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ABSTRACT: As renal transplantation may increase survival rates and improve quality of life for children with end-stage renal disease, we investigated the long-term outcomes and prognostic factors of pediatric renal transplantation.
A retrospective study was conducted to review 25 pediatric renal transplantations, either from live or deceased donors, in our hospital from 1995 to 2008. The cumulative graft survival rate was calculated using the Kaplan-Meier method. Log rank tests were employed to identify categorical prognostic factors for graft survival of the pediatric renal transplantations, and Cox regression analysis for numeric factors.
The mean age of our study subjects was 11.63 ± 3.76 years, and the mean follow-up period was 49.24 ± 33.72 months. The 12-month and 36-month graft survival rates were 92% and 82.14%, respectively. The rejection-free survival rates were 88% and 72.88% in the first and third years, respectively. All of the patients were alive during the follow-up period. Acute rejection (p = 0.0175) and male sex (p = 0.0384) were found to be significant factors for graft survival.
For pediatric patients, we found that renal transplantation is now a safe and effective surgical procedure for children with end-stage renal disease. Acute rejection and male gender were identified as prognostic factors for poor graft survival.
Asian Journal of Surgery 04/2013; 36(2):53-7. · 0.57 Impact Factor
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ABSTRACT: Traditional open surgery for gastrointestinal stromal tumors (GIST) requires a long incision. Moreover, the gas-filling laparoscopic technique used in GIST surgery still has its limitations. Therefore, we developed a gasless laparoscopic (GL) surgery for GIST and compared it with traditional open surgery.
Between October 2007 and September 2009, 62 GIST patients in the National Taiwan University Hospital received wide excisions. Of these 62 patients, 30 underwent the new procedure (GL group) and 32 had open surgery (OS group). Preoperative and postoperative clinicopathologic characteristics were compared between the groups.
There were no significant differences in preoperative characteristics or blood loss. However, the days to first flatus, postoperative hospital stay, wound length, white blood cell count at postoperative day one, and peak daily body temperature were all significantly improved in the GL group. Usage of postoperative analgesia on postoperative days one to five was also significantly lower in the GL group.
Wide-excision laparoscopy for gastric GIST can be performed more safely, more effectively, and with faster postoperative recovery using the gasless technique as compared with the open method. We, therefore, recommend this new surgical technique, which hybridizes the advantages of both the traditional open method and pure laparoscopic surgery.
World Journal of Surgical Oncology 01/2013; 11:44. · 1.12 Impact Factor
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ABSTRACT: There is paucity of risk factors on lung function decline among patients with non-tuberculous mycobacteria (NTM) pulmonary disease in literature.
Patients with NTM pulmonary disease between January 2000 and April 2011 were retrospectively selected. Sixty-eight patients had at least two pulmonary function tests within a mean follow-up period of 47 months.
Sixty-eight patients were included. They had a median age of 65 years and 65% had impaired lung function (Forced expiratory volume in 1 second [FEV1] <80% of predicted value). The mean FEV1 decline was 48 ml/year. By linear regression, younger age (beta: 0.472, p<0.001), initial FEV1>50% of predicted value (beta: 0.349, p = 0.002), male sex (beta: 0.295, p = 0.018), bronchiectasis pattern (beta: 0.232, p = 0.035), and radiographic score >3 (beta: 0.217, p = 0.049) were associated with greater FEV1 decline. Initial FEV1>50% of predicted value (beta: 0.263, p = 0.032) was also associated with greater FVC annual decline, whereas M. kansasii pulmonary disease was marginally associated with greater annual FVC decline (beta: 0.227, p = 0.062).
NTM pulmonary disease is associated with greater decline in lung function in patients who are young, male, with bronchiectasis, and with a high radiographic score. Special attention should be given to patients with these risk factors.
