Endoscopic diagnosis of retrograde jejunojejunal intussusception.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
A K Li
Publications and source records attributed to A K Li.
Prospective evaluation of laparoscopic-assisted large bowel excision for cancer.
OBJECTIVE: The authors described their experience with laparoscopic-assisted colorectal resection for colorectal carcinoma, both curative and palliative, with emphasis on patient selection. The techniques of the operations were described. SUMMARY BACKGROUND DATA: Laparoscopic colorectal procedures for treatment of benign lesions have been shown to be less painful and to enhance early postoperative recovery. However, use of laparoscopic procedures for treatment of colorectal cancer are controversial. The authors have used laparoscopic techniques for curative and palliative resections of colorectal carcinoma with satisfactory early results. METHODS: One hundred patients with colorectal carcinoma were selected over a 30-month period for laparoscopic-assisted colorectal resection. For 17 patients, laparoscopy revealed bulky tumor or locally advanced disease, and open surgery was performed. For 83 patients, laparoscopic-assisted colon and rectal resections were attempted. Procedural data and postoperative results were entered prospectively. The median follow-up period was 15.2 months (range, 2.5-32.7 months). RESULTS: Fourteen of 83 patients eventually required conversion to open surgery. The median operative time was 180 minutes. The patients could return to a normal diet in a median of 4 days. The median number of doses of analgesics required was two, and the median hospital stay was 6 days. The morbidity rate was 12%, and there was no deaths attributable to the procedure. There were four distant recurrences and one pelvic recurrence. CONCLUSIONS: Laparoscopic-assisted colorectal resection for selected patients is feasible, and early postoperative results are encouraging. This procedure does not appear to be associated with an excessive recurrence rate, and long-term follow-up is necessary for late survival figures.
Adolescent↗
A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique.
OBJECTIVE: This study compares laparoscopic versus open repair and suture versus sutureless repair of perforated duodenal and juxtapyloric ulcers. BACKGROUND DATA: The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet of the peritoneal cavity has been established. Whether repair of the perforated peptic ulcer by the laparoscopic approach is better than conventional open repair and whether sutured repair is better than sutureless repair are both undetermined. METHODS: One hundred three patients were randomly allocated to laparoscopic suture repair, laparoscopic sutureless repair, open suture repair, and open sutureless repair. RESULTS: Laparoscopic repair of perforated peptic ulcer (groups 1 and 2) took significantly longer than open repair (groups 3 and 4; 94.3 +/ 40.3 vs. 53.7 +/ 42.6 minutes: Student's test, p < 0.001), but the amount of analgesic required after laparoscopic repair was significantly less than in open surgery (median 1 dose vs. 3 doses) (Mann-Whitney U test, p = 0.03). There was no significant difference in the four groups of patients in terms of duration of nasogastric aspiration, duration of intravenous drip, total hospital stay, time to resume normal diet, visual analogue scale score for pain in the first 24 hours after surgery, morbidity, reoperation, and mortality rates. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer is a viable option. Sutureless repair is as safe as suture repair and it takes less time to perform.
Adult↗
Unexplained septicaemia and pneumoperitoneum in Vietnamese boat people: a self-inflicted condition?
BACKGROUND: Ten Vietnamese boat people with septicaemic shock or pneumoperitoneum were admitted between April and July 1993. METHODS: In order to investigate the cause of unexplained septicaemic shock and spontaneous pneumoperitoneum in Vietnamese boat people, an audit was carried out. Attention was paid to the mode of presentation, abnormal physical signs, presence of injection marks, radiological signs, subsequent progress outcome. RESULTS: The clinical and radiological findings were all in favour of self-inflicted conditions. A retrospective review from the hospital record revealed that the emergency admission rate and disappearance rate of the Vietnamese boat people was higher than those of other patients (P<0.001). CONCLUSION: It is concluded that self-inflicted conditions are a serious problem among the Vietnamese boat people, who may use a hospital admission to avoid the detention centre.
Adolescent↗
Mesh hernioplasty using a stapler.
