Biomedical subjects

C H Su

Publications and source records attributed to C H Su.

At least 55 records · Page 3Linked to original sources

PubMed1996

Adenomyomatosis of the gallbladder.

BACKGROUND: Adenomyomatosis of the gallbladder in Chinese patients has rarely been analyzed. METHODS: The clinical, radiological and pathological features of 18 patients with histologically-proven adenomyomatosis, collected during a 5-year period, were retrospectively analyzed. RESULTS: According to the extent and site of involvement, adenomyomatosis of the gallbladder was conventionally classified into three types: localized, generalized and segmental. In our series, the disease was localized in 17 patients (15 in the fundus and 2 in the neck), generalized in one patient and segmental in none. Only 5 patients showed sonographic features correlative to pathologic findings, and 2 of them were correctly diagnosed before operation. Only mild nonspecific abnormalities of liver function test or urine analysis were noted in some patients with gallbladder adenomyomatosis. The clinical manifestations were not related to coincidental diseases in 11 patients. All these 11 patients, with gallstone in 9 and without in 2, complained of epigastralgia, right upper quadrant abdominal pain or dyspepsia, which relieved all after cholecystectomy. CONCLUSIONS: Some patients with adenomyomatosis may be symptomatic and relieved by cholecystectomy. In patients with adenomyomatosis of the gallbladder and right upper quadrant pain of abdomen without other explanation, cholecystectomy may be considered. Infrequent accurate diagnosis in Chinese patients calls for a high suspicion of the disease entity in clinical practice.

Adenomyoma↗

PubMed1996

Surgical management of primary retroperitoneal sarcoma.

BACKGROUND: Retroperitoneal sarcoma is a rare and challenging group of diseases for surgeons, characterized by extensive growth and high recurrent rate. We analyzed data from our patients to identify the factors of survival. METHODS: From 1971 to 1993, medical records of 40 patients with primary retroperitoneal sarcoma were reviewed. Clinical factors including age, sex, tumor size, histopathology, type of operation, disease-free interval, and number of operation were collected to correlate with patient's survival. RESULTS: Most patients presented with huge abdominal mass. There were 22 liposarcomas, 8 leiomyosarcomas, 5 malignant fibrous histiocytomas, 2 fibrosarcomas, 2 malignant mesenchymomas and one rhabdomyosarcoma. Twenty-eight patients received complete resection and 12 had incomplete resection. The group with complete resection showed a better survival than incomplete resection group (p = 0.0001). Nineteen patients with complete resection had tumor recurrence. The recurrent rate was 68%. Patients having been disease-free for more than 12 months showed to have better survival than those less than 12 months (p = 0.005). Aggressive surgical resection was done in case of tumor recurrence. Patients who received more than 2 (> or = 3) operations also showed a better survival than those with less than 2 operations (p = 0.0247). CONCLUSIONS: Complete surgical resection and aggressive repeated surgical intervention are the most effective treatment modality for better survival in patients with retroperitoneal sarcoma.

Adult↗

PubMed1995

Piperacillin/tazobactam in comparison with clindamycin plus gentamicin in the treatment of intra-abdominal infections.

BACKGROUND: Concerned about the inactivation of piperacillin by beta-lactamase and the risk of aminoglycoside-induced nephrotoxicity and clindamycin-induced enterocolitis, we conducted the following phase III clinical trial. METHODS: Between November 1991 and March 1993, 77 surgical patients with intraabdominal infections were enrolled and randomly assigned in a 3:2 ratio to receive either piperacillin/tazobactam or clindamycin plus gentamicin to compare safety, tolerance and efficacy between both two treatment groups. RESULTS: There were 76 clinically and 50 bacteriologically evaluable patients with 80 isolated pathogens. The demographic data were comparable in both groups. There was no statistically significant difference of clinical response at any time-point of treatment, with 97.8% favorable clinical response rate in piperacillin tazobactam group and 96.6% in clindamycin plus gentamicin group at endpoint. The bacteriological eradication rates were similar, with 97.7% in piperacillin/tazobactam group and 94.4% in clindamycin plus gentamicin group at pathogen level, and 96.7% in piperacillin/tazobactam group and 95.0% in clindamycin plus gentamicin group at patient level. By susceptibility tests, only 3 (4%) isolated pathogens were resistant to piperacillin/tazobactam, which was much superior to the use of piperacillin, clindamycin or gentamicin alone in antimicrobial activity. The piperacillin tazobactam-related adverse experiences included 1 (2.1%) urticaria and 2 (4.3%) diarrhea. However, there were no significant differences in the adverse experiences between these two groups. CONCLUSIONS: This study has demonstrated that piperacillin/tazobactam is comparable with clindamycin plus gentamicin in efficacy, safety and tolerance in the treatment of surgical patients with intra-abdominal infections. The combination of piperacillin/tazobactam could potentially be the treatment of choice in adjunt to surgical management in intra-abdominal infection.

