Chin-Roa Kao

Pulmonary metastasis of hepatocellular carcinoma associated with transarterial chemoembolization.

UNLABELLED Recent advances in both diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the subsequently increasing distant metastases. Pulmonary metastasis of hepatocellular carcinoma associated with transcatheter arterial chemoembolization has rarely been reported. METHODS To evaluate whether transcatheter arterial chemoembolization increases the risk of pulmonary metastasis of hepatocellular carcinoma, 230 patients were studied. Among them, 156 received transcatheter arterial chemoembolization with an interval of 12-16 weeks, the remaining 74 cases refused transcatheter arterial chemoembolization and received only conservative treatment. All patients were followed up with chest x-ray films taken before transcatheter arterial chemoembolization, during admission or in the out-patient department. The mean follow-up interval was 3.37 +/- 1.51 months. RESULTS Pulmonary metastasis was found in 25.6% (40/156) and 8.1% (6/74) of the patients with and without transcatheter arterial chemoembolization (p = 0.002). The median interval between initial diagnosis and pulmonary metastasis was 3.39 +/- 0.08 and 11.72 +/- 2.91 months among patients with and without transcatheter arterial chemoembolization (p = 0.001). The mean age, sex, existence of cirrhosis, severity of cirrhosis, presence of collateral arterial circulation, amount of lipiodol and agent of anti-cancer drugs were not associated with the development of lung metastasis. However, factors predisposing to lung metastasis included: solitary tumor with tumor size > 10 cm, multiple tumors with main tumor > 5 cm or diffuse hepatocellular carcinoma, intrahepatic portal vein thrombosis, arterioportal or arteriovenous shunt, and the presence of incomplete tumor necrosis after transcatheter arterial chemoembolization (especially combined with necrotic area > 50% main tumor size). CONCLUSIONS Pulmonary metastasis associated with transcatheter arterial chemoembolization has a strong adverse impact on patient survival.

Management of symptomatic polycystic liver disease: Laparoscopy adjuvant with alcohol sclerotherapy

Abstract An 81 year old woman with extensive polycystic liver disease received laparoscopic unroofing and fenestration, followed by 95% ethanol sclerotherapy, resulting in almost complete disappearance of the cysts. Such a procedure can avoid complications of both the multi‐segmental liver resections and extensive fenestrations, and untoward reactions from a large amount of alcohol. In addition, it can achieve a satisfactory result. It is suggested that this procedure could be a safe and effective alternative to traditional open surgery in selective patients.

Diffuse Large B-Cell Lymphoma with Extensive Gastrointestinal Tract Involvement: Report of a Case

Capsule endoscopy is a new technology developed to investigate diseases of small intestine. It has been shown to be superior to current modalities such as small bowel radiology and enteroscopy. A 77-year-old man presented with occult gastrointestinal bleeding was found to have extensive small bowel mucosal lesion by capsule endoscopy. However his earlier serial examinations, i.e. gastroduodenoscopy, colonoscopy, and small bowel series, computed tomography and angiography, failed to disclose the bleeding source. The final diagnosis of diffuse large B cell lymphoma was established by histology & immunohistochemical studies of biopsy specimen from push enteroscopy Patient was treated with systemic chemotherapy and currently remains in complete remission. Our experience suggests capsule endoscopy is a valuable, complementary tool in the detection and evaluation of small bowel lymphoma.

Human Intestinal Capillariasis with Enteritis Cystica Profunda: Report of two Cases

Human intestinal capillariasis is a rare parasitosis first recognized in the Philippines in the 1960s. It is a potentially life-threatening disease that has also been reported in Thailand, Japan, southern Taiwan (Kaohsiung), Korea, Iran, Egypt, Italy and Spain. Symptoms include chronic diarrhea, abdominal pain, borborygmi, marked weight loss, protein and electrolyte loss, and cachexia. We report two patients with capillariasis living in rural Taiwan. They had no history of travelling abroad or eating raw freshwater fish. Both underwent emergency laparotomy for peritonitis and were found to have enteritis cystica profunda. They both had good responses to mebendazole.

Retroperitoneal Tuberculous Lymphadenitis Mimicking a Pancreatic Head Tumor: Report of a Case

This reported case concerns a 28-year-old male suffering from fever of unknown origin. An intraabdominal tumor was found at the pancreatic head portion by ultrasonography. A pancreatic head tumor was suspected initially. Abdominal computed tomography and endoscopic ultrasonography also revealed a pancreatic head lesion. Laparotomy was performed later and an enlarged lymph node around the pancreatic head was noted. The pathology report was consistent with the diagnosis of tuberculous lymphadenitis. Anti-tuberculous therapy was given and the patient became afebrile. This case is the first that we have encountered. The clinical features, pathogenesis and treatment of the retroperitoneal tuberculous lymphadenitis are described with a brief review and discussion.

