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World Journal of Gastroenterology 2007年第12期13卷 1811-1815页

作者： Chi-Chang Yu Jeng-Hwei Tseng Chun-Nan Yeh Tsann-Long Hwang Yi-Yin Jan Department of Surgery Chang Oung Memorial Hospital Chang Gung University Kwei-shan Taoyuan Taiwan China Department of Radiology Chang Gung Memorial Hospital Chang Gung University Kwei-shan Taoyuan Taiwan China

AIM: To report the clinicopathological features and magnetic resonance imaging (MRI) findings of solid and pseudopapillary tumor (SPT) of ***: From 1981 to 2005, 26 surgically treated cases of SPT were retrospectively reviewed. MRI findings of the latest 11 consecutive SPT cases were ***: There were 25 women and one man having SPT (median age: 23 year) with a median tumor size of 7.5 cm. Among them, nine patients developed solid pseudopapillary carcinoma. During the median follow-up period of 66 mo, the 5-year survival rate of the 26 SPT patients was 96.2%. Three MRI features were proposed including Type 1 image, displaying SPT with completely solid part. All SPT patients with type 1 image were detected incidentally. Type 2 image displays of SPT with solid mass hemorrhage and type 3 image with massive hemorrhage. All the eight SPT patients with type 2 and 3 images suffered abdominal pain due to hemorrhage from ***: SPT had a favorable survival rate irrespective of surgical procedures, malignancy, and MRI findings, however, MRI could reliably correlate with its clinicopathological features.

关键词： Solid and pseudopapillary tumor Pancreas Magnetic resonance imaging

Treatment of patients with advanced gastrointestinal stromal tumor of small bowel: Implications of imatinib mesylate

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World Journal of Gastroenterology 2006年第23期12卷 3760-3765页

作者： Chun-Nan Yeh Tsung-Wen Chen Ting-Jung Wu Swei Hsueh Yi-Yin Jan Department of Surgery Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwanChina Department of Pathology Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwan China

AIM： To examine the impact of imatinib mesylate （Glivec） on patient survival and response and its safety, and the correlation of the response rate with the kit gene mutation status. METHODS： Thirty-three of 74 （44.6%） small bowel gastrointestinal stromal tumor （GIST） patients who developed recurrence after curative resection and not treated with Glivec were classified as group A patients. Twenty-two advanced small bowel GIST patients treated with Glivec were classified as group B patients. Clinicopathological features, post-recurrence and overall survival rates were compared. Each tumor in group B patients was investigated for mutations of kit or plateletderived growth factor alpha （PDGFRA）. The mutation type was correlated with clinical outcomes. The antitumor effect and safety of Glivec in group B patients were also assessed. RESULTS： Advanced small bowel GIST patients treated with Glivec had substatntially longer post-recurrence survival and higher overall survival rates than those not treated with Glivec. A total of 15 patients had a partial response （PR）（67.8%）. Activated mutations of c-kit were found in 16 of 19 tested patients and no PDGFRA mutant was identified. In 13 patients with GISTs harboring exon 11 kit mutations, the partial response rate （PR） was 69.3%, whereas two of three patients with tumors containing an exon 9 kit mutation had an overall response rate （ORR） of 66.7% （not significant）. CONCLUSION： Glivec significantly prolongs the postrecurrence and overall survival of Asian patients with advanced GISTs. Glivec induces a sustained objective response in more than half of Asian patients withadvanced small bowel GISTs. Activated mutations of kit exon 11 are detectable in the vast majority of GISTs. There is no difference in the PR rate for patients whose GISTs have kit exon 9 and exon 11 mutations.

关键词： Gastrointestinal stromal tumor Glivec Patient survival Kit gene mutation

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

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World Journal of Gastroenterology 2009年第19期15卷 2376-2380页

作者： Chun-Nan Yeh Hsiang-Lin Lee Chun-Yi Tsai Chih-Chung Lin Tzu-Chieh Chao Ta-Sen Yeh Yi-Yin Jan Department of Surgery Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuan 33375TaiwanChina Department of Anesthesiology Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuan 33375TaiwanChina

AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of ***:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 *** group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before *** amount of analgesics use was also *** demographics,laboratory data,hospital stay,and perioperative complications were compared between the two ***:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory *** surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two ***,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at *** analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia *** group also had a shorter hospital ***:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain *** explains the lower meperidine use and earlier discharge for these patients.