Abdomen↗

PubMed1995

Anastomotic leakage following pancreaticoduodenectomy.

BACKGROUND: Since Whipple's successful resection of the head of the pancreas and duodenum in 1935, pancreaticoduodenectomy has become a standard operation for periampullary malignancies. Although the operative mortality has decreased dramatically in the recent years, it continues to be associated with high morbidity; with anastomotic leakage remaining a major problem. METHODS: One hundred and seventy-six pancreaticoduodenectomies performed for periampullary lesions during the past 27 years were reviewed. These included 171 Whipple operations, 4 total pancreatectomies and 1 pylorus-preserving pancreaticoduodenectomy. Among them, 40 cases were complicated with anastomotic leakage following pancreaticoduodenectomy. Their management strategy and outcome were reevaluated. Furthermore, the factors suggested to affect pancreaticojejunostomy leakage were also analyzed. RESULTS: The overall operative mortality was 15.3%, which decreased to 6.7% in recent two years. However, a high complication rate of 50% remained. Among the complications of the whole series (46.6%), anastomotic leakage accounted for 22.7% (40/176). Leakage occurred in 28 pancreaticojejunostomies (16.3%), 9 hepaticojejunostomies (5.1%) and 6 gastrojejunostomies (3.4%). Twelve patients required reoperation for ongoing sepsis or bleeding. This experience disclosed that in most cases hepaticojejunostomy leakage (8/9) could be successfully managed without operation. While three of the six gastrojejunostomy leaks survived after conservative treatment, two of the remaining three patients operated died of sepsis. Among cases with pancreaticojejunostomy leakage, 12 survived after conservative treatment, whereas 6 died of sepsis. Among 10 operated patients, only 3 patients survived. Earlier reexploration for uncontrolled leakage, probably within the first eight postoperative days, seemed to be the only chance for life saving. As far as the risk factors of pancreaticojejunostomy leakage are concerned, there seemed to exert no significant influence in terms of intraoperative blood loss, type and sequence of anastomosis as well as pancreatic stenting. The only clue that may affect the surgical outcome is technical; more experienced (> or = 10 Whipple operations) surgeons tended to render less morbidity and mortality. CONCLUSIONS: The retrospective analysis of our experience in pancreaticoduodenectomy discloses a trend toward decreased mortality rates in the recent years but operative complications remain high. Among the possible complications, anastomotic leakage is still a troublesome concern. Although conservative treatment can benefit most patients, earlier reexploration for uncontrolled sepsis should be considered. If a good result is anticipated, this complicated procedure should only be performed by an experienced surgeon.

Adolescent↗

PubMed1995

Complications of continuous ambulatory peritoneal dialysis: one surgeon's experience with 668 patient-month follow-up.

BACKGROUND: The technique of continuous ambulatory peritoneal dialysis (CAPD) catheterization is critical to patient success. To clarify how important a surgeon's experience to CAPD is, the experience exclusively from a single surgeon was presented and compared with those from a group of surgeons. The roles of intraoperative fluoroscopy and laparoscopy in CAPD catheterization and the rescue of tube migration in the authors' experience would also be introduced. METHODS: Fifty-five patients followed for a total of 668 patient-months between July 1990 and July 1993 were included for analysis. All of the catheterization procedures were done by one surgeon. RESULTS: The overall complication rate was 56%. Twenty-two percent of the patients had peritonitis, with an incidence of 0.56/patient-year, and 25% of the patients had exit-site infection, with an incidence of 0.36/patient-year. Tube migration occurred in two patients (4%). There was no dialysate leakage or incisional hernia. These incidences were much lower than previous reports by groups of surgeons. Laparoscopy successfully rescued a migrated tube. The cumulative 1-year, 2-year and 3-year catheter survival rates were 81%, 75% and 63% respectively. The previous abdominal operation, catheter type and catheterization site were not the prognostic factors of catheter survival. CONCLUSIONS: Based on this favorable outcomes, an experienced CAPD-surgeon may be one of the factors in minimizing the complications and improving the catheter survival in CAPD. Intraoperative fluoroscopy for every catheterization procedure and laparoscopy for the migrated or dysfunctional tube are highly recommended.

