Lein-Ray Mo

Tainan Municipal Hospital, 臺南市, Taiwan, Taiwan

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Publications (31)97.83 Total impact

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    ABSTRACT: Hepatocellular carcinoma (HCC) frequently occurs with chronic hepatitis C (HCV) infection. This study tried to identify clinical and laboratory factors affecting development of HCC in a longitudinal follow-up of chronic HCV patients. A total of 373 patients with CHC who were HCV RNA-seropositive were recruited during 2000-2003. The remaining 164 patients after application of exclusion criteria (90 males; 74 females; mean age: 58.2 +/- 14y/o) were prospectively recruited and followed-up with periodic liver function tests, alfa-fetoprotein and abdominal ultrasound examinations. During follow-up between January 2000 and May 2008, HCC was identified in 19 (11.6%) patients. The incidence rate of HCC was 14.5/1,000 person-years. Fifteen patients (9.1%) developed a cirrhotic liver. Male gender (p=0.018), genotype 1b (p=0.034), cirrhosis (p<0.001) and older age (> or = 65y/o) (p=0.02) are significant risk factors for HCC. Overall, there was 2.7-fold increased risk in patients with HCV RNA > or = 1 million copies/mL to develop HCC. The incidence rate of HCC was 8.8% for pegIFNa/RBV-treated patients with sustained viral response and 14.3% for untreated patients (p=0.352). This cohort study highlights the roles of male gender, older age and genotype 1b in the progression from chronic HCV to HCC in an area endemic for hepatitis B.
    Hepato-gastroenterology 01/2011; 58(107-108):904-8. · 0.91 Impact Factor
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    ABSTRACT: We report a rare case of diffuse esophageal intramural pseudodiverticulosis in a 35-year-old man complaining of severe dysphagia and vomiting for several months. The advanced morphological change in the esophagus caused irregular track formation, mimicking an ulcerative lesion on esophagogram. Endoscopic examination revealed an esophageal stricture with intact mucosa. Endoscopic ultrasonography and chest computed tomography showed multiple hyperechoic lesions of unknown nature and multiple air collection sites in the esophageal wall, respectively, making diagnosis difficult. The patient finally received a subtotal esophagectomy because of severe symptoms. The lesion was pathologically proven to be intramural pseudodiverticulosis with marked submucosal fibrosis. Our experience suggests that awareness of this rare pathology and the related image changes will be helpful for early diagnosis and treatment in the future.
    Journal of the Formosan Medical Association 03/2010; 109(3):241-4. DOI:10.1016/S0929-6646(10)60048-4 · 1.70 Impact Factor
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    ABSTRACT: On an ultrasound and multislice computed tomography (MSCT), a 76-year-old woman was found to have a huge mass lesion in the pancreatic head. MSCT showed 8.4 cm well-enhancing exophytic tumor of the pancreatic head which also protruded into the duodenum. A tongue-like protrusion into the main pancreatic duct was depicted. Laboratory data showed elevated carbohydrate antigen 19-9. Whipple's operation was performed. The pathological diagnosis was acinar cell carcinoma (ACC) originating in the pancreatic head and directly invading through the duodenal wall and the main pancreatic duct, without any lymph node involvement. A peculiar ACC with good enhancement, exophytic picture and tongue-like protrusion into the main pancreatic duct on MSCT is presented.
    Journal of Hepato-Biliary-Pancreatic Surgery 02/2009; 16(2):238-41. DOI:10.1007/s00534-008-0034-x · 1.60 Impact Factor
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    ABSTRACT: Isolated pancreatic transection is rare. Associated main pancreatic duct injury is the principal determinant factor of outcome. Earlier computed tomographic scanner may be unreliable in determining the location and severity of pancreatic injury. Multiplanar reconstruction (MPR) and curved views of multidetector computed tomography are helpful in accurate diagnosis of pancreatic transection with the main pancreatic duct injury.
