Chie-Song Shieh’s research while affiliated with Chang Gung Memorial Hospital and other places

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Publications (12)


Patterns of Hepatoblastoma and Hepatocellular Carcinoma in Children After Universal Hepatitis B Vaccination in Taiwan
  • Article

February 2009

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51 Reads

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16 Citations

Journal of Pediatric Hematology/Oncology

Chih-Cheng Hsiao

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Jiin-Haur Chuang

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Mao-Ming Tiao

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[...]

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Chie-Song Shieh

To retrospectively evaluate clinical features, treatment, and outcome of patients with hepatoblastoma (HB) and hepatocellular carcinoma (HCC). From January 1994 to December 2007, 16 patients of HB and 13 cases of HCC were reviewed. The mean age of HB patients was much younger than HCC patients (1.2 vs. 11.5 y). There was an 84.6% positive rate for hepatitis B surface antigen in HCC, but none for HB. Mean serum alpha-fetoprotein level was higher with HCC (654,158 ng/mL) than the HB patients (352,843 ng/mL), especially higher in HCC with lung metastasis. Among the HB patients, 12 (75%) had thrombocytosis and 6 (37.5%) had microcytic anemia with high or normal ferritin, whereas only 3 of 13 with HCC (23.1%) had thrombocytosis and none had microcytic anemia. All HBs were resectable either before or after chemotherapy, but only 4 (30.8%) HCCs were resectable. Five-year disease-free survival rate was significantly higher in HB (87%) than in HCC (30%, P<0.001). Hepatitis B infection was still the most important factor associated with HCC in children even after the national vaccination program against hepatitis B. Extreme thrombocytosis, anemia, alpha-fetoprotein levels are important factors associated with difference in long-term outcomes in children with HB and HCC.


Renal cell carcinoma presented as fever of unknown origin: Report of one case

November 2005

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113 Reads

Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi

A 10-year-old girl, with an intermittent fever for 15 days, visited our emergency department. Initial work-up revealed no signs of infection and no palpable abdominal mass. KUB showed only displaced bowel gas. Abdominal ultrasound was performed which disclosed a huge mass at the lower pole of the right kidney. Abdominal computed tomography (CT) confirmed a huge, heterogeneous mass arising from the right kidney and without involvement of regional lymph nodes and inferior vena cava. Radical nephrectomy was performed and Stage 2 renal cell carcinoma (RCC) was confirmed. Fever subsided spontaneously after operation. No local recurrence or distant metastasis was detected in the following 3 years. Thus, occult malignant neoplasm as infrequent as RCC should be in the list of differential diagnoses of fever of unknown origin (FUO). An abdominal ultrasound is a useful screening tool for early diagnosis of RCC.


Urachal Inflammatory Mass Mimicking an Intra-Abdominal Tumor Two Years after Excision of the Urachal Sinus in a Child

September 2003

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17 Reads

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13 Citations

Chang Gung medical journal

A 2-year-and-2-month-old boy presented with a tender fist-sized mass in the lower abdomen for 3 days. Turbid urine was also a complaint. His urachal sinus and umbilicus had been removed at the age of 2 months. Abdominal ultrasonography and computed tomography revealed a tumor mass beneath the lower abdominal wall. Total excision of the mass was performed. Microscopic examination showed an abscess located next to a small urachal remnant without stitches or foreign body reaction. To our knowledge, an urachal inflammatory mass mimicking an intra-abdominal tumor after excision of the urachal sinus, especially in children, is very rare. The factors causing such an urachal mass are discussed.


Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy

March 2003

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28 Reads

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8 Citations

Journal of the Formosan Medical Association

Obstructive jaundice often occurs as a late manifestation of non-Hodgkin's lymphoma (NHL), but has rarely been reported as a presenting manifestation, especially in children. We report a case of a 4-year-old boy with Burkitt's lymphoma (small non-cleaved cell NHL) who presented with obstructive jaundice, resulting from encasement of the common bile duct by the tumor. The patient underwent near-total excision of the tumor and biliary-enteric bypass to relieve the jaundice. Combined chemotherapy was not given because of refusal by his family. Two weeks after the operation, obstructive jaundice reappeared due to a large recurrent tumor compressing the liver hilum. He received chemotherapy and the jaundice disappeared within 6 days. Follow-up computed tomography 1 year later revealed total resolution of the tumor. Three conclusions are suggested by this case. First, although NHL presenting as obstructive jaundice is uncommon in children, it should be included in the differential diagnosis. Second, relief of obstructive jaundice can be effectively accomplished by chemotherapy alone. Third, chemotherapy should be given once NHL is diagnosed.


