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Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report

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World Journal of Gastroenterology 2006年第44期12卷 7213-7215页

作者： Ming-Yu Chang Ming-Ling Chang Chang-Teng Wu Division of Pediatric Critical Care and Emergency Medicine Chang Gung Children's Hospital Taoyuan Taiwan 333 China Department of Hepatogastroenterology Chang Gung Memorial Hospital Taoyuan Taiwan 333 China Division of Pediatric Critical Care and Emergency Medicine Chang Gung Children's Hospital Taoyuan Taiwan 333 Chang Gung University Taoyuan Taiwan 333 China

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagno.is of esophageal perforation follow- ing fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion no.ed in initial chest radiogram. Neck computed tomo- graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tra- cheal fistula was shown by esophagogram. The initial re- sponse to treatment of fish bone removal guided by pan- endoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortica- tion, mediastino.omy and perforated esophagus repair. To our kno.ledge, this is the first case report of esopha- geal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the inno.ent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

关键词： Fish bone Esophageal perforation Mediastinitis Decortication Mediastino.omy

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Disproportional exaggerated aspartate transaminase is a useful progno.tic parameter in late leptospirosis

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World Journal of Gastroenterology 2005年第35期11卷 5553-5556页

作者： Ming-Ling Chang Chih-Wei Yang Jeng-Chang Chen Yu-Pin Ho Ming-Jeng Pan Cheng-Hui Lin Deng-Yn Lin Department of Hepatogastroenterology Chang Gung MemorialHospital 5 Fu-Shin Street Kweishan Taoyuan Taiwan China Department of Nephrology chang Gung MemorialHospital Taoyuan Taiwan China Department of Surgery Chang Gung MemorialHospital Taoyuan Taiwan China National Taiwan University Taipei Taiwan China Supported by the Chang Gung Medical Research Project fundNo. CMRPG 33014

AIM: To evaluate the hepatic dysfunction in leptospirosis is usually mild and resolved eventually. However,sequential follow-up of liver biochemical data remained lacking..METHODS: The biochemistry data and clinical symptoms of 11 sporadic patients were collected and analyzed, focusing on the impacts of leptospirosis upon liver biochemistry ***: The results disclosed that of the 11 cases, 5 or 45% died. The liver biochemistry data in the beginning of the disease course were only mildly ***, late exaggerated aspartate transaminase (AST)elevations were no.ed in three cases who finally died when compared with the typical course. Besides, significant higher AST/alanine transaminase (ALT) ratios (AARs) of the peak levels for transaminase were also no.ed in the cases who eventually succumbed. The mean±SD of AARs for the survival group and dead group were 5.65±2.27 (n = 5)and 1.86±0.64 (n = 6) respectively (P= 0.006). The ratios of the cases who finally died were all more than ***, the survival group's ratios were less than ***: Serial follow-up of transaminase might provide evidence to predict some rare evolutions in leptospirosis. If AST elevated progressively without a concomitant change of ALT, it might indicate an acute disease course with ensuing death. Additionally, AAR is ano.her progno.tic parameter for leptospirosis. Once the value was higher than 3.0, a grave progno.is is inevitable.

关键词： Leptospirosis Liver Aspartate transaminase Alanine transaminase AST/ALT ratios

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Topological and evolutional relationships between HCV core protein and hepatic lipid vesicles: Studies in vitro and in conditionally transgenic mice

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World Journal of Gastroenterology 2007年第25期13卷 3472-3477页

作者： Ming-Ling Chang Jeng-Chang Chen Chau-Ting Yeh I-Shyan Sheen Dar-In Tai Ming-Yu Chang Cheng-Tang Chiu Deng-Yn Lin D Montgomery Bissell Liver Research Center and Department of Hepatogastroenterology Chang Gung MemorialHospital Chang Gung University College of Medicine TaoyuanTaiwan China Department of Surgery Chang Gung Children's Hospital Taoyuan Taiwan China Liver Center and Department of Medicine University of California San FranciscoUnited States

AIM: To investigate a specific association between hepatic steatosis and hepatitis C virus (HCV) core. METHODS: HeLa cells and primary mouse hepatocytes were transfected with HCV core plasmid, and conditional transgenics in which hepatic over-expression of HCV core is regulated by the tetracycline-off system, were developed. The expression of the HCV core was assessed over one to six months after withdrawal of doxycycline (dox) by immuno.istochemistry (IHC) and Western blotting and by sequential liver biopsy. Hepatic steatosis was evaluated using oil red stain. 8-hydroxydeoxyguano.ine (8-OHdG) stains and caspase levels were conducted to clarify hepatic oxidative stress and apoptosis rate. Serum amino.ransferase was checked. RESULTS: The transfected hepatocytes had globular cores under the lipid vesicles. In transgenic mice on control diet, core expression was robust, localized to the cytoplasmic vesicle membrane and strongly associatedwith microvesicular steatosis, which was gradually replaced by macrovesicular steatosis. However, both steatosis and core positive hepatocytes diminished with time. Increases in amino.ransferase, caspase and 8-OHdG were associated with peak core expression. CONCLUSION: The core protein was readily detected and morphologically associated with steatosis in individual hepatocytes both in vitro and in vivo. In vivo, oxidative stress caused by the core potentially reduced the number of core positive hepatocytes and in parallel the level of steatosis. To our kno.ledge, this is the f irst animal model that directly shows topological relationship between HCV core and hepatic lipid vesicles.

关键词： Hepatic steatosis Conditional transgenicmice HCV core Oxidative stress

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