PLoS ONE 01/2013; 8(3):e58214. · 4.09 Impact Factor
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ABSTRACT: Background/Aims: It has been a matter of debate whether the advantage of gasless laparoscope setting is obvious when compared with the conventional operation. Thus, we compare the systemic response of proinflammatory markers and the adhesion molecules in serum levels after surgery between these two procedures. Methodology: There were 23 patients in the gasless laparoscopy (GL) group, and 12 patients in the open surgery (OS) group. Results: The created wound length was smaller in the GL group (5.3±0.3cm vs. 8.9±0.5cm), the post operative recovery including the visual analog pain score on op day and day 1, flatus day, and hospital stay were also shown less in GL group. The levels of IL-6, IL-8 and ICAM were significantly lower in the GL group. Conclusions: Immune response is less in gasless laparoscopy-assisted gastrectomy (GLAG) when compared with traditional approach, and the difference may have effects on the post operative recovery.
Hepato-gastroenterology 11/2012; 60(125). · 0.66 Impact Factor
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ABSTRACT: BACKGROUND: The extrapancreatic nerve plexus may give rise to schwannomas. The aim of this study was to define the clinicopathologic features of peripancreatic schwannoma and to allow improved diagnosis and treatment for this condition. METHODS: A retrospective analysis was performed on 17 patients with pathologically proven peripancreatic schwannoma (defined as schwannoma in anatomic proximity to the pancreas) treated at our hospital between 1995 and 2011. RESULTS: The patient group included 9 men and 8 women between the ages of 26 and 67 years. The tumor size ranged from 2.5 to 13 cm. Tumor locations were the pancreatic head plexus in 5 patients, the superior mesenteric plexus in 3, the pancreatic head and superior mesenteric plexus in 2, the celiac plexus in 4, and the splenic plexus in 3. The main symptoms were vague abdominal pain (n = 5; 29.4%) and abdominal mass (n = 2; 11.8%). A correct preoperative diagnosis was made in 12 patients by either computed tomography (CT) or magnetic resonance imaging (MRI). Sixteen patients (94.1%) underwent total resection and 1 patient (5.9%) underwent subtotal resection. Three patients underwent concomitant pancreatectomy. No recurrences were noted in the 16 patients who underwent total tumor resection. CONCLUSION: Most peripancreatic schwannomas are benign. Peripancreatic schwannoma may often be accurately diagnosed before surgery by its typical location and CT or MRI findings. Total resection is important for treatment, and no recurrences are seen when resection is complete. Prognosis after total resection is extremely good.
Surgery 10/2012; · 3.10 Impact Factor
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ABSTRACT: BACKGROUND: New-onset diabetes mellitus (DM) is associated with pancreatic ductal cell adenocarcinoma (PDCA) and can resolve after pancreaticoduodenectomy (PD). Whether DM also resolves after PD in patients operated for disease other than PDCA remains to be determined. METHODS: We compared glycemic status before and after PD between patients with and without PDCA by review of a prospectively maintained database including all patients receiving PD from 2005 to 2011. New-onset DM was defined as diagnosis of DM less than 24 months before PD, and cases with DM diagnosis ≥24 months preceding PD were described as long-standing DM. RESULTS: Of 458 patients receiving PD, there were 146 (31.9 %) PDCA and 312 (68.1 %) non-PDCA, including 160 benign diseases, 113 ampulla cancer, 29 distal common bile duct cancer, and 10 duodenal cancer. Overall prevalence of DM was higher in PDCA group than non-PDCA group (37.7 vs. 25.6 %; P = 0.011). Resolution of new-onset DM after PD was observed in 9 (41 %) of 22 patients with PDCA and in 12 (63 %) of 19 patients without PDCA. Resolution of long-standing DM after PD was also observed in 3 (9.1 %) of 33 patients with PDCA and in 6 (9.8 %) of 61 patients without PDCA. CONCLUSIONS: DM resolved after PD in some patients both with and without PDCA. These findings suggest that PD-associated anatomic change may play a role in resolution of DM after PD.
