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Biomedical subjects

A K Li

Publications and source records attributed to A K Li.

At least 19 recordsLinked to original sources
PubMed1997

Laparoscopic ultrasonography during laparoscopic cholecystectomy.

BACKGROUND: This study assessed the effectiveness of laparoscopic ultrasonography in demonstrating biliary anatomy, confirming suspected pathology, and detecting unsuspected pathology. METHODS: Laparoscopic ultrasonography was performed on 48 patients (17 M:31 M) who underwent laparoscopic cholecystectomy. An Aloka 7.5-MHz linear laparoscopic ultrasound transducer was used for scanning. RESULTS: Gallbladder stones were confirmed by laparoscopic ultrasonography in all patients and unsuspected pathology was found in five patients. Two patients were found to have common bile duct stones by laparoscopic ultrasonography and this was confirmed by laparoscopic cholangiography. Laparoscopic ultrasound was found to be helpful during dissection in four patients, particularly in a patient with Mirizzi syndrome. The entire common bile duct was visualized by laparoscopic ultrasonography in 40 patients but was poorly seen in eight patients. The mean time taken for the examination was 9 min (range 4-18 min). CONCLUSION: Laparoscopic ultrasound is useful during laparoscopic cholecystectomy.

Adult↗
PubMed1997

A logical approach to hepatocellular carcinoma presenting with jaundice.

OBJECTIVE: This prospective cohort study on patients with hepatocellular carcinoma (HCC) presenting with jaundice emphasized the importance of differentiating patients with hepatic insufficiency from patients with obstructive jaundice caused by tumor. SUMMARY BACKGROUND DATA: There are little data in the medical literature on the management of patients with HCC presenting with jaundice. Experience has accumulated mainly from case reports and retrospective studies. METHODS: Data were collected prospectively on 2095 patients with HCC seen over a 12-year period. All patients were investigated with blood tests, abdominal ultrasound, and chest radiography. Endoscopic retrograde cholangiopancreatography-percutaneous transhepatic cholangiography, computed tomography and hepatic angiography were carried out in selected patients. RESULTS: Of the 530 patients who had clinically detectable jaundice, 481 had jaundice due to hepatic insufficiency and 49 patients had obstructive jaundice. Patients with hepatic insufficiency had extremely poor prognosis, and 90% of them died within 10 weeks of first presentation. "Curative" resection, however, was possible in 9 of 49 patients with obstructive jaundice, and histologic analysis showed resectional margin involvement by tumor in 1 patient. In addition, 35 patients were treated with biliary stents to relieve the obstructive jaundice. Supportive treatment only was given to five patients who were considered too terminally ill. The overall survival of patients with HCC with obstructive jaundice was similar to those patients who presented with no clinical detectable jaundice and was much better than those with jaundice due to hepatic insufficiency (log-rank test, p < 0.001). CONCLUSIONS: The prognosis of patients with HCC who presented with jaundice due to hepatic insufficiency was dismal. It is important to identify the patients who had obstructive jaundice because with proper treatment, good palliation and occasional cure are possible.

Adult↗
PubMed1997

Spontaneous internal herniation through the foramen of Winslow: a case report.

A 41-year-old woman, who presented with acute onset of generalized peritonitis, was found to have a segment of strangulated small bowel incarcerated in the lesser peritoneal sac through the foramen of Winslow. The strangulated small bowel was reduced and resected. The predisposing factors for this condition as mentioned in the literature were not present in this case. In particular, the herniation was associated with a small foramen of Winslow and the presentation was one of rapidly developing peritonitis.

Adult↗
PubMed1996

Urinary 6 beta-hydroxycortisol excretion in Hong Kong Chinese patients with hepatocellular carcinoma and other chronic liver diseases.

