaging relating to the recurrence of appendicitis is the presence of calcified appendicolith (the recurrence versus the nonrecurrence group, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). It is most likely that appendicitis will recur if a calcified appendicolith on CT imaging or a past history of appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent appendicitis.

Research paper thumbnail of A Clinical Study of 130 Patients with Biliary Tract Cancers and Periampullary Tumors

Oncology, 1996

A retrospective review of 130 patients with peripheral-type cholangiocarcinomas (PTCC), hilar-typ... more 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.

Research paper thumbnail of Pneumoperitoneum Caused by Air Leakage Through the Percutaneous Puncture Tract as a Complication of Rendezvous Technique: A Case Report

The Kaohsiung Journal of Medical Sciences, 2008

The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effecti... more The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effective method to achieve biliary cannulation if an endoscopic approach fails. The two procedures in this technique can be carried out simultaneously or in stages. A simultaneous approach is reported to be associated with fewer complications, and patients undergoing this approach can recover and be discharged more rapidly. Here, we report a complication of pneumoperitoneum in a patient who underwent percutaneous and endoscopic procedures simultaneously for the removal of a common bile duct stone. It was supposed that prolonged air insufflation during endoscopy forced intestinal air to track into the peritoneal cavity through the bile ducts and the puncture tract. Accordingly, a short wait before removing the percutaneous catheter to deflate the intestinal air will be helpful to avoid such a complication.

Research paper thumbnail of Increasing Incidence and Lifetime Risk of Inflammatory Bowel Disease in Taiwan

Inflammatory Bowel Diseases, 2013

The incidence of inflammatory bowel disease is increasing worldwide, but data of epidemiological ... more The incidence of inflammatory bowel disease is increasing worldwide, but data of epidemiological trends from low-endemic area are limited. As one of the low-endemic countries, we describe the trends of this disease in Taiwan over time. This study was based on data obtained from the Catastrophic Illnesses Registration in the National Health Insurance Research Database, which covers more than 98% of the people in Taiwan. Every certificate of catastrophic illness must be approved by 2 expert gastroenterologists. Thirteen years (1998-2010) of data were analyzed for the trends of Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD) and ulcerative colitis (UC). A total of 2915 incident cases (1818 men and 1097 women) were identified, including 2357 cases of UC and 558 cases of CD. The mean annual incidence rates were 0.80 for UC and 0.19 for CD per 100,000 inhabitants, with lifetime risks for those 20 to 79 years of age of 0.066% and 0.013%, respectively. The mean annual prevalence was 4.59 for UC and 1.05 for CD per 100,000 inhabitants. Poisson regression showed significantly increased trends during the observation period for both diseases, with a men/women ratio of 1.50 in UC and 2.14 in CD (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The mean age of individuals at diagnosis was higher for UC as compared with CD (44.7 versus 37.9, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Inflammatory bowel diseases are still relatively uncommon in Taiwan, but the incidence and prevalence rates are increasing.

Research paper thumbnail of P-229 Sequential changes of bile contents in patients with obstructive jaundice from different etiologies — bile from drainage catheter

Research paper thumbnail of The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma - The influence of sampling time and hepatolithiasis

Hepato-gastroenterology

This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled ... more This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled in different situations for the diagnosis of cholangiocarcinoma. Bile was obtained from patients with bile duct obstruction on the day of biliary drainage and 3 days later separately. The etiology of biliary obstruction included choledocholithiasis (N = 51), hepatolithiasis (N = 19) and cholangiocarcinoma (N = 28). Patients of the former two conditions were all complicated with cholangitis. The sensitivity of biliary CEA, CA 19-9 and CA 125, whenever checked were all less than 70%. The biliary CEA and CA 19-9 were elevated in the presence of cholangitis. In addition, the biliary CEA was also increased in the patients with hepatolithiasis. The specificity of CA 125 was better than those of CEA and CA 19-9 (75.7% vs. 33.3% and 60%, respectively) on the day of biliary drainage. The diagnostic efficiency was slightly improved when combining biliary CA 125 and CEA. As the biliary CA 125 was less affected by inflammation and hepatolithiasis, it is more useful than CEA and CA 19-9 in the diagnosis of cholangiocarcinoma. The single tumor marker test of CA 125 or combined tumor marker test of CEA and CA 125 may be used as a useful complement to other investigative methods to differentiate benign from malignant causes of the bile duct obstruction.

