Min-Ho Huang

Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan : Metabolic significance of nonalcoholic fatty liver disease in nonobese adults

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) is rarely reported in Taiwan. Goals To determine the prevalence and risk factors of NAFLD in an adult population of Taiwan. Study The cross-sectional community study examined 3245 adults in a rural village of Taiwan. The diagnostic criteria for NAFLD included no excessive alcohol intake, no chronic viral hepatitis, no known etiologies of liver disease, and ultrasonography consistent with fatty liver. Results The prevalence of NAFLD was 11.5% (372/3245). The risk factors for NAFLD in the general population were male sex [odds ratio (OR), 1.44; 95% confidence interval (CI), 1.09-1.90], elevated alanine aminotransferase (ALT) (OR, 5.66; 95% CI, 3.99-8.01), obesity (OR, 7.21; 95% CI, 5.29-9.84), fasting plasma glucose ≥126 mg/dL (OR, 2.08; 95% CI, 1.41-3.05), total cholesterol ≥240 mg/dL (OR, 1.50; 95% CI, 1.06-2.13), triglyceride ≥150 mg/dL (OR, 1.76; 95% CI, 1.32-2.35), and hyperuricemia (OR, 1.53; 95% CI, 1.16-2.01). Age ≥65 years was inversely related to NAFLD (OR, 0.53; 95% CI, 0.36-0.77). The only NAFLD risk factors among nonobese subjects were age between 40 and 64 years (OR, 2.35; 95% CI, 1.34-4.11, P=0.003), elevated ALT (OR, 15.45; 95% CI, 8.21-29.09, P<0.001), and triglyceride ≥150 mg/dL (OR, 2.48; 95% CI, 1.42-4.32, P=0.001). In subjects with NAFLD, the prevalence of elevated ALT in the presence of each metabolic risk factor, such as obesity, fasting plasma glucose ≥126 mg/dL, total cholesterol ≥240 mg/dL, triglyceride ≥150 mg/dL, and hyperuricemia, did not differ from that of subjects with normal ALT levels. Conclusions NAFLD is closely associated with elevated ALT, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and hyperuricemia. Among the metabolic disorders, only hypertriglyceridemia was related to NAFLD in nonobese subjects. Serum ALT level was not a good predictor of metabolic significance in subjects with NAFLD.

Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis

OBJECTIVES:Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) for the treatment of hepatolithiasis is particularly suited for those patients who are poor surgical risks or who refuse surgery and those with previous biliary surgery or stones distributed in multiple segments. However, hepatolithiasis is characterized by high rates of treatment failure and recurrence. We examined the long-term results of 245 patients with hepatolithiasis treated by PTCSL.METHODS:This was a retrospective study of 245 patients who underwent PTCSL for hepatolithiasis; the patients were followed for 1–22 yr to evaluate the immediate and long-term results. Sonography was used to search for stone recurrence every year or whenever the patients presented symptoms suggestive of cholangitis. Cholangiography and/or CT were performed to verify recurrence.RESULTS:PTCSL achieved complete clearance of hepatolithiasis in 209 patients (85.3%); the rate of incomplete clearance was higher in patients with intrahepatic duct stricture (29/118, 24.6% vs 7/127, 5.5%; p = 0.002). The rate of major complications was 1.6% (4/245) and included liver laceration (n = 2), intra-abdominal abscess (n = 1), and disruption of the percutaneous transhepatic biliary drainage fistula (n = 1). The overall recurrence rate of hepatolithiasis and/or cholangitis was 63.2%. The absolute rate of stone recurrence was not significantly related to the presence of intrahepatic duct stricture (51/89, 56.2% vs 53/120, 44.4%; p = 0.08), although the median time to recurrence was less in those with stricture (11 vs 18 yr; p = 0.007). In the patients without intrahepatic duct stricture, the rate of complete stone clearance was not related to the presence of dilation (34/38, 89.5% vs 86/89, 96.6%; p = 0.196), but the recurrence rate was higher in those with dilation (20/34, 58.8% vs 33/86, 38.4%; p = 0.042). Among the 209 patients with a successful initial PTCSL, the incidence of recurrent cholangitis or cholangiocarcinoma was significantly higher in those with incompletely removed recurrent hepatolithiasis than in those without coexisting hepatolithiasis (44.3%, 27/61 vs 16.2%, 24/148; p < 0.001 and 6.6%, 4/61 vs 0.7%, 1/148; p = 0.026).CONCLUSIONS:PTCSL is a relatively safe and effective procedure for treating hepatolithiasis. Long-term follow-up is required because the overall recurrence rate of hepatolithiasis and/or cholangitis is high. The rate of complete stone clearance and the median time to stone recurrence are less in the presence of stricture, but the absolute rate of stone recurrence is not significantly related to stricture. In the absence of stricture, the rate of stone recurrence is higher in patients with dilated intrahepatic duct. Complete stone clearance is necessary, because the incidence of recurrent cholangitis or cholangiocarcinoma is higher in patients with incomplete clearance of recurrent hepatolithiasis.

Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan

Background:  The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population‐based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed.

Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey

Background and Aims:  The aim of this study was to determine the prevalence and risk factors of gallstone disease (GSD) in an adult population of Taiwan through a population‐based screening study.

Percutaneous trans-hepatic cholangioscopy and lithotripsy in the treatment of intrahepatic stones: a study with 5 year follow-up

BACKGROUND Intrahepatic stones are characterized by high treatment failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but surgical intervention may not be feasible in previously operated patients or those classified as poor surgical risks. The development of percutaneous trans-hepatic cholangioscopy and lithotripsy has played an important role in the treatment of these patients. METHODS We reviewed our results in 165 patients with intrahepatic stones treated by percutaneous trans-hepatic cholangioscopy and lithotripsy in the past 12 years. RESULTS The rate of complete stone removal was 80% (132 cases) and the rate of recurrent biliary stones after a mean 58 month follow-up interval was 32.6% (43 of 132 cases). There were 2 deaths during the treatment period and 10 deaths during follow-up. CONCLUSIONS Percutaneous trans-hepatic cholangioscopy and lithotripsy are good alternatives in treating primary intrahepatic stones, especially for those patients unsuitable for surgery.

Comparison of robot-assisted laparoscopic adrenalectomy with traditional laparoscopic adrenalectomy - 1 year follow-up

BackgroundLaparoscopic adrenalectomy offers distinct benefits to patients and has now become the gold standard for the removal of adrenal lesions. Nonetheless, the procedure poses a challenge for surgeons in regards to the maneuverability of instruments, the two-dimensional operating field and the counterintuitive movements. This study reports our experience using the Zeus robotic surgical system in laparoscopic adrenalectomy compared with traditional laparoscopic adrenalectomy.Patients and MethodsFrom January 2003 to February 2005, a total of 12 patients were prospectively enrolled to receive robot-assisted laparoscopic adrenalectomy (RALA) or traditional laparoscopic adrenalectomy (TLA). The time necessary for robotic setup and operation was recorded, as well as complications, technical problems, postoperative hospital stay, morbidity, and mortality.ResultsFive RALA procedures and seven TLA were successfully completed. There was no significant difference between the groups in terms of age, body mass index, and tumor size. Resection times were longer in the RALA group (168.0 ± 30.7 min vs. 131.4 ± 29.0 min, p = 0.05). There were no perioperative complications. There was neither postoperative mortality nor morbidity at the time of discharge and during one year follow-up.ConclusionsRALA is as safe and technically feasible as TLA, It provides a real benefit for the surgeon with the three dimensional view, a comfortable sitting position, the elimination of the surgeon’s tremor, and increased degrees of freedom of the operative instruments compared with TLA. However, patient outcomes and operative costs should be evaluated further.

Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis

BackgroundA review of the literature pertaining to percutaneous transhepatic cholangioscopic lithotomy (PTCSL) showed that more than 50% of reported patients had undergone earlier biliary surgery.MethodsA retrospective study investigated 74 patients undergoing initial PTCSL for hepatolithiasis who had undergone no prior biliary surgery or manipulation. The patients were followed for 1 to 23 years after PTCSL for effective evaluation of the procedure outcome.ResultsComplete clearance of hepatolithiasis was achieved for 61 (82%) patients. The incomplete clearance rate was higher for patients with intrahepatic duct stricture (11/37 [30%] vs 2/37 [5%]; p < 0.05), although it showed no relation to the actual lobar distribution of hepatolithiasis (left: 7/41 [17%] vs right: 2/11 [18%] vs bilateral: 4/22 [18%]; p < 0.05). The recurrence rate for hepatolithiasis also was higher for patients with intrahepatic duct stricture (18/26 [69%] vs 13/35 [37%]; p < 0.05), but the recurrence rate showed no relation to the lobar distribution of hepatolithiasis (left: 18/34 [53%] vs right: 4/9 [44%] vs bilateral: 9/18 [50%] p > 0.05) or the presence of gallbladder stones (5/12 [42%] vs 26/49 [53%]; p > 0.05). Patients showing the coexistence of retained or recurrent hepatolithiasis demonstrated a higher incidence of recurrent cholangitis (57% [13/23] vs 14% [7/51]; p < 0.01) or cholangiocarcinoma (17% [4/23]) vs 0% [0/51]; p < 0.01).ConclusionsThe findings show that PTCSL is effective for treating primary hepatolithiasis, and that complete stone clearance is mandatory to diminish the sequelae of hepatolithiasis. Intrahepatic duct stricture was the main factor contributing to incomplete clearance and stone recurrence.

The mechanisms of failure of totally implantable central venous access system: analysis of 73 cases with fracture of catheter.

