Shou-Chuan Shih

Prenatal diagnosis of cephalothoracopagus janiceps disymmetros using three-dimensional power Doppler ultrasound and magnetic resonance imaging.

We report the prenatal imaging findings of a rare case of cephalothoracopagus janiceps disymmetros diagnosed at 28 weeks gestation. Two‐dimensional ultrasound and magnetic resonance imaging demonstrated janiceps conjoined female twins with a single fused cranial vault, duplicated cerebra, two faces, four eyeballs, a fused thorax, two hearts, two thoracic spines, eight limbs and polyhydramnios. Three‐dimensional and power Doppler ultrasound established the definitive classification of cephalothoracopagus conjoined twins and displayed the shared circulation between the two separate hearts. Copyright

CONGENITAL RICKETS : A PATIENT REPORT

We present a premature newborn with congenital rickets, born to a mother with untreated chronic renal insufficiency. X-ray films showed blurred metaphyseal ends and decreased bone density in the femurs and ribs. With treatment including calcium, phosphate, and vitamin D, her rickets healed and she grew normally.

Investigation of cytotoxic T-lymphocyte-associated protein 4 gene polymorphisms in symptomatic gallstone disease

Gallstone disease (GSD), which is increasingly prevalent in Taiwan, develops through a complex process involving genetic, environmental, and immune factors. Cytotoxic T-lymphocyte-associated protein 4 (CTLA4) limits T-cell proliferation. The present study looked for associations between symptomatic GSD and polymorphisms of the CTLA4 gene. For this case-control cross-sectional study among Taiwanese, 275 patients with symptomatic GSD and 852 controls were enrolled. Genotyping of CTLA4-318 C/T, +49 A/G, and CT60 A/G single nucleotide polymorphisms (SNPs) was performed by polymerase chain reaction-restriction fragment length polymorphism. The genotype, allele, carrier, and haplotype frequencies were calculated by direct counting or with Haploview 4.1 software. Genotype, allele, carrier, and haplotype frequencies of the CTLA4 SNPs studied were equally distributed in symptomatic GSD patients and controls. No significant associations between symptomatic GSD and these 3 SNPs were observed. Our data suggest that CTLA4-318 C/T, +49 A/G, and CT60 A/G SNPs do not confer increased susceptibility to symptomatic GSD.

Gender-specific association of the interleukin 18 gene with symptomatic gallstone disease.

Symptomatic gallstone disease (SGSD) induced several inflammatory responses and affected extrahepatic bile ducts. Although the pathology and environmental risk factors of gallstone disease are well documented, immune or inflammatory responses in SGSD development are still inconclusive. Interleukin 18 (IL18) is a pro‐inflammatory cytokine that plays an important role in immune, infectious, and inflammatory diseases because of the induction of interferon‐γ. In this study, we investigated whether polymorphisms of the IL18 gene were associated with SGSD susceptibility.

The Association between Intestinal Transit Time and Uncertain Significance of Diagnostic Yields in Capsule Endoscopy

Background: Capsule endoscopy is a highly sensitive examination for the detection of small bowel lesions. However, lesions can be missed due to rapid or delayed small bowel transit. The objective of this study was to determine whether the diagnostic yields vary according to intestinal transit times. Methods: In patients with complete small intestinal mucosa evaluation were assessed after negative upper and lower endoscopy, positive findings could be established in twenty-six of 49 cases (53.1%), which included angiodysplasias, active bleeding, ulcers and tumors. The mean intestinal transit time for all patients was 258.3±67.2 minutes. The patients were divided into two groups: faster than mean intestinal transit time (Group Ⅰ) and slower than mean intestinal transit time (Group Ⅱ). The intestinal transit time was analyzed by computerized software SPSS, comparisons between both groups were carried out using x^2 test. Results: The intestinal transit time were 199.6±37.4 minutes in group I and 310.2±38.2 minutes in group Ⅱ. Diagnostic yields were 47.8% in group Ⅰ and 57.7% in group Ⅱ (p=0.69). Conclusion: The diagnostic yields of capsule endoscopy did not significantly increase for group Ⅱ than group Ⅰ. However, the higher diagnostic yield is obtained in patients with slower intestinal transit time.

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.

Esophageal Gastrointestinal Stromal Tumor Presenting as a Mediastinal Mass: A Case Report

Although gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract, it rarely arises from the esophagus and is thus very rarely the cause of a mediastinal mass. We report a case of esophageal GIST presenting as a mediastinal mass in a 59-year-old male. If such a tumor has extremely exophytic growth, it may result in a huge mediastinal mass without causing dysphagia. The CT features of a huge well-demarcated mass with heterogeneous enhancement and extensive central necrosis may mimic that of a primary sarcoma of the mediastinum. Esophageal GIST should be in the differential diagnosis of a mediastinal mass, even if there is little evidence of luminal involvement of the esophagus demonstrated on imaging.

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.