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Biomedical subjects

A K Li

Publications and source records attributed to A K Li.

At least 145 records · Page 8Linked to original sources
PubMed1993

A double-blind randomized controlled trial comparing sodium tetradecyl sulphate and ethanolamine oleate in the sclerotherapy of bleeding oesophageal varices.

The efficacy and side effects of 3% sodium tetradecyl sulphate (STD) and 5% ethanolamine oleate (ETH) were compared in 95 patients admitted with variceal bleeding. The patients were allocated in a randomised fashion to one of the treatment groups when varices were identified which were either actively bleeding or had signs of recent haemorrhage. Endoscopic examination was performed within 24 hours of admission. The endoscopist had no knowledge of which sclerosant was used. Intravariceal injections of 2 ml aliquots up to a maximum of 20 ml were made in a double-blinded manner. Repeat injections were performed at weekly intervals until all oesophageal varices were obliterated. Bleeding was successfully controlled in 42/48 (87.5%) patients in the STD group and 41/47 (87.2%) patients in the ETH group after one session of therapy. Variceal obliteration was achieved after 3.3 +/- 1.3 sessions of STD and 4.5 +/- 1.9 sessions of ETH (p < 0.05 Student's t-test). Post-injection pyrexia was significantly more common in the STD group (42% vs 30% p < 0.05, chi-square test). There was no difference in the rates of subsequent oesophageal ulceration, stricture formation or perforation of the oesophagus. It is concluded that STD and ETH are both effective in controlling variceal haemorrhage, but STD obliterates the varices in significantly fewer sessions.

Double-Blind Method↗
PubMed1993

Removal of bulky tissue at laparoscopic surgery.

A technique for extraction of bulky tissue during laparoscopic surgery is presented. One laparoscopic cannula is replaced with a sigmoidoscope which acts as a wide-bore cannula. At laparoscopic cholecystectomy, 22 of 60 (38%) patients were found to require wound enlargement to remove a grossly diseased gall-bladder. Use of a sigmoidoscope as a cannula was associated with fewer technical complications than surgical wound extension. At laparoscopic appendicectomy, the appendix could not be removed through the standard laparoscopic cannula in 16 of 46 (31%) cases. The incidence of wound infection was significantly lower after laparoscopic appendicectomy than among a group of 98 patients having conventional appendicectomy (P = 0.024). It is concluded that a sigmoidoscope can be used as a replacement cannula allowing uncomplicated removal of bulky tissue and reducing wound contamination.

Appendectomy↗
PubMed1993

Lost stone during laparoscopic cholecystectomy: retrieval using a condom.

Laparoscopic cholecystectomy is becoming increasingly popular for the treatment of gall stone disease. In this technique, the gall bladder is dissected free under laparoscopic vision and then extracted. We report an interesting complication that occurred during extraction of a gall bladder containing a large stone and a novel method of overcoming the problem.

Abdomen↗
PubMed1992

Randomised controlled trial of short term treatment to eradicate Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE: To determine whether one week's drug treatment is sufficient to eradicate Helicobacter pylori in patients with duodenal ulcer. DESIGN: Single blind, randomised controlled trial. SETTING: Specialised ulcer clinic in a teaching hospital. PATIENTS: 155 patients with H pylori and a duodenal ulcer verified endoscopically which had either bled within the previous 24 hours or was causing dyspepsia. INTERVENTIONS: Patients were allocated randomly to receive either omeprazole for four weeks plus bismuth 120 mg, tetracycline 500 mg, and metronidazole 400 mg (all four times a day) for the first week (n = 78), or omeprazole alone for four weeks (n = 77). Further endoscopy was performed four weeks after cessation of all drugs. MAIN OUTCOME MEASURES: Presence or absence of H pylori (by urease testing, microscopy, and culture of antral biopsy specimens), duodenal ulcer, and side effects. RESULTS: Eradication of H pylori occurred in 70 (95%) patients taking the four drugs (95% confidence interval 86% to 97%) compared with three (4%) patients taking omeprazole alone (1% to 11%). Duodenal ulcers were found in four (5%) patients taking the four drugs (2% to 12%) and in 16 (22%) patients taking omeprazole alone (14% to 32%). Mild dizziness was the only reported side effect (six patients in each group) and did not affect compliance. CONCLUSIONS: A one week regimen of bismuth, tetracycline, and metronidazole is safe and effective in eradicating H pylori and reduces the number of duodenal ulcers four weeks after completing treatment.

Bismuth↗
PubMed1992

Multiple primary cancers in Hong Kong Chinese patients with squamous cell cancer of the head or neck.