Annals of Surgical Oncology 08/2012; · 4.17 Impact Factor
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Kuo-Liang Chen,
Shing-Hwa Liu,
Chin-Chuan Su,
Cheng-Chieh Yen, Ching-Yao Yang,
Kuan-I Lee,
Feng-Cheng Tang,
Ya-Wen Chen,
Tien-Hui Lu,
Yi-Chang Su,
Chun-Fa Huang
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ABSTRACT: Mercury is a toxic heavy metal that is an environmental and industrial pollutant throughout the world. Mercury exposure leads to many physiopathological injuries in mammals. However, the precise toxicological effects of mercury on pancreatic islets in vivo are still unclear. Here, we investigated whether mercuric compounds can induce dysfunction and damage in the pancreatic islets of mice, as well as the possible mechanisms involved in this process. Mice were treated with methyl mercuric chloride (MeHgCl, 2 mg/kg) and mercuric chloride (HgCl(2), 5 mg/kg) for more than 2 consecutive weeks. Our results showed that the blood glucose levels increased and plasma insulin secretions decreased in the mice as a consequence of their exposure. A significant number of TUNEL-positive cells were revealed in the islets of mice that were treated with mercury for 2 consecutive weeks, which was accompanied by changes in the expression of the mRNA of anti-apoptotic (Bcl-2, Mcl-1, and Mdm-2) and apoptotic (p53, caspase-3, and caspase-7) genes. Moreover, plasma malondialdehyde (MDA) levels increased significantly in the mice after treatment with mercuric compounds for 2 consecutive weeks, and the generation of reactive oxygen species (ROS) in the pancreatic islets also markedly increased. In addition, the mRNA expression of genes related to antioxidation, including Nrf2, GPx, and NQO1, were also significantly reduced in these islets. These results indicate that oxidative stress injuries that are induced by mercuric compounds can cause pancreatic islets dysfunction and apoptosis in vivo.
International Journal of Molecular Sciences 01/2012; 13(10):12349-66. · 2.60 Impact Factor
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ABSTRACT: CNS infections caused by non-tuberculous mycobacteria (NTM) are rare and only three cases of CNS infections due to Mycobacterium abscessus complex have been reported.
We searched the Mycobacteriology Database of the National Taiwan University Hospital and identified patients with CNS infections due to NTM.
A total of 15 patients, namely 4 HIV-seropositive patients and 11 HIV-seronegative patients, with CNS infections caused by NTM were identified during 2000-10. All of the HIV-seropositive patients had disseminated Mycobacterium avium complex infections. Among the 11 HIV-seronegative patients, NTM CNS infections were due to M. abscessus complex in 8 patients, M. avium complex in 2 patients and Mycobacterium kansasii in 1 patient. All the six preserved M. abscessus complex isolates were confirmed to be Mycobacterium massiliense by erm(41) PCR and 23S rRNA gene sequence analysis. Among the eight patients with infections due to M. abscessus complex, three had otolaryngological diseases, four had received neurosurgery and one had disseminated disease. Five patients received surgical debridement or intracranial device removal and three patients died of M. abscessus complex CNS infection. Among the five patients who survived, all received clarithromycin-based combination therapy with a median duration of 12 months and four received surgical intervention. All six isolates available for drug susceptibility testing showed uniform susceptibility to clarithromycin and five were susceptible to amikacin.
Our study revealed that M. abscessus complex isolates, particularly M. massiliense, should be considered potential pathogens causing CNS infections. Long-duration clarithromycin-based combination therapy plus surgical intervention may provide the best chance of cure.
