Tumor metastasis to the pancreas is a rare but recognized cause of acute pancreatitis. Autopsy series have reported a 24-40% of pancreatic involvement in small cell lung cancer. However, only a very ...few cases of tumor-induced acute pancreatitis have been described. Budd-Chiari syndrome complicating lung cancer is a rarely reported condition. We report a 68-year-old woman with extensive small cell lung cancer with the unusual initial presentation of both acute pancreatitis and acute Budd-Chiari syndrome. This patient suffered from progressive epigastralgia for 3 weeks. Severe epigastralgia with radiation to back and progressive jaundice developed 2 days prior to admission. After admission, the liver enlarged rapidly and the ascites increased markedly. Chest roentgenogram showed a mass lesion over the left lower lung field. Poorly differentiated carcinoma cells were found in ascites and bone marrow. The patient died on the ninth day of hospitalization before chemotherapy was initiated. Prompt diagnosis of extensive-stage small cell lung cancer may allow early chemotherapy treatment which favorably influences recovery when the pancreatitis is mild. Although prolonged survival might have been expected had this patient recovered from pancreatitis and received chemotherapy, diagnosis was delayed due to difficulty in immunohistochemical diagnosis of the tumor and the unusual clinical presentation. The use of stains employing antibodies against neurofilament and neuron-specific enolase cell antigens is important for early diagnosis of poorly differentiated metastatic tumor cells.
Background: Mouth washing is often mentioned as a possible method to eliminate the interference of urease activity in the oral cavity before the 13C‐urea breath test (UBT). However, the effectiveness ...of mouth washing prior to testing has not been demonstrated clearly in the literature. Thus, the present study was designed to examine the consistency of the 13C‐UBT and the effects of mouth washing on it.
Methods: A total of 101 healthy volunteers underwent the 13C‐UBT three times. The first and second tests used a standard protocol and collected samples at 5, 10, 15 and 30 min. In the third test, the procedure was the same except that mouth washing was omitted.
Results: We used 5 permil (‰) as the cut‐off value and there were 21 (20.8%) positive cases. The κ values for the samples collected at 5, 10, 15 and 30 min between the first and second tests were 0.68, 0.97, 1 and 1, respectively, and all showed good consistency, except for the sample collected at 5 min. Judging from the mean value of the 13C enrichment of the first and second tests (with mouth washing) and the third test (without mouth washing), 50 (63.3%), 15 (18.8%), 0 and 0 cases at 5, 10, 15 and 30 min, respectively, changed from negative to positive. There were 14 (17.5%) and six (7.5%) cases at 15 and 30 min, respectively, whose 13C enrichment changed from less than 3 (negative) to between 3 and 5 (border zone).
Conclusions: These results indicate that mouth washing had an important effect on samples obtained at 5 and 10 min, while this influence decreased at 15 min and was lowest at 30 min.
To elucidate the role of p53 mutation in hepatocarcinogenesis in Taiwan, a hepatitis B viral infection hyperendemic area, exons 5 to 8 of the p53 gene in the tumor tissue of 61 hepatocellular ...carcinomas were amplified and sequenced. A total of 20 cases (32.8%) were found to have mutations; 36.6% (15 of 41) for the hepatitis B surface antigen positive group and 25.0% (5 of 20) for the hepatitis B surface antigen negative group. The corresponding normal liver showed no mutation. The mutation is widely distributed throughout exons 5 to 8. Only 4 cases (6.6%), all positive for hepatitis B surface antigen, had a specific hot spot mutation at codon 249 with G to T transversion. Our results show that scattered point mutations in p53 are not uncommon in hepatocellular carcinoma samples from Taiwan and may be important in the development of this cancer. However, the aflatoxin related specific mutation seems much less related to the genesis of hepatocellular carcinoma in Taiwan.
