Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease

BACKGROUND/AIMS: With the recent progress in medical treatment, surgery still plays a necessary and important role in treating ulcerative colitis (UC) patients. In this study, we analyzed the surgical results and outcomes of UC in Taiwan in the recent 20 years, via a multi-center study through the collaboration of Taiwan Society of IBD. METHODS: A retrospective analysis of surgery data of UC patients from January 1, 1995, through December 31, 2014, in 6 Taiwan major medical centers was conducted. The patients' demographic data, indications for surgery, and outcome details were recorded and analyzed. RESULTS: The data of 87 UC patients who received surgical treatment were recorded. The median post-operative follow-up duration was 51.1 months and ranged from 0.4 to 300 months. The mean age at UC diagnosis was 45.3±16.0 years and that at operation was 48.5±15.2 years. The 3 leading indications for surgical intervention were uncontrolled bleeding (16.1%), perforation (13.8%), and intractability (12.6%). In total, 27.6% of surgeries were performed in an emergency setting. Total or subtotal colectomy with rectal preservation (41.4%) was the most common operation. There were 6 mortalities, all due to sepsis. Emergency operation and low pre-operative albumin level were significantly associated with poor survival (P=0.013 and 0.034, respectively). CONCLUSIONS: In the past 20 years, there was no significant change in the indications for surgery in UC patients. Emergency surgeries and low pre-operative albumin level were associated with poor survival. Therefore, an optimal timing of elective surgery for people with poorly controlled UC is paramount.

Crystal structures of D-psicose 3-epimerase from Clostridium cellulolyticum H10 and its complex with ketohexose sugars

D-psicose 3-epimerase (DPEase) is demonstrated to be useful in the bioproduction of D-psicose, a rare hexose sugar, from D-fructose, found plenty in nature. Clostridium cellulolyticum H10 has recently been identified as a DPEase that can epimerize D-fructose to yield D-psicose with a much higher conversion rate when compared with the conventionally used DTEase. In this study, the crystal structure of the C. cellulolyticum DPEase was determined. The enzyme assembles into a tetramer and each subunit shows a (β/α)(8) TIM barrel fold with a Mn(2+) metal ion in the active site. Additional crystal structures of the enzyme in complex with substrates/products (D-psicose, D-fructose, D-tagatose and D-sorbose) were also determined. From the complex structures of C. cellulolyticum DPEase with D-psicose and D-fructose, the enzyme has much more interactions with D-psicose than D-fructose by forming more hydrogen bonds between the substrate and the active site residues. Accordingly, based on these ketohexose-bound complex structures, a C3-O3 proton-exchange mechanism for the conversion between D-psicose and D-fructose is proposed here. These results provide a clear idea for the deprotonation/protonation roles of E150 and E244 in catalysis.

Clinical value of non-invasive positive pressure ventilation in the therapy of acute pulmonary edema / 中国综合临床

Objective To investigate the change of HR,RR and arterial blood gas in the treatment of BiPAP ventilation in patients with acute pulmonary.Methods Fifty eight patients with acute pulmonary edema were randomized into two groups.The control group(n =29)were given conventional general treatment only,but treatment group(n =29)were given BiPAP ventilation besides conventional treatment.4 h later,heart rate (HR),respiratory rate(RR),SaO2,pH,PaO2 and PaCO2 were compared between the two groups.Hospitalization duration and incidence of invasive mechanical ventilation were recorded after discharge.Results Compared with pre-treatment,HR,RR,SaO2 and PaO2 in treatment group were improved significantly(HR 124 ± 12 beat/min vs 83 ±6 beat/min,t =5.372,P ＜0.01)(RR 37 ±5 beat/min vs 19 ± 8 beat/min,t =4.285,P ＜0.01)(SaO2 81.4％ ±5.4％ vs94.1％ ±4.2％,t=2.731,P＜0.05)(PaO2 53.2±5.4 mm Hg vs 89.1 ±8.5 mm Hg,t=5.763,P ＜0.O1).And these four indicators were also improved in control group after treatment,(HR 123 ± 10 beat/min vs 95 ± 8 beat/min,t =t =3.459,P ＜ 0.01)(RR 36 ± 7 beat/min vs 24 ± 6 beat/min,t =3.127,P ＜0.01)(SaO2 81.8％ ±5.7％ vs 88.3 ±4.5％％,t =2.314,P ＜0.05)(PaO2 53.5 ±4.6 mm Hg vs 72.8 ±9.5 mm Hg,t =3.756,P ＜0.01).HR,RR,SaO2 and PaO2 in treatment group were more significantly improved than that of control group(P ＜ 0.01 or P ＜ 0.05).Hospitalization duration in treatment group was significantly shorter than that of control group(9 d vs 15 d,t =3.763,P ＜ 0.01).The incidence of invasive ventilation were lower than that of control group too(but P ＞ 0.05.Conclusion These results suggested that BiPAP ventilation can regulate HR RR and blood gas value to accetable levels,shorten hoptipitalization duration and reduce the incidence of invasive ventilation.It is proved to be an effective therapeutic technique in the treatment of acute pulmonary edema patients.

