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World Journal of Gastroenterology 2003年第6期9卷 1208-1211页

作者： Shee-Chan Lin shou-chuan shih Chin-Roa Kao Sun-Yen Chou Division of Gastroenterology Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwanChina

AIM: To investigate the relationship between transcatheterarterial embolization (TAE) and pulmonary metastasis insubjects with hepatocellular carcinoma (HCC).METHODS: A total of 287 patients with HCC followed upfor more than 1 week were included. 102 patients underwenttranscatheter arterial embolization (TAE group) and 185received conservative treatment(control group). Thepatients' chest x-rays and chest CT scans were examinedfor pulmonary ***: Patients with TAE had a median survival of 19.3months while that of the control group was only 10.0 months(P＜0.05). Pulmonary metastasis occurred in 14 (13.7 %)patients in the TAE group and 14 (7.6 %) patients in the control group, there was no significant difference (P＞0.05).The 1-year, 2-year and 5-year cumulative incidence of pulmonary metastasis was 11.8 %, 17.6 % and 24.0 % in the TAE group and 7.0 %, 13.0 % and 21.7 % in the control group, respectively (P＞0.05). On the univariate analysis,tumor size, abnormal serum alanine aminotransferase levels and heterogeneity on sonography were significantly associated with pulmonary metastasis. However, on the multivariate analysis, only tumor size was significantly predictive of pulmonary ***: TAE is effective on prolonging survival of patients with HCC. It does not significantly increase the risk of pulmonary metastasis. Tumor size is the only significant predictive factor associated with lung metastasis.

关键词：肝细胞癌选择性动脉栓塞治疗肺转移癌危险因素

Polymorphism in transmembrane region of MICA gene and cholelithiasis

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World Journal of Gastroenterology 2003年第7期9卷 1541-1544页

作者： shou-chuan shih Yann-Jinn Lee Hsin-Fu Liu Ching-Wen Dang shih-chuan Chang Shee-Chan Lin Chin-Roa Kao Division of Gastroenterology Department of MedicineMackay Memorial Hospital Mackay Junior School of Nursing TaipeiTaiwan Department of Pediatrics and Medical Research Mackay Memorial Hospital College of Medicine Taipei Medical UniversityTaipeiTaiwan Department of Medical Research Mackay Memorial HospitalTaipeiTaiwan Division of Gastroenterology Department of MedicineMackay Memorial HospitalTaipeiTaiwan

AIM: To study the significance of polymorphism of MHC class I chain-related gene A (MICA) gene in patients with cholelithiasis. METHODS: Subjects included 170 unrelated adults (83 males) with cholelithiasis and 245 randomly selected unrelated adults (130 males) as controls. DNA was extracted from peripheral leukocytes and analyzed for polymorphism of 5 alleles (A4, A5, A5.1, A6 and A9) of the MICA gene. RESULTS: There was no significant difference in phenotype, allele, and genotype frequencies of any of the 5 alleles between cholelithiasis patients and controls .CONCLUSION: This study demonstrates that MICA alleles studied bear no relation to cholelithiasis.

关键词：胆石病 MICA基因基因多态性发病学

Eosinophilic gastroenteritis: Clinical experience with 15 patients

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World Journal of Gastroenterology 2003年第12期9卷 2813-2816页

作者： Ming-Jen Chen Cheng-Hsin Chu Shee-Chan Lin shou-chuan shih Tsang-En Wang Division of Gastroenterology Department of Internal MedicineMackay Memorial HospitalMackay Junior College of NursingTaipeiTaiwanChina