The sequential variations of amino acid sequences in the hypervariable region (HVR)-l of hepatitis C virus (HCV) and changes of viremia in 2 patients with different clinicopathologic courses of ...chronic hepatitis C were studied. By using polymerase chain reaction amplification, cloning, and sequencing of HVR-l, genetic heterogeneity of HCV was shown. The highest annual rate of consensus amino acid variation per 100 sites in HVR-l of a patient with acute exacerbation was 15.4 versus 2.3 in a patient without acute exacerbation. The serial serum HCV titers were also quantified. An abrupt elevation of serum titer was associated with acute exacerbation, whereas constant viremia was observed when acute exacerbation did not occur. These results show that a quasispecies of HCV exists and patients with different courses of chronic hepatitis may have different sequential changes in virus titer and genetic drift of HVR-1.
In a prospective study of posttransfusion hepatitis, 14 patients who were diagnosed with posttransfusion hepatitis C were enrolled randomly for the study of hepatitis C virus (HCV) RNA in saliva. ...Saliva and serum samples were collected on the same day. Spouses of 11 married patients were also tested for anti-C100 and HCV RNA. Paired serum and saliva samples were tested for HCV RNA by a nested polymerase chain reaction (PCR). Two primer pairs specific for the non-coding region of HCV were used for the PCR and a oligonucleotide sequence between the primers was used as the probe for Southern hybridization. Six patients were positive for HCV RNA by first round PCR amplification and an additional four patients were detected after second round PCR. All patients were negative for HCV RNA in saliva after first round PCR, while seven were positive after second round PCR amplification. All seven patients were positive for HCV RNA in paired serum samples. HCV RNA was detectable in saliva from 1 week to 38 months after the onset of hepatitis. All spouses were negative for anti-C100 and HCV RNA. We conclude that HCV RNA is present in the saliva of approximately half of patients with acute and chronic hepatitis C, and the presence of HCV RNA correlates with HCV viremia. The efficiency of HCV transmission is low among spouses.
Plasma samples from 206 volunteer blood donors were tested for hepatitis B virus (HBV) DNA by dot blot hybridization and polymerase chain reaction (PCR). All donors were negative for hepatitis ...Bsurface antigen (HBsAg) and had normal serum alanine aminotransferase levels.None of the 206 plasma samples was positive for HBV DNA by dot blot hybridization assay. However, nine samples were positive for HBV DNA by PCR using two primer pairs specific for surface and core regions. Nine persons received the HBV-DNA-positive plasma, and one developed posttransfusion non-A, non-B hepatitis; the others remained well 6 months later. Therefore, rv 4% of blood donors in Taiwan have low titers ofHBV DNA, and a more sensitive method to screen donors may beneeded in the future, although the current serologic test remains the most practical at present.
The growth rate of 31 asymptomatic hepatocellular carcinomas (diameter less than or equal to 5 cm) discovered in 28 patients by a prospective screening program was determined by real-time ...ultrasonography over 36-860 days. Except for one tumor that shrank on follow-up, the doubling time ranged from 29 to 398 days, with a median of 117 days, an arithmetic mean of 136 days, and a geometric mean of 110 days. In 17 tumors with more than two measurements, the growth rate remained exponential in nine, declined in growth in seven, and showed an initial lag period in one. Doubling time correlated with initial tumor diameter but was independent of the patient's age, sex, hepatitis B surface antigen status, tumor location, liver function tests, stage of liver cirrhosis, histologic type, or grade of malignancy. Although initial alpha-fetoprotein levels did not correlate well with growth rate, in 14 patients with an exponential increase of serum alpha-fetoprotein, the alpha-fetoprotein doubling time was closely related to the tumor doubling time. Based on the above data, the median detectable subclinical period of hepatocellular carcinoma was deduced to be 3.2 yr, and the suitable screening interval for its early detection in our area was 4-5 mo.
