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Biomedical subjects

A K Li

Publications and source records attributed to A K Li.

At least 163 records · Page 9Linked to original sources
PubMed1992

Bleeding angiodysplasia of the gastrointestinal tract.

Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre-operatively and to locate intra-operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre-operative investigations and intra-operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin. The median follow-up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleeding source.

Adult↗
PubMed1992

Diverticulitis of the right colon--experience from Hong Kong.

Diverticulitis affects the right side of the colon more commonly than the left side in the Far East. A consecutive series of 35 patients (mean age 44 years) with right sided diverticulitis seen at this hospital is presented. All had localised pain in the right iliac fossa but systemic upset was uncommon. All but one were thought to have acute appendicitis. Thirty one were explored through a right iliac fossa incision but in more than half this had to be closed and a full laparotomy performed. A correct diagnosis was then made at the time of surgery in 28 (80%). Five patients underwent simple diverticulectomy, the remainder having a right hemicolectomy. On histological analysis most (26) had a single false diverticulum. All patients made a satisfactory recovery from surgery.

Adult↗
PubMed1992

Lugol's iodine dye-enhanced endoscopy in patients with cancer of the oesophagus and head and neck.

Lugol's iodine dye indicates the presence of unsuspected early oesophageal cancers during endoscopy at which such cancers fail to show the characteristic black colour change. We evaluated Lugol's iodine dye-enhanced endoscopy in 17 patients with oesophageal cancer. In a further 37 patients with head and neck cancer we examined the use of Lugol's iodine since these patients have a 29% risk of synchronous oesophageal cancer. The oesophagus was sprayed with Lugol's iodine (1.5%) during endoscopy. Any areas not turning black were biopsied. In 13 patients with oesophageal cancer discrete areas beyond the macroscopically obvious primary tumour showed no change in colour. Biopsy revealed cancer in all cases. Six synchronous cancers were found in the head and neck group, one of which was identified only by the use of Lugol's iodine. Lugol's iodine augmented the information gained about the oesophageal mucosa during endoscopy. It revealed unsuspected cancer which altered the management of patients with primary oesophageal cancer as well as those with head and neck cancer. We recommend the routine use of Lugol's iodine-enhanced endoscopy for surveillance of all 'at risk' oesophageal cases.

Adult↗
PubMed1992

Phytobezoar: an uncommon cause of small bowel obstruction.

Phytobezoars are an unusual cause of small bowel obstruction. We report 13 patients presenting with 16 episodes of small bowel obstruction from phytobezoars. Eleven patients had previously undergone surgery for peptic ulceration (eight truncal vagotomy and pyloroplasty). A history of ingestion of persimmon fruit was common and the majority of cases presented in the autumn when this fruit is in season. One phytobezoar causing obstruction at the third part of the duodenum was removed by endoscopic fragmentation, while an episode of jejunal obstruction was precipitated by endoscopic fragmentation of a gastric bezoar. Twelve patients underwent surgery for obstruction on 15 occasions, with milking of the phytobezoar to the caecum performed in ten, enterotomy and removal in four and resection in one patient. Associated gastric phytobezoars were found in two cases and multiple small bowel bezoars in two other cases. These were removed to prevent recurrent obstruction. Phytobezoar should be considered preoperatively as a cause of obstruction in patients with previous ulcer surgery. Wherever possible milking of a phytobezoar to the caecum should be performed. Careful assessment for other phytobezoars should be made. Prevention of phytobezoars is dependent upon dietary counselling of patients by surgeons after gastric resection or vagotomy and drainage for peptic ulcer.

Adult↗
PubMed1992

Late swallowing and aspiration problems after esophagectomy for cancer: malignant infiltration of the recurrent laryngeal nerves and its management.

One hundred eleven patients who underwent esophagectomy for squamous carcinoma of the esophagus were followed up during a 42-month period. Forty-three patients who had normal swallowing in the postoperative period had recurrent dysphagia on follow-up. The causes were benign anastomotic stricture (n = 15), malignant anastomotic recurrence (n = 2), recurrent laryngeal nerve palsy (n = 22), and no known cause (n = 4). Twenty-six patients were assessed by laryngoscopy and 15 were deemed suitable for Teflon injection of the vocal cord. All but one patient had improved swallowing and phonation after the procedure. Mean survival time after Teflon injection was 5 1/2 months. A significant proportion of swallowing problems after esophagectomy are not caused by mechanical obstruction. Teflon injection of a unilateral paralyzed vocal cord provides good palliation in these patients.

Aged↗
PubMed1992

Traumatic extradural hematoma of delayed onset is not a rarity.