BACKGROUND: The risk of multiple primary tumors in the head and neck area is higher than that in other areas of the body. METHODS: A total of 573 patients with squamous cell carcinoma of the head or neck were studied prospectively during a 4.5-year period to determine the incidence of associated synchronous and metachronous second primary carcinoma. RESULTS: Multiple primary carcinoma was found in 2.4% of these patients (69% with synchronous primary tumors). Sixty-three percent of all second primary tumors occurred in the esophagus. CONCLUSIONS: This report emphasizes the importance of esophagoscopy in the initial assessment of patients with squamous cell carcinoma of the head or neck.

Alcohol Drinking↗
PubMed1992

Does hepatitis C virus infection contribute to hepatocellular carcinoma in Hong Kong?

BACKGROUND: Hong Kong has a high incidence of hepatocellular carcinoma (HCC) and, because it is an endemic area for hepatitis B virus (HBV) infection, the etiologic association between HCC and HBV infection is reported to be as high as 80%. Hepatitis C virus (HCV) recently was shown to be a possible pathogenetic agent for HCC in a number of countries. METHODS: To assess the relative importance of these two viruses in HCC in Hong Kong, a retrospective study of 424 Chinese patients with HCC was performed. RESULTS: Three hundred forty-one (80.3%) patients were found to be carriers of hepatitis B surface antigen (HBsAg). Hepatitis C antibodies (anti-HCV) were detected in 31 patients (7.3%). Fifteen patients with positive findings for anti-HCV had concurrent HBV infection, 11 had serologic evidence of previous HBV infection, and only 5 patients had anti-HCV marker alone. Patients with positive findings for anti-HCV were older than those with HBsAg (mean ages, 60 and 53 years, respectively). A higher preponderance of male patients was found in the HBsAg-positive group; the male to female ratio was 11:1, compared with 7:1 among patients with anti-HCV. Anti-HCV was detected in 0.64% of 175 age-matched and sex-matched controls. CONCLUSIONS: These data indicate a possible causal role of HCV infection in HCC, but it is of relatively minor epidemiologic significance in Hong Kong, where HBV infection is overwhelming.

Adolescent↗
PubMed1992

Basic fibroblast growth factor in human prostate cancer cells.

To increase our understanding of the potential role of basic fibroblast growth factor (bFGF) in malignant progression of prostate cancer, we determined the production of bFGF, the expression of FGF receptor (flg), and the response to exogenous bFGF in LNCaP, DU 145, and PC 3 cells. We observed that these three prostate cancer cell lines, which differed in their dependence on androgens for growth in vitro and in their in vivo behavior in nude mice, could be distinguished as follows: (a) androgen-sensitive LNCaP cells, which do not metastasize in nude mice, did not produce measurable amounts of bFGF, expressed small but measurable amounts of FGF receptor mRNA, and did respond to exogeneous bFGF; (b) androgen-insensitive, moderately metastatic DU 145 cells did produce measurable amounts of biologically active bFGF, expressed large amounts of FGF receptor mRNA, and responded to exogeneous bFGF and the heparin-binding fractions from DU 145 cell extracts; (c) androgen-insensitive and highly metastatic PC3 cells also produced measurable amounts of bFGF but did not demonstrate a growth response to either the heparin-binding fractions from PC3 cell extracts or exogenous bFGF, even though large amounts of FGF receptor mRNA were expressed in PC 3 cells. These results suggest the possibility that differences in production of, and response to, bFGF may be associated with different biological behavior.

3T3 Cells↗
PubMed1992

Treatment of inoperable hepatocellular carcinoma by intra-arterial lipiodol and 4'-epidoxorubicin.

A total of 30 patients presenting with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial Lipiodol (5 ml) and 4'-epidoxorubicin (90 mg/m2) once every 4 weeks. The treatment results included no complete response, 2 partial responses, 6 cases of static disease and 19 cases of progressive disease. The median survival was 18.9 weeks. All patients had died by the time of this writing, with survival duration ranging from 4.1 to 87.3 weeks. Toxicities were minimal and included anaemia and alopecia. As compared with a historic control group that had received the same dose of intravenous 4'-epidoxorubicin, the treatment group showed similar response rates but developed fewer toxicities. There was no significant survival benefit over the control group. We concluded that although this form of treatment had comparable activity and produced fewer side effects, it provided no survival benefit over intravenous treatment. The slight prolongation of survival achieved in the treatment group as compared with the control arm might have been due to case selection.

Adult↗
PubMed1992

Alcohol injection: a treatment for ruptured hepatocellular carcinoma.