Adolescent↗

PubMed1995

Pseudomyxoma peritonei: does a true mucolytic agent exist? In vitro and in vivo studies.

Reproducibility of the so-called "mucolytic effect" of the 2%-10% dextrose-water solution is questioned. To test the mucolytic effect of 5% and 10% dextrose-water solutions and to determine what could be a true mucolytic agent, in vitro and in vivo studies were undertaken in two proven pseudomyxoma peritonei cases. In vitro study: Immediately after the mucin jelly was taken out of the peritoneal cavity, the jelly was immersed in various 40 cc solutions including: 1) 5% dextrose-water; 2) 10% dextrose-water; 3) normal saline; 4) lactated Ringer; 5) distilled water. The mucolytic effects of these solutions were observed once every hour after vigorous mixing. In vivo study: After completion of the operation, the peritoneal cavity was repeatedly irrigated with massive warm 5% dextrose-water and normal saline solutions in an attempt to dissolve the residual mucin cake and jelly. Neither 5% and 10% dextrose-water solution nor control solutions of normal saline, lactated Ringer, and distilled water could dissolve the mucin jelly in test tubes at 0, 1, 2, and 3 hours. The "claimed" mucolytic agent, 5% dextrose-water solution could not facilitate the removal of both mucin jelly and cake in the peritoneal cavity. The 5% dextrose-water solution was not superior to the normal saline solution in terms of mucolytic effect. In the present study, a true mucolytic agent does not exist. Currently, multiple laparotomy for aggressive cytoreduction remains the treatment of choice for pseudomyxoma peritonei.

Aged↗

PubMed1995

Is pancreatoduodenectomy justified for periampullary cancers with regional lymph node involvement?

Justification of pancreatoduodenectomy for highly malignant periampullary cancers with regional lymph node involvement is questioned. Attempting to clarify the therapeutic dilemma, we compared the prognoses of resectable periampullary cancers with and without lymph node involvement, as well as unresectable cancers with lymph node involvement. The medical records of surgical patients with periampullary adenocarcinoma were reviewed. We compared the survival times of resectable cancers with (resectable TanyN1M0) and without (resectable TanyN0M0) regional lymph node involvement, and the survival times of resectable cancers with lymph node involvement (resectable TanyN1M0) and unresectable cancers with lymph node involvement (unresectable TanyN1M0). There were 138 resectable and 115 unresectable periampullary cancers including 117 cancers of the pancreatic head, 117 cancers of ampulla of Vater, 7 cancers of duodenum, and 12 cancers of distal common bile duct. The prognosis was very poor in cancer of the pancreatic head. Neither resectability nor status of lymph node involvement could influence the survival time of the cancer of pancreatic head. In resectable non-pancreatic periampullary cancers, the prognosis was significantly better in the group without lymph node involvement. However, once the lymph node was involved, the outcomes were the same in the resectable and unresectable groups. Although pancreatoduodenectomy does not seem to be justified for periampullary cancers with regional lymph node involvement, this procedure should be considered for periampullary cancers without nodal involvement.

Adenocarcinoma↗

PubMed1994

Comparison of resectable and unresectable periampullary carcinomas.

