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Biomedical subjects

C K Kum

Publications and source records attributed to C K Kum.

At least 37 records · Page 2Linked to original sources
PubMed1995

Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: a prospective randomized trial.

A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10,000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0.01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.

Adult↗
PubMed1995

The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements--September 1994. The Educational Committee of the European Association for Endoscopic Surgery.

Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.

Appendectomy↗
PubMed1995

Palliation of advanced gastric cancer by laparoscopic gastrojejunostomy.

Palliation of unresectable gastric carcinoma by conventional gastrojejunostomy is associated with significant morbidity and mortality. Laparoscopic gastrojejunostomy may be an alternative as it can achieve the same results with less morbidity. This is a case report of a 68-year-old man with an obstructed, unresectable gastric carcinoma that has metastasized to the lungs and liver. Attempt at laser boring was unsuccessful. Laparoscopic assessment revealed an immobile tumour fixed to the pancreas. A totally intraabdominal laparoscopic gastrojejunostomy was fashioned with endoGIAs (USSC Norwalk, CT). Operation time was 85 minutes. He was able to tolerate feeds on the 3rd postoperative day (POD), diet on the 5th POD and was discharged on the 8th POD. Satisfactory palliation at home was achieved for ten weeks before death. Laparoscopic gastrojejunostomy is thus a good option for palliation of obstructed advanced gastric cancer.

Adenocarcinoma↗
PubMed1994

Laparoscopic cholecystectomy for acute cholecystitis.

The safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedure for this condition (43 patients) and routine laparoscopic cholecystectomy (227 patients). The laparoscopic procedure for acute cholecystitis was successful in 46 of 66 patients. There was no difference in mean operating time when the inflamed gallbladder was removed laparoscopically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min; P < 0.01). There was no difference in analgesic requirement between patients who underwent laparoscopic removal of an acutely inflamed gallbladder and those in the other two groups. Postoperative recovery was significantly faster than that after open surgery (P < 0.01), but took longer than that following routine laparoscopic cholecystectomy (P < 0.01). Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cholecystitis. Bile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine laparoscopic cholecystectomy but in no patient who underwent open cholecystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfully, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and should be attempted only by experienced surgeons.

Acute Disease↗
PubMed1994

Endoscopic patch closure of malignant esophagotracheal fistula using Histoacryl glue.

Esophagotracheal fistula is one sequel of advanced carcinoma of the esophagus. Although the pneumatic cuffed tracheoesophageal fistula stent provides satisfactory palliation for fistulas, high fistulas remain a major problem. We report a case of a 64-year-old gentleman with a high fistula that was treated successfully with endoscopic patch closure using Histoacryl glue.

Enbucrilate↗
PubMed1994

Laparoscopic cholecystectomy: the Singapore experience.

A questionnaire survey was conducted in April 1992, 2 years after the first laparoscopic cholecystitis (LC) was performed in Singapore. The aim was to evaluate the safety and efficacy of this new procedure. Twenty surgeons performed 1,066 LC, of which 93% were done electively, mainly for biliary colic and chronic cholecystitis. Acutely inflamed gallbladders accounted for 6.5% of cases. Fifty-seven (5.4%) patients had to be converted to open surgery, 108 (10.1%) patients required preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis, and 57 (5.4%) intraoperative cholangiograms were done. Common bile duct injuries occurred in 10 (0.9%) patients, of which six (0.6%) were transections. Seven (0.6%) patients developed bile leakage. Minor complications occurred in another 10 (0.9%) patients. There was one (0.09%) death.

Biliary Tract Diseases↗
PubMed1994

Endoscopic sphincterotomy for the treatment of cystic duct leak following laparoscopic cholecystectomy.

Two patients who underwent laparoscopic cholecystectomy had postoperative cystic duct leak from slipped metallic clips. One patient presented with biliary ascites and the other with biliocutaneous fistula. Open surgery done in the first patient was not successful in controlling the fistula. Rapid closure of the fistulae was achieved in both cases using endoscopic sphincterotomy.

Adult↗
PubMed1994

Comparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy.