BACKGROUND: The biotransformation of xenobiotics into toxic metabolites by cytochrome P-450 has been implicated in carcinogenesis. This study investigated CYP3A4 activity, which metabolically activates procarcinogens such as aflatoxin B1, by measuring the urinary 6 beta-hydroxycortisol (6 beta OHF) to free cortisol (F) ratio in patients with hepatocellular carcinoma (HCC) and other chronic liver diseases. METHODS: One hundred forty-three controls and 150 patients with different liver diseases, including chronic liver disease (due to alcoholism and/or chronic hepatitis B virus infection), cirrhosis (any cause), and resectable and nonresectable HCC, were recruited. Twenty-four hour urine samples were collected for measurement of 6 beta OHF and free cortisol by an enzyme-linked immunosorbent assay (ELISA) and a radioimmunoassay, respectively. RESULTS: Patients with nonresectable HCC showed a significant increase in 6 beta OHF excretion as well as their 6 beta OHF/F ratio (P < 0.05) when compared with the controls and other liver disease groups including patients with resectable HCC. The nonresectable HCC group showed a bimodal distribution in the 6 beta OHF/F ratio. Using a ratio of 9 or more in all HCC patients, the sensitivity and specificity of using the 6 beta OHF/F ratio to predict nonresectability of HCC was 48.8% and 92.6%, respectively. CONCLUSIONS: Our results show an increase in mean CYP3A4 enzyme activity, reflected as an increase in the 6 beta OHF/F ratio, in Hong Kong Chinese with nonresectable HCC compared with those with resectable HCC and other liver diseases. Although the role of increased CYP3A4 activity in the aetiology of HCC is not known, our specificity and sensitivity estimates suggest that a high 6 beta OHF/F ratio indicates probable inoperability. However, a normal level is a poor predictor of resectability.

Adolescent↗
PubMed1996

Risk of further ulcer complications after an episode of peptic ulcer bleeding.

To identify the risk factors for developing recurrent ulcer complications after recovery from an episode of peptic ulcer bleeding 611 patients admitted with peptic ulcer bleeding were studied. Some 557 (91 per cent) were discharged without operation. A total of 22 patients were lost to follow-up and five were excluded as maintenance H2 blockers were required. Of the remaining 530 patients at risk, 169 (32 per cent) developed another complication (166 bleeding, three perforations) over a median follow-up period of 36 months. Patients with duodenal ulcers at the time of bleeding, previous history of peptic ulcer, previous bleeding, history of dyspepsia longer than 3 months, and a short interval between previous ulcer complications and the index bleed were more likely to develop further complications. Sex, age, smoking, coexisting illness, non-steroidal anti-inflammatory drugs intake and time taken to achieve ulcer healing had no predictive value.

Adolescent↗
PubMed1996

Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma.

The distal resection margin measured in situ at operation, on the fresh specimen and on the fixed specimen was analysed prospectively in 55 consecutive patients undergoing anterior resection for carcinoma of the rectum. There was obvious contraction in length from the operative margin to the specimen margin and to the fixed margin. As measured by contraction coefficients, contraction was greater in more proximal tumours than in distal ones. Eight of 55 patients had microscopic intramural spread in the fixed distal margin and the maximum spread was 12 mm. Taking contraction of the fixed margin into account, the extrapolated microscopic spread in the operative margin ranged from 0 to 47 mm.

Adult↗
PubMed1996

Pitfalls in the management of preauricular sinuses.

A total of 159 operations for the excision of a preauricular sinus carried out in 117 patients over an 8-year period were reviewed. Previous excision, the use of a probe to delineate the sinus and operating under local anaesthesia all increased the chance of recurrence. The condition recurred more often in patients who developed post-operative wound sepsis than in those who healed primarily. Means of decreasing the recurrence rate include: (1) meticulous dissection of the sinus by an experienced head and neck surgeon under general anaesthesia; (2) the use of an extended preauricular incision; (3) clearance down to the temporalis fascia to ensure complete removal of all epithelial components; (4) avoidance of sinus rupture; and (5) closure of wound dead space.

Abscess↗
PubMed1996

High prevalence of Helicobacter pylori infection in duodenal ulcer perforations not caused by non-steroidal anti-inflammatory drugs.

There has been controversy regarding the relationship between Helicobacter pylori and perforated peptic ulcer, which is known to have a high recurrence rate if only simple patch repair is performed. The aim of this study was to evaluate the association between H. pylori infection and intake of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with perforated duodenal ulcers. Of the 73 patients recruited over a 16-month period, 51 (70 per cent) had evidence of H. pylori infection by intraoperative gastroscopy and antral biopsies. The infection rate rose to 80 per cent if NSAID users were excluded. The H. pylori-infected group was significantly younger (mean 47.6 versus 62.5 years), with a male preponderance (49 of 51 versus 14 of 22 patients), and had significantly less NSAID consumption (three of 51 versus ten of 22) and more prolonged dyspepsia (40 of 51 versus ten of 22), compared with H. pylori-negative patients. H. pylori infection probably plays an important role in the causation of non-NSAID-induced duodenal ulcer perforation. Whether eradication of the bacteria can alleviate the strong ulcer diathesis in this subgroup of patients is unknown.