BACKGROUND: The recent development of laparoscopic hernioplasty has evoked extensive re-examination of the safety and effectiveness of using synthetic mesh materials in hernia surgery. We have investigated the efficacy of anterior stapling mesh repair in the treatment of inguinal hernia. METHODS: From July 1993 to June 1994, a modified open mesh hernioplasty using staples for anchorage has been performed in 127 patients. RESULTS: The mean age of patients was 61.4 +/- 13.0 years. Over 90% of them were operated on under local anaesthesia. The operation time ranged from 30 to 95 min with a median of 39 min. Only sixteen patients (12.6%) required postoperative parenteral analgesics and the median time for resuming daily activities was 7 days. Apart from two patients with reactionary haemorrhage, there was no other significant complication observed. Only one recurrence was encountered over the 26-month median follow-up period. CONCLUSIONS: We conclude that the modified mesh hernia repair with a stapling device is a feasible, inexpensive and safe procedure that is well tolerated under local anaesthesia by most patients.
Adult↗
A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstruction.
BACKGROUND: The purpose of this prospective study was to determine the value of water-soluble contrast follow-through radiology in predicting the outcome in patients with small bowel obstruction. METHODS: Patients with clinical and radiological evidence of small bowel obstruction were selected according to pre-set criteria. A water-soluble contrast follow-through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as 'significant obstruction' if the contrast failed to reach the caecum in 4 h or if there was a clear cut-off in the gastrointestinal tract. The result was interpreted as 'insignificant obstruction' if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the contrast examination in the patient management, and the decision to operate was based entirely on conventional clinical grounds. RESULTS: Fifty-one patients in an 18 month period underwent the contrast examinations. Thirty-four patients (67%) had previous abdominal operations. The results showed that significantly more patients who had 'significant obstruction' on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had "insignificant obstruction' (1/32; Fisher's exact test, P < 0.0001). This difference was found to be significant in both patient subgroups: patients with or without previous abdominal operation. There was no major morbidity or mortality related to the contrast radiology procedure. CONCLUSIONS: Urografin follow-through examination is a safe procedure; using 4 h as the cut-off it is highly predictive of the outcome in small bowel obstruction in patients with or without previous abdominal operation.
Abdomen↗
Hepatic haemangioendothelioma presenting with early heart failure in a newborn: treatment with hepatic artery embolization and interferon.
We report our management of a newborn presenting in utero with congestive heart failure secondary to a giant hepatic haemangioendothelioma. Control of heart failure was achieved by transcatheter hepatic artery embolization, and rapid regression of the tumor was observed after a course of alpha 1 interferon. The combination of hepatic artery embolization and interferon may be a useful approach in the management of this rare, potentially fatal condition.
Antineoplastic Agents↗
The use of liver grafts infested with Clonorchis sinensis for orthotopic liver transplantation.
In the Orient, millions are known to have Clonorchis sinensis (biliary trematodiasis) infestation. When these infested livers become available as donor organs, there are potentially serious implications that the transplant team would need to consider. We report the use of two such infested livers, one from a cadaveric donor and the other from a live related donor, for orthotopic liver transplantation. The parasite was encountered not only during organ procurement, but also caused early postoperative blockage of the hepatico-jejunostomy splintage tube and cessation of bile flow in the second recipient. Upon follow-up for four and two years, respectively, no other ill effect has been observed in either patient. Repeated examination of stool for ova of C sinensis in both patients during follow-up visits had been negative, indicating that all the parasites probably had been killed by the cold perfusion. In view of the severe shortage of liver grafts and the lack of serious morbidity associated with the use of these infested livers, we have adopted the policy to include these livers for future transplantation. Special considerations and precautions are, however, required during the perioperative period and on long-term follow-up.
Animals↗
Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography.
PURPOSE: To prospectively compare magnetic resonance (MR) cholangiography with endoscopic retrograde cholangiography (ERC) in the diagnosis of choledocholithiasis. MATERIALS AND METHODS: Forty-seven patients with suspected choledocholithiasis underwent non-breath-hold, heavily T2-weighted, respiratory-triggered turbo spin-echo MR cholangiography. They then underwent ERC within 5 hours. The results of the two procedures were compared in 45 patients. RESULTS: The absence of ductal dilatation was shown in 16 patients at MR cholangiography and at ERC. MR cholangiography showed common duct dilatation in 28 of the 29 patients with dilatation shown at ERC. MR cholangiography helped correctly identify 18 of the 19 patients with choledocholithiasis and 22 of the 26 patients without choledocholithiasis. Sensitivity with MR cholangiography was 95%, specificity was 85%, positive predictive value was 82%, and negative predictive value was 96%. Two of the false-positive findings were due to pneumobilia. CONCLUSION: Non-breath-hold MR cholangiography is as accurate for the evaluation of choledocholithiasis as ERC.
