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Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleedinq

World Journal of Gastroenterology 2006年第19期12卷 3108-3113页

作者： Tai-Cherng Liou Shee-Chan Lin Horng-Yuan Wang wen-hsiung chang Division of Gastroenterology Department of Internal Medicine Mackay Memorial HospitalMackay MedicineNursing and Management CollegeTaipeiTaiwanChina

AIM： To define the optimal injection volume of epinephrine with high efficacy for hemostasis and low complication rate in patients with actively bleeding ulcers. METHODS： This prospective, randomized, comparative trial was conducted in a medical center. A total of 228 patients with actively bleeding ulcers （spurting or oozing） were randomly assigned to three groups with 20, 30 and 40 mL endoscopic injections of an 1：10000 solution of epinephrine. The hemostatic effects and clinical outcomes were compared between the three groups. RESULTS： There were no significant differences in all background variables between the three groups. Initial hemostasis was achieved in 97.4%, 98.7% and 100% of patients respectively in the 20, 30 and 40 mL epinephrine groups. There were no significant differences in the rate of initial hemostasis between the three groups. The rate of peptic ulcer perforation was significantly higher in the 40 mL epinephrine group than in the 20 and 30 mL epinephrine groups （P 〈 0.05）. The rate of recurrent bleeding was significantly higher in the 20 mL epinephrine group （20.3%） than in the 30 （5.3%） and 40 mL （2.8 %） epinephrine groups （P 〈 0.01）. There were no significant differences in the rates of surgical intervention, the amount of transfusion requirements, the days of hospitalization, the deaths from bleeding and 30 d mortality between the three groups. The number of patients who developed epigastric pain due to endoscopic injection, was significantly higher in the 40 mL epinephrine group （51/76） than in the 20 （2/76） and 30 mL （5/76） epinephrine groups （P 〈 0.001）. Significant elevation of systolic blood pressure after endoscopic injection was observed in the 40 mL epinephrine group （P 〈 0.01）. Significant decreasing and normalization of pulse rates after endoscopic injections were observed in the 20 mL and 30 mL epinephrine groups （P 〈 0.01）.CONCLUSION： Injection of 30 mL diluted epinephrine （1：10000） can effectively prevent recurrent bleedin

关键词： Endoscopic injection Epinephrine Volume Peptic ulcer bleeding

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Biloma following repeated transcatheter arterial embolization and complicated by intrahepatic duct stones: A case report

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World Journal of Gastroenterology 2005年第30期11卷 4764-4765页

作者： Ming-Jen Chen Ching-Chung Lin wen-hsiung chang Fei-Shih Yang Division of Gastroenterology Department of Radiation

Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases,we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.

关键词： Biloma Biliary tract Transcatheter Arterial embolization

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Endoscopic findings in a patient with Henoch-Schonlein purpura

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World Journal of Gastroenterology 2005年第15期11卷 2354-2356页

作者： Ming-Jen Chen Tsang-En Wang wen-hsiung chang Shu-Jung Tsai Division of Gastroenterology

Henoch-Schonlein purpura (HSP) is a systemic vasculitis of the small vessels of the skin, joints, GI tract, and kidney. It preferentially affects children but may also occur in adults. We report a 60-year-old man with HSP who presented with colicky abdominal pain, bloody diarrhea, arthralgia, and skin rash. The gastrointestinal tract was viewed by upper endoscopy and colonoscopy. We found characteristic endoscopic findings in the stomach, cecum and sigmoid colon, the combination of which has rarely been demonstrated in one patient. Histologic examination of skin biopsy specimens revealed leukocytoclastic vasculitis with positive staining for IgA in the capillaries. Endoscopy appears to have substantial diagnostic utility in patients suspected of having HSP, especially when abdominal symptoms precede the cutaneous lesions.

关键词： Henoch-Schonlein purpura Purpura Endoscopy

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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

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Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones

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World Journal of Gastroenterology 2005年第4期11卷 593-596页

作者： wen-hsiung chang Cheng-Hsin Chu Tsang-En Wang Ming-Jen Chen Ching-Chung Lin Division of Gastroenterology Department of Internal Medicine Mackay Memorial HospitalMackay MedicineNursing and Management college TaipeiTaiwan

AIM: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL), where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL) or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance. METHODS: During the period from August 1996 to December 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone>1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients. RESULTS: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis, and 10 patients had delayed bleeding, and no patient died. Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis, and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1.4

关键词： Common bile duct stones Mechanical lithotripsy

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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

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Analysis of clinical manifestations of symptomatic acquired jejunoileal d i verticil la r disease

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World Journal of Gastroenterology 2005年第35期11卷 5557-5560页

作者： Chia-Yuan Liu wen-hsiung chang Shee-Chan Lin Cheng-Hsin Chu Tsang-En Wang Shou-Chuan Shih Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan China Department of Medical Research Mackay Memorial Hospital Taipei Taiwan China Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan China Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan China Mackay Medicine Nursing and Management College Taipei Taiwan China

AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening ***: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel ***: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.