AIM: To evaluate the clinic features of eosinophilicgastroenteritis and to examine the diagnosis, treatment,long-term outcome of this ***: Charts with a diagnosis of eosinophilicgastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or operative specimen and in 2 by radiologic imaging and the presence of eosinophilic ***: All the patients had gastrointestinal symptoms and 12 (80 %) had hypereosinophilia (absolute eosinophil count 1 008 to 31 360/cm3). The most common symptoms were abdominal pain and diarrhea. Five of the 15 patients had a history of allergy. Seven patients had involvement of the mucosa, 2 of muscularis, and 6 of subserosa. One with a history of seafood allergy was successfully treated with an elimination diet. Another patient improved spontaneously after fasted for several days. The remaining 13 patients were treated with oral prednisolone, 10 to 40 mg/day initially,which was then tapered. The symptoms in all the patients subsided within two weeks. Eleven of the 15 patients were followed up for more than 12 months (12 to 104 months,mean 48.7), of whom 5 had relapses after discontinuing steroids (13 episodes). Two of these patients required longterm maintenance oral prednisolone (5 to 10 mg/day).CONCLUSION: Eosinophilic gastroenteritis is a rare condition of unclear etiology characterized by relapses and remissions. Short courses of corticosteroids are the mainstay of treatment, although some patients with relapsing disease require long-term low-dose steroids.

关键词：嗜曙红粒细胞增多性肠胃炎临床特点预后诊断药物疗法氢化泼尼松

Decision making in right-sided diverticulitis

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World Journal of Gastroenterology 2003年第3期9卷 606-608页

作者： Li-Rung Shyung Shee-Chan Lin shou-chuan shih Chin-Roa Kao Sun-Yen Chou Division of Gastroenterology Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwanChina

AIM: To evaluate systematically our nine-year experience in treating right-sided diverticulitis of the colon, and to explore its clinical and radiological ***: The clinical and radiological data of 40 patients with colonic diverticulitis treated in Mackay Memorial Hospital,Taipei, from 1993 through 2002 were reviewed ***: The average age of the patients with right-sided diverticulitis was 53.1 years, which was 11.6 years younger than that of the patients with left-sided diverticulitis. The preoperative diagnosis of appendicitis was made in 8 of 13 right-sided diverticulitis patients. Nine (69 %) had right lower quadrant abdominal pain for more than 48 hours, and ten patients (77 %) presented with fever. CT findings suggesting acute right-sided diverticulitis including thickening of the intestinal wall and pericolonic inflammation were present in five ***: Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than that in left-sided diverticulitis. Barium enema and CT are helpful for the early diagnosis of rightsided diverticulitis. While clearly not required in the majority of patients with right lower quadrant abdominal pain, barium enema and CT may be helpful in making the decision with a clinical history or physical examinations atypical of acute appendicitis.

关键词：右结肠憩室炎放射影像学临床特点 CT表现诊断

Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis

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World Journal of Gastroenterology 2003年第12期9卷 2821-2823页

作者： Ay-Jiun Wang Tsang-En Wang Ching-Chung Lin Shee-Chan Lin shou-chuan shih Division of GastrOenterology Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwanChina

AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene,perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).METHODS: The medical records of patients hospitalized from January1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase,bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness ＞3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or ***: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males *** patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52 %, group A) and absent in 25(group B).Six patients died with a mortality of 12 %.Four of the 6 who died were in group *** in group A were significantly older than those in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P=0.04) and had a significantly higher white blood cell count (mean 15 885.19 vs. 9 948.40,P=0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band *** most commonly cultured bacteria in both blood and bile were E. Coli and Klebsiella pneurnoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more ***: Older patients with a high white cell count are more li

关键词：急性胆囊炎并发症临床特点早期诊断急腹症

Fatty metamorphosis of the liver in patients with breast cancer:Possible associated factors

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World Journal of Gastroenterology 2003年第7期9卷 1618-1620页

作者： Cheng-Hsin Chu Shee-Chan Lin shou-chuan shih Chin-Roa Kao Sun-Yen Chou Division of Gastroenterology Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwanChina

AIM: To investigate the relationship between breast cancer and fatty liver in Chinese ***: The study group consisted of 217 patients with newly diagnosed breast cancers and the control group of 182 subjects undergoing routine health examination in the same hospital. All subjects were female and the groups were matched for date of study. Ultrasound scanning was performed by the same operator using a 3.5 mHz *** of the liver was diagnosed based on the criteria of Saverymuttu et al. Clinical variables were statistically ***: Fatty liver was diagnosed in 98 patients of the study group and 37 patients of the control group, a significant difference was found in incidence (98/217, 45.2 % and 37/182, 20.3 %; P＜0.0001). On univariate analysis, fatty liver in breast cancer patients was associated with overweight,hyperlipidemia, and hepatitis. On multivariate analysis in the same patients, obesity and hyperlipidemia were significantly associated with fatty ***: The cause of fatty liver in women with breast cancer may be multifactorial. The present study confirms its link with overweight and hyperlipidemia.

关键词：乳腺癌脂肪肝相关性超重高血脂

Clinical analysis of multiple primary malignancies in the digestive system: A hospital-based study

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World Journal of Gastroenterology 2005年第27期11卷 4215-4219页

作者： Hui-Yun Cheng Cheng-Hsin Chu Wen-Hsiung Chang Tzu-Chi Hsu Shee-Chan Lin chuan-chuan Liu An-Ming Yang shou-chuan shih shih Health Evaluation Center Mackay Memorial hospital TaipeiTaiwan China Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan China Department of Surgery Mackay Memorial HospitalTaipei Taiwan China Mackay Medicine Nursing and Management College Taipei Taiwan China

AIM： To analyze the characteristics of multiple primary malignancies （MPMs） of digestive system; including incidence, types of tumor combinations, time intervals between development of multiple tumors, clinical course,and prognostic factors affecting survival and ***： Data from a total of 129 patients treated from January 1991 to December 2000 for pathologically proved MPMs, including at least one originating from the digestive system, were reviewed ***： Among 129 patients, 120 （93.02%） had two primary cancers and 9 （6.98%） had three primary cancers. The major sites of MPMs of the digestive system were large intestine, stomach, and liver. Associated nondigestive cancers included 40 cases of gynecological cancers, of which 31 were carcinoma of cervix and 10 cases of genitourinary cancers, of which 5 were bladder cancers. Other cancers originated from the lung, breast,nasopharynx, larynx, thyroid, brain, muscle, and *** tract cancers, especially cervical, ovarian,bladder, and prostate cancers were the most commonlyassociated non-G! cancers, followed by cancer of the lung and breasts. Forty-three cases were synchronous, while the rest （86 cases） were metachronous cancers. Staging of MPMs and treatment regimes correlated with the prognosis between survival and non-survival ***： As advances in cancer therapy bring about a progressively larger percentage of long-term survivors, the proportion of patients with subsequent primary lesions will increase. Early diagnosis of these lesions, based on an awareness of the possibility of second and third cancers, and multidiscipiinary treatment strategies will substantially increase the survival of these patients.

关键词： Multiple primary malignancies Digestive system

Solid-pseudopapillary tumor of the pancreas: Clinical experience and literature review

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World Journal of Gastroenterology 2005年第9期11卷 1403-1409页

作者： Hsueh-Lien Huang shou-chuan shih Wen-Hsiung Chang Tsang-En Wang Ming-Jen Chen Yu-Jan Chan Division of Gastroenterology

AIM: To evaluate the clinical presentations of solidpseudopapillary tumor of the pancreas (SPT) and examine the diagnosis, treatment, low grade malignant potential of this rare ***: We retrospectively reviewed a series of seven patients with SPT managed in our hospital between July 1990 and October 2003. Six females and one male with mean age of 31 years (range 13 to 50 years) were diagnosed with SPT at our ***: Clinical presentation included a palpable abdominal mass in two patients and vague abdominal discomfort in another two. Two patients were asymptomatic;their tumors were found incidentally on abdominal sonographic examination for other reasons. The final patient was admitted with hemoperitoneum secondary to tumor rupture. The mean diameter of the tumors in the seven patients was 10.5 cm (range 5 to 20 cm). The lesions were located in the body and tail in five cases and in the head of the pancreas in two. Surgical procedures included distal pancreatectomy (3), distal pancreatectomy with splenectomy (2), pancreaticoduodenectomy (1) and a pylorus-preserving Whipple procedure (1). There were gross adhesions or histological evidence of infiltration to the adjacent pancreas and/or splenic capsule in four cases. None of the patients received adjuvant *** mean follow up was 7 years (range 0.5 to 14 years).One patient developed multiple liver metastases after 14 years of follow ***: SPT is a rare tumor that behaves less aggressively than other pancreatic tumor. However, in cases with local invasion, long-term follow up is advisable.