Adult↗
Thoracoscopic resection of oesophageal diverticulum: a case report.
The introduction of video-assisted surgery has revolutionized thoracic surgery. The main attraction is the avoidance of a large thoracotomy incision and its associated morbidity. We present the case of a 55-year-old woman with an oesophageal diverticulum presenting with troublesome dysphagia. A thoracoscopic assisted oesophageal diverticulectomy was performed. Post-operative recovery was uneventful, and only two doses of intramuscular opiate analgesic were required. The patient remained asymptomatic at a follow-up of 3 months.
Diverticulum, Esophageal↗
Endoscopic drainage aborts endotoxaemia in acute cholangitis.
Forty patients with acute calculous cholangitis had successful endoscopic drainage. Bile from nasobiliary drains and venous blood was collected at 0, 12, 24, 36 and 48 h after endoscopy. Endotoxin levels were measured by the chromogenic Limulus Amoebocyte Lysate assay. There was a significant reduction in both bile and serum endotoxin levels after endoscopic drainage (P < 0.001). Endotoxaemia occurred when bile endotoxin reached 10(3) EU/ml and rose exponentially beyond this threshold. Significant association was demonstrated between both bile and serum endotoxins to the clinical features of cholangitis (P < 0.05). No correlation was evident between serum endotoxin and the parameters of white cell count, serum bilirubin and alkaline phosphatase (r = 0.53, 0.00 and 0.00 respectively). Endoscopic drainage is effective in lowering bile and serum endotoxin levels and clinical signs and symptoms reliably predict endotoxaemia.
Acute Disease↗
Optimal position of working ports in laparoscopic surgery: an in vitro study.
We investigated the optimal position of the laparoscope in relationship to the working ports. The optical angle (theta), defined as the angle formed by the line of action (determined by the working ports) and the line of vision (determined by the laparoscope), was varied by 30 degrees intervals from 0 degree to 180 degrees to the left and to the right. We also studied the time taken to accomplish a standardized task of tying a square knot with each optical angle in a laparoscopic simulator setting. The optimal position is at the optical angle of 0 degree. The optimal range of the optical angle is 60 degrees to the left and 60 degrees to the right of the optimal position of 0 degree.
Analysis of Variance↗
Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors.
PURPOSE: To investigate the clinical, histopathological, and radiological features of radiation pneumonitis arising as a complication of selective internal radiation treatment for liver tumors. To correlate the development of radiation pneumonitis with the degree of lung shunting as assessed by 99mTechnetium-labeled macroaggregated albumin (Tc-MAA) scan. METHODS AND MATERIALS: Five out of 80 patients who had inoperable hepatic tumors and underwent treatment with intraarterial 90Yttrium- (90Y)-microspheres, developed progressive restrictive ventilatory dysfunction without an infective or cardiovascular cause. Histopathological evidence of a pneumonitis and the presence of microspheres in the lung tissue suggested a diagnosis of radiation pneumonitis. The clinical course, radiological and histopathological findings, percentage tumor shunting to the lungs (lung shunting, as predicted by gamma camera scanning after intraarterial Tc-MAA), and the estimated radiation dose to the lungs were analyzed. In an attempt to reduce pulmonary shunting of the microspheres, three patients received partial hepatic embolization with inert particles before selective internal radiation therapy. RESULTS: In the five patients who developed radiation pneumonitis, lung shunting percentages (as predicted by Tc-MAA scan) ranged from 13.1 to 45.6% (median 23.7%). The estimated whole lung radiation dose ranged from 10.43 Gy to 36.44 Gy (median 25.04 Gy). Among 75 patients who did not develop radiation pneumonitis, the percentage lung shunting ranged from less than 1% to 15% (median 6%). Nine patients had lung shunting greater than 13% and five of them developed radiation pneumonitis, whereas this developed in none of those in whom shunting was below 13%. The onset of radiation pneumonitis ranged from 1 to 6 months after internal radiation treatment. All five patients exhibited characteristic plain radiographic and computerized tomographic changes comprising extensive consolidation with well-defined lateral margins. Clinical improvement after corticosteroid treatment was seen in two patients. Three patients died from respiratory failure and two from other causes. Partial hepatic arterial embolization reduced the degree of lung shunting to less than 13%, but did not prevent the development of radiation pneumonitis. CONCLUSION: Radiation pneumonitis may become a complication after intraarterial 90Y-microspheres treatment when lung shunting, as assessed by Tc-MAA scan, is high (above 13%). Prescribed activity of 90Y and lung shunting of Tc-MAA should be considered together before giving selective internal radiation (SIR) therapy for hepatic tumors, and preferably avoided if the lung shunting is above 13%.