Research paper thumbnail of Chen, CY, Liu, HS and Lin, XZ. Hydrodynamics-based gene delivery to the liver by bile duct injection of plasmid DNA-the impact of lasting biliary obstruction and injection volume. Hepatogastroenterology 52: 25-28

Hepato-gastroenterology

ABSTRACT

Research paper thumbnail of Su1464 Features Associated With Interval Progression of Small Pancreatic Cystic Lesions - A Retrospective Study

Research paper thumbnail of Spontaneous Rupture of Hepatocellular Carcinoma: A Review of 141 Taiwanese Cases and Comparison with Nonrupture Cases

Journal of Clinical Gastroenterology

ABSTRACT

Research paper thumbnail of Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma

World Journal of Gastroenterology

To identify factors that were related to the short term effectiveness of percutaneous transhepati... more To identify factors that were related to the short term effectiveness of percutaneous transhepatic biliary drainage in cholangiocarcinoma patients and to evaluate the impact of palliative drainage on their survival. Seventy-four patients with hilar cholangiocarcinoma who underwent percutaneous biliary drainage were enrolled in the study. The demographic and laboratory data as well as the imaging characteristics were retrospectively analyzed to correlate with the bile output and reduction rate of serum bilirubin 1 wk after drainage. Patients with more bile duct visualized on percutaneous transhepatic cholangiography or absence of multiple liver metastases on imaging studies had more bile output after biliary drainage [odds ratio (OR): 8.471, P = 0.010 and OR: 1.959, P = 0.022, respectively]. Patients with prolonged prothrombin time had a slow decrease in serum bilirubin (OR: 0.437, P = 0.005). The median survival time was not significantly different in patients with low or high bile ...

Research paper thumbnail of Development of biodegradable radiopaque microsphere for arterial embolization-a pig study

World journal of radiology, Jan 28, 2015

To develop a new type of calibrated, biodegradable, and imaging detectable microsphere and evalua... more To develop a new type of calibrated, biodegradable, and imaging detectable microsphere and evaluated its embolization safety and efficacy on pig's liver and spleen. Six kinds of pharmaceutical excipient were combined and atomized to form our microsphere. Twenty-four male Lanyu pigs weighing 25-30 kg were used. The arteries of spleen and liver were embolized with Gelfoam, Embosphere, or our microsphere. The serum biochemical tests, computed tomography (CT), liver perfusion scan, and tissue microscopy examination were done to evaluate the safety and efficacy of embolization. Radiopaque microspheres with a size ranging from 300 to 400 μm were produced. Embolization of hepatic and splenic artery of pigs with our microsphere significantly reduced the blood flow of liver and resulted in splenic infarction. The follow-up CT imaging and the microscopic examination showed intraarterial degradation of Gelfoam and microsphere. The blood tests demonstrated insignificant changes with regards...

Research paper thumbnail of Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study

The Kaohsiung journal of medical sciences, 2014

The management of acute cholecystitis is still based on clinical expertise. This study aims to in... more The management of acute cholecystitis is still based on clinical expertise. This study aims to investigate whether the outcome of acute cholecystitis can be related to the severity criteria of the Tokyo guidelines and additional clinical comorbidities. A total of 103 patients with acute cholecystitis were retrospectively enrolled and their medical records were reviewed. They were all classified according to therapeutic modality, including early cholecystectomy and antibiotic treatment with or without percutaneous cholecystostomy. The impact of the Tokyo guidelines and the presence of comorbidities on clinical outcome were assessed by univariate and multivariate regression analyses. According to Tokyo severity grading, 48 patients were Grade I, 31 patients were Grade II, and 24 patients were Grade III. The Grade III patients had a longer hospital stay than Grade II and Grade I patients (15.2 days, 9.2 days, and 7.3 days, respectively, p < 0.05). According to multivariate analysis,...

Research paper thumbnail of Hydrodynamics-based gene delivery to the liver by bile duct injection of plasmid DNA--the impact of lasting biliary obstruction and injection volume

Hepato-gastroenterology

Increased biliary pressure may mediate an opening of intrahepatic tight junctions. The biliary pr... more Increased biliary pressure may mediate an opening of intrahepatic tight junctions. The biliary pressure is related to the duration of biliary obstruction and the injected volume. Their effects on the efficiency of gene delivery to the liver were studied. The luciferase gene with a volume of 0.5, 1.0, 1.5 or 2.0mL was injected into the bile duct of Sprague-Dawley rats. After the injection, the bile ducts were occluded in some of the rats, while left to drain in the others. The activity of luciferase was the highest in rats that received 2.0mL of DNA injection and biliary occlusion, while the lowest in the rats that received 0.5mL of DNA only. The bile duct can be an efficient route for gene delivery to the liver depending on the volume of injected DNA. Biliary occlusion can enhance the expression of genes but it may induce a certain degree of liver injury, which should be taken into concern.