Journal of Antimicrobial Chemotherapy 01/2012; 67(1):222-5. · 5.07 Impact Factor
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ABSTRACT: Arsenic is a naturally occurring toxic metalloid of global concern. Many studies have indicated a dose-response relationship between accumulative arsenic exposure and the prevalence of diabetes mellitus (DM) in arseniasis-endemic areas in Taiwan and Bangladesh, where arsenic exposure occurs through drinking water. Epidemiological researches have suggested that the characteristics of arsenic-induced DM observed in arseniasis-endemic areas in Taiwan and Mexico are similar to those of non-insulin-dependent DM (Type 2 DM). These studies analyzed the association between high and chronic exposure to inorganic arsenic in drinking water and the development of DM, but the effect of exposure to low to moderate levels of inorganic arsenic on the risk of DM is unclear. Navas-Acien et al. recently proposed that a positive association existed between total urine arsenic and the prevalence of Type 2 DM in people exposed to low to moderate levels of arsenic. However, the diabetogenic role played by arsenic is still debated upon. An increase in the prevalence of DM has been observed among residents of highly arsenic-contaminated areas, whereas the findings from community-based and occupational studies in low-arsenic-exposure areas have been inconsistent. Recently, a population-based cross-sectional study showed that the current findings did not support an association between arsenic exposure from drinking water at levels less than 300 μg/L and a significantly increased risk of DM. Moreover, although the precise mechanisms for the arsenic-induced diabetogenic effect are still largely undefined, recent in vitro experimental studies indicated that inorganic arsenic or its metabolites impair insulin-dependent glucose uptake or glucose-stimulated insulin secretion. Nevertheless, the dose, the form of arsenic used, and the experimental duration in the in vivo studies varied greatly, leading to conflicting results and ambiguous interpretation of these data with respect to human exposure to arsenic in the environment. Moreover, the experimental studies were limited to the use of arsenic concentrations much higher than those relevant to human exposure. Further prospective epidemiological studies might help to clarify this controversy. The issues about environmental exposure assessment and appropriate biomarkers should also be considered. Here, we focus on the review of mechanism studies and discuss the currently available evidence and conditions for the association between environmental arsenic exposure and the development of DM.
The Kaohsiung journal of medical sciences 09/2011; 27(9):402-10. · 0.61 Impact Factor
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Hsi-Chin Wu, Ching-Yao Yang,
Dong-Zong Hung,
Chin-Chuan Su,
Kuo-Liang Chen,
Cheng-Chieh Yen,
Tsung-Jung Ho,
Yi-Chang Su,
Chun-Fa Huang,
Chun-Hung Chen,
Ling-Mei Tsai,
Ya-Wen Chen
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ABSTRACT: Nickel (Ni), a well-known toxic metal, is widely used in electroplating and alloy production. It is also significantly implicated in industrial and environmental pollution caused by uncontrolled industrial and municipal discharges. In this study, we characterized and investigated the cytotoxic effects of Ni exposure and their probable toxicological mechanisms in the pancreatic β-cells. The results showed that it was significantly decreased cell viability after exposing pancreatic β-cell-derived RIN-m5F cells to NiCl(2) for 24h in a dose-dependent manner. NiCl(2) also increased sub-G1 hypodiploid cells and Annexin V-Cy3 binding population in RIN-m5F cells, indicating that it has apoptosis-inducing ability. Moreover, the exposure of RIN-m5F cells to NiCl(2) induced distinct signals of mitochondria-dependent apoptosis, including mitochondrial dysfunction (the disruption of mitochondrial membrane potential (MMP) and increase in mitochondrial cytochrome c release into the cytosol), Bak and Bid mRNA up-regulation, and activation of caspase-3, caspase-7, and caspase-9, and poly(ADP-ribose) polymerase (PARP) degradation. In addition, NiCl(2) also markedly induced the activation of c-Jun N-terminal kinases (JNK), but not of extracellular signal-regulated kinase (ERK)1/2 and p38. These NiCl(2)-induced apoptosis-related signaling responses could be effectively reversed by specific JNK inhibitor SP600125. To the best of our knowledge, this study is the first to show that Ni causes pancreatic β-cell death through a JNK activation-regulated mitochondria-dependent apoptosis-signaling pathway.