The existence of four genotypes of hepatitis C virus (HCV)--types 1a, 1b, 2a, and 2b--has been suggested based on variations in nucleotide sequences of the core region. The aim of this study was to ...investigate the prevalence of HCV genotypes in chronic type C liver disease in Taiwan and correlate distinct genotypes to severity of liver disease. The genotypes of 175 patients with chronic type C liver disease were determined by a polymerase chain reaction with type-specific primers. The prevalence of each genotype in Taiwan was as follows: type 1a, n = 1 (0.6%); 1b, n = 125 (71.4%); 2a, n = 21 (12%); 2b, n = 6 (3.4%); mixed types, n = 18 (10.3%); and unclassified, n = 4 (2.3%). The demographic and clinical features were comparable between patients with different genotypes, except that the mean peak serum transaminase levels of patients with double viruses and type 1b HCV infections were significantly higher than were those of patients with type 2a virus. Moreover, type 1b HCV was more prevalent in patients with liver cirrhosis alone or with hepatocellular carcinoma. In conclusion, type 1b virus is the predominant genotype in chronic hepatitis C in Taiwan, and type 1b virus and mixed infection may trigger more severe liver disease.
For early detection of hepatocellular carcinoma (HCC), real‐time ultrasonography (US) was performed prospectively in 528 patients, including 236 with cirrhosis, 81 with chronic hepatitis, 168 ...asymptomatic hepatitis B surface antigen carriers, and 43 with a family history of HCC. Simultaneous measurement of serum alpha‐fetoprotein (AFP) level was also done. In addition, 233 patients had regular controls at 3‐ to 6‐month intervals, with an average follow‐up period of 1.4 years. On initial screening, a total of 17 patients were found to have HCC: 13 in the cirrhotic group, 3 in the HCC family group, and 1 in the asymptomatic carriers. Of these HCCs, 7 were smaller than 3 cm, 6 were between 3 to 5 cm, and 4 were larger than 5 cm. In patients with tumors smaller than 5 cm, the AFP levels were normal in 46.2%, between 20 to 400 ng/ml in another 46.2%, and only 7.6% were over 400 ng/ml. On follow‐up, another seven patients, all in the cirrhotic group, were found to have HCCs varying from 1.6 to 4.7 cm; three of them had normal serum AFP level. The authors conclude that real‐time US is more sensitive than AFP assay in early detection of HCC, and the high‐risk subjects should receive this procedure at regular intervals.
The predictive value of gastroesophageal reflux disease (GERD) symptoms for erosive esophagitis is controversial. This study evaluated the sensitivity of heartburn and acid regurgitation as ...indicators of erosive esophagitis in Taiwanese.
Data collected from 521 consecutive health check-up participants who received panendoscopy and completed a self-administered questionnaire for GERD were analyzed. A classification system was used based on the presence of typical symptoms (heartburn or acid regurgitation) experienced 1 or more times per week (I), less than once per week, but more than once per month (II), and in the past (III), and in subjects free of typical symptoms, comprised those with atypical symptoms (IV), extraesophageal symptoms (V), both atypical and extraesophageal symptoms (VI), and lack of all of the above symptoms (VII). The Los Angeles classification was used for the endoscopic assessment of erosive esophagitis.
The sensitivity, positive predictive value (PPV), and specificity of criteria I+II were 30.5%, 32%, and 78.9%, respectively, for erosive esophagitis in Taiwanese. Inclusion of symptoms in category III increased sensitivity by 13.3%. Combined symptoms in categories IV+V+VI had the highest negative predictive value of 85.5% and a fair specificity of 73.8% for those free of typical symptoms. In the overall classification system, the combination of symptoms in categories IV+V+VI increased sensitivity by 17.9 to 61.7%, and decreased specificity by 26.3 to 40.4%. The most specific indicator was symptoms in category I (with a PPV of 45% for erosive esophagitis in symptomatic patients). About two-fifths (38.3%) of patients with erosive esophagitis had none of the symptoms in the classification system.
Heartburn and acid regurgitation are insensitive predictors of erosive esophagitis in Taiwanese. Step-wise addition of previous typical symptoms, currently atypical and extraesophageal symptoms to the "heartburn and acid regurgitation" criterion can greatly increase sensitivity, but endoscopy remains the method of choice to detect erosive esophagitis.
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