Two hundred and fifty-eight patients with pathologically proved periampullary carcinomas who underwent surgical treatment between the years 1965 and 1992 were evaluated. Comparison was carried out between the resectable and unresectable groups. Carcinoma of the pancreatic head occurred in less than one-half (47 percent) of the patients, and only 23 percent were resectable. In contrast, carcinoma of the ampulla of Vater had a similar rate of occurrence, but a much higher resectable rate (86 percent). Thus, carcinoma of the pancreatic head was the minor group (19 percent) in the resectable patients we studied. The main clinical presentations and durations of symptoms before diagnosis did not differ in the resectable and unresectable groups, so it was impossible to predict the resectability by symptoms. Incidences of diabetes mellitus and diarrhea increased twofold in the unresectable group. Preoperative biopsy was difficult to perform for those with carcinoma of the pancreatic head. Comparing pancreatoduodenectomy and palliative operation, pancreatoduodenectomy resulted in a higher complication rate (43 versus 13 percent), a higher surgical mortality rate (17 versus 9 percent) and a longer hospitalization period (31 versus 20 days), but there was no statistical difference in the median survival time between the resectable and unresectable carcinomas of the pancreatic head (seven and one-half versus five months). Most of the patients (81 percent in the resectable group and 70 percent in the unresectable group) we studied died of cachexia with tumor recurrence. Although the advantage of pancreatoduodenectomy for resectable carcinoma of the pancreatic head was questioned, we still recommend this procedure for all periampullary carcinomas to avoid depriving the occasional patients with pancreatic carcinomas of long term survival and forfeiting the chance of cure for some misdiagnosed patients with other more favorable periampullary carcinomas.

Age Factors↗

PubMed1994

Intraductal mucin-hypersecreting papillary adenocarcinoma of the pancreas: a case report.

A 68-year-old male was admitted with jaundice and abdominal fullness. Abdominal ultrasonography and computed tomography (CT) scan showed a diffusely dilated main pancreatic duct (MPD) with microcystic lesions over the pancreatic head and dilatation of the biliary tract. Duodenoscopy revealed mucin secretion at the orifice of the papilla of Vater. Findings of endoscopic retrograde cholangiopancreatography (ERCP) were compatible with a mucinous tumor of pancreas invading the common bile duct. The patient was treated with a modified Whipple's operation. Pathological diagnosis was papillomatosis with papillary adenocarcinoma of the pancreas.

Adenocarcinoma, Mucinous↗

PubMed1994

Comparison of aged and young adult patients with cholelithiasis: a prospective controlled study.

BACKGROUND: Surgical operations for gallstones are associated with increased perioperative mortality in the elderly. The presence of pre-existing cardiovascular disease and acute cholangitis might be the cause as found in the literature. METHODS: From August 1989 to December 1990, twenty-nine patients (Age > or = 70 years) with cholelithiasis undergoing biliary surgery in Veterans General Hospital-Taipei were collected as experimental group. Twenty-nine patients from 62 patients (Age < or = 50 years) with cholelithiasis were selected as control group. The basic data, symptomatology, blood biochemistry, peri-operative complications, mortality and gallstone compositions were analyzed and compared between both groups. RESULTS: There was a higher male to female ratio (4.8:1) in the aged group. Aged patients had higher incidence of common bile duct stone (11/29 versus 3/29, P < 0.025), while young adult patients had higher incidence of intrahepatic stone (1/29 versus 10/29, P < 0.05). The perioperative morbidity and mortality was higher in the aged group (37.9% and 3.4%) as compared with the young age group (3.4% and 0%, P < 0.005). CONCLUSIONS: Aged cholelithiatic patients were associated with male preponderance, more common bile duct stones, higher perioperative morbidity and mortality, as compared with the young adult cholelithiatic patients.

Adult↗

PubMed1993

DNA ploidy as a major prognostic factor in resectable ampulla of Vater cancers.

The archival paraffin-embedded specimens from 63 ampulla of Vater cancers after pancreaticoduodenectomy between 1965 and 1991 were analyzed by flow cytometry. Of the 63 cancers, 31 (49.2%) were diploid DNA cancers and 32 (50.8%) were aneuploid. Patients with diploid DNA cancer had a median survival time of 159.0 months, and patients with aneuploid DNA cancer had 24.0 months. This difference is statistically significant (P = 0.0257). The aneuploid group did have a poorer prognosis than the diploid group. The multivariate analysis demonstrated that DNA ploidy was an independent and very important prognostic factor, even stronger than the stage and lymph node status. There was a tendency toward higher values of S-phase fraction, proliferative index, and total aneuploid DNA fraction in the shorter survival groups, but they were of no statistical significance. These data suggest that DNA ploidy appears to be the most important and the only pre-operative predictor of prognosis in resectable ampulla of Vater cancers since endoscopic biopsy is feasible.