Aged↗
PubMed1996

Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours.

A uniform distribution of yttrium-90 (90Y) microspheres throughout the entire liver has always been assumed for dose calculation in treating hepatic tumours. A simple mathematical model was formulated which allows estimation of the activities of a therapeutic dose of 90Y microspheres partitioned between the lungs, the tumour and the normal liver, and hence the radiation doses to them. The doses to the tumour and normal liver were verified by intra-operative direct beta-probing. The percentage of activity shunted to the lung and the tumour-to-normal tissue ratio (T/N) were obtained from gamma scintigraphy using technetium-99m-labelled macroaggregated albumin (MAA) which simulates the 90Y microspheres used in subsequent treatment. The intrahepatic activity was partitioned between the tumour and the normal liver based on the T/N and their masses determined from computerized tomography slices. The corresponding radiation doses were computed using the MIRD formula. The estimated radiation doses were correlated with the doses directly measured using a calibrated beta-probe at laparotomy by linear regression. The radiation doses to the tumour and the normal liver, estimated using the partition model, were close to that measured directly with coefficients of correlation for linear regression: 0.862 for the tumours and 0.804 for the normal liver compartment (P<0.001). The partition model permits a distinction between the radiation doses received by the tumour and the normal liver to be made and the doses thus estimated are close to the actual doses received. The optimal doses to the tumour and normal liver and hence the required quantity of 90Y microspheres to be administered can be easily predetermined.

Brachytherapy↗
PubMed1996

Dual therapy versus triple therapy for Helicobacter pylori-associated duodenal ulcers.

We compared the ulcer healing effect and eradication of H. pylori by one-week triple therapy of bismuth, metronidazole, and tetracycline with two-week dual therapy of amoxicillin and omeprazole. One hundred twelve patients with confirmed H. pylori infection and duodenal ulcers were recruited in a prospective, randomized, single-blinded trial. Ulcer healing, eradication of H. pylori in the stomach six weeks after randomization and side effect reported by patients during the therapy. Duodenal ulcers were healed in 44 of 49 (89.8%, 95% CI, 81.3-98.3 %) patients receiving triple therapy and in 44 of 53 (83.0%, 95% CI, 72.9-93.1%) patients receiving dual therapy (P=0.32). H. pylori was successfully eradicated in 41 of 49 (83.6%, 95% CI 73.4-94%) patients and in 40 of 53 (75.5%, 95% CI 63.9-87.1%) patients in the triple therapy group and the dual therapy group respectively (P=0.31). Side effects experienced by patients who received triple therapy were significantly more frequent than those who received dual therapy (P=0.0076). In conclusion, a two-week course of omeprazole and amoxicillin achieves a comparable rate of H. pylori and ulcer healing with fewer side effect.

Adolescent↗
PubMed1996

Absorbable clips for cystic duct ligation in laparoscopic cholecystectomy.

BACKGROUND: The efficacy and applicability of an absorbable polydioxanone (PDS) clip for cystic duct ligation were evaluated in 297 patients undergoing laparoscopic cholecystectomy. METHODS: The indications for cholecystectomy were symptomatic gallstones (179 patients), acute cholecystitis (67), biliary pancreatitis (23), acute cholangitis (24), and gallbladder polyp (4). RESULTS: Twenty-five patients required conversion to open surgery (8.4%). The conversion rate was 2.7% for uncomplicated and 17.5% for complicated gallbladder diseases. Of the 272 patients with laparoscopic cholecystectomy, the cystic ducts were successfully ligated with PDS clips in 227 patients (83.5%). The success rate was higher in uncomplicated (163/178) than in complicated (64/94) gallbladder diseases (chi square = 24.6, P < 0.001). There was no clip-related complication on follow-up (range 0.4-39.2, median 17.5 months). In 45 patients, PDS clip failed. They were treated with endoloop (14 patients), Roeder slip knot (13), metallic clips and endoloop (8), metallic clips alone (6), and intracorporeal tie (4). CONCLUSIONS: The PDS clip is effective and applicable to the majority of patients. It should be attempted first because of the ease of application.