Adult↗
Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy-associated malignancies.
BACKGROUND: Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. METHODS: A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words "Hepatocellular Carcinoma" and "Pregnancy" was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed. RESULTS: To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma. CONCLUSION: Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk.
Adult↗
Antibacterial treatment of gastric ulcers associated with Helicobacter pylori.
BACKGROUND: There is a strong association between infection with Helicobacter pylori and gastric ulcers that are unrelated to the use of nonsteroidal antiinflammatory medications. We studied the efficacy of antibacterial therapy without medication to suppress gastric acid for the treatment of patients with H. pylori infection and gastric ulcers unrelated to the use of nonsteroidal agents. METHODS: Patients with gastric ulcers seen on endoscopy and with H. pylori infection confirmed by smear or culture were randomly assigned to receive either a one-week course of antibacterial agents (120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, each given orally four times a day) or a four-week course of omeprazole (20 mg orally per day). Follow-up endoscopies were performed after five and nine weeks. The patients and their physicians were aware of the treatment assignments, but the endoscopists were not. RESULTS: A total of 100 patients were randomly assigned to treatment, and 85 completed the trial. At five weeks, H. pylori had been eradicated in 41 of the 45 patients in the antibacterial-treatment group (91.1 percent; 95 percent confidence interval, 82.9 to 99.3) and in 5 of the 40 in the omeprazole group (12.5 percent; 95 percent confidence interval, 2.3 to 22.7; P < 0.001). The gastric ulcers were healed in 38 of the patients treated with antibacterial drugs (84.4 percent; 95 percent confidence interval, 73.9 to 95.0) and in 29 of those treated with omeprazole (72.5 percent; 95 percent confidence interval, 58.6 to 86.4; P = 0.28). At nine weeks, ulcer healing was confirmed in 43 of the patients receiving antibacterial therapy and in 37 of those receiving omeprazole (P = 1.0). The mean (+/- SD) duration of pain during the first week of treatment was 1.9 +/- 2.6 days in the omeprazole group, as compared with 3.6 +/- 3.0 days in the antibacterial-treatment group (P = 0.004). One year after treatment, recurrent gastric ulcers were detected in 1 of 22 patients (4.5 percent) in the antibacterial-treatment group and in 12 of 23 (52.2 percent) in the omeprazole group (P = 0.001). H. pylori was detected in the 1 patient with a recurrent ulcer who had received antibacterial treatment and in 10 of the 12 patients with recurrent ulcers who had received omeprazole. CONCLUSIONS: In patients with H. pylori infection and gastric ulcers unrelated to the use of nonsteroidal antiinflammatory drugs, one week of antibacterial therapy without acid suppression heals the ulcers as well as omeprazole and reduces the rate of their recurrence.
Adult↗
Medical future for Hong Kong.
Explore the source record for details and available documents.
Education, Medical↗
Preoperative highly selective catheter localization of occult small-intestinal hemorrhage with methylene blue dye.
Explore the source record for details and available documents.
Catheterization↗
Resection of hepatocellular carcinoma with diaphragmatic invasion.
Fourteen consecutive patients with hepatocellular carcinoma (HCC) and diaphragmatic invasion found during operation and confirmed histopathologically were studied. They were treated by resection of the liver tumour en bloc with part of the diaphragm. Eight of the 14 patients had a diaphragmatic hump on chest radiography. Preoperative ultrasonography, computed tomography and hepatic angiography were unable to diagnose diaphragmatic invasion in these patients. A control group of 14 closely matched patients were selected from 98 undergoing curative resection for HCC during the period of the study. No evidence of a diaphragmatic hump was found in the control patients (P < 0.001). There was no significant difference in survival, operative morbidity or mortality rates between the two groups. In patients with HCC situated in the dome of the liver, the presence of a diaphragmatic hump on chest radiography strongly suggests invasion of the diaphragm. There was no difference in outcome in patients with or without diaphragmatic invasion; the tumour should be resected if the patient is fit for operation.
Carcinoma, Hepatocellular↗