Ampulla of Vater↗

PubMed1992

Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study.

For many years, it has been said that Taiwan has the highest relative prevalence of hepatolithiasis among the Asian countries. To confirm this, and to reevaluate the chronological changes regarding gallstone disease in Taiwan, a retrospective nationwide cooperative study was conducted in this country. A total of 17,182 patients from 28 medical centers are included in this survey. A gradual increase during the past 20 years in gallstone prevalence with a concomitant decrease of choledocholithiasis and hepatolithiasis are well demonstrated. Both nutritional and environmental factors are involved in these changes. With respect to hepatolithiasis, Taiwan continues to have the highest prevalence among Asian countries, and 20% may be the average figure for the whole country.

Bile Duct Diseases↗

PubMed1992

[The incidence and cause of death following surgery for benign biliary tract disease].

A total of 4056 consecutive patients operated for benign biliary tract disease between January 1983 and June 1990 were reviewed retrospectively. There were 71 in-hospital deaths, representing 1.75% of morality rate. Cholecystectomy was performed in 2275 patients; common bile duct exploration was carried out in 1494, with operative mortality rates of 0.4% and 3.1% respectively. Sepsis was the leading cause of mortality. The second common cause of death was hepatic failure, and respiratory failure the third. Cardiovascular problems accounted for 11.3% of death, which was much lower than reports from western series. Other causes of mortality included hypovolemic shock, anaphylactic shock, epilepsy and hypoglycemia. Of the total 4056 patients, 28.5% underwent emergency surgery. The mortality rate for emergency surgery was 3.6 times higher than for those who underwent elective operations (p less than 0.005) Significantly higher mortality rates were also seen for those aged over 70 years and of male gender. Because the mortality rate of patients who underwent emergency operation due to acute inflammatory or obstructive complications were much higher than that of elective operation group, we suggested early surgical intervention for the symptomatic patients before complications occurred.

Adolescent↗

PubMed1992

Extracorporeal shock-wave lithotripsy of gallbladder stones.

Recently, extracorporeal shock-wave lithotripsy has been introduced as a nonoperative treatment for gallstone disease. To evaluate its applicability in Taiwan, where cholesterol stones are not very frequent, 18 patients out of 194 (9.3%) were selected according to the Munich inclusion criteria to receive this treatment. Chenodeoxycholic acid and ursodeoxycholic acid were administered as adjunctive litholytic therapy. Twenty-eight sessions of lithotripsy were performed, resulting in a 83% satisfactory fragmentation rate (< or = 5 mm). No serious complications were encountered; however, two patients later underwent laparoscopic cholecystectomy. The stones disappeared in four patients after treatment, but recurred in one after discontinuation of oral bile acids. The long-term result was discouraging compared to European reports. A 13% stone-free rate was noticed at one year and 25% was anticipated during the 13-18 month follow-up. It is our conclusion that low eligibility, low cost-effectiveness and poor treatment results will restrict the wide-spread use of this nonoperative therapy in Taiwan.

Adult↗

PubMed1992

Age-dependent 6kb deletion in human liver mitochondrial DNA.

Using PCR technique, restriction mapping and DNA sequencing, we analyzed liver mitochondrial DNA (mtDNA) of 2 stillborn babies and 62 Chinese subjects with non-liver disease from 27 to 86 years old. The results showed an age-dependent 6,063 bp deletion in the liver mtDNA of older subjects. We found a TAACAGAC sequence flanking the 5'-end breakpoint at 7,842 nucleotide position and an imperfect repeat sequence CAACATAC flanking the 3'-end breakpoint at 13,905 nucleotide position. The incidence of the deleted mtDNA was found to increase with age. The deleted mtDNA was not detected in the liver of the stillbirth or blood cells of all the subjects. This is the first account that an age-related 6,063 bp deletion occurs in the liver mtDNA of old humans. The occurrence of this and previously reported 4,977 bp deletions is consistent with our recent finding that liver mitochondrial respiratory functions decline with age and support the hypothesis that continuous accumulation of mtDNA mutations is an important contributor to ageing process in the human.

Adult↗

PubMed1991

DNA polymorphisms and deletion analysis of the Duchenne-Becker muscular dystrophy gene in the Chinese.