Research paper thumbnail of The value of biliary fibronectin for diagnosis of cholangiocarcinoma

Hepato-gastroenterology

The fibronectin in various body fluids was reported to be useful in the differential diagnosis of... more The fibronectin in various body fluids was reported to be useful in the differential diagnosis of benign and malignant diseases. We conducted this study to assess the diagnostic value of biliary fibronectin. Bile was collected from patients with gallstones (n = 62), benign biliary stricture (n = 5) and cholangiocarcinoma (n = 28). All patients with gallstones were complicated with cholangitis. The absolute biliary level of fibronectin was determined by an immunoenzymatric assay and divided by the biliary concentration of bile acids to calculate the relative concentration. The relative concentration of biliary fibronectin was significantly different among the patients with benign biliary obstruction, gallstone and cholangiocarcinoma (7.1 +/- 14.3 vs. 350.5 +/- 1535.4 vs. 180592.6 +/- 917236.2, p < 0.05). With a cut-off value of 40 ng/mumol, its sensitivity for diagnosing cholangiocarcinoma was 0.57, and specificity, 0.79. As bile may be concentrated or diluted to a various extent ...

Research paper thumbnail of Expression of oncogene products HER2/Neu and Ras and fibrosis-related growth factors bFGF, TGF-beta, and PDGF in bile from biliary malignancies and inflammatory disorders

Digestive diseases and sciences, 2001

The expression of several growth factors and K-ras gene mutation in bile were studied to better u... more The expression of several growth factors and K-ras gene mutation in bile were studied to better understand the pathogenesis and improve early diagnosis of bile duct cancers. Bile samples were collected from 12 cholangiocarcinomas (CLC), 10 ampullary cancers (APC), 3 gallbladder cancers (GBC), 7 pancreatic cancers (PNC), 9 biliary tract infection (BTI), 8 biliary stone disease (ST), and 5 normal controls (NC). The highest mean value of TGF-beta in bile was in patients with BTI; the mean levels of bFGF and PDGF were highest in CLC, and patients with APC and CLC had higher expression of HER2/Neu than other groups. In bile, a K-ras gene codon 12 mutation was found in 5 of 6 (83%) cases of CLC by the PCR-RFLP method. The results suggest overexpression of bFGF, PDGF, and HER2/Neu and the presence of K-ras mutation are important for carcinogenesis of bile duct cancers, and detection of the above abnormalities in bile is helpful for early diagnosis.

Research paper thumbnail of Protective effect of melatonin on renal injury of rats induced by bile duct ligation

Digestive diseases and sciences, 2001

Oxygen radicals have been implicated in the pathogenesis of renal injury induced by extrahepatic ... more Oxygen radicals have been implicated in the pathogenesis of renal injury induced by extrahepatic cholestasis. We conduct this study to investigate whether melatonin can have a protective effect against such injury. Either normal saline or gentamicin with or without melatonin was injected into rats that received either a bile duct ligation or a sham operation. The serum levels of malondialdehyde and total antioxidative activity were measured. The kidney was fixed for histologic scoring of renal injury. The serum malondialdehyde level was highest in the rats that received both bile duct ligation and gentamicin injection. Treatment with melatonin significantly increased the serum total antioxidative activity and reduced the serum malondialdehyde concentration. The mean score of renal injury, highest in the rats receiving bile duct ligation and gentamicin injection, was significantly reduced with melatonin treatment. By reducing the systemic oxygen radicals, supplementation with antioxi...

Research paper thumbnail of The effects of bile duct obstruction on the biliary secretion of ciprofloxacin in piglets

The American journal of gastroenterology, 1999

The aim of this study was to evaluate the effect of bile duct obstruction on biliary secretion of... more The aim of this study was to evaluate the effect of bile duct obstruction on biliary secretion of ciprofloxacin and to look for useful parameters to guide clinical use of antibiotics in patients with acute cholangitis. Twenty-five Landrace piglets were used in this study. Their common bile ducts were ligated, with a duration ranging from 1 to 7 days. The changes of liver biochemical tests, intrabiliary pressure, diameter of common bile duct, and concentration of ciprofloxacin in bile were compared among the piglets with different severity of bile duct obstruction. The bile-to-serum ratio of the ciprofloxacin concentration was 586.4% +/- 140.3% before the ligation of bile duct and was reduced significantly to 94.5% +/- 118.0% after 1-day obstruction. The biliary secretion of ciprofloxacin was greatly affected by the intrabiliary pressure in that the bile-to-serum ratio of ciprofloxacin concentration was reduced to 12.2% +/- 14.8% when the intrabiliary pressure reached to 32 cm H2O. T...

