Biomedical subjects

C G Ker

Publications and source records attributed to C G Ker.

At least 37 records · Page 2Linked to original sources

PubMed1992

[The management of obstructive jaundice caused by pancreatic head carcinoma and periampullary carcinoma].

We had treated 115 patients with malignant obstructive jaundice, including 69 pancreatic head carcinoma and 46 periampullary carcinoma during the period between 1982 and 1991. In the 115 jaundiced patients 33 had undergone pancreaticoduodenectomy, 50 had bypass operation and the remaining 32 patients undergone percutaneous transhepatic biliary drainage (PTBD) only. No operative mortality happened for the 33 pancreaticoduodenectomies. Postoperative complications occurred in 12 patients. Leakage from the choledochojejunostomy was the most often occurred complications, it was found in 7 patients (21.2%). Intraabdominal abscesses happened in six patients (18.2%) which recovered by treating with ultrasound-guided catheteral drainage. Leakage from pancreaticojejunostomy was also found in five patients (15.2%), the complication recovered uneventfully after administration of total parenteral nutrition and good abdominal drainage. Twenty-two out 33 patients with pancreaticoduodenectomy received preoperative biliary drainage. However, despite preoperative biliary drainage, 10 of 22 patients (45.5%) still suffered postoperative complications. It implied that hyperbilirubinemia would trend to carry a high postoperative morbility. The prognosis for our patients with pancreatic head carcinoma was extremely poor. The mean survival period for all of them was not exceeding 12 months. Those who had PTBD as the sole treatment had the shortest survival period, which was 3.4 +/- 3.1 months only. On the other hand, the mean survival period for those who had periampullary cancer and had pancreaticoduodenectomy was 35.5 +/- 27.2 months, while it was 13.3 +/- 10.1 and 11.8 +/- 10.0 months for those having bypass operation and PTBD respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Choledochoscopic heat-probe therapy: an adjunctive palliative treatment for intrahepatic cholangiocarcinoma with hepatolithiasis.

From 1983 to 1988, 20 out of 440 patients undergoing surgery for hepatolithiasis were discovered to have proximal bile duct adenocarcinomas, an incidence of 4.54%. Pre- and intra-operative diagnosis in all patients was hepatolithiasis. Four patients had left lateral segmentectomies and were found to have intrahepatic cholangiocarcinoma on subsequent histopathologic studies. In 16 patients, choledocholithotomy and biliary drainage were performed requiring post-operative choledochoscopy for removal of residual intrahepatic stones. Follow-up choledochoscopies revealed bile duct cancers in the biopsy specimens obtained. All patients refused any form of reoperation, eight patients accepted heat-probe therapy as an alternative, and were classified under group A. Group B patients (n = 8) refused any form of treatment whatsoever and agreed to periodic follow-ups and maintenance of external biliary drainage. At the half year follow-up, group A had a survival rate of 100%, whereas group B had a survival rate of 62.5%. At the end of one year, there was one survivor in group B, while group A has 2, 3 and 4 year survival rates of 50%, 37.5% and 12.5% respectively. This study has shown that gross and histological documentation of unsuspected proximal biliary cancers in hepatolithiasis patients are possible with the use of the flexible choledochoscope. Furthermore, we believe that choledochoscopic cauterization of tumors with the heat-probe is a reasonable palliative that can lead to appreciably longer survival rates.

Adenoma, Bile Duct↗

PubMed1990

Percutaneous post-operative choledochofiberscopic lithotripsy for residual biliary stones.

A total of 5,116 post-operative percutaneous choledochofiberscopy (POC) sessions were performed on 739 patients with residual bile duct stones between 1980 and 1988. These residual stones were detected and removed by choledochoscopy. The success rate of non-surgical stone removal using POC was 100% for residual common duct stones and required 414 treatment sessions in this group of 168 patients. The success rate was 92.2% (525/569) for patients with residual intrahepatic stones; in this group a total of 4,694 treatment sessions were needed. Two patients with residual cystic duct stones were also successfully treated with POC. The distribution of residual intrahepatic stones was as follows: 166 (29.2%) in the right hepatic duct, 255 (44.8%) in the left hepatic duct and 148 (26.0%) in both hepatic ducts. Complications after POC were minimal and subsided after conservative treatment except in 2 patients. One patient had hemobilia and another a large subphrenic abscess, which required surgical drainage. Choledochofiberscopic electrohydraulic shock-wave lithotripsy was effective treatment for large stones and was well tolerated. Residual stones in Oriental gallstone disease are not preventable, and we believe that POC should be the first choice for these patients. Many of the problems associated with residual stones can be overcome by this method and good results achieved.

Adult↗

PubMed1990

Instrumental neutron activation analysis of gallstones.

Four kinds of gallstones from 40 patients have been analyzed for the presence of a total of 18 elements by instrumental neutron activation analysis. Of these elements, Ca, Mg, Fe, Co, Zn, Na, and Cl are found in the core of all types of stones. The differences in elemental composition of the various types of stones as well as the differences in the cross-sectional layers of stones are statistically evaluated.

Cholelithiasis↗

PubMed1989

The ultrasound survey of gallstone diseases of patients infected with Clonorchis sinensis in southern Taiwan.

