Chung-Chieng Wu

Assessment of serum and bile levels of CA19-9 and CA125 in cholangitis and bile duct carcinoma

In this study, CA19‐9 and CA125 in serum and bile were measured to evaluate their diagnostic value in cholangitis and bile duct carcinoma. Patients were classified into three groups: group A, the control group, had cholelithiasis without infection (n= 23), group B had acute cholangitis (n= 25) and group C had bile duct carcinoma without bacterial infection (n= 18). All patients had undergone surgery, and bile and serum of the patients were measured for the two tumour markers by radio‐immunoassay. The positivity rate for serum CA19‐9 was 4.4% in the control group, 28.0% in group B and 61.1% in group C. The positivity rates for serum CA125 in groups control, B and C were 0%, 4% and 27.78% respectively. The diagnostic accuracy for bile duct carcinoma was 67.4% for both CA19‐9 or CA125. The concentration of CA19‐9 in bile was more than 1200 ng/mL in 72% of patients with acute cholangitis, in 61.1% of all patients with bile duct carcinoma and 0% in the control group. The frequency of concentrations of CA125 in bile greater than 200 ng/mL was 38.89% in bile duct carcinoma and none was observed in the control or acute cholangitis groups. In conclusion, the concentration of CA19‐9 was increased not only by the tumour itself, but also by infection. In the diagnosis of bile duct carcinomas, the sensitivity of CA125 was low but its specificity was very high.

The Effects of Radiation Therapy on Salivary Function in Patients with Head and Neck Cancer

Eighty nasopharyngeal carcinoma (NPC) patients and another eighty head and neck cancer (HNC, non-NPC) patients were enrolled as two experimental groups to study their salivary function by using Tc99m sialography. Twenty healthy subjects were also employed as a control group. The patients received an intravenous injection of 4 mCi of 99mTc-pertechnetate (Tc-99mO4-). The data were collected at a rate of 1 frame per 15 seconds for the total time of 30 minutes, and the patients received stimulations for salivary secretion by ingesting 0.5cc of lemon juice 15 min after the start of data acquisition. The salivary function was measured on Pre-RT (radiation therapy), During-RT and Post-RT periods. The results showed no statistical significance for maximum uptake (%) and excretion rate (%) between Control and Pre-RT group on parotid or submandibular glands function. This was the same in the age groups (age below 40 and age above 40) and sex groups. The NPC group had a decreasing maximum uptake (%) 3 months after RT on both parotid glands and submandibular glands, whereas the HNC group showed no obvious difference. The excretion rate (%) of both parotid and submandibular glands reached its lowest mark after 3-6 months in both the NPC and HNC groups and then started to recover progressively. For NPC patients, the radiation damage to the parotid glands was greater than to the submandibular glands, whereas the effect was reversed on HNC patients. It is important that the radiation therapist should preserve salivary function whenever possible.

Hepatitis D Virus Infection in Patients with Chronic Hepatitis B Virus Infection

To assess the prevalence and influence of HDV infection in patients with chronic HBV infection, 111 pathologically proven chronic HBV infection patients, including 64 chronic hepatitis, 10 liver cirrhosis and 37 hepatocellular carcinoma cases were studied. The prevalence of HDV infection was 7.2% (8/111). The prevalence in male and female of occurrence subjects was 7.1% (7/91) and 7.8% (1/13) respectively. The difference of HDV infection among the different age groups was not significant. The prevalence in HBeAg positive, anti-HBe positive and both HBeAg and anti-HBe negative patients was 5.3% (3/56), 8.3% (4/44) and 14% (1/7), respectively. Three patients with HBV DNA were combined with HDV infection (8.1%, 3/37) and 7.1% (2/28) of HBV DNA negative patients were anti-D positive. None of the HBsAg negative patients was anti-D positive (0/26). Patients with liver cirrhosis had a higher HDV infection rate (30%, 3/10), but p values were over 0.05 when compared with chronic hepatitis and hepatoma groups. The prevalence of anti-D in patients with SGPT levels over 10 times was less than in patients with SGPT levels between 5 to 10 times (p=0.034). In patients with anti-D, four (50%) were HBeAg positive, three (60%, 3/5) were HBV DNA positive, three (37.5%) had liver cirrhosis and none was with SGPT level over 10 times of normal. From these data, it could be concluded that: (1) male and female subjects were equally susceptible to HDV: (2) HDV infection did not influence the status of HBV infection; (3) the prevalence in different age groups of adults showed no significant differences; (4) HDV infection might increase liver damage; (5) HDV infection played a less important role in acute exacerbation of chronic HBV infection in southern Taiwan.