Effect of partial splenic embolization in prevention of gastroesophageal variceal rebleeding / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of partial splenic embolization (PSE) in prevention of gastroesophageal variceal rebleeding.</p><p><b>METHODS</b>Sixty-two patients with recent gastroesophageal variceal bleeding were treated by PSE with Seldinger technique. All the patients were followed-up for 12 months. The data including peripheral blood cell count, liver function, plasma prothrombin time (PT), portal vein diameter, and appearance of gastroesophageal varices under gastroscopy were collected before and after embolization for statistical analysis.</p><p><b>RESULTS</b>Five days after the operation, the numbers of leucocytes and platelets were significantly increased (P<0.05), and PT was significantly shortened (P<0.05). All the patients showed a good response after PSE with reduced internal diameter of the portal vein and blood flow (P<0.05). Gastroesophageal varices were relieved in all the patients. Rebleeding occurred in 11 patients during the follow-up.</p><p><b>CONCLUSION</b>PSE can be effective in preventing gastroesophageal variceal rebleeding.</p>

Omental Actinomycosis Coexisting with Colon Cancer

Actinomycosis is a rare infection caused by Actinomyces species, normal commensal inhabitants of the human bronchial and gastrointestinal tract. Infection occurs after preceding mucosal break-down by variable causes. A preoperative diagnosis is difficult because of its nonspecific clinical features, mimicking malignancy, tuberculosis or other inflammatory diseases. We report a case of abdominal actinomycosis presenting as an omental mass, which coexists with ascending colon cancer. Actinomycosis was diagnosed by histopathologic demonstration of sulfur granules in a specimen resected by laparoscopic exploration. Following surgery, the patient was treated with IV penicillin (20 million IU/day) for 3 weeks, and follow-up colonoscopy showed adenocarcinoma in the ascending colon. The patient underwent right hemicolectomy, then treated with intravenous penicillin for 4 weeks postoperatively and oral penicillin for 6 months. The patient has been free of recurrence for 6 months.

Optimization and Limitation of Calcium Ionophore to Generate DCs from Acute Myeloid Leukemic Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Calcium ionophore (CI) is used to generate dendritic cells (DCs) from progenitor cells, monocytes, or leukemic cells. The aim of this study was to determine the optimal dose of CI and the appropriate length of cell culture required for acute myeloid leukemia (AML) cells and to evaluate the limitations associated with CI. MATERIALS AND METHODS: To generate leukemic DCs, leukemic cells (4 x 10(6) cells) from six AML patients were cultured with various concentrations of CI and/or IL-4 for 1, 2 or 3 days. RESULTS: Potent leukemic DCs were successfully generated from all AML patients, with an average number of 1.2 x 10(6) cells produced in the presence of CI (270 ng/ml) for 2 days. Several surface molecules were clearly upregulated in AML cells supplemented with CI and IL-4, but not CD11c. Leukemic DCs cultured with CI had a higher allogeneic T cell stimulatory capacity than untreated AML cells, but the addition of IL-4 did not augment the MLR activity of these cells. AML cells cultured with CI in the presence or absence of IL-4 showed increased levels of apoptosis in comparison to primary cultures of AML cells. CONCLUSION: Although CI appears to be advantageous in terms of time and cost effectiveness, the results of the present study suggest that the marked induction of apoptosis by CI limits its application to the generation of DCs from AML cells.