Nine patients with bleeding from a ruptured hepatocellular carcinoma had absolute alcohol injection. Laparotomy and alcohol injection stopped the bleeding in seven patients. Injection under laparoscopic visualization was attempted in two patients and in one patient haemostatis was achieved initially. He rebled, however, 4 h later and laparotomy failed to control the bleeding. He died 2 days later because of coagulopathy and renal failure. In the second patient, bleeding was not controlled laparoscopically and immediate laparotomy and alcohol injection stopped the bleeding. The eight patients who survived left hospital between 8 and 21 days after surgery (median 10 days). In our experience, laparotomy and alcohol injection achieved good results in bleeding hepatocellular carcinoma.

Adult↗
PubMed1992

Patterns of failure after radical neck dissection for recurrent nasopharyngeal carcinoma.

Radical neck dissection (RND) for recurrent nasopharyngeal carcinoma (NPC) after radiotherapy was retrospectively evaluated in 38 patients treated between April 1986 and December 1991. Thirty patients (79%) had advanced-stage disease. Four patients required nasopharyngectomy as well as RND. The mortality was 0%, and the morbidity was 13%. The actuarial survival rates at 5 years from the time of initial radiotherapy and RND were 50% and 25%, respectively. Of the 21 patients with relapses after surgical salvage, 5 had recurrences in the nasopharynx, 3 had recurrences in the neck, and 13 had distant metastases. We conclude that RND for recurrent NPC is safe and efficacious; however, it is associated with a significant (34%) incidence of distant metastases. These results can be improved by evaluating patients for distant metastases and excluding those with distant metastases. Improvement in the treatment of distant metastases is also needed.

Adult↗
PubMed1992

Role of ultrasound in the management of thyroid nodules.

One hundred twenty patients undergoing thyroid surgery for thyroid nodules or goiter were examined by preoperative ultrasound and fine needle aspiration (FNA) cytology. In the determination of whether a lesion was malignant, FNA had sensitivity, specificity, and positive predictive values of 86%, 85%, and 58%, respectively. Ultrasound had sensitivity, specificity, and positive predictive values of 74%, 83%, and 51%, respectively. The different types of thyroid pathology showed different ultrasonic features in most cases, although no single feature was pathognomonic. Malignant lesions tended to be solid and hypoechoic without a halo, but there was a cystic element in 26% of the lesions and calcification in 37%. Ultrasound was superior to FNA in diagnosing nodular goiter with sensitivity, specificity, and positive predictive values of 70%, 93%, and 92%, respectively, compared with 55%, 86%, and 83%, respectively. The two modalities are complementary.

Adolescent↗
PubMed1992

Distribution of Lipiodol and evidence for tumor necrosis in hepatocellular carcinoma.

To study the distribution and thromboembolic effect of Ultrafluid Lipiodol, 15 surgically removed hepatocellular carcinomas with selective intraarterial Lipiodol injection 7 to 10 days before surgery and 15 noninjected controls were studied radiologically and histologically. Tissue blocks were processed with an en bloc silver impregnation technique for Lipiodol localization in histologic sections. Lipiodol was distributed evenly in tumors measuring less than 5 cm in diameter and peripherally in tumors measuring 10 cm or more. Lipiodol droplets were mainly extracellular. There was no difference in tumor architecture or in hemorrhage and necrosis scores between Lipiodol-injected cases and negative controls (1.18 versus 0.92). Similarly, in injected cases, no differences were observed between Lipiodol-positive and Lipiodol-negative areas (scores of x-ray Lipiodol-positive versus Lipiodol-negative areas: 1.17 versus 1.36; scores of microscopic Lipiodol-positive versus Lipiodol-negative areas: 1.18 versus 1.14). Lipiodol-negative but hypodense areas examined by x-ray proved to be necrosis or fibrosis with or without viable tumor islands. Lipiodol has no thromboembolic effects. The uneven Lipiodol distribution may account for its failure as a carrier for chemotherapeutic agents in large tumors.

Carcinoma, Hepatocellular↗
PubMed1992

Microwave tissue coagulator in liver resection for cirrhotic patients.

The use of the microwave tissue coagulator was studied on 20 consecutive elective hepatic resections carried out for symptomatic hepatocellular carcinoma with liver cirrhosis. The mean operative blood loss (excluding one patient with hepatic vein injury) was 1132 mL. Five patients required no blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. Apart from the complications similar to those occurring in hepatic resections for cirrhotic patients, higher incidences of intra-abdominal sepsis (20%), sympathetic pleural effusion in the absence of chest or intra-abdominal sepsis (20%), and persistent fever lasting more than 1 week (40%) were encountered. It was considered that these complications were related to the coagulated tissue present in the liver remnants (mean depth of tissue coagulation = 3.8 mm) and concluded that although the hospital mortality rate of 10% and the mean operative blood loss of 1132 mL were acceptably low, microwave liver surgery carried a high morbidity rate which is a drawback in major hepatic resectional surgery.

Adolescent↗