Research paper thumbnail of Biliary sludge and pigment stone formation in bile duct-ligated guinea pigs

Digestive diseases and sciences, 1999

We studied the effects of bile stasis in a guinea pig model of pigment gallstone. The common bile... more We studied the effects of bile stasis in a guinea pig model of pigment gallstone. The common bile ducts of guinea pigs were partially ligated, and the guinea pigs killed one or two weeks later. Biliary sludge or stones were examined with the Fourier transform infrared spectroscopy and the scanning electromicroscopy. The bile was analyzed for pH, free calcium, bile acids and bilirubin fractions, and the activities of both bacterial and endogenous beta-glucuronidase. After bile duct ligation, calcium bilirubinate precipitates or stones formed in all except one of the animals studied. The bile pH and the proportion of unconjugated bilirubin rose after bile duct ligation, with a concomitant fall of bilirubin monoglucuronide. The activity of bacterial beta-glucuronidase decreased after ligation, while the activity of endogenous beta-glucuronidase rose at week 2. Our results imply that precipitation of calcium bilirubinate in this animal model was induced by an increased bile pH and the n...

Research paper thumbnail of Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma ≤ 3 cm: A preliminary report

Advances in Digestive Medicine, 2014

ABSTRACT Background Conventional monopolar radiofrequency ablation (RFA) bears the risks of incom... more ABSTRACT Background Conventional monopolar radiofrequency ablation (RFA) bears the risks of incomplete ablation and tumor seeding. This study aimed to evaluate the effectiveness and safety of multipolar RFA with non-touch technique for hepatocellular carcinoma (HCC) ≤ 3 cm. Methods Fifteen cirrhotic patients (9 men, 6 women; age 51–83 years, mean 64.4 years, Child-Pugh score: A = 10 and B = 5) with 17 HCCs of ≤ 3 cm (mean: 26 mm), which were diagnosed based on typical radiologic findings were enrolled. Two or three Celon Prosurge Bipolar electrodes with 3-cm active tip were deployed with non-touch technique via percutaneous approach under ultrasound guidance. Results Complete ablation was achieved in all 17 lesions. This is defined as no enhanced part around the ablated index tumors according to dynamic computed tomography or magnetic resonance imaging at least 1 month after ablation. No local tumor progression was detected at follow-up (range, 3–21.5 months; mean, 10 months). No track seeding was observed. There was one distant recurrence 15.4 months after ablation. One patient had procedure-related biliary stricture and died of pneumonia 3.5 months after tumor ablation. Conclusion Multipolar RFA with non-touch technique is an effective method to achieve complete tumor ablation and an adequate safety margin. This method has low complication rate and bears minimal risk of tumor seeding.

Research paper thumbnail of Spontaneous Rupture of Hepatocellular Carcinoma: A Review of 141 Taiwanese Cases and Comparison with Nonrupture Cases

Journal of Clinical Gastroenterology, 1995

ABSTRACT

Research paper thumbnail of Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis

The American Journal of Surgery, 2006

The purpose of this study was to study the clinical symptoms, laboratory data, and the characteri... more The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated appendicitis for predicting the recurrence of appendicitis. Thirty-five patients with nonoperated perforated appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. Both of the 2 patients who had a past history of appendicitis suffered recurrent appendicitis (the recurrence versus the nonrecurrence group, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The only CT imaging relating to the recurrence of appendicitis is the presence of calcified appendicolith (the recurrence versus the nonrecurrence group, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). It is most likely that appendicitis will recur if a calcified appendicolith on CT imaging or a past history of appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent appendicitis.

Research paper thumbnail of A Clinical Study of 130 Patients with Biliary Tract Cancers and Periampullary Tumors

Oncology, 1996

A retrospective review of 130 patients with peripheral-type cholangiocarcinomas (PTCC), hilar-typ... more 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.

Research paper thumbnail of Pneumoperitoneum Caused by Air Leakage Through the Percutaneous Puncture Tract as a Complication of Rendezvous Technique: A Case Report

The Kaohsiung Journal of Medical Sciences, 2008

The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effecti... more The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effective method to achieve biliary cannulation if an endoscopic approach fails. The two procedures in this technique can be carried out simultaneously or in stages. A simultaneous approach is reported to be associated with fewer complications, and patients undergoing this approach can recover and be discharged more rapidly. Here, we report a complication of pneumoperitoneum in a patient who underwent percutaneous and endoscopic procedures simultaneously for the removal of a common bile duct stone. It was supposed that prolonged air insufflation during endoscopy forced intestinal air to track into the peritoneal cavity through the bile ducts and the puncture tract. Accordingly, a short wait before removing the percutaneous catheter to deflate the intestinal air will be helpful to avoid such a complication.