A Comparative Study with Intracavernous Injection of Prostaglandin E1 versus Papaverine for the Diagnostic Assessment of Erectile Impotence

The intracavernous injection of vasoactive drugs is a valuable diagnostic aid and an important tool for the treatment of erectile failure. A comparative study with intracavernous injection of prostaglandin E1 (PGE1) and papaverine was performed in 60 patients with impotence. We evaluated the efficiency and side effects of both agents. The overall positive response rate was 85.0% in the PGE1 group and 65.0% in the papaverine group which suggests PGE1 has a stronger vascular effect. The mean onset of maximal erection was after 9.6 minutes in the PGE1 group and after 6.5 minutes in the papaverine group. The mean maintenance of erection was for 53.2 minutes in the PGE1 group and for 38.6 minutes in the papaverine group. There were no systemic side effects of either agent. Three instances of injection pain and 2 of burning sensation in the penis were noted in the PGE1 group, while in the papaverine group, there were 21 reports of injection pain, 4 of prolonged erection and 2 of burning sensation in the penis. These results suggest that PGE1 is a more desirable vasoactive alternative for the diagnosis of impotence.

A Study of Cea, Ca 19-9 and Ca 125 in Biliary Tract Diseases

Sixty-six patients were classified into three groups; control group A was (n = 24), group B those with hepatolithiasis (n = 24) and group C those with the bile duct carcinoma (n = 18). All patients had accepted operation and the patients bile and serum were send for determination with radioimmuno assay. The positive rate of serum CEA were 4.17%, 37.5% and 66.67% for the control, hepatolithiasis and bile duct carcinoma groups respectively. The positive rate of serum CA 19-9 were 8.33%, 25% and 61.11% for the control, hepatolithiasis and bile duct carcinoma respectively. The positive rate of serum CA 125 were 5%, 0% and 31.25% for control, hepatolithiasis and bile duct carcinoma groups respectively. The sensitivity level of serum CEA, CA 19-9 and CA 125 for the bile duct carcinoma group was 66.67%, 61.11% and 31.25% respectively. The diagnostic accuracy for bile duct carcinoma with regard to bile CEA was 94.44% but the accuracy ratio was only 45.24%. The bile concentration of CA 19-9 level of more than 1200 ng/ml were 75% and 61.11% for the hepatolithiasis and bile duct carcinoma group and none in control group. The bile concentration of CA 125 more than 200 ng/ml was 43.75% in the bile duct carcinoma and none in control or hepatolithiasis group. Finally, the concentration of CA 19-9 will be effected not only by tumor itself but also by severe infection in the hepatolithiasis patients. The sensitivity of CA 125 was low but accuracy was high for the diagnosis of the bile duct carcinoma.

Evaluation of Serum CA 19-9 in Malignant Tumors

Carbohydrate antigen (CA 19-9), a tumor-associated antigen by recently developed immunoradiometric assays utilizing monoclonal antibody 19-9, was evaluated in the serum of 42 healthy adults and 112 patients with and without malignant diseases. The assay is sensitive and simple to perform. The average coefficient of variation (CV) is 8.2% in a range of 5.8 to 120.0 units/ml. The minimum detectable dose is 4.8 units/ml and analytical recovery of CA 19-9 is 90%to 108%. The mean ±SD of the CA 19-9 in 42 healthy adults was 11.6±5.2 units/ml with a range of 5.6 to 28.4 units/ml. Based on a concentration of 37 units/ml as the upper normal limit, the false positive rate is 11.4%(4/35) and the true positive rates in malignancies were as follows: 100% (3/3) in pancreatic carcinoma. 100% (4/4) in cholangio-carcinoma, 50% (11/22) in colon carcinoma, 100% (3/3) in common bile duct carcinoma, 50% (4/8) in hepatocellular carcinoma, 40% (2/5) in liver metastasis, 7.7% (1/3) in gastric carcinoma, 0% (0/10) in lung carcinoma, 0% (0/2) in ovarian carcinoma, 0% (0/4) in adenocarcinoma of papilla of Vater and 0% (0/3) in esophageal carcinoma, respectively. The overall sensitively, specificity and diagnostic accuracy of CA 19-9 in the diagnosis of malignant tumors were 36.4%, 88.6%, and 52.7% respectively. It is concluded that CA 19-9 is a valuable tumor marker, especially in the diagnosis of pancreatic carcinoma, cholangio carcinoma and common bile duct carcinoma. However, non-malignant disease of the gall bladder (G.B) may also have elevated serum level of CA 19-9.