Toxicology 08/2011; 289(2-3):103-11. · 3.68 Impact Factor
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ABSTRACT: Arsenic (As), a ubiquitous toxic metal, is an important environmental and industrial pollutant throughout the world. Inorganic As (iAs) is usually more harmful than organic ones and with a high risk of diabetes incidence by exposure. However, the toxicological effects of iAs on growth and function of pancreatic β-cells still remain unclear. Here, we found that iAs significantly decreased insulin secretion and cell viability, and increased ROS and MDA formation in pancreatic β-cell-derived RIN-m5F cells. iAs also induced the increases in sub-G1 hypodiploids, annexin V-Cy3 binding, and caspase-3 activity in RIN-m5F cells, indicating that iAs could induce β-cell apoptosis. Moreover, iAs induced MAPKs activation, mitochondria dysfunction, p53 up-regulation, Bcl-2 and Mdm-2 down-regulation, PARP, and caspase cascades, which displayed features of mitochondria-dependent apoptotic signals. In addition, exposure of RIN-m5F cells to iAs, could trigger ER stress as indicated by the enhancement in ER stress-related molecules induction (such as GRP78, GRP94, CHOP, and XBP1), procaspase-12 cleavage, and calpain activation. The iAs-induced apoptosis and its-related signalings could be effectively reversed by antioxidant N-acetylcysteine. We next observed that exposure of mice to iAs in drinking water for 6 consecutive weeks significantly decreased decreased the plasma insulin, elevated glucose intolerance and plasma lipid peroxidation, and induced islet cells apoptosis, which accompanied with arsenic accumulation in the whole blood and pancreas. N-acetylcysteine effectively antagonized the iAs-induced responses in mice. Taken together, these results suggest that iAs-induced oxidative stress causes pancreatic β-cells apoptosis via the mitochondria-dependent and ER stress-triggered signaling pathways.
Toxicology Letters 02/2011; 201(1):15-26. · 3.23 Impact Factor
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ABSTRACT: The effect of lotus leaf ( Nelumbo nucifera Gaertn.) on diabetes is unclear. We hypothesized that lotus leaf can regulate insulin secretion and blood glucose levels. The in vitro and in vivo effects of lotus leaf methanolic extract (NNE) on insulin secretion and hyperglycemia were investigated. NNE increased insulin secretion from β cells (HIT-T15) and human islets. NNE enhanced the intracellular calcium levels in β cells. NNE could also enhance phosphorylation of extracellular signal-regulated protein kinases (ERK)1/2 and protein kinase C (PKC), which could be reversed by a PKC inhibitor. The in vivo studies showed that NNE possesses the ability to regulate blood glucose levels in fasted normal mice and high-fat-diet-induced diabetic mice. Furthermore, the in vitro and in vivo effects of the active constituents of NNE, quercetin, and catechin, on glucose-induced insulin secretion and blood glucose regulation were evaluated. Quercetin did not affect insulin secretion, but catechin significantly and dose-dependently enhanced insulin secretion. Orally administered catechin significantly reversed the glucose intolerance in high-fat-diet-induced diabetic mice. These findings suggest that NNE and its active constituent catechin are useful in the control of hyperglycemia in non-insulin-dependent diabetes mellitus through their action as insulin secretagogues.