In our investigation of Duchenne muscular dystrophy (DMD)-Becker muscular dystrophy (BMD) gene in the Chinese, the analysis of relevant restriction fragment length polymorphisms (RFLPs) was first made in 30 normal female volunteers to determine their allele and genotype frequencies, and then in 29 DMD-BMD families for informativeness of different combinations of RFLPs in making carrier detection and prenatal diagnosis. We further screened the mutant gene, first with four 5' end intronic, genomic probes (pERT87-1, pERT87-8, pERT87-15, and XJ1.1) which did not show any deletions, and then with all dystrophin cDNA probes which disclosed 13 partial gene deletions out of 29 patients studied (45%). The deletions were nonrandomly distributed, clustering primarily near the central region of the gene. Fifty percent of the deletions involved single exon-containing HindIII restriction fragments, and again most were located near the center of the gene, emphasizing the importance of this area. Some exceptions were found against the previous suggestion that intactness of translational open reading frame resulted in a BMD phenotype. Neither the location of the breakpoints nor the length of the deletions was useful in predicting a certain phenotype. One of our patients had an intriguing pattern of partial gene deletion that lost part of the gene at the 3' end. Carrier determination was attempted by use of dosage analyses or identification of junction fragments which greatly improved accuracy and reliability.

Alleles↗

PubMed1990

Angiographic arterio-venous shunt and venous thrombosis in the prognosis of hepatoma.

Angiograms and clinical data for 249 patients with hepatoma were evaluated, with particular attention paid to the arteriovenous (A-V) shunt and venous thrombosis (including occlusion). There were 43 cases (17.3%) with A-V shunt and 140 cases (56.2%) with venous thrombosis. A statistically significant difference in survival was noted among the unresectable patients with and without these vascular changes. Furthermore, in the resectable patients, presence of venous thrombosis also showed a poor prognosis. A-V shunt did not influence the survival in the unresectable patients with venous thrombosis, and 93.0% of A-V shunt was associated with venous thrombosis. This seemed to imply that these two vascular changes might be the same entity. In the presence of either A-V shunt or venous thrombosis, the survival rate in the surgical group was still better than that of medical groups treated by either transarterial embolization (TAE) or conservative methods. Most of the A-V shunt (81.4%) and venous thrombosis (56.4%) occurred in the diffuse type of hepatoma, and the prognosis for unresectable patients was the worst in this type, with a mean survival time of 3 months. Since A-V shunt and venous thrombosis are factors in poor prognosis and occur frequently, careful preoperative evaluation of these vascular changes is mandatory. However, in patients with localized tumor, coexisting with such vascular involvement, surgical resection is still recommended.

Arteriovenous Fistula↗

PubMed1990

[Breast cystosarcoma phyllodes. A clinicopathologic study of twenty-seven cases].

Twenty-seven cases of cystosarcoma phyllodes (CSP) diagnosed at the Veterans General Hospital, Taipei, were reviewed. Of the twenty-seven cases, seventy per cent were benign, thirty per cent were malignant. One of the malignant cases was transformed from benign one. Of the benign CSPs, one had multifocal lesions and eight were associated with other breast lumps, including fibroadenoma and fibrocystic disease. The mean age of patients with benign CSP was 33 years old, and with malignant CSP, 52 years old. The most frequent location was in upper outer quadrant. We found no positive correlation between tumor size, clinical symptoms, tumor epithelial carcinoembryonic antigen, hypervascularity, mixed mesenchymal components, and benign or malignant CSP. Estrogen and/or progesterone receptors were positive in five benign CSPs detected, but malignant CSP was negative. Variable degrees of epithelial hyperplasia, squamous metaplasia, and apocrine metaplasia, were found in both benign and malignant CSPs. Part of the epithelial component in CSP may be derived from normal breast lobule and duct being trapped into the tumor during tumor infiltration. The mesenchymal differentiation in malignant CSPs include fibrosarcoma, malignant fibrous histiocytoma, liposarcoma, and collision of chondrosarcoma and malignant fibrous histiocytoma. One of the malignant CSPs was found within an old, calcified fibroadenoma. When benign CSP was excised under impression of fibroadenoma, the recurrent rate was 50%. In view of this, we recommend a wide excision for a benign CSP. No axillary lymph node metastasis was detected in malignant CSP, so radical mastectomy was not indicated.

Adolescent↗