Wen-Chieh Wu

Younger hepatocellular carcinoma patients have better prognosis after percutaneous radiofrequency ablation therapy.

Goals: To evaluate the impact of age on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). Background: Whether age plays an important role in the outcomes of HCC after RFA remains controversial. Study: Two hundred fifty-eight consecutive treatment naive HCC patients who underwent RFA were enrolled. Patients aged ⩽65 years (n=100) were defined as the younger group and those aged >65 years (n=158) were the elderly group. Their clinicopathologic features and prognosis were compared. Results: Younger patients had a higher male-to-female ratio, higher prevalence of hepatitis B virus, and smaller tumor size than elder patients. After median follow-up of 28.5±18.7 months, 45 patients died. The cumulative 5-year survival rates were 81.3% and 65.4% in younger and elder HCC patients, respectively (P=0.008). Multivariate analysis disclosed that age >65 years, serum albumin level ⩽3.7 g/dL, prothrombin time international normalized ratio >1.1, &agr;-fetoprotein (AFP) >20 ng/mL, and no antiviral therapy after RFA were independent risk factors associated with poor overall survival. Besides, there were 163 patients with tumor recurrence after RFA. Multivariate analysis showed that age >65 years, platelet count ⩽105/mm3, AFP >20 ng/mL, multinodularity, and tumor size >2 cm were the independent risk factors predicting recurrence. Conclusions: Both liver functional reserve (serum albumin level, prothrombin time international normalized ratio, platelet count, and antiviral therapy) and tumor factors (tumor size, number, and AFP level) were crucial in determining post-RFA prognosis in HCC patients. Moreover, younger HCC patients have better overall survival and lower recurrence rate after RFA compared with elder patients.

Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects

The sensitivity of current upper limit of normal (ULN) of serum alanine aminotransferase (ALT) levels for detecting chronic liver disease has been challenged recently.

Application of serologic assays for diagnosing acute hepatitis E in national surveillance of a nonendemic area.

Variant performance of immunoglobulin M (IgM) and immunoglobulin G (IgG) hepatitis E virus (HEV) assays may impact the diagnosis. The present study aimed to evaluate four different IgM/IgG assays for HEV infection for application in national surveillance in nonendemic areas. Sera from 300 patients that were stored in the Centers for Disease Control (CDC) of Taiwan for suspected acute HEV infection from 2004 to 2008, and 18 serum samples from acute cases of HEV infection in Taipei Veteran General Hospital were evaluated. Performances of EIAgen HEV IgG/M (Adaltis, Bologna, Italy), recomWell HEV IgG/M (Mikrogen, Neuried, Germany), MP HEV IgG/M (MP Biomedicals, Singapore), and in‐house kits, HEVLPs (HEV virus‐like particles) IgG/M were compared. Positive results of serum RNA detected by reverse transcription‐polymerase chain reaction were defined as the definite diagnosis. There were five genotype 1, one genotype 3, and nine genotype 4 HEV samples. The four different IgM/IgG assays had excellent performance in terms of negative predictive value (98.4–100%) and varying performance in relation to sensitivity (66.7–93.3%) and specificity (62.9–95.6%). RecomWell IgM had the best overall performance. In addition, the combination of anti‐HEV IgM ELISA with anti‐HEV IgG or another anti‐HEV IgM ELISA provided better screening performance, especially the recomWell IgM and HEVLPs IgM combination (area under the receiver operating curve: 0.94; sensitivity: 100%, specificity 88.1%). In conclusion, anti‐HEV IgM ELISA is a good screening test for the national surveillance of acute HEV infection in nonendemic areas and not limited by inconsistent performances of sensitivity and specificity among different assays. J. Med. Virol. 86:720–728, 2014.

Prognostic significance of computed tomography scan-derived splenic volume in hepatocellular carcinoma treated with radiofrequency ablation.