Ultrasonography was used to evaluate the relationship between the gallstone diseases and infection with Clonorchis sinensis. One thousand and ninety-one Hakkanese in southern Taiwan were examined in the past 2 years. Among the 947 cases infected with clonorchiasis, 89 cases were found to have gallstone diseases, which included gallbladder stones (85 cases), common bile duct stones (three cases) and one case of intrahepatic duct stone, indicating a prevalence of 8.97, 0.32 and 0.11% respectively. The overall prevalence of gallstones in the infected group was 9.39%. In the other 144 cases without clonorchiasis infection, eight patients were found to have gallstone disease, which included gallbladder stone (six cases) and intrahepatic duct stone (two cases), indicating an incidence of gallstone of 4.16 and 1.39% respectively. The overall prevalence of gallstones in the non-infected group was 5.56%. A comparison between the infected and non-infected groups was made and showed no significant relationship between gallstone disease and clonorchiasis.

Adolescent↗

PubMed1989

A comparative study of cefotaxime sodium versus a combination of cefapirin and gentamicin in the prophylactic treatment of patients undergoing cholecystectomy.

This was a randomized open evaluation of claforan vs. combination treatment of cefapirin + gentamicin. Patients taking part in the study were randomized in 3 parallel groups: 3 x 1 g claforan given during a period of 24 h (regimen I) was compared to 1 x 1 g claforan given at the time of incision (regimen II) and to a combination of cefapirin + gentamicin given in divided doses for 5 days (regimen III). Sixty-five patients (31 males and 34 females) aged between 23 and 76 years, who underwent cholecystectomy, were included in the study. There were no significant differences between the study groups in terms of sex, age, height, weight, diagnosis, aggravating factors and clinical condition of patients. Sixty of sixty-five patients noted "cholelithiasis" as diagnosis. The majority of patients documented an acute exacerbation of chronic condition. Twenty-three patients documented concomitant diseases/conditions or aggravating factors. The most frequent were: Diabetes mellitus, jaundice and clonorchiasis. During the study no additional administration of antibiotics or other concurrent treatment was recorded. Tolerance of the test substances was noted as "good" by 63 patients and satisfactory in 2 patients. In 3 patients (one patient in each treatment group) a postoperative wound infection was documented. One patient from regimen II with wound infection, therefore, received more than 1 g claforan. Postoperative hemoglobin decreased in all 3 groups (p less than 0.05). BUN decreased in the regimen group I (p less than 0.05) and increased together with creatinine in the group of regimen III (p less than 0.05). No side effects were documented in any treatment groups. The use of a single or three doses of claforan was more convenient and simple than the combination regimen. Less laboratory adverse effects (renal function) were also noted in claforan treated patients than the combination of cefapirin + gentamicin group.

Adult↗

PubMed1989

A study of CEA, CA 19-9 and CA 125 in biliary tract diseases.

Sixty-six patients were classified into three groups; control group A was (n = 24), group B those with hepatolithiasis (n = 24) and group C those with the bile duct carcinoma (n = 18). All patients had accepted operation and the patients bile and serum were send for determination with radioimmuno assay. The positive rate of serum CEA were 4.17%, 37.5% and 66.67% for the control, hepatolithiasis and bile duct carcinoma groups respectively. The positive rate of serum CA 19-9 were 8.33%, 25% and 61.11% for the control, hepatolithiasis and bile duct carcinoma respectively. The positive rate of serum CA 125 were 5%, 0% and 31.25% for control, hepatolithiasis and bile duct carcinoma groups respectively. The sensitivity level of serum CEA, CA 19-9 and CA 125 for the bile duct carcinoma group was 66.67%, 61.11% and 31.25% respectively. The diagnostic accuracy for bile duct carcinoma with regard to bile CEA was 94.44% but the accuracy ratio was only 45.24%. The bile concentration of CA 19-9 level of more than 1200 ng/ml were 75% and 61.11% for the hepatolithiasis and bile duct carcinoma group and none in control group. The bile concentration of CA 125 more than 200 ng/ml was 43.75% in the bile duct carcinoma and none in control or hepatolithiasis group. Finally, the concentration of CA 19-9 will be effected not only by tumor itself but also by severe infection in the hepatolithiasis patients. The sensitivity of CA 125 was low but accuracy was high for the diagnosis of the bile duct carcinoma.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1988

Ultrasonic guided percutaneous transhepatic bile drainage for cholangitis due to intrahepatic stones.

Acute cholangitis due to intrahepatic stones is frequently associated with biliary sepsis. Emergency surgery for these high-risk patients is usually associated with a high mortality. Therefore, we recommend nonoperative methods for the management of this acute disease. Percutaneous transhepatic cholangiography and drainage (PTCD) combined with antibiotic and fluid treatment was used successfully in the management of 41 patients with acute pyogenic cholangitis due to intrahepatic stones. The general condition of these patients improved after treatment with PTCD. Repeated cholangiography should be performed so that the entire biliary tree and lesions can be viewed. Elective surgery (21 patients) or removal of the stone through the sinus tract via PTCD (14 patients) was performed when the patients' general condition improved following emergency PTCD. Therefore, we recommend PTCD over emergency surgery in the treatment of acute septic intrahepatic stones.

Acute Disease↗

PubMed1988