During a 4.5-year period, 73 patients with traumatic extradural hematoma (EDH) were admitted to the neurosurgical unit of the same hospital and managed with surgical evacuation. Of these consecutive admissions, 22 patients with delayed EDH are reported. The incidence of this condition (30%; 22 of 73) contrasts with reports in the literature of 0 to 10%. This may be related to the availability of computed tomography and its liberal and early use in all head injuries. The overall mortality of traumatic EDH (5%; 4 of 73) was related to cases of delayed onset EDH. In addition to a high index of suspicion, early diagnosis of delayed EDH can be facilitated by liberal use of intracranial pressure monitoring and serial computed tomography.

Adult↗
PubMed1992

Obscure bleeding in the gastrointestinal tract originating in the small intestine.

In the past 12 years, we operated upon 49 patients with bleeding lesions of the small intestine. After endoscopic examination and barium studies of the upper and lower gastrointestinal tract excluded esophagogastroduodenal and lesions of the colon and rectum, preoperative examinations consisted of technetium-99m pertechnetate scan, technetium-99m labeled erythrocyte scan, barium studies of the small intestine and selective visceral angiogram. In one patient, diagnostic laparotomy had to be done before any procedure because of severe bleeding and angiosarcoma of the ileum. The results of gross examination at operation revealed bleeding lesions in 40 patients. Special intraoperative localization procedures consisting of methylene blue injection through superselectively prepositioned angiographic catheter was done on eight patients, and intraoperative enteroscopy was done on 17 patients. These two procedures were complementary, having their own indications and limitations. Our regimen of preoperative and intraoperative localization procedures was effective in the management of bleeding small intestinal lesions.

Adolescent↗
PubMed1991

Management of bleeding liver tumours in Hong Kong.

A retrospective study was undertaken of 41 patients diagnosed as having suffered spontaneous liver rupture over a 4-year period to identify the clinical features, treatment and outcome of this complication in an area in which hepatocellular carcinoma is endemic. Two patients were excluded with a revised diagnosis of haemorrhagic malignant ascites. Of the remaining 39 patients, 37 bled from ruptured hepatocellular carcinoma, one from peliosis hepatis and multiple liver cell adenomas, and one from a malignant hepatic epithelioid haemangioendothelioma. Analysis showed that 59 per cent of patients were in shock on admission and that all but two of the 37 patients with ruptured hepatocellular carcinoma were men with cirrhosis. The association with cirrhosis was significantly higher than in a series of 45 patients with hepatocellular carcinoma undergoing elective resection during the same period (P less than 0.05). Treatment consisted of supportive care only in two patients, angiographic embolization in four, emergency liver resection in 11 of whom six died, hepatic artery ligation in 12 of whom eight died, and suture and/or packing in eight of whom six died. One patient died at laparotomy and in another patient bleeding was successfully arrested by intratumoural injection of absolute alcohol. Because of the high operative mortality of emergency surgery in these poor risk patients, prospective evaluation of emergency angiographic embolization is required.

Adult↗
PubMed1991

Devine exclusion for unresectable carcinoma of the stomach.

Between July 1986 and July 1988, Devine exclusion was performed in 20 patients with unresectable carcinoma of the gastric antrum. All 20 patients presented with repeated vomiting. On endoscopy, 16 patients had complete gastric outlet obstruction while the remainder manifested significant gastric outlet stenosis. There was no hospital mortality. All except two patients could take an oral diet after surgery until their demise. Devine exclusion is safe and effective in relieving gastric outlet obstruction and is not associated with prolonged delay in return of gastric emptying.

Aged↗
PubMed1991

Operative choledochoscopy in patients with acute cholangitis: a prospective, randomized study.

A prospective, randomized evaluation of operative choledochoscopy was carried out during emergency surgery in patients with acute cholangitis or acute suppurative cholangitis when conservative management had failed. After common bile duct exploration, 79 patients were randomized to have choledochoscopy and 78 patients to the control group. Laboratory and clinical parameters showed that choledochoscopy did not increase the incidence of septicaemia, acute pancreatitis, persistent cholangitis, postoperative wound sepsis, intraperitoneal sepsis and hospital mortality. The incidence of retained common bile duct stones detected by T tube cholangiography performed in the second postoperative week was significantly reduced (P less than 0.01) after choledochoscopy. Choledochoscopy detected stones missed by conventional common bile duct exploration in ten patients. It is concluded that choledochoscopy is a safe and effective technique in patients with acute cholangitis and acute suppurative cholangitis.

Acute Disease↗
PubMed1991

Mechanical lithotripsy of large common bile duct stones using a basket.

Experience with the Olympus basket mechanical lithotriptor (BML-1Q) in crushing large common bile duct stones before their endoscopic removal is reported. From January 1988 to January 1990, 68 patients with common duct stones too large to be extracted by Dormia baskets or balloon catheters after sphincterotomy were treated with the BML system. The largest stones in each patient ranged from 1.0 to 4.9 cm in diameter. Fifty-seven patients required one session of lithotripsy, ten patients two sessions and one patient three sessions; 26 patients required further endoscopic extraction of stone fragments after successful lithotripsy. The stones were successfully crushed by the BML system and the ducts cleared in 55 patients (81 per cent). In 13 patients mechanical lithotripsy failed because the stones could not be engaged in the lithotriptor basket. In one patient the stone was crushed with the Soehendra lithotriptor, six patients were successfully managed by electrohydraulic lithotripsy through a 'mother and baby' endoscope, indwelling stents were inserted in four patients and two patients underwent surgery.