Goals: To evaluate the clinical implication of splenic volume measured by computed tomography (CT) scan in hepatocellular carcinoma (HCC) patients undergoing percutaneous radiofrequency ablation (RFA). Background: Splenomegaly is an important sign of portal hypertension and poor liver function in patients with advanced liver disease. But whether it could predict the prognosis of patients with HCC is still obscure. Study: We enrolled 161 treatment-naive HCC patients. Splenomegaly was defined as splenic volume >300 mL by CT scan and its impact on prognosis was analyzed. Moreover, noninvasive serum markers were validated to predict splenomegaly. Results: A total of 78 patients were with splenomegaly, while the remaining 83 patients had normal splenic volume at the time of receiving RFA. After a median follow-up of 38.1±20.8 months, 41 patients died. The cumulative 5-year survival rates were 54.8% and 77.8% in patients with splenomegaly and in those with normal splenic volume, respectively (P=0.003). By multivariate analysis, age 65 years and older, serum albumin levels ⩽3.5 g/dL, and splenic volume >300 mL were independent risk factors associated with poor overall survival after RFA. For predicting splenomegaly by noninvasive serum markers, platelet count yielded the highest area under the curve from corresponding receiver operating curves with a level of 0.868 at a cut-off value of 11,7000/mm3. Conclusions: HCC patients with splenomegaly measured by CT scan have relatively poorer liver functional reserve than those with normal splenic volume. Splenomegaly is an independent risk factor predicting overall survival for patients with small HCC undergoing RFA.

Second primary cancers in patients with hepatocellular carcinoma: a nationwide cohort study in Taiwan

There has been no large‐scale population‐based study on the incidence and clinical manifestations of second primary cancer (SPC) after diagnosis of hepatocellular carcinoma (HCC).

Wandering abdominal pain due to a floating gallbladder

Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

Uterine cervical squamous cell carcinoma with duodenal metastasis causes obstructive jaundice

This 73‐year‐old female had undergone right middle lobe lobectomy for adenocarcinoma of lung (pT2N0M0) and got cured without recurrence. However, two years later, she was diagnosed as another cancer, uterine cervical squamous cell carcinoma (the International Federation of Gynecology and Obstetrics stage IIB), and received a series of concurrent chemoradiotherapy (CCRT). After 6 months of CCRT, she was admitted due to abdominal pain and nausea for one week. Physical examination disclosed mild epigasrtic tenderness and icteric sclera. Upper gastrointestinal endoscopy showed friable mucosa and narrowed lumen over the 2nd portion of duodenum, and the result of biopsy confirmed metastatic carcinoma of uterine cervix by positive for P16 immunohistochemically. Moreover, abdominal computed tomography (CT) scan disclosed increased infiltrative soft tissue at pancreatic head, uncinate process, pancreaticoduodenal groove, with eccentric thickening of the wall of bulb to 1st – 2nd portion of duodenum. The diagnosis was made as uterine cervical squamous cell carcinoma with duodenal metastasis and intestinal obstruction. The patient received supportive care. However, she died due to sepsis about one month later. Small intestinal neoplasm is rare and adenocarcinoma is more prevalent than other types of tumors. Common metastatic sites of uterine cervical cancer are the liver, lung, and bone marrow. Small intestine metastasis is found only in about 1.5 – 5.3% of patients with uterine cervical carcinoma beyond stage IIA. The presentation of patients with duodenal metastasis varies from epigastric pain, upper gastrointestinal hemorrhage to intestinal obstruction. Diagnosis is difficult and dependent on high alert of clinical physicians.

Low air temperature increases the risk of oesophageal variceal bleeding: a population and hospital‐based case‐crossover study in Taiwan

Studies concerning seasonal variations and the impact of air temperature on oesophageal variceal bleeding have yielded conflicting results. We aimed to explore the impact of air temperature on the occurrence of variceal bleeding.

Healthy Chinese with benign pancreatic hyperenzymemia

Benign pancreatic hyperenzymemia, or Gullos syndrome, is an uncommon syndrome characterized by a long-term increase of serum pancreatic enzyme in the absence of pancreatic diseases. It is primarily discovered incidentally and occurs in either sporadic or familial form. Herein, we report the first case of benign pancreatic hyperenzymemia in Taiwan. A 57-year-old Chinese male was incidentally noted with elevated serum amylase and lipase levels during a health check-up and was diagnosed with benign pancreatic hyperenzymemia using a series of image and serological tests. Although this is the first case of benign pancreatic hyperenzymemia in Taiwan, its prevalence may be underestimated due to the diagnostic difficulties. Correct diagnosis of this disease is important to avoid costly test duplication, unfounded anxieties, and multiple consultations.