Duplication of transverse colon: Report of one case

January 2003

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12 Reads

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4 Citations

Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi

Alimentary tract duplications are very rare, with a reported incidence of 1 in 5000 live births. However, it rarely affects the transverse colon. We reported a case of duplication of the transverse colon in a 12-year-old boy with an unusual presentation mimicking megacolon. Barium enema revealed a large sac with massive fecal material retention in the left side of abdomen. Barium filling of the sac displacing bowel loops was noted on the post-evacuation film. He received a segmental resection of the transverse colon including the duplicated colon and end-to-end colo-colostomy. Pathology revealed whole muscle layer of colon compatible with duplication. No other associated anomaly was noted in this case. The case demonstrates three relatively uncommon presentations, including transverse colon location, late manifestation and dilated colon mimicking megacolon radiologically. It also emphasizes that barium enema with post-evacuation film aids in the preoperative diagnosis of duplication.


Small Bowel Intussusception in Symptomatic Pediatric Patients: Experiences with 19 Surgically Proven Cases

May 2002

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36 Reads

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91 Citations

World Journal of Surgery

Nineteen cases of surgically proven symptomatic pediatric small bowel intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and small bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.


Reappraisal of the role of the bilioenteric conduit in the pathogenesis of postoperative cholangitis

January 2000

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13 Reads

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18 Citations

Pediatric Surgery International

The incidence of postoperative cholangitis has changed very little despite progressive improvement in the treatment of biliary atresia. The role of the bilioenteric conduit in its pathogenesis is still uncertain. A retrospective study of 39 patients undergoing either a conventional Kasai operation (group 1, n = 20) or with placement of an antireflux valve (group 2, n = 10) or lengthening (group 3, n = 9) of the jejunal conduit from 40 to 60 cm was performed to compare the incidence of cholangitis. Postoperative cholangitis developed in 18 of the 39 patients (46%). The incidence was 10/20 (50%) in group 1, 5/10 (50%) in group 2, and 3/9 (33%) in group 3 (P = 0.679). An animal experiment was conducted concomitantly to compare quantitative bacterial cultures of the bilioenteric anastomosis and the liver before and 1 week after Roux-en-Y hepaticojejunostomy (HPJ) in piglets without (group A, 25 cm) and with (group B, 50 cm) lengthening of the jejunal conduit in a porcine model of extrahepatic biliary obstruction. The growth of bacteria in both the bilioenteric anastomosis and the liver was not affected by lengthening the jejunal conduit from 25 to 50 cm (P = 0.612 and 0.057, respectively), despite a geometric increase in bacterial concentrations in both groups after HPJ. It is concluded that neither bacterial growth in the liver nor cholangitis following bile-duct reconstruction was affected by valving or lengthening the bilioenteric conduit.



Retrograde intussusception after Roux-en-Y hepaticojejunostomy for choledochal cyst

July 1995

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10 Reads

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2 Citations

Pediatric Surgery International

The authors report the first documented case of a retrograde jejunojejunal intussusception after a Roux-en-Y hepaticojejunostomy for choledochal cyst in a 2-year-old girl. She suffered from obstructive jaundice and ileus; the jaundice was alleviated but the ileus worsened after conservative treatment, and abdominal computed tomography demonstrated an intussusception and gangrene of the bowel. Surgery confirmed the presence of a retrograde jejunojejunal intussusception at the previous end-to-side anastomosis, with a dilated Roux limb and proximal duodenojejunal segment. Intestinal obstruction in a jaundiced child following Roux-en-Y anastomosis may be due to a retrograde intussusception as well as a stricture of the hepaticojejunostomy or adhesive ileus.