Journal of Agricultural and Food Chemistry 02/2011; 59(4):1087-94. · 2.82 Impact Factor
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ABSTRACT: Despite the objections to transplant tourism raised by the transplant community, many patients continue travel to other countries to receive commercial transplants. To evaluate some long-term complications, we reviewed medical records of 215 Taiwanese patients (touring group) who received commercial cadaveric renal transplants in China and compared them with those of 321 transplant recipients receiving domestic cadaveric renal transplants (domestic group) over the same 20-year period. Ten years after transplant, the graft and patient survival rates of the touring group were 55 and 81.5%, respectively, compared with 60 and 89.3%, respectively, of the domestic group. The difference between the two groups was not statistically significant. The 10-year cumulative cancer incidence of the touring group (21.5%) was significantly higher than that of the domestic group (6.8%). Univariate and multivariate stepwise regression analyses (excluding time on immunosuppression, an uncontrollable factor) indicated that transplant tourism was associated with significantly higher cancer incidence. Older age at transplantation was associated with a significantly increased cancer risk; however, the risk of de novo malignancy significantly decreased with longer graft survival. Thus, renal transplant tourism may be associated with a higher risk of post-transplant malignancy, especially in patients of older age at transplantation.
Kidney International 01/2011; 79(8):908-13. · 6.61 Impact Factor
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ABSTRACT: Laproscopic surgery is widely used in treating gastrointestinal disease. This study investigated the clinical result, short-term outcomes, and cost analysis of the newly developed gasless laparoscopy-assisted distal gastrectomy (GLADG) and compared it with conventional open distal gastrectomy (ODG).
Seventy-five patients underwent distal gastrectomy with radical lymph node dissection for early gastric cancer from December 2005 to January 2008. Thirty-one patients underwent GLADG and 44 underwent ODG. Postoperative pain, morphine use, disease-free and overall survival, and surgical and hospital costs were measured postoperatively and compared between the two groups.
Patients in the two groups were comparable by age, sex, body mass index, tumor size, tumor location, cancer staging, and operative time. The GLADG group had early start of oral intake and shorter postoperative hospital stay (P < .05). There was less morphine use from postoperative day 1 to 4 in the GLADG group than in the ODG group (P < .05), and body temperature from postoperative day 1 to 2 was lower in the GLADG than in the ODG group (P < .05). Cost analysis showed that operation cost (100,242 ± 5385 versus 36,455 ± 1419) and equipment cost (65,909 ± 5385 versus 2122 ± 1419) was higher in the GLADG group, but its total hospital cost (193,552 ± 12,715 versus 206,676 ± 41,920) was lower than in the ODG group (P < .05). The 2-year disease-free and overall survival rates were not different between the two groups.
GLADG is feasible for early gastric cancer. It is advantageous because of less pain, less postoperative inflammatory response, less blood loss, and shorter total hospital stay while achieving the same oncologic results as ODG.
Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2011; 21(3):215-20. · 1.40 Impact Factor
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ABSTRACT: We had developed an innovative method of minimally invasive surgery using gasless laparoscopy in resection of the small bowel lesion. This study aimed at evaluating the feasibility and efficacy of this procedure by comparison with traditional open small bowel surgery.
A wedge or segmental resection of the small bowel for removal of the lesion was performed in 25 patients at National Taiwan University Hospital from September 2006 to January 2009. Thirteen patients underwent gasless laparoscopy-assisted surgery (GLAS), and 12 patients underwent open surgery. The perioperative characteristics and clinical results between the two groups were compared.
The demographics, clinical data, lesion size, and operative time were comparable between the GLAS and open surgery groups, but the wound length and blood loss were significantly less in the GLAS group (P < 0.001 and P = 0.021, respectively). The time to first postoperative flatus and first oral intake were significantly less in the GLAS group (P = 0.007 and 0.036, respectively). No major complication occurred in either group. No tumor recurrence was found after a median follow-up period of 14 months (range = 1-30) in the GLAS group.
GLAS for resection of the small bowel may be a feasible and safe procedure for the small bowel lesions. It has the advantages of better cosmetic outcome, less blood loss, and earlier recovery of bowel movement.
Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2010; 20(8):699-703. · 1.40 Impact Factor
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ABSTRACT: Mercury is a well-known highly toxic metal. In this study, we characterize and investigate the cytotoxicity and its possible mechanisms of inorganic mercury in pancreatic beta-cells. Mercury chloride (HgCl2) dose-dependently decreased the function of insulin secretion and cell viability in pancreatic beta-cell-derived HIT-T15 cells and isolated mouse pancreatic islets. HgCl2 significantly increased ROS formation in HIT-T15 cells. Antioxidant N-acetylcysteine effectively reversed HgCl2-induced insulin secretion dysfunction in HIT-T15 cells and isolated mouse pancreatic islets. Moreover, HgCl2 increased sub-G1 hypodiploids and annexin-V binding in HIT-T15 cells, indicating that HgCl2 possessed ability in apoptosis induction. HgCl2 also displayed several features of mitochondria-dependent apoptotic signals including disruption of the mitochondrial membrane potential, increase of mitochondrial cytochrome c release and activations of poly (ADP-ribose) polymerase (PARP) and caspase 3. Exposure of HIT-T15 cells to HgCl2 could significantly increase both apoptotic and necrotic cell populations by acridine orange/ethidium bromide dual staining. Meanwhile, HgCl2 could also trigger the depletion of intracellular ATP levels and increase the LDH release from HIT-T15 cells. These HgCl2-induced cell death-related signals could be significantly reversed by N-acetylcysteine. The intracellular mercury levels were markedly elevated in HgCl2-treated HIT-T15 cells. Taken together, these results suggest that HgCl2-induced oxidative stress causes pancreatic beta-cell dysfunction and cytotoxicity involved the co-existence of apoptotic and necrotic cell death.
Toxicology and Applied Pharmacology 12/2009; 243(3):323-31. · 4.45 Impact Factor
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ABSTRACT: To compare the outcome of hand-assisted laparoscopic live donor nephrectomy (HLDN) and total laparoscopic live donor nephrectomy (TLDN) in a single center.
The demographics, complications, and outcomes were compared between successfully performed 51 HLDN and 42 TLDN.
The patients' demographics including body mass index were all similar. Four conversions were excluded for the outcome analysis. The operation time of HLDN group (188 ± 62 min) was shorter, although not significantly, than that of TLDN group's (207 ± 30 min) (p = 0.065). However, the operation time of the first 24 cases (237 ± 66 min) was significantly longer than that of the later 69 performed (180 ± 35 min). The warm ischemia time was shorter in HLDN (2.5 ± 1.3 min) compared to that of TLDN (4.1 ± 1.7 min) (p < 0.01), but the serum creatinine values (mg/dL) of recipients were equivalent (HLDN/TLDN = 1.18 ± 0.3:1.14 ± 0.3, p = 0.587). There was no difference in the length of hospital stay (6.7 vs. 6.4 d, p = 0.475). There was no graft loss, but one ureter stricture (HLDN group) and one urinary leakage (TLDN group) were recorded.
Both HLDN and TLDN are effective and safe as reflected in graft functions and limited complications. There was a learning curve in establishing the technique of laparoscopic donor nephrectomy.
Clinical Transplantation 12/2009; 24(5):E182-7. · 1.67 Impact Factor
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ABSTRACT: Angelica genus (Umbelliferae) has traditionally been used as the medicine and health food considered alleviating several disorders including diabetes mellitus. Angelica hirsutiflora Liu Chao & Chuang is an endemic species and a folk medicine in Taiwan.
The scientific evidence of anti-diabetic effect for Angelica hirsutiflora remains unknown. The methanolic extracts isolated from Angelica hirsutiflora were studied for its insulin secretagogue and hypoglycemic activities.
The in vitro effects and possible mechanisms of Angelica hirsutiflora extract on the insulin secretion in isolated mouse and human islets and pancreatic beta-cell line HIT-T15 were determined; and tested the regulation of blood glucose in fasted mice and high-fat diet-induced diabetic mice.