关键词： Solid-pseudopapillary tumor of the pancreas Distal pancreatectomy Pancreaticoduodenectomy

Are gap junction gene connexins 26,32 and 43 of prognostic values in hepatocellular carcinoma?A prospective study

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World Journal of Gastroenterology 2004年第19期10卷 2785-2790页

作者： I-Shyan Sheen Kuo-Shyang Jeng Po-chuan Wang shou-chuan shih Wen-Hsing Chang Horng-Yuan Wang Chung-Chu Chen Li-Rung Shyung Division of Hepatogastroenterology Chang Gung Memorial HospitalTaipeiTaiwanChina Departments of Surgery Mackay Memorial HospitalTaipeiTaiwanChina Mackay Junior School of NursingTaipeiTaiwanChina M.D.F.A.C.S. Department of Internal Medicine Mackay Memorial HospitalTaipeiTaiwanChina

AIM: To investigate the prognostic value of the expression of connexin (Cx) 26, 32 and 43 messenger RNA (mRNA) in hepatocellular carcinoma (HCC) tissues. METHODS: Using a reverse-transcriptase polymerase chain reaction (RT-PCR), Cx 26, Cx 32 and Cx 43 mRNAs were determined in the liver tissues of 15 controls and in HCC tissues of 25 patients undergoing curative hepatic resection. The patients were followed up ***: Cx 26 and Cx 32 mRNAs were significantly lower in HCC tissues compared with controls (both P<0.01). By multivariate analysis, a lower level of Cx 26 and Cx 32 mRNA correlated significantly with a risk of HCC recurrence (P = 0.033) and recurrence-related mortality (P = 0.031,P= 0.031). Cx 43 mRNA was higher in HCC tissues compared with controls but did not correlate with postoperative recurrence or recurrence-related mortality. Other significant predictors of HCC recurrence included cellular dedifferentiation (P = 0.033), less encapsulation (P = 0.050), vascular permeation (P= 0.046), and daughter nodules (P= 0.046). Significant variables related to recurrence-related mortality consisted of cell dedifferentiation (P = 0.031), vascular permeation (P = 0.048), and daughter nodules (P = 0.048).The levels of Cx 26 and Cx 32 mRNAs correlated significantly with cell differentiation (P= 0.031). CONCLUSION: A low expression of Cx 26 and Cx 32 mRNAs in HCC tissues is predictive of postoperative recurrence of HCCs.

关键词：缺口联合基因接合素肝细胞癌肿瘤 mRNA HCC RT-PCR

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

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World Journal of Gastroenterology 2009年第30期15卷 3788-3792页

作者： Chen-Wang Chang Wen-Hsiung Chang Ching-Chung Lin Cheng-Hsin Chu Tsang-En Wang shou-chuan shih Wen-Hsiung Chang Ching-Chung Lin Cheng-Hsin Chu Tsang-En Wang Division of Gastroenterology Department of Intemal Medicine Mackay Memorial Hospital Mackay Medicine Nursing and Management College Taipei 10449 Taiwan China Division of Gastroenterology Department of Internal Medicine Health Evaluation Center Mackay Memorial Hospital Mackay Medicine Nursing and Management College Taipei 10449 Taiwan China

AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

关键词： Acute transient hepatitis Cholelithiasis Cholecystitis Hyperbilirubinemia Leukocytosis