The laparoscopic technique of cholecystectomy leads to shorter hospitalization, faster recuperation, and earlier return to economic activity. Although reduction in pain is considered a major factor, no objective clinical trial has confirmed this assumption. This prospective trial compared the pain level of laparoscopic (n = 28) and conventional (n = 11) cholecystectomy. The level of pain was determined by an independent observer using the visual analog scale (VAS). Intramuscular pethidine or oral naproxen was given intermittently on demand. Patients who underwent the laparoscopic procedure had significantly less pain on the day of operation (mean VAS score 3.8 vs 7.7) and on the first postoperative day (mean VAS score 2.8 vs 6.2) (p < 0.05). The proportion of patients requiring intramuscular pethidine was correspondingly less in the laparoscopy group. On the second and third postoperative day, the level of pain was not statistically different. All patients who had conventional cholecystectomy required at least one dose of analgesia (pethidine or naproxen), whereas only 53.6% of patients who had the laparoscopic procedure required analgesia (p < 0.05). This study verifies that pain reduction is an important advantage of laparoscopic cholecystectomy.

Analgesia↗
PubMed1993

Randomized controlled trial comparing laparoscopic and open appendicectomy.

A study was carried out of 137 patients with a diagnosis of acute appendicitis who were randomized to either laparoscopic or open appendicectomy. Patients found to have perforated or normal appendices at histological examination were excluded. Fifty-two patients undergoing laparoscopic appendicectomy and those receiving 57 open procedures were analysed. Laparoscopic appendicectomy took no longer than the open procedure (mean 43 versus 40 min). The number of doses of pethidine (1 mg per kg body-weight) required in the immediate postoperative period did not differ between the two groups but the mean number of doses of oral analgesic (naproxen sodium 550 mg twice daily) required was less in patients undergoing laparoscopic appendicectomy (2.8 versus 5.0, P < 0.05). There was no significant difference between time to resumption of fluid and diet intake and length of hospital stay. There were five (9 per cent) wound infections after open appendicectomy compared with none after the laparoscopic operation (P < 0.01). Patients who underwent laparoscopy returned to full home (17 versus 30 days, P < 0.01) and social (19 versus 32 days, P < 0.05) activities earlier than those who underwent open operation. Laparoscopic appendicectomy may allow reduction in the number of wound infections and earlier return to normal activities.

Adolescent↗
PubMed1993

Diagnostic laparoscopy: reducing the number of normal appendectomies.

A prospective, controlled study was conducted to determine whether a selective policy of diagnostic laparoscopy could reduce the number of unnecessary normal appendectomies in patients with acute right iliac fossa pain. The cohort consisted of patients admitted with acute right iliac fossa pain by the emergency department. Of 102 patients in the study group, 28 subsequently required a diagnostic laparoscopy when a definite diagnosis could not be reached after 8 to 12 hours of observation. Of these, only 18 had inflamed appendices, which were removed. In the rest of the patients (10), the appendices were normal and unnecessary laparotomies were avoided. In the control group, wherein equivocal cases were laparotomized after a similar period of observation, there was a normal appendectomy rate of 15.7 percent (P < 0.05). There was no significant difference in the incidence of perforation between the control and study groups. Diagnostic laparoscopy in equivocal cases could thus significantly reduce the number of unnecessary appendectomies without compromising on the rate of perforation.

Adolescent↗
PubMed1993

Laparoscopic Billroth II gastrectomy: a review.

The operation of Billroth II gastrectomy has not changed substantially in concept or technique since it was first performed in 1885 by Theodor Billroth. The advent of stapling has made the procedure faster for the surgeon but the operation has remained as painful and as traumatic for the patient. The totally intra-abdominal laparoscopic Billroth II gastrectomy offers a minimally invasive option that is remarkably less traumatic and more 'patient friendly'. Initial experience in this operation around the world has largely concentrated on resection for benign gastric ulcer but the possibility of resection for cancer is not inconceivable. Experience with a small experimental series of eight cases showed that this operation has many advantages over open surgery in terms of postoperative pain, quicker mobilization, fewer wound problems, better cosmesis and quicker discharge. No anastomotic leak, chest or wound complications were encountered. The main problem remains the cost of disposable stapling devices.

