Tzee-Chung Wu

Cyclic Vomiting Syndrome in Taiwanese Children

BACKGROUND/PURPOSE Cyclic vomiting syndrome (CVS) is a periodic and Stereotypic pattern of intractable nausea or vomiting episodes, which has been well-recognized in previous decades, although the actual pathogenesis is still unclear. Recurrent, discrete, but self-limited symptoms of nausea and vomiting bother children, and increase the cost of family and health care. This report described the clinical features of patients who fulfill the diagnostic criteria for CVS. METHODS This was a retrospective study that reviewed the medical records of children with CVS in our department from 1992 to 2008. The clinical features and results of long-term follow-up of these children were analyzed. RESULTS Twenty-four patients (16 boys and 8 girls) were enrolled in this study. The mean age of onset was 6.8 ± 3.3 years (2.2-15.4 years), and the mean interval from onset to proper diagnosis was 2.1 ± 2.2 years. Comparing initial presentation and latest condition, the duration of attack was 4.1 ± 2.2 days and 0.8 ± 1.4 days, respectively, and the admission/emergency department visit dropped from 2.3 ± 2.0 to 0.6 ± 1.1 times per year. Twenty-three of 24 patients had been treated with amitriptyline, cyproheptadine, or propranolol. Nine patients (38%) had no symptoms in the past 12 months. CONCLUSION The diagnosis of CVS must be based on the detailed history of the clinical manifestations of vomiting pattern, complete symptom-free intervals between the attacks, and absence of neurological, gastrointestinal, or metabolic abnormalities. Most of our patients improve when they grow up, but prompt diagnosis and early intervention may improve quality of life.

Medical treatment of duodenal ulcer: Acid inhibition or Helicobacter pylori eradication?

To ascertain whether acid inhibition or Helicobacter pylori (HP) colonization is the decisive factor in the healing of duodenal ulcer, we treated 54 patients with famotidine and carried out long‐term follow‐up. Helicobacter pylori colonization was found in 70.4% of patients before treatment. There were no differences in the pre‐treatment characteristics between patients with HP positive or HP negative ulcers. The 4‐week and 8‐week healing rates after famotidine treatment were 72.5% and 82.4% respectively. No difference in HP colonization was found between patients with ulcer healed and those with ulcer not healed (78.4%vs 64.3% at 4th week and 77.3%vs 71.4% at 8th week, P > 0.05). In patients with ulcer healed at 4th week, the intragastric pH was raised significantly and the antral acute inflammation was less severe than those with ulcer not healed. Ulcer recurrence was found in 76.9% of patients within 1 year, but there was no difference in ulcer recurrence between the patients with positive or negative HP colonization at the time of ulcer healing. Our results suggest that duodenal ulcer healing and recurrence are closely related to acid inhibition rather than to HP colonization.

Evaluation of Cortical Perfusion in Renal Transplants: Application of Quantified Power Doppler Ultrasonography

Perfusion of renal transplants may be altered by various pathological conditions. This study assessed cortical perfusion of renal transplants during acute rejection episodes using power Doppler quantification. Forty-eight renal transplant patients with clinical indications for biopsy were included in this study. Power Doppler ultrasonography (US) of these renal transplants was performed prior to biopsy. Power Doppler image intensity in the proximal outer cortex of renal transplants was quantified by image analysis software. The results of power Doppler quantification were compared with the clinical data and histological findings. Biopsies were classified into three groups based on Banff diagnostic categories: group 1 (no acute rejection; 26 patients), group 2 (acute cell-mediated rejection alone; 12 patients), and group 3 (acute antibody-mediated rejection with/or without acute cell-mediated rejection; 10 patients). The power Doppler intensity of the outer renal cortex was 1.98 +/- 1.50 dB for group 1, 1.38 +/- 0.86 dB for group 2, and 0.81 +/- 0.66 dB for group 3. Statistically, there was a significant difference between group 1 and group 3 (1.98 vs 0.81 dB, P = .01) but not between group 1 and group 2 (1.98 vs 1.38 dB, P = .34). In conclusion, the status of cortical perfusion of renal transplants can be determined noninvasively by quantified power Doppler US. Accordingly, acute antibody-mediated rejection is associated with significantly decreased cortical perfusion, which, we propose, is due to this distinct pathological process.

An uncommon cause of abdominal pain and diarrhea—gastrinoma in an adolescent

Gastrinoma is a hormone-secreting tumor associated with the Zollinger–Ellison syndrome. It is quite rare among children, and it is also uncommon in locations other than the pancreas and the duodenum in the pediatric group. Here, we describe an adolescent male, presenting with recurrent secretory diarrhea and abdominal cramping pain, who had a solitary gastrinoma in the lesser sac, close to the stomach. The prognosis was good after complete resection.