关键词： Prospective randomized trial Localanesthesia Ropivacaine Normal saline Laparoscopic cholecystectomy

Sporadic somatic mutation of c-kit gene in a family with gastrointestinal stromal tumors without cutaneous hyperpigmentation

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World Journal of Gastroenterology 2006年第11期12卷 1813-1815页

作者： Chun-Nan Yeh Tsung-Wen Chen Department of Surgery Chang Gung Memorial Hospital Chang Gung University 5Fu-Hsing StreetKwei-ShanTaoyuanTaiwanChina

We described two members in a family with gastrointestinal stromal tumors （GISTs） without cutaneous hyperpigmentation. The patients were father and son who did not have cutaneous hyperpigmentation. Histological examination showed that these tumors were GISTs expressing CD34 and CD117. Tumor DNA extracted from paraffin-embedded specimens revealed somatic mutation with a deletion mutation at different codons in exon 11 of c-kit gene after direct sequencing analysis. No germline mutation was detected in DNA extracted from peripheral leukocytes obtained from the father and son. We propose that GISTs could be caused by sporadic somatic mutation in a family without germline mutation and hyperpigmentation.

关键词： Sporadic GIST Somatic c-kit mutation

Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

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World Journal of Gastroenterology 2009年第5期15卷 628-632页

作者： Kun-Chun Chiang Jun Te Hsu Shyh Chuan Jwo Tsann-Long Hwang Yi-Yin Jan Chun-Nan Yeh Department of Surgery Chang Gung Memorial Hospital Chang Gung University 5 Fu-Hsing Street Kwei-Shan Taoyuan Taiwan 333 China

Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas, papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982. It has been most commonly described in 60 to 70 years old males, and represents a relatively ''new'' but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.

关键词： Intraductal papillary mucinous neoplasm Pancreas Multifocal Pancreatectomy Intraductalpapillary mucinous neoplasms

Survival outcome of lobar or segmental transcatheter arterial embolization with ethanol-lipiodol mixture in treating hepatocellular carcinoma

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World Journal of Gastroenterology 2005年第18期11卷 2792-2795页

作者： Yun-Chung Cheung Sheung-Fat Ko Shu-Hang Ng Siu-Cheung Chan Department of Diagnostic Radiology Chang Gung Memorial Hospital at Keelung and at Kaohsiang 5 Fu Hsing Street Kwei Shan Tao Yuan Hsien Taiwan China

AIM: To evaluate the dinical outcome and cost-effectiveness of transcatheter arterial ethanol-lipiodoi embolotherapy on hepatocellular carcinoma (HCC). METHODS: One hundred patients with HCC who were treated only by lobar or segmental transarterial embolization (TAE) with ethanol-lipiodoi mixture were enrolled in this study. The 1st- and 2nd-year survival rates were analyzed to evaluate the feasibility of its method. These outcomes of our patients were individually correlated to the Child-Pugh classification and the computed tomographic features of HCC. RESULTS: The overall 1st- and 2nd-year survival rates were 72% and 46%, respectively. The patients were classified into three groups according to their liver function status: 68 patients as Child-Pugh class A, 26 as Child B, and 6 as Child C. Child A had better survival rate than the Child B and/or C. The 1st-year survival rates of patients with Child A-C were 84%, 50%, and 33.3% respectively and the 2nd-year survival rates were 55.5%, 28.5%, and 33.3%, respectively. According to the computed tomographic features, solitary HCC with maximum diameter less than 5 cm had the best outcome with the lst-year survival rate of 100% and the 2nd-year survival rate of 71.4%, while solitary HCC with maximum diameter over 5 cm and multiple HCC had the lst-year survival rates of 75% and 63.7%, respectively, and the 2nd-year survival rates of 33.3% and 44.4%, respectively. Only one patient was complicated with abscess formation and was cured with antibiotic therapy. No mortality resulted from the procedures performed. CONCLUSION: TAE with ethanol-lipiodoi mixture is an economic, safe and feasible method for treating HCC, especially for the patients with smaller solitary HCC or with liver function status of Child-Pugh class A.

