Chih- Lin

Clinical Significance of Hepatitis B Virus Pre-S Deletion Mutants in Patients with Chronic Hepatitis B Virus Infection: A Case Control Study

Background and Aim: The cytopathic effects of pre-S deletion mutant on natural course of chronic hepatitis B remain largely unclear. In the case-control study, we therefore investigated the clinical significance of pre-S deletion mutant in Taiwanese hepatitis B virus (HBV) carriers. Methods: By using molecular assays, pre-S deletion mutant of HBV were determined in 160 patients with chronic HBV infection, including 80 carriers with persistently normal serum alanine aminotransferase levels (PNALT) and 80 chronic hepatitis B patients. They were matched for gender and each 10-year categories of age. Results: The overall prevalence of pre-S deletion mutant was 20.6%. Compared to HBV carriers with PNALT, chronic hepatitis B patients had a significantly higher frequency of pre-S deletion mutant (31.2% vs. 10%, P=0.002). The prevalence of pre-S deletion mutant in HBeAg-positive patients was significantly higher than HBeAg-negative patients (27.8% vs. 13.6%; P=0.032). In addition, the frequency of pre-S deletion mutant was significantly higher in genotype C patients than genotype B patients (33.8% vs. 11.6%, P=0.01). By multiple logistic regression analysis, presence of pre-S deletion mutant was the only independently risk factor associated with hepatitis activity (odds ratio, 3.91; 95% CI, 1.57-9.76, P=0.003). Conclusion: Pre-S deletion mutant is more frequent in HBeAg-positive HBV carriers, particular in those with genotype C infection. Taiwanese HBV carriers with pre-S deletion mutants might have an increased risk for hepatitis activity, irrespective of HBeAg status.

Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate‐stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1‐year mortality in patients treated solely with TACE.

CYP2C19 polymorphism has no influence on rabeprazole-based hybrid therapy for Helicobacter pylori eradication

AIM To evaluate the impact of cytochrome P450 2C19 (CYP2C19) and interleukin-1β (IL-1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole-based hybrid therapy. METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94% (79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers (EM) and 95.83% in non-EM. The H. pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori. CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H. pylori eradication using rabeprazole-based hybrid therapy.

Undifferentiated embryonal sarcoma of the liver in an adult: Case report and literature review

Undifferentiated embryonal sarcoma of the liver often presents in the childhood. Its occurrence rate in adults is extremely low. A 70‐year‐old woman suffered from right upper quadrant abdominal pain, fever, and body weight loss of 10 kg over half a year. Abdominal ultrasonography and computed tomography revealed one 9‐cm tumor with a cystic component at S6/S7 of the liver. The tumor markers, such as serum alpha‐fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19‐9, were in the normal range. Repeated biopsies showed no malignancy. After exclusion of infectious diseases through an inflammation scan, she underwent S6/7 bisegmentectomy. The final report of pathology was undifferentiated embryonal sarcoma. No evidence of recurrence or metastases was noted during follow‐up visits. The rate of misdiagnosis before operation is high. The enhancing of radiological feature‐reading skills and clinical awareness are considered to be necessary to reduce misdiagnosis. The prognosis was considered to be poor before. Multimodal treatment with complete surgical excision and chemotherapy provided the best chance of long‐term disease‐free survival. We concluded that undifferentiated embryonal sarcoma should be included in the differential diagnostic list of malignant liver tumors in adults.

Sigmoid colonic endometriosis mimicking colon cancer: A case report

Endometriosis is common in women of reproductive age, which can involve the intestinal tract. However, large bowel obstruction is an extremely rare complication of colonic endometriosis. In this article, we present a case of intestinal endometriosis with the symptom of rectal bleeding in the menstrual period for 1 year. Colonoscopy showed a semicircular tumor with luminal narrowing at rectosigmoid junction. The pathology of biopsy specimen revealed endometrial glands by repeated check after reviewing the patients history. Surgical resection was performed because of luminal stricture. Intestinal endometriosis should always be kept in mind as a differential diagnosis in reproductive‐aged female patients who have symptoms of gastrointestinal bleeding and abdominal pain in the menstrual period.

CYP2C19 polymorphism has no influence on rabeprazole-based sequential therapy

The aim of this prospective study was to evaluate the impact of cytochrome P450 2C (CYP2C19) and interleukin‐1β (IL‐1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole‐based sequential therapy.

Risk Factors of Upper Gastrointestinal Bleeding in Patients Hospitalized in a Chronic Ward

Objectives: Upper gastrointestinal (UGI) bleeding is one of the most frequent complications among patients who need long-term care in a chronic ward. In this retrospective study, we therefore investigated the characteristics of UGI bleeding among patients hospitalized on a chronic ward. Methods: A total of 173 patients admitted to the chronic ward of the Ren-Ai Branch, Taipei City Hospital, were retrospectively enrolled. These individuals consisted of 109 patients with UGI bleeding and 64 patients without UGI bleeding. The demographic data and clinical courses of these patients were compared. Results: There were 135 (78.0%) patients who needed long-term naso-gastric (NG) tube feeding. Patients with UGI bleeding had a significantly higher rate of NG tube placement than those without UGI bleeding (89.9% vs. 57.8%, p＜0.001). All 12 patients with uremia suffered from UGI bleeding. In addition, the presence of a NG tube (odds ratio, 6.19; 95% CI, 2.69-14.21, p＜0.001) and the presence of diabetes mellitus as a comorbidity (odds ratio, 2.63; 95% CI, 1.16-5.96, p=0.021) were independent risk factors associated with UGI bleeding. A total of 75 UGI bleeding associated lesions were observed among 53 patients who underwent upper gastrointestinal endoscopy. Esophagitis or an esophageal ulcer was the most frequent causes of UGI bleeding (36%). The overall mortality rate was 50.3%. However, only 3.5% of the patients died from uncontrolled bleeding. Conclusions: UGI bleeding occurs frequently in patients with chronic illness. The presence of a NG tube, uremia as a comorbidity and diabetes mellitus as a comorbidity were found to be risk factors associated with UGI bleeding. The most common source of UGI bleeding in patients who were undergoing NG tube feeding was esophagitis and/or esophageal ulcer.

Hepatoid Adenocarcinoma of the Stomach: Report of Two Cases

Hepatoid adenocarcinomas had been reported in various sites, of which the stomach was the most common. Metastasis at the time of resection and poor prognosis had been emphasized in most reports. Here we report two cases of hepatoid adenocarcinoma of the stomach. Both of the patients underwent surgical operation. One of them had a tumor with superficial ulceration at the posterior wall of upper body of the stomach with elevation of alpha-fetoprotein (AFP). The patient had no tumor recurrence 7 years after surgery. The other patient had a polypoid submucosal tumor at the junction of antrum and low body of the stomach. After surgery, the patient was followed nearly six years without recurrence. This article also provide brief review of hepatoid adenocarcinoma of the stomach including clinical presentation, pathogenesis of metastasis, differential diagnosis, and immunohistochemical stain.