Congenital bile duct dilatation in children

Fifteen children under the age of 15 were identified to have congenital dilatation of the biliary tree. Thirteen of them (87%) had dilatation of both intrahepatic and extrahepatic bile ducts, while two had extrahepatic biliary dilatation only. Visualization of both intrahepatic and extrahepatic biliary tree in small children before operation is possible by ultrasonography, endoscopic retrograde cholangio-pancreatography, or percutaneous transhepatic cholangiography. The advantage and disadvantage of those methods of examinations in children are discussed here. Dilatation of intrahepatic bile ducts is common in children with extrahepatic biliary dilatation. Assessment of both the intrahepatic and extrahepatic bile ducts bears a crucial role in the management of congenital biliary dilatation at operation and during the postoperative follow-up. Rouxen-Y hepaticojejunostomy with hepaticocutaneous arm was performed in our patients with satisfactory results. Residual intrahepatic stones could be removed through the hepaticocutaneous arm by choledochoscopy.

Growth rate of asymptomatic hepatocellular carcinoma and its clinical implications

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.

Early detection of hepatocellular carcinoma by real-time ultrasonography. A prospective study

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.

Bronchopulmonary sequestration associated with aspergilloma, with special reference to the finding of radionuclide venoangiography

A case of intralobar bronchopulmonary sequestration associated with aspergilloma was reported. It was suggested by radionuclide venoangiography and aortic cineangiography. The diagnosis was confirmed by subsequent pathologic examination of the lobectomized lung tissue. The pulmonary perfusion scan with 99mTc-MAA showed a perfusion defect in the right lower lung field. Perfusion defect could also be traced in the same anatomical location in the pulmonary phase of radionuclide venoangiography with 99mTc-pertechnetate. However, the area of perfusion defect was visualized as hot area, when the injected radionuclide was pumped into the aorta after its first pass through the lung. The radionuclide venoangiography can efficiently detect abnormal systemic blood supply of the lung tissue. It can be an useful method for suggestive diagnosis of bronchopulmonary sequestration.

Ultrasonography of small hepatic tumors using high-resolution linear-array real-time instruments

Abdominal ultrasonography using a high-resolution linear-array real-time scanner was compared to computed tomography, celiac arteriography, and radionuclide imaging in 24 patients with a total of 33 hepatocellular carcinomas (HCC), 10 patients with cavernous hemangioma (12 tumors), and 2 patients with metastatic carcinoma of the liver (3 tumors), all smaller than 3 cm. Ultrasound proved to be the most sensitive method of detecting such small tumors. Most small HCCs were hypoechoic and most small hemangiomas hyperechoic. Aspiration cytology and/or biopsy under ultrasound guidance detected 92.3% of HCCs and 100% of hemangiomas. Intraoperative ultrasound was employed in 19 cases of small HCC and aided resection in 8. Real-time ultrasound may play a prominent role in early detection and diagnosis of small HCCs.

Endoscopic examination of the upper gastrointestinal tract in infancy

Forty endoscopic examinations of the upper gastrointestinal tract were performed in 38 infants with an age range from 2 days to 12 months. The main indications were upper gastrointestinal bleeding, chronic intractable vomiting, and small intestinal biopsy. Duodenal ulcer, hemorrhagic gastritis, and gastric erosions were the most common causes of upper gastrointestinal bleeding in infancy. An acute viral infection with fever, aspirin ingestion, and diarrhea frequently preceded gastrointestinal bleeding from duodenal ulcer and gastric erosion. Four of the 27 bleeding patients demonstrated no abnormality endoscopically.

Hepatitis B e antigen and antibody in asymptomatic Chinese with hepatitis B surface antigenemia in Taiwan

Two hundred and twenty two asymptomatic carriers of hepatis B surface antigen (HBsAg) with age between 4 months and 68 years, 172 healthy persons with antibody to HBsAg (anti-HBs) and 85 healthy persons seronegative for both HBsAg and anti-HBs were studied by double immunodiffusion for the evaluation of the meaning of hepatitis B e antigen (HBeAg) and its antibody (anti-HBe). In 222 asymptomatic carriers, HBeAg was detected in 32.4% and anti-HBe in 31.5%. The geometric titer of HBsAg was 1:2159 in the HBeAg positive and 1:149 in the anti-HBe positive persons. Frequencies of HBeAg and anti-HBe in asymptomatic carriers of HBsAg correlated closely with age. The highest frequency of HBeAg was found in the first decade in 64% decreasing steadily to 20.8% in the fourth and then suddenly down to 4.1% in the fifth decade. A reverse trend was observed in anti-HBe frequency. From our analysis, it is likely that the high frequency of HBeAg in serum of Chinese, especially in females of fertile age, might be an important contributing factor for the high rates of hepatitis B virus (HBV) infection and HBsAg carrier in Taiwan. The presence of HBeAg/anti-HBe system is not only a market of infectivity and prognosis but also a chronologic marker of HBV infection.

Hepatitis A virus infection in Taiwan. A hospital-based study

One hundred and thirty-four healthy subjects and 220 patients with liver diseases were studied for antibody to hepatitis A virus (anti-HAV) with radio-immunoassay. The frequency of anti-HAV related closely to the age of healthy subjects; the rate of positivity increased with age, being 5.9% in those under four years, 13.3% in the late first decade and over 90% after the third decade. Taking meals at stalls with poor sanitary standards is suspected to cause the prevailing infection in teenagers, although a cohort effect due to environmental and socio-economic improvement can not be excluded. Anti-HAV was present in most patients with frequencies comparable to healthy subjects of the same age. It is concluded that in Taiwan the prevalent chronic liver diseases and hepatocarcinoma are unrelated to HAV infection and the patients are infected to an extent similar to healthy people of the same age.

Purification and properties of bovine brain calmodulin-dependent cyclic nucleotide phosphodiesterase

Calmodulin-dependent cyclic nucleotide phosphodiesterase was purified from bovine brain to apparent homogeneity by a new procedure involving DEAE-cellulose, Affi-Gel blue, calmodulin-Sepharose 4B, and Sephadex G-200 column chromatographies. The enzyme was purified more than 3,000-fold from the brain extracts with greater than 12% yield. The purified phosphodiesterase could be activated 10- to 15-fold by calmodulin and Ca2+ to a specific enzyme activity of more than 300 mumol of cAMP hydrolyzed/min/mg of protein. Molecular weight of the enzyme was determined to be 115,800 by the sedimentation equilibirum method or 124,000 from the sedimentation constant and Stokes radius of the protein. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the enzyme showed a single protein band with an apparent molecular weight of 58,000. These results suggested that the calmodulin-dependent phosphodiesterase from bovine brain has a subunit structure of alpha2. Molecular weight of the complex of calmodulin and phosphodiesterase was the complex of calmodulin and phosphodiesterase was also calculated from the sedimentation constant and Stokes radius to be 159,000. Since calmodulin has a molecular weight of about 17,000, the result indicated that the stoichiometry of the complex is calmodulin2 alpha2. The catalytic subunit of cylic AMP-dependent protein kinase was found to catalyze the phosphorylation of the purified phosphodiesterase with the incorporation of 2 mol of phosphate/mol of the enzyme.