Angelica hirsutiflora extract potently stimulated the release of insulin from cultured HIT-T15 cells and isolated mouse and human islets. The intracellular calcium levels were also increased in HIT-T15 cells and isolated human islets treated with Angelica hirsutiflora extract. Angelica hirsutiflora extract was capable of enhancing the phosphorylation of extracellular signal-regulated protein kinases (ERK)1/2 protein in HIT-T15 cells. Specific ERK inhibitor PD98059 inhibited the increase of insulin secretion by Angelica hirsutiflora extract in HIT-T15 cells and isolated mouse islets. When Angelica hirsutiflora extract was administered to the fasted mice, it decreased the rise in blood glucose level after starch loading. The plasma insulin level was also increased by Angelica hirsutiflora extract treatment. In high-fat diet-induced diabetic mice, Angelica hirsutiflora extract markedly improved the oral glucose intolerance as compared with the vehicle control.
These findings support that Angelica hirsutiflora extract may be useful in the control of hyperglycemia in non-insulin-dependent diabetes mellitus by acting as an insulin secretagogue.
Journal of ethnopharmacology 06/2009; 123(2):208-12. · 2.32 Impact Factor
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ABSTRACT: A safety issue has been noted in applying rituximab to renal transplant patients with HCV infection, as a hepatitis C virus (HCV) flare-up and lethal cholestatic hepatitis C occurred in a renal transplant patient treated with rituximab for lymphoproliferative disorder. As double-filtration plasmapheresis (DFPP) and cyclosporine were reported to reduce hepatitis C viremia, we performed ABO-incompatible renal transplantation in two patients with positive HCV RNA by using rituximab, DFPP and cyclosporine-based immunosuppressant. The HCV RNA level was 3.3 x 10(5) IU/mL for Case 1 and 1.2 x 10(3) IU/mL for Case 2 before DFPP. After DFPP and renal transplantation, Case 1 had stable ALT levels and a transient decrease in HCV RNA to 7.9 x 10(4) IU/mL at 1 month followed by a gradual increase to 7.6 x 10(6) at 12 months, but Case 2 had a dramatic and persistent elevation of HCV RNA to 7.7 x 10(6) from 1 week to 12 months accompanied by elevated ALT levels. The serum creatinine levels were 1.5 mg/dL for Case 1 and 1.9 mg/dL for Case 2 at 12 months. Although cholestatic hepatitis C did not occur in our patients, who received rituximab for ABO-incompatible renal transplantation, the antiviral effect of cyclosporine and DFPP did not seem evident.
The International journal of artificial organs 06/2009; 32(5):308-9. · 1.86 Impact Factor
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ABSTRACT: Since gastroparesis is unavoidable in a certain proportion of patients after pancreaticoduodenectomy, measures to avoid its occurrence or at least minimize its impact are needed. A prospective randomized trial was performed to test the effectiveness of biliopancreatic diversion with modified Roux-en-Y gastrojejunostomy reconstruction and of enteral feeding to minimize impacts of gastroparesis after pancreaticoduodenectomy.
In total, 247 patients with periampullary tumors were randomized at the time of pancreaticoduodenectomy to have either (1) modified Roux-en-Y gastrojejunostomy reconstruction (by creating a side-to-side jejunojejunostomy between afferent and efferent loop and closing the afferent loop with a TA-30-3.5 stapler) and insertion of a jejunostomy feeding tube (modified group) or (2) conventional gastric bypass (control group). Outcomes including complications, duration of nasogastric tube placement, and length of hospital stay were followed prospectively.
Gastroparesis occurred in 20 patients (16.3%) in the modified group and 27 patients in the control group (21.7%, P = 0.27). However, the International Study Group of Pancreatic Surgery grades of gastroparesis were significantly lower in the modified group (10A, 5B, 5C) than in the control group (4A, 5B, 18C, P = 0.01).
Modified procedure does not reduce the risk of gastroparesis but appears to reduce the severity when it occurs.
Journal of Gastrointestinal Surgery 03/2009; 13(5):929-37. · 2.83 Impact Factor