Absorption↗
PubMed1996

Debridement of burn wounds with a surgical ultrasonic aspirator.

Ultrasonic ablation of tissue by the surgical ultrasonic aspirator (SUA) is an established technique in neurosurgery and hepatobiliary surgery. We report the first use of SUA in the debridement of burn wound in three patients. Our initial experience suggested that SUA allows meticulous wound debridement and cleansing with minimal bleeding and destruction of normal tissue and, therefore, is an extremely useful surgical instrument to add to the armamentarium of the burn surgeon.

Adult↗
PubMed1996

Laparoscopic truncal vagotomy and gastroenterostomy for pyloric stenosis.

BACKGROUND: Gastric outlet obstruction secondary to chronic duodenal ulceration is an indication for surgery as conservative management with balloon dilatation frequently fails. The standard operation is truncal vagotomy and a drainage procedure. However, development of minimally invasive surgery has revolutionized the surgical approach to this clinical problem. METHODS: Twelve male patients with pyloric stenosis secondary to duodenal ulceration underwent laparoscopic truncal vagotomy and gastrojejunostomy. The perioperative and long term outcome of this group of patients were analyzed. RESULTS: The median operating time was 210 (range 180 to 240) minutes. Median postoperative stay was 6 (range 4 to 41) days. Conversion to laparotomy was necessary in one patient. Delayed gastric emptying occurred in two patients but resolved on conservative measures. At a median postoperative followup of 6 (range 1 to 12) months all patients had a good symptomatic outcome (Visick grades I or II). CONCLUSIONS: Laparoscopic truncal vagotomy and gastrojejunostomy is a feasible technique. Intermediate followup shows good symptomatic results when used for pyloric stenosis.

Adult↗
PubMed1996

Through-the-scope balloon dilation for pyloric stenosis: long-term results.

BACKGROUND: Through-the-scope balloon dilation has been used for treatment of benign pyloric stenosis; however, long-term results are lacking in the literature. METHOD: A retrospective analysis using the Kaplan-Meier method. RESULTS: Between November 1986 and December 1993, 54 patients underwent through-the-scope balloon dilations for pyloric stenosis. The mean age was 57.5 years. There were 5 (9.3%) initial treatment failures due to tight stenoses and perforations from dilation occurred in 4(7.4%) patients. Forty-five (83.3%) patients underwent successful dilation. Four patients developed rapid restenoses and were found to have malignant obstructions. Forty-one patients entered our study. Time at risk commenced on the date of initial dilation. The end point was defined at the time at which patients presented with recurrent obstruction or other ulcer complications. The median follow-up period was 39 months. The ulcer complication-free probability at 3 months, and at 1, 2, and 3 years was 79.1%, 73.4%, 69.3%, and 54.7%, respectively. In all, 21 (51.2%) patients required subsequent surgery: 18 for recurrent obstructions, 2 for interval perforations, and 1 for bleeding. CONCLUSION: While through-the-scope balloon dilation may palliate symptoms of obstruction, recurrent obstruction and other ulcer complications are common. It should be reserved only for patients at high risk for operative surgery.

Adult↗
PubMed1996

Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial.

BACKGROUND: Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10% to 20% of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis. METHODS: A prospective randomized controlled trial was conducted to compare injections with epinephrine alone or epinephrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surgery was performed when arterial bleeding could not be controlled endoscopically, clinical rebleeding with hematemesis or shock occurred, or the transfusion total exceeded 8 units. RESULTS: One hundred sixty patients were enrolled (epinephrine alone, 81; epinephrine and absolute alcohol, 79). They were matched in age, sex, location of ulcers, hemoglobin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5%) versus 75 of 79 with epinephrine and absolute alcohol (94.9%). No difference was observed between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, three units vs two units), hospital stay (median, 5 days vs 4 days), mortality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). CONCLUSIONS: The additional injection of absolute alcohol after endoscopic epinephrine injection confers no advantage.

Adolescent↗