关键词： Liver Hepatoma Transcatheter arterial embolization Treatment Survival outcome

Epigenetic changes in virus-associated human cancers

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Cell Research 2005年第4期15卷 262-271页

作者： Hsin Pai LI,Yu Wei LEU Graduate Institute of Basic Medical Sciences Chang Gung University kwei-shan Taoyuan Department of Life Science and Institute of Molecular Biology ChungCheng University Ming-Hsiung Chia-Yi 5] Taiwan

Epigenetics of human cancer becomes an area of emerging research direction due to a growing understanding ofspecific epigenetic pathways and rapid development of detection technologies. Aberrant promoter hypermethylation is aprevalent phenonmena in human cancers. Tumor suppressor genes are often hypermethylated due to the increasedactivity or deregulation of DNMTs. Increasing evidence also reveals that viral genes are one of the key players inregulating DNA methylation. In this review, we will focus on hypermethylation and tumor suppressor gene silencing andthe signal pathways that are involved, particularly in cancers closely associated with the hepatitis B virus, simian virus40 (SV40), and Epstein-Barr virus. In addition, we will discuss current technologies for genome-wide detection ofepigenetically regulated targets, which allow for systematic DNA hypermethylation analysis. The study of epigeneticchanges should provide a global view of gene profile in cancer, and epigenetic markers could be used for early detection,prognosis, and therapy of cancer.

关键词： epigenetics DNA methylation cancer HBV SV40 EBV.

Prenatal diagnosis of choledochal cyst using magnetic resonance imaging: A case report

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World Journal of Gastroenterology 2005年第32期11卷 5082-5083页

作者： Alex Mun-Ching Wong Yun-Chung Cheung Yu-Hung Liu Koon-Kwan Ng Siu-Cheung Chan Shu-Hang Ng Department of Diagnostic RadiologyChang Gung Memorial Hospital Kwei-ShanTao-YuanTaiwanChina Obstetrics and GynecologyChang Gung Memorial Hospital 222Mei Chin RoadKeelungTaiwanChina

Choledochal cysts are congenital anomalies of the biliary ducts, characterized by cystic dilatation of the *** diagnosis of this anomaly using ultrasonography (US) has been well documented. Magnetic resonance imaging (MRI) has recently become an important complement to US in prenatal diagnosis of fetal anomalies. We herein report a patient in whom at 24 wk' gestation US suggested a right upper quadrant abdominal cyst and in whom at 26 wk' gestation MRI more clearly delineated the cyst and its surrounding structures and suggested a choledochal cyst, which was confirmed at postnatal surgery and histopathology.

关键词： Choledochal cyst Prenatal diagnosis MRI

Direct Interaction of Arginine and Methylglyoxal Generates Superoxide Anion: An Ideal Superoxide Generating System Suitable for The Assessment of Superoxide-Scavenging Ability of Food Extracts Using Ultraweak Chemiluminescence Analyzer

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Direct Interaction of Arginine and Methylglyoxal Generates S...

Management of patients with stercoral perforation of the sigmoid colon:Report of five cases

第九次全国生物物理大会学术会议

作者： Tsan-Zon Liu School of Medical Technology and Graduate Institute of Medical Biotechnology Chang Gung UniversityKwei-ShanTaoyuanTaiwan

In the interest of developing a simple and rapid ultraweak chemiluminescence assay for assessing thesuperoxide (O)-scavenging activities of various aqueous extracts of food constituents, a specific and stableO-generating system was sought. Reported herein is the obtainment for the first time of a specific andstable O-generating system consisting of methylglyoxal (MG), a reactive 2- oxo- aldehyde and arginine,

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World Journal of Gastroenterology 2006年第3期12卷 500-503页

作者： Wen-Shih Huang Chia-Siu Wang Ching-Chuan Hsieh Paul Y Lin Chih-Chien Chin Jeng-Yi Wang Divisionof Colon and Rectal Surgery Chang Gung Memorial Hospital Putzu 613 Taiwan China Division of GeneralSurgery Chang Gung Memorial Hospital Pu-tzu 613 TaiwanChina Division of Anatomical Pathology Chang GungMemorial Hospital Pu-tzu 613 Taiwan China Graduate Institute of Clinical Medicine Chang Gung University Kwei-Shan Taiwan China

To our knowledge, stercoral perforation of the colon is rarely seen with fewer than 90 cases reported in the literature till date. We explored the principles of management to prevent impending mortality in five patients with this condition. Five patients, two males and three females, whose median age was 64 years, had sustained stercoral perforation of the sigmoid colon. Chronic constipation was the common symptom among these patients. Three patients underwent a Hartmann＇s procedure and another two were treated with segmental colectomy with anastomosis and diverting colostomy. There was one surgical mortality and the other patients had an uneventful hospital stay. Timely intervention to prevent and/or treat any associated sepsis along with extensive peritoneal lavage and surgical intervention to remove diseased colonic tissue at the primary stercoral ulceration site coupled with aggressive therapy for peritonitis are key treatment modalities in salvaging patients presenting with stercoral perforation of the colon.

关键词： Stercoral perforation Colon Management