Technique of laparoscopically assisted on-table colonic irrigation.
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Aged↗
Biomedical subjects
C C Chung
Publications and source records attributed to C C Chung.
Use of a cotton tape tie in laparoscopic colorectal surgery.
In this short article we describe the use of a cotton tape tie in laparoscopic colorectal surgery. This technique is useful in: (i) retraction and manipulation of the bowel; (ii) exteriorization of a bulky specimen; and (iii) occlusion of the rectal lumen to permit effective cytocidal rectal lavage.
Colectomy↗
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↗
Obturator hernia revisited: a review of 12 cases in 7 years.
Twelve patients with obturator hernia seen over a 7-year period were reviewed retrospectively. All were elderly females presenting with small bowel obstruction. The median body weight was 35 kg. A significant proportion of patients (33%) came from homes for elderly people and were either bed-ridden or wheel chair-bound. All 12 patients were classified as high-risk-patients in pre-operative assessment. Only one patient (8.8%) had a history of previous abdominal operation. Clinical signs such as Howship-Romberg sign and palpable groin mass were absent in these patients. Contrast radiography was performed in three patients and was not helpful in the diagnosis. A correct pre-operative diagnosis was suspected in only one case. The medium treatment delay was 1.5 days and the gut resection rate was 75%. The overall mortality rate was high (25%). A high index of clinical suspicion is important in the diagnosis and obturator hernia should be suspected whenever an elderly thin female with no previous abdominal surgery developed small bowel obstruction. Early laparotomy is recommended in such patients.
Aged↗
Anal and perianal tuberculosis: a report of three cases in 10 years.
From the computerized pathology record, three cases of anal and perianal tuberculosis were encountered in the Prince of Wales Hospital, Hong Kong during the last 10 years. The clinical history, examination findings and relevant investigations were reviewed retrospectively. Comparison was made with previous literature. Emphasis was put on the diversity of clinical presentations including acute perianal abscess, chronic anal ulcer and fistula in ano. It is concluded that a high index of suspicion is important to ensure an early diagnosis.
Abscess↗
Fulminant hepatic failure as the first manifestation of Wilson disease: a report of two cases.
Two cases of fulminant hepatic failure as a first manifestation of Wilson disease are reported. They were diagnosed as acute hemolytic anemia initially, and took a fatal course despite intensive medical therapy. The main object of this report is to emphasize that Wilson disease must be included in the differential diagnosis of fulminant hepatic failure in children. Liver transplantation is the only effective means of treatment in patients presenting with fulminant hepatic failure, but this procedure is difficult to perform because of insufficient organ donation in Taiwan. The best treatment for Wilson disease is prevention through diagnosis at a presymptomatic stage, and institution of life-long therapy with D. penicillamine.
Adolescent↗
Laparoscopy-assisted sigmoid colectomy for volvulus.
We report on five male patients with sigmoid volvulus treated by laparoscopy-assisted sigmoid colectomy. Intraoperative colonic irrigation was used in two patients prior to resection and primary anastomosis. An intracorporeal technique of bowel anastomosis was used that allowed smaller skin incisions as compared with the extracorporeal technique. All five patients recovered uneventfully, and most were discharged within 1 week after the operation. There was no recurrence at the conclusion of the follow-up. Laparoscopy-assisted sigmoid colectomy may prove to be the procedure of choice in patients with sigmoid volvulus.
Adult↗
Ectopic gallbladder revisited, laparoscopically: a case report.
A case of the rare congenital anomaly ectopic gallbladder is presented. A 16-year-old girl suffered attacks of epigastric pain unrelated to eating. On abdominal ultrasonography, the gallbladder could not be found in its usual position. Endoscopic retrograde cholangiography demonstrated the gallbladder on the left side of the common duct and the cystic duct arising from the right hepatic duct. Laparoscopic cholecystectomy was done without complication. This appears to be the first reported case of laparoscopic removal of an ectopic gallbladder. The importance of preoperative cholangiography is emphasized for accurate diagnosis and preoperative location of the gallbladder.
Adolescent↗
Malignant anal tumours in the Chinese population in Hong Kong.