Aged↗
PubMed1993

Papillary carcinoma arising in a thyroglossal cyst.

Carcinoma arising in a congenital thyroglossal cyst is rare, with less than 150 cases reported worldwide. This is a case report of a papillary carcinoma arising within a thyroglossal cyst in a 51 year old woman. Management of this condition remains controversial. Most of these tumours arise from ectopic thyroid tissue within the cyst. Prognosis is good as metastasis is uncommon. Sistrunk procedure is adequate if histology does not reveal extracystic extension.

Carcinoma, Papillary↗
PubMed1993

Elderly patients with perforated peptic ulcers: factors affecting morbidity and mortality.

Morbidity and mortality of perforated peptic ulcers (PPUs) have been higher when they occur in elderly patients. Seventy-three PPUs were reviewed to determine the factors accounting for the poor outcome in patients at or above 65 years old (elderly PPU). The presentation of 44 young PPUs was compared to 29 elderly PPUs. Delay in diagnosis, associated comorbid factors and shock on admission were found to be the primary factors. There was a significant difference between the two groups in terms of duration of pain before the diagnosis was made (8.2 h vs 16.4 h) (P < 0.05). The delay in diagnosis was partly due to the vague presentation, as 41.4% (11 patients) of the elderly presented with abdominal pain not localized in the epigastrium. In addition, 55.2% (16) of elderly patients did not have a history of prior ulcer disease and one-third (nine) did not have air under the diaphragm on chest X-ray. Significant comorbid factors were present in 65.5% compared to 15.9% in the younger group (P < 0.001). Shock on admission was present in six (20.7%) elderly patients, but only in one (2.3%) young patient (P < 0.05). As a result, morbidity was 89.6% in the elderly group compared to 27.2% in the younger patients (P < 0.001). Wound complications accounted for a significant proportion of the morbidity. Mortality was 17.2% and 2.3% respectively (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Deep vein thrombosis complicating colorectal surgery in the Chinese in Singapore.

It has been reported that the risk of thromboembolism after general surgery in Chinese is negligible, thus, prophylaxis has not been used. This study examined the incidence in the high risk subgroup of patients undergoing colorectal operations. In a two-year retrospective review, 35 rectum resections for cancer, 72 colon resections for cancer, and 22 colon resections for benign disease were analysed. The clinical incidence of deep vein thrombosis (DVT) in patients with malignancy was 4.7% (5/107). None of the patients with benign disease had DVT. Three of the five patients with DVT had pulmonary embolism, of which one died. Rectal surgery incurred a higher risk (11.4%) compared to colonic resection (1.4%) (p = 0.038). Postoperative wound infection was an important predisposing factor (p = 0.027). In view of these findings, a prospective trial has been planned to further evaluate the need for prophylaxis in selected high risk patients.

Adult↗
PubMed1993

A rare wandering splenic cyst removed with laparoscopic assistance.

This is a report of the first case of a true cyst arising in a wandering spleen. Laparoscopic splenectomy was attempted. The spleen was mobilized under laparoscopic control and the cyst aspirated. Dissection of the pedicle was technically feasible. However, the procedure was aborted due to uncontrollable bleeding from a moderate-sized artery. Although the whole procedure was not completed laparoscopically, laparoscopic assistance facilitated extirpation of the spleen through a 5-cm oblique left iliac fossa incision in a minimally invasive fashion.

Adult↗
PubMed1993

Laparoscopic-assisted right hemicolectomy--a case report.

Laparoscopic colon resection has recently attracted attention as a viable option to open colectomy due to its excellent postoperative recovery. We report the first right hemicolectomy done laparoscopically in Asia in a 62-year-old female patient with Dukes-B2 caecal carcinoma. Bowel sounds were present on the first post-operative day (POD) and diet was resumed on the third. The patient was discharged on the fourth POD. There was no complication of anastomotic leakage or wound infection.

Adenocarcinoma, Mucinous↗