    Hepato-gastroenterology 01/2009; 56(93):1211-2. · 0.91 Impact Factor
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    ABSTRACT: Patients with chronic hepatitis C (CHC) can achieve a sustained virologic response if they received pegylated interferon plus ribavirin therapy; however, some of them do not respond or relapse after treatment. The aim of this study was to compare the ability of two statistical models to predict treatment outcomes. Clinical data, biochemical values, and liver histological features of 107 patients with CHC were collected and assessed using a logistic regression (LR) model and an artificial neural network (ANN) model. Both the LR and ANN models were compared by receiver-operating characteristics curves. Aspartate aminotransferase (p = 0.017), prothrombin time (p = 0.002), body mass index (BMI; p = 0.003), and fibrosis score of liver histology (p = 0.002) were found to be significant predictive factors by univariate analysis. The independent significant predicting factor was BMI by multivariate LR analysis (p = 0.0095). The area under receiver-operating characteristics of the ANN model was larger than that of the LR model (85 vs. 58.4%). It was found that BMI is an independent factor for identifying patients with favorable treatment response. A useful ANN model in predicting outcomes of standard treatment for CHC infection was developed and showed greater accuracy than the LR model.
    Intervirology 02/2008; 51(1):14-20. DOI:10.1159/000118791 · 1.77 Impact Factor
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    ABSTRACT: Pancreatic pseudocyst bleeding is an unusual entity of acute abdomen, usually occurring among alcoholics. A high mortality developed in patients with conservative treatment of hemorrhagic pancreatic pseudocyst. We report a 37-year-old male with a pseudoaneurysm in the tail of the pancreas presenting with sudden onset of abdominal pain and swelling. Emergency laparotomy after blood transfusion and fluid resuscitation was successfully performed. An abdominal radiography showed multiple calcifications in the epigastric area. Computed tomography of the abdomen showed a cystic lesion with a calcified wall in the tail of the pancreas and a large amount of ascites. After contrast enhancement, there was hemorrhage into the pancreatic pseudocyst with extravasation of contrast into the peritoneal cavity. At operation, active bleeding was noted from a ruptured pseudocyst in the tail of the pancreas and ligation of the bleeding vessel was done. Hemorrhage into the pancreatic pseudocyst associated with intraperitoneal bleeding is a potentially life threatening condition. Emergency surgical treatment should be carried out as soon as possible.
    The American Journal of Surgery 08/2006; 192(1):87-8. DOI:10.1016/j.amjsurg.2005.11.020 · 2.41 Impact Factor
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    ABSTRACT: Capsule endoscopy (CE) is a new diagnostic modality that is being utilized with increasing frequency for examination of lesions suspected to be of small bowel origin. The most common indication for CE is obscure gastrointestinal bleeding. This study investigated the safety and diagnostic value of CE in patients with obscure gastrointestinal bleeding. From February 1 to October 30, 2003, 35 patients with obscure gastrointestinal bleeding among 43 consecutive patients with suspected small bowel pathology were enrolled. The mean age of the patients was 50.5 years (range, 24-81 years). A negative panendoscopy and colonoscopic study were required for study eligibility. An M2A video capsule endoscope was swallowed by each patient after an overnight fast if plain abdominal radiograph done 1 day prior to the procedure was negative for obstruction. Bowel preparation using a mixed solution containing magnesium carbonate, citric acid anhydrous and potassium bicarbonate, and bisacodyl was performed only in selected patients. Abnormal findings were noted in 31 of 35 patients (89%), 20 (57.2%) of whom had gastrointestinal pathology explaining their symptoms. Only 12 (34%) of the 20 patients had lesions solely in the small bowel. Angiodysplasia was the most common source of bleeding (37%), followed by Crohn's disease (14%). Other findings included Osler-Weber-Rendu's disease, gastrointestinal stromal tumor, vascular ectasia and small bowel diverticulum. Three capsules became lodged and did not provide images during subsequent transit through the colon, but serial abdominal plain radiographs done every 3 days after capsule ingestion showed passage of the capsules had occurred by 1 week. No discomfort or side effects were noted up to 2 months after ingestion. CE is a safe, painless and effective method for diagnosing obscure gastrointestinal bleeding. A final diagnosis was reached in more than one half of the patients and positively affected treatment. The capsule produced clear and recognizable images of lesions even without bowel preparation. If done early, CE can aid in directing proper management in patients with suspected small bowel pathology.