Ultrasonography and 99m Tc-DISIDA Cholescintigraphy in the Diagnosis of Choledochal Cyst in Children

Eighteen children with choledochal cyst have underwent abdominal ultrasonography and Tc-DISIDA (di-isorpropylphenylcarbamoylmethylimidodiacetic acid) cholescintigraphy before surgery. All patients had typical sonographic findings of a large cystic mass in the porta hepatis with direct continuity to the biliary system. The gallbladder could be easily recognized and distinguished from the cystic mass in every except one case. Dilatation of the intrahepatic ducts was noted in 12 patients (67.%). Coexisting biliary stones were found in 3 patients (17%). ON the choescintigams, 14 patients (78%) had characteristic findings of a round or ovoid photondefect area in the porta hepatis with delayed filling and stasis of the tracer defect over the porta hepatis without visualization of gallbladder or bowel radioactivity, which was thought to suggest a choledochal cyst with obstruction. A combination of ultrasonography and cholescintigraphy can provide a very accurate preoperative diagnosis of choledochal cyst.

Characteristic Sonographic Features of Chronic Hepatic Schistosomiasis Japonica - Three Cases Report

Three cases of hepatic schistosomiasis japonica were encountered in Kaohsiung Medical College Hospital in the past year with pathological proof. In general, there was a diffuse network-like appearance of liver in abdominal sonography. The first case had had malignant tonsillar lymphoma about two years earlier, and was misdiagnosed as having diffuse liver metastasis by use of sonography. The second and third cases were then correctly diagnosed by ultrasound before liver biopsy was performed. All of these three cases had normal liver function by blood biochemical examination, and the first and Stool hatching tests and skin tests for schistosomiasis were all unremarkable. However, they all came from China mainland ─around the Yangtze River. It is suggested that if there is diffuse network-like appearance in the liver echo-pattern, hepatic schistosomiasis might be the first choice of diagnosis.

Intravenous Dipyridamole Technetium-99m Mmi Myocardial Perfusion Scintigraphy for Detection of Coronary Artery Disease

To evaluate the efficacy of stress technetium-99m MMI (N-2-methoxy-2-methyl propyl isonitrile) myocardial perfusion scintigraphy (Tc-99m MMI) using intravenous dipyridamole for detection of coronary artery disease (CAD), we collected 66 cases (53 men, 13 women, aged 40-79 years old) between Sept. 1990 and Oct. 1991. The cases were divided into two groups: group I involving 44 patients received coronary arteriography (CAG) examination without previous percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG); group II embracing 22 patients received no CAG examination but all were suffering from old myocardial infarction (MI) evidenced by history and electrocardiography (ECG). All cases underwent Tc-99m MMI planar and single photon emission computed tomography (SPECT) both on intravenous dipyridamole stress and separate day rest tests. Of the 44 group I patients receiving both Tc-99m MMI and CAG, 35 (79.5%) were positive and 7 (16%) were negative by both tests and another 2 (4.5%) were positive by CAG only. Of those positive by both tests, 21 (60%) suffered from identical coronary arterial involvement, including 13 one-vessel disease, 5 double-vessel disease and 3 triple-vessel disease. Of group II patients, 14 suffered from old inferior wall (IW) MI, 6 from old anterior or anteroseptal wall (AW) MI, 1 from old lateral wall (LW) MI and another 1 from combined old anterior and lateral wall (ALW) MI by ECG. Of the 14 patients with IWMI by ECG, all suffered from right coronary artery (RCA) disease but 7 (50%) of them from multivessel disease (MVD) by Tc-99m MMI. 5 of the 6 patients with AWMI by ECG suffered from left anterior descending coronary artery (LAD) disease, but 3 of them from MVD by Tc-99m MMI. Both patients with LWMI and ALWMI by ECG suffered from triple-vessel disease by Tc-99m MMI. The sensitivity of Tc-99m MMI in detecting CAD in group I was 95%, the specificity was 100%. The sensitivity for detection of individual coronary artery disease in LAD, left circumflex coronary artery (LCX) and RCA was 96%, 45% and 89% in this order and the respective specificity was 94%, 100% and 88%. In group II the sensitivity was 95%. The overall sensitivity of intravenous dipyridamole Tc-99m MMI for detection of CAD in groups I and II was 95%; specificity was 100% and accuracy was 95%. In conclusion, stress Tc-99m MMI using intravenous dipyridamole is a valuable method for evaluation and detection of CAD.

The Study on the Formulation of a Tc(V)-99m-DMS Lyophilized Instant Kit for Tumor Scintigraphy

The Tc(V)-99m Dimercaptosuccinate (DMS) as a tumor seeking agent has been studied by several laboratories. The published preparation methods were either in situ complexation or two step constitution of commercial renal imaging kit. A new formulation of lyophilized instant kit for one step preparation of Tc(V)-99m DMS complex has been developed in this study. High labeling yield (over 95%) and good shelf stability of the kit were obtained in our laboratory by investigating the formulation of Tc-99m complexes with radio-TLC, electrophoresis and HPLC methods. The results of clinical trial showed the superiority of scintigraphy for diagnosis of bone tumors, soft-tissue tumors and their malignant metastases.