Adult↗
PubMed1991

Prospective randomised comparison of current coagulation and injection sclerotherapy for the outpatient treatment of haemorrhoids.

The feasibility and early results of a new technique of outpatient proctoscopic coagulation of haemorrhoids by means of an electronic probe (Ultroid, Microvasive Inc., USA) were evaluated in comparison to conventional injection sclerotherapy. Age, symptom and sex-matched groups were analysed before and 6 weeks after outpatient treatment, using scoring systems (n = 51). A mean of 6.2 +/- 0.4 ml of phenol in oil were injected over 2.4 +/- 0.2 min compared to a mean current of 15.8 +/- 0.2 mA over a period of 11.9 +/- 0.8 min (p less than 0.001, treatment time). Sclerotherapy was found significantly less tedious than coagulation. More patients complained of discomfort during coagulation, but the difference in tolerance scores between the 2 groups was not significant. Three patients in the coagulation group but none in the injection group refused to be treated by the same method again due to discomfort. Significant benefits were achieved by both modes of treatment after 6 weeks. The early cure rates for bleeding were 84% for sclerotherapy and 64% for coagulation (p = 0.2) and for prolapse 56% and 44% respectively (p = 0.72). Injection sclerotherapy is preferable to Ultroid coagulation for the outpatient treatment of haemorrhoids because it is a quicker, less tedious and more comfortable procedure with equally effective early results.

Adult↗
PubMed1991

Injection or heat probe for bleeding ulcer.

A prospective randomized trial was performed to compare the efficacy of endoscopic epinephrine injection and heat probe treatment in actively bleeding peptic ulcers. Emergency endoscopy in 1758 patients over an 18-month period identified 132 patients with active ulcer bleeding. They were randomized to receive either endoscopic epinephrine injection or heat probe treatment. After endoscopy, the patients were transferred to the surgical gastroenterology ward and were managed by surgeons unaware of the treatment option. Bleeding was initially controlled in 96% by epinephrine injection and in 83% by heat probe (P less than 0.05). There was no significant difference in outcome as measured by transfusion requirement (4.5 units vs. 3.8 units), emergency surgery (20% vs. 22%), hospital stay (8 days vs. 7 days), and mortality (2 vs. 4) between the injection group and the heat probe group. Two patients in the heat probe group experienced perforation. We conclude that both endoscopic epinephrine injection and heat probe treatment are effective in stopping bleeding from actively bleeding ulcers. Epinephrine injection is technically easier to perform and has a higher initial success rate.

Adolescent↗
PubMed1991

Comparison of management outcome of primary and secondary referred patients with traumatic extradural haematoma in a neurosurgical unit.

A total of 104 patients with a traumatic extradural haematoma in a 5-year period were studied. The mortality of the 71 patients managed primarily by the neurosurgical unit was less than that of the 33 patients secondarily transferred from the district general hospital: 4 per cent vs 24 per cent. This better result was associated with a shorter delay between the time of conscious level deterioration and decompressive operation: 0.7 +/- 1.0 h vs 3.2 +/- 0.5 h. Direct admission of all head injured patients to a neurosurgical unit resulted in significant reduction in mortality and morbidity in patients with an extradural haematoma.

Adolescent↗
PubMed1991

A radiological-pathological correlation of hepatocellular carcinoma (HCC).

The histological distribution of lipiodol within hepatocellular carcinoma (HCC) was correlated with that seen on computed tomography (CT), arteriography and high resolution plain films of 15 resected specimens. By means of special stains, the arterially administered lipiodol was shown to be maximally distributed at the periphery of large tumours and nodules. The centre of large lesions often remained unopacified. In multinodular tumours some nodules were heavily stained while others contained little or no contrast medium. In small tumours there was a more uniform distribution. In large tumours, those areas where there are large arteries (and slow flow) contained little or no lipiodol. There was also no consistent match of areas of angiographic blush with lipiodol deposition. The lipiodol patterns were poorly shown by CT when compared with high resolution films taken on a mammography unit. We conclude from this study that lipiodol on its own as an embolic agent or as a chemotherapeutic carrier has great limitations because of its peripheral and otherwise haphazard distribution in large tumours. However, such treatments might be more effective in small tumours where a greater concentration of lipiodol is likely. Nevertheless, lipiodol staining of tumours remains a useful diagnostic aid as small HCC can be difficult to visualize both on arteriography and conventional CT.

Adult↗