    Journal of the Formosan Medical Association 10/2005; 104(9):659-65. · 1.70 Impact Factor
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    ABSTRACT: Hepatic portal venous gas is an unusual entity associated with a variety of abdominal catastrophes. There is usually a grave prognosis when hepatic portal venous gas is associated with ischemic bowel disease. We reported a 57-year-old man with hepatic portal venous gas associated with extensive infarction of the jejunum and a concomitant perforation at a site in the terminal ileum leading to two operations performed 24 hours apart. Progressive ischemia and infarction after the initial laparotomy resulted in massive resection of the small bowel. A follow-up abdominal radiography showed progressive dilatation of the small intestine and thickening of the bowel wall. Computed tomography of the abdomen showed pneumatosis intestinalis and gas collection within the intrahepatic and extrahepatic portal vein and superior mesenteric vein and free gas in the peritoneal cavity. At surgery, a long segment of ischemic change of the jejunum with focal necrosis and one perforation in the terminal ileum with no relation to the ischemic area was discovered. These two areas were resected respectively, and anastomosis was performed. Extensive necrosis of the residual bowel was found on the second-look operation performed 24 hours later, and subsequent resection of involved bowel was performed, resulting in a short-bowel condition. When hepatic portal venous gas associated with ischemic bowel disease is encountered, coexistence of other abdominal condition with no relation to ischemic segment should be considered.
    The American Journal of Surgery 05/2005; 189(4):501-3. DOI:10.1016/j.amjsurg.2004.09.014 · 2.41 Impact Factor
  • Gastrointestinal Endoscopy 11/2004; 60(4):603-4. DOI:10.1016/S0016-5107(04)01869-3 · 4.90 Impact Factor
  • The American Journal of Surgery 10/2004; 188(3):325-6. DOI:10.1016/j.amjsurg.2004.03.009 · 2.41 Impact Factor
  • Gastrointestinal Endoscopy 03/2004; 59(2):317-8. DOI:10.1016/S0016-5107(03)02686-5 · 4.90 Impact Factor
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    ABSTRACT: A case of pulmonary tumorlets with ectopic adrenocorticotropin (ACTH) production and lymph node metastasis in a bronchiectatic patient is reported. A 65-year-old man underwent right lower lobe lobectomy because of a sudden attack of cough and hemoptysis. Histological study revealed multiple discrete uniform small nests of tumor cells surrounding dilated bronchioles. Tumor nests were also found in the hilar lymph node. Immunohistochemically, the proliferating cells were confirmed to be neuroendocrine in origin with ectopic ACTH production, despite being clinically silent. The findings in the present case suggest that the clinical behavior of pulmonary tumorlets may be like a carcinoid, and need to be treated as tumor-like lesions. Ectopic hormonal production in the present case suggests pulmonary tumorlets should be considered in the differential diagnosis of Cushing's syndrome.
    Pathology International 01/2004; 53(12):883-6. DOI:10.1046/j.1440-1827.2003.01567.x · 1.59 Impact Factor
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    ABSTRACT: Radical resection with either pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy is considered to be the standard treatment for most ampullary carcinomas, but the prognostic predictive model has not yet been developed. The pretreatment, treatment, and follow-up variables of data of 47 patients undergoing radical resection for the ampullary carcinoma were analyzed to determine the favorable prognostic variables. Employing the Kaplan-Meier method, the cumulative survival rates of the ampullary carcinoma were calculated. By Cox regression model, a stepwise multivariate analysis was performed to analyze the contributing factors of the survival rate, and a predictive survival equation was obtained. With the results of the univariate analysis, the variables significantly associated with favorable prognosis were younger age (<63 years), TNM stage (stage I or II or III), and the degree of tumor differentiation (well or moderately differentiated). When the above three variables were examined as covariates by Cox regression in multivariate analysis, the TNM stage and the degree of tumor differentiation were independently correlated with the survival. A predictive survival equation obtained with the beta-coefficients of the above three variables was as follows: S (t) = [So (t)] P, P = exp (0.0234 x age - 1.8744 x tumor differentiation + 1.1576 x TNM stage) This predictive survival equation can predict the survival and the favorable outcome of patients treated with radical resection of ampullary carcinoma.
    Hepato-gastroenterology 01/2004; 51(59):1495-9. · 0.91 Impact Factor
  • Gastrointestinal Endoscopy 08/2003; 58(1):156-8. DOI:10.1067/mge.2003.312 · 4.90 Impact Factor
  • Journal of Clinical Gastroenterology 08/2003; 37(1):91. DOI:10.1097/00004836-200307000-00027 · 3.19 Impact Factor
  • Gastrointestinal Endoscopy 08/2003; 58(1):97-8. DOI:10.1067/mge.2003.287 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 06/2003; 57(6):717-8. DOI:10.1067/mge.2003.177 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2003; 57(4):561-2. DOI:10.1067/mge.2003.90 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 03/2003; 57(2):240. DOI:10.1067/mge.2003.68 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 02/2003; 57(1):95-6. DOI:10.1067/mge.2003.4 · 4.90 Impact Factor