Sheng-Lei Yan

Hepatitis B reactivation in chronic myeloid leukemia patients receiving tyrosine kinase inhibitor

Hepatitis B virus (HBV) reactivation is a well-recognized complication in patients with chronic HBV infection receiving cytotoxic or immunosuppressive chemotherapy. Imatinib mesylate and nilotinib are selective Bcr/Abl tyrosine kinase inhibitors, which are now widely used in the treatment of patients with chronic myeloid leukemia. Although HBV reactivation induced by imatinib mesylate has been reported, nilotinib-related HBV reactivation has not been reported in the English literature. We report here 2 cases of HBV reactivation in chronic myeloid leukemia patients receiving imatinib mesylate and a novel case of nilotinib related HBV reactivation.

Pure red cell aplasia caused by pegylated interferon-α-2a plus ribavirin in the treatment of chronic hepatitis C

Pure red cell aplasia (PRCA) is a rare hematological disorder which is characterized by severe anemia, reticulocytopenia and almost complete absence of erythroid precursors in bone marrow. The pathophysiology of PRCA may be congenital or acquired. To our knowledge, there is only one case report in the English literature of PRCA after pegylated interferon combination therapy for chronic hepatitis C. We report a second case of PRCA after pegylated interferon combination treatment for chronic hepatitis C. The diagnosis of PRCA was confirmed by the typical findings of bone marrow biopsy. The possible etiologies of our case are also discussed in this paper.

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case.

BackgroundHemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.Case presentationA 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm.ConclusionsPseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.

The Relationship between the Methylated Septin‐9 DNA Blood Test and Stool Occult Blood Test for Diagnosing Colorectal Cancer in Taiwanese People

Colorectal cancer (CRC) is a common and lethal disease in the world. There is an increasing number of cases in Taiwan and a higher rate at advanced stages. The immune fecal occult blood test (iFOBT) has been used as a screening method in Taiwan for years. A new novel diagnostic tool, the Methylated Septin‐9 (MS‐9) DNA blood test, had been reported to have high sensitivity and specificity for CRC detection. There are no available data in Taiwan, so we conducted this prospective randomized trial to investigate the relationship among the MS‐9 DNA blood test, iFOBT, and a combination of the two tests for diagnosing CRC in Taiwanese people.

Hepatitis B reactivation in patients receiving targeted therapies

ABSTRACT Objectives: Hepatitis B virus (HBV) reactivation may occur spontaneously, during or after antiviral therapy, or when receiving immunosuppressive chemotherapy. HBV reactivation has also been reported in cancer patients receiving targeted therapies, such as monoclonal antibody and mammalian target of rapamycin (mTOR) inhibitor. This review article is aimed to discuss the issue regarding chronic HBV reactivation in patients receiving targeted therapies, with a special focus on tyrosine kinase inhibitors. Methods: Using MEDLINE search, the literature relevant to hepatitis B reactivation, monoclonal antibody therapy and tyrosine kinase inhibitor was reviewed. Results: HBV-infected patients receiving tyrosine kinase inhibitors (TKIs) may develop HBV reactivation even with resolved HBV infection status. Although the exact mechanism of TKI-induced HBV reactivation remains unclear, off-target immunological effects of TKI may play an important role in contributing to HBV reactivation. Discussion: Further well-designed studies are necessary to find out the incidence and mechanism of HBV reactivation in patients receiving TKIs. Screening, monitoring and prophylaxis or pre-emptive antiviral therapy is mandatory in HBV patients who are going to receive immunosuppressive therapy or targeted therapy. Conclusion: HBV reactivation may occur in patients receiving monoclonal antibodies and TKIs, even with resolved HBV infection status. Although the exact mechanism of TKI-induced HBV reactivation remains unclear, off-target immunological effects of TKI may play an important role in contributing to HBV reactivation.

Pyogenic granuloma of the transverse colon

A 68-year-old woman underwent positron emission DISCLOSURE tomography/CT (PET/CT) for staging of lung cancer. High fluorodeoxyglucose signal (standardized uptake value maximum, 10.48) was identified in the ascending colon (A). Colonoscopy found a whitish, flat elevated lesion with reddish depression (Paris class IIaþIIc) 15 mm in diameter in the ascending colon (B). Magnification colonoscopy demonstrated a type VI high-grade irregularity in the depressed area with a type II–like pit pattern in the flat elevated area, according to Kudo’s classification. According to these endoscopic findings, an early invasive cancer arising from a sessile serrated adenoma/polyp (SSA/P) was suspected. Laparoscopic-assisted right hemicoloectomy was performed, and the pathologic examination demonstrated moderately differentiated adenocarcinoma arising from a sessile serrated adenoma/polyp invading the muscular layer (C). This lesion was considered an adenocarcinoma developing through a serrated neoplastic pathway.