Correlation of Decreased Expressions of Claudin 4 and E-cadherin Proteins and the Clinicopathologic Factors of Stomach Cancer

PURPOSE: We examined the expressions of claudin-4 and E-cadherin, which are known as cell adhesion-associated proteins, in stomach cancer. The relationship of their expression with the clinicopathologic factors was examined to investigate the roles of these proteins in the invasion or metastasis of stomach adenocarcinoma. METHODS: The expressions of claudin-4 and E-cadherin were examined in 73 cases of adenocarcinoma of the stomach by performing immunohistochemical staining. RESULTS: The expressions of claudin-4 and E-cadherin in the stomach adenocarcinoma were both correlated with the histologic grade, the T-stage and nodal metastasis, respectively (P<0.05). The expression of claudin-4 was significantly associated with the expression of E-cadherin. CONCLUSION: Our data suggests that claudin-4 and E-cadherin are involved in the processes of histologic differentiation, invasion and metastasis of stomach adenocarcinoma.

Analysis and Consideration of the Complications of Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard treatment and it has widely gained rapid acceptance. However, laparoscopic cholecystectomy has many complications and it can require conversion to open cholecystectomy or further management. We reviewed our cases for determining the complications and clinical results in order to improve the efficacy and safety of laparoscopic cholecystectomy in our hospital. METHODS: The data from 3,224 laparoscopic cholecystectomies that were performed at our hospital from January 1995 to December 2004 were reviewed retrospectively. The pre-operative laboratory data, operative findings, post-operative pathologic findings, complications and proper treatment were evaluated. RESULTS: 52 of all the patients developed complications. The median patient age was 51.8+/-11.6 years, and the median admission time was 29.9+/-10.6 days. The most common complications were post operative bleeding (20 case), and bile duct injury (15 cases). A collection of bile was noted in 12 cases. The treatment of complications were operations (16 case) radiologic interventions (14 case), and observation with conservative management (22 case). CONCLUSION: There were various complications of laparoscopic cholecystectomy, and these patients needed a longer hospital stay and operative treatment. So, improvement of surgeons' skill with a carefully approach and better understanding of the anatomical variations of the biliary tree and vascular system, recognition of pre-operative patients' general condition and the severity of inflammation, and prompt and proper management for complications should be done to prevent serious problems.

Polypoid Lesions of Gallbladder: Clinicopathological Features and Indication of Operation

PURPOSE: Polypoid lesions of the gall bladder (PLG) have a variety of pathologies. Problems exist in the selection of patients for operation and in the operative approach used. We studied the accuracy of the preoperative radiologic diagnosis and suspected risk factors. METHODS: 121 polypoid lesions of gallbladder were sugically treated during 10 years. Preoperative radiologic diagnosis, age, gender, related symptoms, concurrent gallstone, size, shape, number and histologic diagnosis of the ployps were retrospectively reviewed. RESULTS: The average size of malignancy was 23.0 mm, and that of benign tumors was 7.1 mm (P=0.000). The mean age of patients with a malignancy was significant higher than that of those with benign tumor (P=0.000). The preoperative sensitivity of computed tomography for a malignancy was 67.7%. The patients with malignancy more frequently had related symptoms. CONCLUSION: A CT must be considered, for patients with risk factors, even if the ultrasonographic diagnosis was benign. An Age greater than 60 years, a tumor size greater than 10 mm, a solitary polyp, sessile shape, and related symptoms are predictive factors of a malignancy.

Metachronous Tripple Primary Malignant Neoplasm

According to the development of new diagnostic techniques and the extension of aging population, the diagnosis of multiple primary malignant neoplasm has increased. We report a 76 years old man who had prostate cancer, colon cancer and stomach cancer metachronously and review literatures about the history, criteria, incidence and causes of the multiple primary malignant neoplasm.

Clinical analysis of complications of laparoscopic cholecystectomy / 한국간담췌외과학회지

No abstract available.

A clinical analysis of laser laparoscopic cholecystectomy

No abstract available.

A Clinical Analysis of 300 Case of Laparoscopic Cholecystectomy / 대한소화기내시경학회지

With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)

Clinical analysis ofbiliary stone disease in Korea: 3,000 cases

No abstract available.