关键词： Acquired Symptomatic Jejunoileal Diverticulardisease

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Report of gossypiboma from the standpoint in medicine and law

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World Journal of Gastroenterology 2005年第8期11卷 1248-1249页

作者： Li-Rung Shyung wen-hsiung chang Shee-Chan Lin Shou-Chuan Shih Chin-Roa Kao Sun-Yen Chou Division of Gastroenterology L.L.B. Department of LawNational Taiwan UniversityChina

We report on a case of gossypiboma. A 78-year-old man was admitted to our hospital with acute abdomen. He had undergone an operation for colon cancer 4 mo *** ultrasonography revealed an echogenic lesion with a hypoechoic rim and strong posterior acoustic shadowing in the lower abdomen. Diagnosis of gossypiboma can be made by ultrasonography to avoid loss-of-chance of survival. We reviewed the English literature briefly of gossypiboma from the medical and juridical view. According to the theory of loss-of-chance, the damage of plaintiff is the loss of the chance of survival or recovery, rather than the final harm. The victim would allow recovery for the loss of the chance from the defendant. But the plaintiff would show by a preponderance that he was deprived of a betterchance of a cure. Under the proposed rule, the compensable value of the victim would be the plaintiff's compensation for the loss of the victim's chance of survival.

关键词： Gossypiboma Loss-of-chance Preponderance

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Gastric carcinoid tumor in a patient with a past history of gastrointestinal stromal tumor of the stomach

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World Journal of Gastroenterology 2008年第44期14卷 6884-6887页

作者： Chien-Yuan Hung Ming-Jen Chen Shou-Chuan Shih Tsang-Pai Liu Yu-Jan Chan Tsang-En Wang wen-hsiung chang Division of Gastroenterology Department of Internal MedicineMackay Memorial Hospital and Mackay MedicineNursing and Management CollegeTaipeiTaiwanChina Department of General Surgery Mackay Memorial HospitalTaipeiTaiwanChina Department of Pathology Mackay Memorial HospitalTaipeiTaiwanChina

Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract. It may coexist with other type of cancers,and if so,the tumors usually involve the stomach. The most common associated cancers are gastrointestinal carcinomas. We report a 65-year-old woman with a history of gastric gastrointestinal stromal tumor who had undergone subtotal segmental gastrectomy. New polypoid lesions were detected on a follow-up gastroscopy one year later. The lesions were biopsied and found to be carcinoid tumors. There was serum hypergastrinemia,and type 1 gastric carcinoid tumor was diagnosed. A total gastrectomy was performed. Pathologic examination revealed both carcinoid tumors and a recurrent gastrointestinal stromal tumor.

关键词： Hypergastrinemia Multiple primaryneoplasms Stomach Gastrointestinal stromal tumor Carcinoid tumor

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Ultrasonography of splenic abnormalities

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World Journal of Gastroenterology 2005年第26期11卷 4061-4066页

作者： Ming-Jen Chen Ming-Jer Huang wen-hsiung chang Tsang-En Wang Horng-Yuan Wang Cheng-Hsin Chu Shee-Chan Lin Shou-Chuan Shih Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Mackay Medicine Nursing and Management College Taipei Taiwan China Division of Hematology and Oncology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan China

AIM: This report gives a comprehensive overview of ultrasonography of splenic abnormalities. Certain ultrasonic features are also discussed with pathologic ***: We review the typical ultrasonic characteristics of a wide range of splenic lesions, illustrating them with images obtained in our institution from 2000 to *** hundred and three patients (47 men, 56 women),with a mean age of 54 years (range 9-92 years), were found to have an abnormal ultrasonic pattern of ***: We describe the ultrasonic features of various splenic lesions such as accessory spleen, splenomegaly,cysts, cavernous hemangiomas, lymphomas, abscesses,metastatic tumors, splenic infarctions, hematomas, and rupture, based on traditional gray-scale and color Doppler ***: Ultrasound is a widely available, noninvasive,and useful means of diagnosing splenic abnormalities. A combination of ultrasonic characteristics and clinical data may provide an accurate diagnosis. If the US appearance alone is not enough, US may also be used to guide biopsy of suspicious lesions.

关键词： Ultrasonography Ultrasound Splenic abnormalities Spleen

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