Reticulocyte production index as a predictor of clinically significant anemia in chronic hepatitis C patients receiving pegylated interferon combination therapy

This work was conducted to study the relationship of reticulocyte production index to clinically significant anemia in chronic hepatitis C patients receiving pegylated interferon combination therapy.

Young man, cigarette smoking and abdominal pain: Mesenteric involvement of Buergers disease

Özgür Kurt1, Munkhtsetseg Banzragch2, Christen Rune Stensvold3, Orhan Özcan4 Lee O’Brien Andersen3, Sinem Öktem3 Osman Uğur Sezerman4 1 Acıbadem Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Bilim Dalı, İstanbul 2 Acıbadem Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Gastroenteroloji Bilim Dalı, İstanbul 3 Laboratory of Parasitology, Department of Microbiology and Infection Control, Statens Serum Institute, Copenhagen, DENMARK; 4 Acıbadem Üniversitesi Tıp Fakültesi, Biyoistatistik ve Tıp Bilişimi Ana Bilim Dalı, İstanbul

Effect of Minimally Invasive Surgical Training Center on Laparoscopic Surgery: Observation from Preliminary Results for Primary Stomach GastroIntestinal Stromal Tumor in a Health Care System

Gastrointestinal stromal tumors (GISTs), are different from other mesenchymal tumors by immunohistochemistric biomarkers and are often encountered in the alimentary tract and less commonly originating from omentum, mesentery and peritoneum. They usually present as subepithelial tumors in the gastrointestinal tract or intraabdominal masses with malignant potential. The tumors might cause symptoms such as pain, intraluminal or extraluminal GI tract bleeding and obstruction but might also present as incidental findings. Gastroscopy, Ultrasonography and CT scan are employed for preoperative evaluation. The surgical principles are to excise the tumor with safe margin microscopically. Minimally invasive procedures are revolutionary innovation in surgery. Asian Institute of TeleSurgery training center is established in mid Taiwan in 2008 with the cooperation between Show Chwan Health Care System and European Institute of TeleSurgery in Strasbourg, France. We retrospectively reviewed 24 primary stomach GISTs operated at our institution in the past four years. The patients were divided into laparoscopy group (18 patients) and laparotomy group (6 patients) depending on the main surgical methods. The patients’ age, gender, hospital stay, operative time, blood loss, tumor size and complication rate were used for stastical analysis. There were significant differencesin tumor size and blood loss between the two groups with a p value of less than 0.05. In the past 4 years, 75% of primary gastric GISTs in our hospital were managed by laparoscopic surgery. Our experience showed that laparoscopic surgery is feasible for primary stomach GISTs in selective cases.

Benign Biliary Stricture Managed with Gianturco-Rosch Z Self-Expanding Metalic Stent

Introduction: Benign biliary stricture is an usual complication of biliary tract surgery or hepatolithiasis and frequently caused cholangitis attacks. Benign biliary stricture treated with percutaneous transhepatic cholangiography and drainage (PTCD) had good transient effect but the recurrent rate is high. Metallic stent used for the stricture is controversial in the past but we got good results according to 17 years experience of using metallic stents in the patients. We report the successful management of benign biliary tract strictures with metallic stent placement. Patients and Methods: We reviewed the medical records retrospectively from November 1991 through November 2008 and found 11 patients with postoperative or hepatolithiasis-related bile duct strictures that did not sustaining respond to PTCD. The group consisted of four men and seven women (mean age, 51 years; range, 31-80 years). Gianturco-Rosch Z (GRZ) self-expanding metallic stents were placed in these patients. Patients were monitored with regular abdominal ultrasonography and cholangiography for a mean of of 69 months (range from 19 months to 201 months) postoperatively. Results: The success rate of metallic stent insertion into the stricture site was 100% (11/11). The recurrence rate of biliary tract obstruction after stent placement was 18% (2/11). Nine patients underwent successful initial stent placement without recurrence of stenosis. Two patients in whom the GRZ stents were removed got recovered. Conclusion: These 11 patients provide evidence that self-expanding metallic stent placement may be feasible for treatment of biliary stricture among patients with single, benign, biliary tract stricture.