Adhesive small-bowel obstruction in children

July 1995

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4 Reads

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6 Citations

Pediatric Surgery International

Seventy-one episodes of adhesive small-bowel obstruction (ASBO) in 57 children were reviewed to define the relationship of treatment methods to clinical conditions and to examine the place of conservative treatment. Thirteen children received urgent operations on the day of admission because of signs of suspected strangulation or complete obstruction. The remaining 58 episodes underwent initial conservative treatment, which was successful in 35 while 23 required subsequent surgical intervention, an overall incidence of operation in 36 of the 71 (50.7%) episodes of ASBO. Seven episodes required bowel resection, strangulation was found in 3 (4.2%), and mortality occurred in 1 (1.7%) due to delayed operation. Patients with more than one previous successfully treated occurrence of ASBO were significantly more likely to respond to conservative treatment (71.4% vs. 54.4%, P P


Citations (6)


... 6 Similar findings of a total operative rate of 50.7% was found in a study by Shieh et al; 13 children required immediate surgery, with remaining 58 initially managed nonoperatively with resolution of symptoms in 35 patients. 11 5 Our study demonstrated a relatively lower total operative rate of 37% when compared to other similar studies, supporting our impression of a relatively significant role for non-operative management existing in paediatric patients presenting with adhesive intestinal obstruction. This may have been attributable to a number of factors, including surgeon preference and several acknowledged limitations in our study. ...

Reference:

Non-operative Management of Adhesive Intestinal Obstruction in Children over a 12 year period at Waikato Hospital
Adhesive small-bowel obstruction in children
  • Citing Article
  • July 1995

Pediatric Surgery International

... Most of the cholangitis episodes develop within the first two years of life, and especially within the first year of life [9][10][11][12]. Despite improvements in postoperative management over the last decades, the incidence of cholangitis remains stable over time [13]. Hypotheses about the etiology of cholangitis includes intestinal bacterial migration, translocation from lymphatics, hematogenous spread via portal vein as well as an immune inflammatory response [14]. ...

Reappraisal of the role of the bilioenteric conduit in the pathogenesis of postoperative cholangitis
  • Citing Article
  • January 2000

Pediatric Surgery International

... Thrombocytosis also occurred in ABC-Myc mice, as indicated by an increase in total platelet counts, plateletcrit (PCT), and mean platelet volume (MPV) (Fig. 2d). One study reported that among hepatoblastoma patients, 75% had thrombocytosis and 37.5% had microcytic anemia, whereas only 23.1% of pediatric patients with hepatocellular carcinoma had thrombocytosis and none had microcytic anemia 50 . These chemistry and CBC parameters are consistent with the presence of hepatoblastoma-like disease in ABC-Myc mice. ...

Patterns of Hepatoblastoma and Hepatocellular Carcinoma in Children After Universal Hepatitis B Vaccination in Taiwan
  • Citing Article
  • February 2009

Journal of Pediatric Hematology/Oncology

... Small bowel intussusceptions (SBI) account for the majority of adult intussusceptions, while SBI is less common in the pediatric age group than ileocolic intussusceptions with an incidence of 2.5% 1,2 . In addition, SBI in children is commonly seen together with a concomitant pathological lead point (PLP) [2][3][4][5][6][7] . ...

Small Bowel Intussusception in Symptomatic Pediatric Patients: Experiences with 19 Surgically Proven Cases
  • Citing Article
  • May 2002

World Journal of Surgery

... The incidence pancreaticobiliary tract obstruction caused by NHL ranges from 0.2% to 2% in various reports [9,10]. Although usually obstructive jaundice is the late manifestation of NHL [3,4], it may also be the presenting symptom [3,4,9,10]. Fidias and colleagues reported biliary tract obstruction as the presenting manifestation in 0.8% of their patients with NHL [10]. ...

Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy
  • Citing Article
  • March 2003

Journal of the Formosan Medical Association

... During the physical examination, infraumbilical mass under the skin may be felt. 9 In some cases, the urachal sinus can be infected by Escherichia coli, Enterococcus faecium, Proteus, Streptococcus viridans, and Fusobacterium, leading to urachal sinus abscess causing abdominal pain and umbilical discharge. 2,4 Urachal sinus could be malignant, including less than 5% of bladder cancers, and the most common type is adenocarcinoma. ...

Urachal Inflammatory Mass Mimicking an Intra-Abdominal Tumor Two Years after Excision of the Urachal Sinus in a Child
  • Citing Article
  • September 2003

Chang Gung medical journal