BACKGROUND Totally implantable access ports are often used for the administration of chemotherapy or prolonged intravenous infusions in patients with cancer. The technique has been well described. However, some complications would happen. The pinch-off-syndrome is one of these complications. We report another presentation of pinch-off-syndrome and how to prevent. METHODS From January 2005 to December 2007, 73 patients of catheter fracture were collected. The duration of Port-A implantation ranged from January 2003 to October 2007. During this period, 3358 port-catheters were implanted. There were three brands of Port-A implanted included 46% BardPort (Bard, Salt Lake City, UT, USA), 42% A Port (Arrow international, Reading, PA, USA) and 12% PORT-A CATH (Deltec, St. Paul, MN, USA). RESULTS The most common clinical presentation was difficulty in injection in 32 cases (43.8%). The incidence of brand C was far lower than brand A and B. The most common site of fracture was at the proximal part (anastomosis between injection port and catheter) in 68 cases (93.2%). The incidence of fracture of Port-A was 6 in 738 (0.81%) in cut-down method; 67 in 2620 (2.56%) in percutaneous subclavian method. Most of the cases (34%) were no more than six months. CONCLUSION The most frequent location of fracture Port-A was in proximal part - anastomosis between injection port and catheter. The cause of easily fracture may be associated with pinch-off-syndrome and design of Port-A. This kind of fracture could be prevented by cut-down method and fixed one stitch in proximal part.

Relation of hepatolithiasis to helminthic infestation

Background and Aim:  The relation of helminthic infestation to hepatolithiasis is a subject of dispute. This case–control study was undertaken to evaluate the prevalence of helminthiasis in hepatolithiasis patients and to compare the clinicopathological features of hepatolithiasis between patients with and without helminthiasis.

Metoclopramide decreases emesis but increases sedation in tramadol patient-controlled analgesia

PurposeTo evaluate the clinical benefits and disadvantages of adding metoclopramide to tramadol for patient-controlled analgesia (PCA).,MethodsForty adult patients, undergoing elective arthroplasties, were recruited into this prospective, randomized, double-blind study. During general anesthesia all patients received 2.5 mg·kg−1 of tramadol as a loading dose at the beginning of wound closure. In the postanesthesia care unit (PACU) patients were randomly allocated to receive PCA containing either 20 mg tramadol + 1 mg metoclopramide per millilitre (n = 20, Group T+M) or tramadol 20 mg per millilitre (n = 20, Group T). The PCA setup was 1 mL/bolus with a lockout interval of five minutes. A blinded investigator assessed the vital signs, visual analogue scale, and severity of postoperative nausea and/or vomiting in the PACU. The PCA demand and delivery, overall satisfaction rate and adverse effects were recorded in the PACU and on postoperative days one and two.ResultsNausea/vomiting scores were more severe (1.7 ± 1.0 vs 0.2 ± 0.5, 2.3 ± 1.2 vs 0.6 ± 0.6, 1.9 ± 0.9 vs 0.2 ± 0.5, at 12 hr, 18 hr, 24 hr, respectively,P < 0.05) and more frequent (7/20 vs 1/20, 5/20 vs 0/20 for nausea and vomiting respectively,P < 0.05) on postoperative day one in Group T compared to Group T+M. However, the incidence of sedation was higher in Group T+ M (7/20 vs 1/20,P < 0.05).ConclusionsThe incidence and severity of nausea/vomiting decreased if metoclopramide was added to tramadol for PCA. An increased incidence of sedation was noticed with this drug combination.RésuméObjectifÉvaluer les avantages et les inconvénients cliniques de l’ajout de métoclopramide au tramadol pour l’analgésie auto-contrôlée (AAC).MéthodeQuarante adultes devant subir une arthroplastie non urgente ont participé à l’étude prospective, randomisée et à double insu. Pendant l’anesthésie générale, tous les patients ont reçu 2,5 mg·kg−1 de tramadol comme dose d’attaque au début de la fermeture de la plaie. Une fois à la salle de réveil (SDR), les patients ont été répartis de façon aléatoire et ont reçu une AAC contenant soit 20 mg de tramadol + 1 mg de métoclopramide par millilitre (n = 20, Groupe T+M), soit 20 mg de tramadol par millilitre (n = 20, Groupe T). L’AAC comportait des bolus de 1 mL et des périodes réfractaires de cinq minutes. Un chercheur impartial a évalué les signes vitaux, les scores de l’échelle visuelle analogique et la sévérité des nausées et des vomissements postopératoires. La demande et la disponibilité d’AAC, le taux de satisfaction générale et les effets indésirables ont été notés à la salle de réveil et les premier et deuxième jours postopératoires.RésultatsLes nausées et les vomissements ont été plus sévères (1,7 ± 1,0 vs 0,2 ± 0,5, 2,3 ± 1,2 vs 0,6 ± 0,6, 1,9 ± 0,9vs 0,2 ± 0,5, à 12 h, 18 h et 24 h, respectivement, P < 0,05) et plus fréquents (7/20 vs 1/20, 5/20 vs 0/20 pour les nausées et les vomissements, P < 0,05), du premier jour chez les patients du groupe T comparé au groupe T+M. Cependant, l’incidence de la sédation a été plus élevée chez ceux du groupe T+M (7/20 vs 1/20, P < 0,05).ConclusionL’incidence et la sévérité des nausées et des vomissements diminuent si du métoclopramide est ajouté au tramadol pour l’AAC. Une incidence accrue de sédation a été notée avec cette combinaison de médicaments.