Malignant anal tumours are rare cancers but are particularly common in Switzerland, Poland and Brazil. Very little is known about this condition in the Chinese population. A retrospective study, covering an 11-year period, was performed. A total of 18 patients were treated at the Prince of Wales Hospital, Hong Kong. There were eight squamous cell carcinomas, seven adenocarcinomas and one each of adenosquamous carcinoma, malignant melanoma and leiomyosarcoma. Bleeding per rectum, with or without perianal pain, was the main presenting symptom. Abdominoperineal resection was the treatment modality used in most cases. Adenocarcinomas, seen mainly in males, accounted for about 39% of cases, a figure much higher than that published elsewhere. Another 44% of patients, predominantly females, had squamous cell carcinoma. None had a positive past history of sexually transmitted disease. The local prevalence of HPV infection is much lower than in the Western world, and the role of HPV in the oncogenesis of anal tumours in the Chinese population awaits elucidation.
Adenocarcinoma↗
Purified urinary follicle stimulating hormone induces different hormone profiles compared with menotrophins, dependent upon the route of administration and endogenous luteinizing hormone activity.
The effects of treatment of patients with gonadotrophin-releasing hormone analogue (GnRHa) combined with purified follicle stimulating hormone (FSH) for in-vitro fertilization (IVF) were investigated in detail to determine the influences of different administration routes and the degree of suppression of luteinizing hormone (LH). Responses to exogenous gonadotrophins were studied in infertile women (n = 60) with normal menstrual rhythm whose endogenous gonadotrophin activity was suppressed using a GnRHa in a long protocol. They were randomized to receive i.m. administration of human menopausal gonadotrophins (HMGim, Pergonal) or purified follicle stimulating hormone (FSH, Metrodin High Purity) administered either i.m. (MHPim) or s.c. (MHPsc). Responses were assessed by measuring plasma FSH, LH, oestradiol, testosterone and progesterone. After stimulation day 4, the MHPsc group showed significantly higher circulating concentrations of FSH than either the MHPim or HMGim group. However, the HMG group showed significantly higher oestradiol concentrations after stimulation day 5 than either MHP group. The differences in circulating oestradiol concentrations in the MHP-treated patients appeared to be strongly influenced by the mean circulating concentrations of LH in the follicular phase. The patients who showed mean follicular phase LH concentrations of < 1 IU/l showed longer follicular phases, lower circulating oestradiol and testosterone concentrations and also lower follicular fluid concentrations of oestradiol and testosterone, indicating a reduction in the normal follicular metabolism of progesterone to androgens and oestrogens under these conditions. This group of patients also showed longer follicular phases, which may have consequences for future clinical management.
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↗
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↗
Intravenous regional anaesthesia for circumcision.
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Anesthesia, Conduction↗
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↗
Randomized comparison of ovulation induction with and without intrauterine insemination in the treatment of unexplained infertility.
The aim of this prospective randomized controlled study was to determine the possible role of ovulation induction with intrauterine insemination (IUI) in the treatment of unexplained infertility. A total of 100 patients were randomized to receive ovulation induction with or without IUI. All patients were treated with long-course gonadotrophin-releasing hormone analogue (GnRHa), starting in the luteal phase, and exogenous follicle stimulating hormone (FSH) to induce follicular growth. Ovulation was induced using human chorionic gonadotrophin and timed intercourse (TI) was advised 24-48 h later or IUI was effected 36-48 h later. Both the cycle fecundities (21.8 and 8.5%) and the cumulative ongoing pregnancy rates after three cycles (42 and 20%) were significantly higher (P < 0.03) in the IUI group than in the TI group respectively. This is a clear indication that ovulation induction with IUI is an effective treatment method for unexplained infertility, but ovulation induction with TI has a negligible impact in this large group of patients.
Adult↗
Healthy young and old women differ in their trunk elevation and hip pivot motions when rising from supine to sitting.