Remission of Primary Rectal Lymphoma with Chemotherapy: Report of a Case

Intestinal lymphomas are not rare and most of them are secondary lesions. Few of them are of rectal origin. We here-in present a patient with primary rectal lymphoma at M. M. H. A 49-year-old woman had had chronic watery diarrhea with significant body weight loss for 3 months. Barium examination of colon and sigmoidoscopy showed a space-occupying mass in the rectum. Abdominal computer tomography revealed a few enlarged perirectal fascial lymph nodes with no para-aortic lymph node. Biopsy showed a mixed cell type B cell malignant lymphoma. The patient received 8 courses of chemotherapy during a period of 6 months, and was in persistent remission, which was later confirmed by follow-up sigmoidoscopy in nearly one year.

Serum Amylase and Lipase Levels in Acute Patients with Pancreatitis Versus Nonpancreatic Abdominal Pain

The serum amylase level may be elevated in acute pancreatitis, as well as other conditions which may present with abdominal pain. Conversely, normoamylasemia in acute pancreatitis is not uncommon. Some authors have suggested that serum lipase is a better serum masker for the diagnosis of acute pancreatitis. We conducted a study to evaluate: (1). the differences in serum amylase and lipase levels between patients with acute pancreatitis and those with nonpancreatic abdominal conditions. (2). the diagnostic accuracy of serum amylase and lipase levels between these two groups. The serum amylase and lipase levels were estimated in 47 patients with acute pancreatitis and 30 patients with nonpancreatic abdominal pain. Four (8.5%) patients had normoamylasemia in the acute pancreatitis group, however, almost all the patients in this group had elevated serum lipase levels. Elevated serum amylase levels in eleven (36.7%) and serum lipase levels in four (13.3%) patients were noted in the nonpancreatic abdominal pain group. Ten (33.3%) patients in the nonpancreatic abdominal pain group had serum amylase levels that overlapped those found in the acute pancreatitis patients. Only one (3.3%) patient in this group had serum lipase level that overlapped those found in acute pancreatitis patients. The sensitivity, specificity and the accuracy of the serum lipase levels in the diagnosis of acute pancreatitis were 100%, 86.7% and 94.8%, respectively. These were better than those of the serum amylase levels of 91.5%, 63.3% and 80.5%, respectively. If a higher cutoff value was chosen, that was 1.3 times the upper limit of normal, the sensitivity, specificity and the accuracy for serum lipase would be 100%, 96.7% and 98.7%, respectively and serum amylase 89.4%, 90% and 89.6%, respectively.

Small Cell Carcinoma Involving the Esophagus and Stomach: Report of a Case

A 70-year-old man experienced dull epigastralgia, body weight loss, poor appetite and intermittent melena for one month. Serial work-up showed a tumor occupying the distal esophagus, cardia, fundus, and upper body of the stomach with distant neck lymphadenopathy. Endoscopic biopsy revealed a small cell carcinoma which was confirmed by immunohistochemical stain. The patient underwent palliative surgery. Chemotherapy was precluded by the patients deteriorating general condition. He died two months after admission. Small cell carcinoma involving the esophagus and stomach is unusual. This neoplasm shows an aggresive nature with rapid distant metastasis, similar to pulmonary small cell carcinoma and may be treated with chemotherapy.

Concomitant Digestive Malignancy in Pregnancy

Cancer of the digestive organs occurring during pregnancy is uncommon. To date, there have been fewer than 250 cases of pregnancy associated with alimentary tract carcinoma presented in the literature, the estimated incidence being one in 100,000 pregnancies. From January 1983 through April 1992, we enrolled in our study 13 cases of digestive tract cancer during pregnancy including 8 cases of colorectal cancer, 2 cases of gastric cancer, and 3 cases of hepatocellular carcinoma. Herein, the clinical manifestations, diagnosis, treatment, and prognosis of each pregnant patient as well as the fetus are reviewed. The presenting symptoms in these patients, including nausea, vomiting, abdominal fullness or pain, non-specific dyspepsia, constipation, and rectal bleeding, were often confused with the physiological features of pregnancy. Therefore, the major difficulty in diagnosis of cancer is that the presenting symptoms of pregnancy overshadow the non-specific symptoms of early alimentary tract cancer. This report may help to remind clinicians of the possibility of cancer during pregnancy.

Detection of Antibiotic-Associated Colitis Using the Clostridium Difficile Toxin Test

Twenty five patients with antibiotic-asssociated colitis were evaluated. Thirteen of them were tested with the latex agglutination test for Clostridium difficile toxin (CDT). The positive rate of the CDT test was 30.8%, which was higher than that for stool cultures. Pseudomembranes were observed in 96% of the patients. They underwent colonic endoscopy, which is still the main tool in the diagnosis of antibiotic-associtated colitis. There was one patient who did not have pseudomembranes on the rectosigmoid colon but was tested postive for CDT. The CDT test is complementary to the clinical diagnosis of antibiotic-associated colitis.