How to Improve the Positive Predictive Value of Urinary Decoy Cell Surveillance for Polyomavirus BK-Associated Nephropathy in Kidney Transplant Patients

BACKGROUND Polyomavirus BK-associated nephropathy (BKVN) has been a serious problem after kidney transplantation. Detection of urinary decoy cells (UDCs) and assessment of polyomavirus BK nucleic acids by polymerase chain reactions (PCRs) are currently used, noninvasive tests. PCRs have better positive predictive value (PPV) but higher cost and lower accessibility. This study investigated ways to improve the PPV of UDCs for BKVN prediction. METHODS From 2000 to 2013, kidney transplant recipients with sustained UDCs for more than half a month and who had received allograft biopsies were enrolled. We analyzed the PPV of UDCs for BKVN with 2 variables: (i) the percentage changes in serum creatinine (SCr) levels and (ii) the duration of sustained UDCs by receiver operating characteristic (ROC) curve analysis; we predicted the percentage changes in SCr levels with the corresponding PPV using a linear regression model. RESULTS BKVN was diagnosed in 26 of 68 enrolled patients. The percentage changes in SCr levels significantly deteriorated in the BKVN group during 1-2 months of UDC positivity. According to ROC curve analysis, percentage changes in SCr levels had a significant discriminating power for BKVN during 1-1.5 month, and if the percentage changes in SCr levels were >19%, the PPV of UDCs for BKVN was 50%. CONCLUSIONS An UDC surveillance program is a judicious strategy to predict BKVN in kidney transplant patients, particularly when graft renal function shows deterioration after 1 month of UDC positivity.

Helicobacter Pylori Infection in Patients with Gastric Adenocarcinoma

We examined the biologic tumor behavior in Helicobacter pylori-seropositive patients with gastric adenocarcinoma. A total of 214 consecutive patients with pathologically confirmed adenocarcinoma of the stomach who underwent gastric resection were studied. The stored serum samples were tested for serum antibody to H. pylori by using a highly sensitive and specific IgG enzyme-linked immunosorbent assay. The difference in H. pylori-seropositive and seronegative patients with gastric adenocarcinoma was evaluated in terms of various clinicopathologic parameters. A multivariate logistic regression analysis was used to adjust for potential confounding variables. Antibodies to H. pylori were detected in 65.9% of patients with gastric adenocarcinoma. H. pylori-seropositive patients were younger than seronegative patients and had infiltrative tumor according to Mings criteria. When adjusted for age, infiltrative tumor come out stronger. These findings suggest that H. pylori infection may be related to infiltrative type gastric adenocarcinoma; further study is necessary.

Effect of Colloidal Bismuth Subcitrate on Chinese Patients with Duodenal Ulcer: Role of Campylobacter Pylori

Common presence of Campylobacter Pylori in patients with duodenal ulcer usually manifests itself as the etiology of the disease and treatment of duodenal ulcer with colloidal bismuth subcitrate (CBS) may result in ulcer healing and eradication of C. pylori. This study attempted to evaluate the relations among ulcer healing, C. pylori eradication in patients with active duodenal ulcer receiving (CBS) treatment and the remissions of healed ulcer and C. pylori in a short- term follow-up . A total of 59 patients with active duodenal uicer on endoscopy entered this study, they received (CBS)(120mg×4/day) treatment for one month. Ulcer healing was endoscopically evaluated, and unhealed subjects received another one-month (CBS) treatment. Healed patients were follewed endoscopically at 1, 3 and 6 months, after cessation of medication without maintaining therapy. Unhealed or relapsed subjects were excluded. Antral mucosa were obtained to assess C. pylori status using both culture and urease tests by an independent observer. The prevalence of C. pylori in patients with duodenal ulcer was 74.6%. Ulcer healing rate of 79.7% and C .pylori eradicative rate of 79.6% were achieved by CBS treatment. Initial C. pylori status influenced neither with ulcer healing nor with duration of CBS Treatment. However, once C. pylori infection occurred, eradication was essential to ulcer healing when try to heal active DU with CBS. During follow-up, ulcer healing was found in two-thirds of the patients at the 6th month. Neither initial and final C. pylori status nor (CBS) treated course was found to be associated with afterward ulcer relapses. In most cases, the originally eradicated C. pylori reappeared at the 6th month on follow-up (68.1%), whereas, the duration of CBS treatment was not found to be related to the reappearance of C. pylori. These data suggest That C. pylori may be an etiologic factor of duodenal ulcer, however, CBS treatment for duodenal ulcer involves many mechanisms, and C. pylori is not the solely decisive factor for CBS to heal ulcer.