OBJECTIVE: To describe the differences between healthy young and older women in regards to trunk elevation and hip pivot motions when rising from a supine to a seated position. DESIGN: Cross-sectional comparison. SETTING: University laboratory. PARTICIPANTS: Two groups of healthy female volunteers: young adult female controls (n = 22, mean age 23.5 years) and community-dwelling older female adults (n = 17, mean age 73.8 years). MEASUREMENTS: Subjects were videotaped as they performed three controlled bed mobility tasks, starting from a supine position: (1) rising to a seated position at the edge of a firm plinth surface (SS); and rising to a seated position without moving to the edge of the bed while either (2) using hands (SUH) or (3) not using hands (SUNH). A series of movements involving the trunk were identified as subjects performed the SS task. RESULTS: The older women were more likely to rotate and laterally flex their trunks, particularly in the later phases of the SS task. In addition, during the SS task, the older group was more likely to bear weight on their hip/gluteal area, particularly in the later phases, and more likely to use a broad pivot base, consisting of the hip and the elbow. While all young and old performed the SUH task, less than half of the older group could complete the SUNH task. Moreover, the subgroup of older adults who could not complete the SUNH task may have accounted for much of the differences between the young and the old on the SS task. CONCLUSION: Healthy young and older women differ in their ability to rise from a supine to sitting position, primarily in the strategies used to elevate the trunk and facilitate a pivot. Trunk flexion ability likely contributes to the age group differences noted in rising. These data provide the basis for a biomechanical analysis of the critical body segment motions and the strengths required to perform bed mobility tasks.
Adult↗
A continuous fluorescence assay of renin activity.
A sensitive fluorescence assay that employs a new fluorogenic peptide substrate has been developed to continuously measure the proteolytic activity of human renin. The substrate, DABCYL-gaba-Ile-His-Pro-Phe-His-Leu-Val-Ile-His-Thr-EDANS, has been designed to incorporate the renin cleavage site that occurs in the N-terminal peptide of human angiotensinogen. The assay relies upon resonance energy transfer-mediated, intramolecular fluorescence quenching that occurs in the intact peptide substrate. Efficient fluorescence quenching occurs as a result of favorable energetic overlap of the EDANS excited state and the DABCYL absorption, and the relatively long excited state lifetime of the EDANS fluorophore. Cleavage of the substrate by renin liberates the peptidyl-EDANS fragment from proximity with the DABCYL acceptor, restoring the higher, unattenuated fluorescence of the EDANS moiety. This leads to a time-dependent increase in fluorescence intensity, directly related to the extent of substrate consumed by renin cleavage. The kinetics of renin-catalyzed hydrolysis of this substrate have been shown to be consistent with a simple substrate inhibition model with a substrate Km approximately equal to 1.5 microM at physiological pH; Cleavage of the substrate occurs specifically at the Leu-Val bond and corresponds to the renin cleavage site of angiotensinogen, as reported earlier. In this report, we describe in detail the synthesis of the fluorogenic renin substrate and its application in assays of renin activity. Assay sensitivity has been evaluated by a series of enzyme dilution experiments using the continuous assay format, showing that the assay can detect renin as low as 30 ng/ml after a incubation of only 3-5 min.(ABSTRACT TRUNCATED AT 250 WORDS)
Amino Acid Sequence↗
Characterization of recombinant human renin: kinetics, pH-stability, and peptidomimetic inhibitor binding.
The kinetic behavior and pH-stability of recombinant human renin was analyzed using a new fluorogenic substrate based on the normal P6-P3' renin cleavage sequence in human angiotensinogen. The design of this fluorogenic substrate makes possible, for the first time, direct monitoring of the kinetics of proteolytic conversion of prorenin to renin. The pH-stability profile for renin, measured with the substrate at 25 degrees C, indicated a broad plateau of stability between pH 6.0 and 10.0. Analysis of the pH-activity profile of renin for the substrate indicated a minimum Km (approximately 1.8 microM) at pH approximately 7.4 and a maximum Vm between pH 7.4 and 8.0. The thermodynamics of the binding of a novel, soluble, peptidomimetic inhibitor to renin indicated it is possible to retain the tight-binding characteristics and enthalpy contributions to binding of larger peptide-derived inhibitors, while reducing inhibitor size and entropic contributions to binding. A novel derivative of the fluorogenic substrate, containing a 3-methyl histidine substitution at the P2 site, was used to test the recent hypothesis that renin functions by virtue of substrate-directed catalysis.
Amino Acid Sequence↗