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Biomedical subjects

C S Ho

Publications and source records attributed to C S Ho.

At least 163 records · Page 9Linked to original sources

Periampullary tumours: advances in diagnosis and surgical treatment.

Forty-five carcinomas of the region of the ampulla of Vater were resected at the Toronto General Hospital during a 16-year period. In 26 the presenting symptom was pain and in 32 it was jaundice. The most useful means of investigation was endoscopic retrograde cholangiopancreatography. Angiography was of value in determining resectability prior to operation, and percutaneous aspiration biopsy allowed a preoperative diagnosis in the case of large pancreatic tumours. In 39 patients who had a Whipple procedure the operative mortality was 8%. Total pancreatectomy performed in two patients and local excision of ampullary carcinoma in four patients were attended by no operative deaths. Long-term survival was best in patients with ampullary carcinomas and worst in those with pancreatic cancer.

Ampulla of Vater↗

Percutaneous needle aspiration biopsy.

This paper reviews the history, technique, applications, advantages, disadvantages and complications of percutaneous needle aspiration biopsy. This technique, particularly when performed with a time needle (21-gauge or less), is a relatively painless, inexpensive and safe method of obtaining a pathologic diagnosis, and it can often be carried out at the bedside or in the outpatient department. It complements other methods and may obviate, but never precludes, subsequent excisional biopsy. Its advantages are insufficiently recognized. Considerable expertise of the cytopathologist and close cooperation with the clinician are necessary for consistent results.

Biopsy, Needle↗

Percutaneous fine-needle aspiration biopsy of intra-abdominal masses.

Percutaneous fine-needle aspiration biopsies were performed in 51 patients with various intra-abdominal masses localized by palpation, radiologic studies, ultrasonography or radioisotope scanning. Biopsy specimens were considered positive for malignant disease in 35 (85%) of the 41 patients with such disease, including 26 (96%) of the 27 with metastases. There was one false-positive diagnosis of malignant disease from the biopsy specimens. Surgery became unnecessary as a result of aspiration biopsy in at least 12 patients. One patient showed evidence of intrahepatic bleeding during liver biopsy but recovered spontaneously, and the liver appeared normal at laparotomy 3 weeks later. Aspiration biopsy is an accurate, relatively painless, inexpensive and safe method of establishing a diagnosis of intraabdominal malignant disease. Considerable experience of the cytologist is necessary for good results.

Abdominal Neoplasms↗

Fine needle aspiration biopsy of malignant lesions in and around the pancreas.

A simple method of percutaneous fine needle aspiration biopsy of malignant lesions in and around the pancreas following radiological localization is described. Biopsy was performed in 28 patients. Twenty-three were eventually considered to have malignant disease and biopsy was positive in 19 of these (83%), including 16 of 18 patients with carcinoma of the pancreas (89%). One patient developed an exacerbation of pancreatitis following the procedure. Surgery became unnecessary in 5 of the 18 patients with positive biopsies. From these results and from a review of the literature on percutaneous fine needle aspiration biopsy, we believe that this is a simple, relatively painless, reasonably safe and reliable method of obtaining a preoperative diagnosis and advocate the procedure as desirable in all patients in whom malignant disease is suspected and can be localized radiologically.

Bile Duct Neoplasms↗

Linear shadows in the air-contrast barium enema.

In 3 patients with carcinoma of the colon, lesions were seen as linear shadows on air-contrast barium enema studies. When the elevation of a lesion is slight or the tumor--mucosal interface is gently sloping, the tumor's proximal and distal edges may be ill-defined or disappear altogether. Thus only a linear shadow representing the interface between the tumor surface and air in the lumen appears. Other causes of these lines are also discussed.

Aged↗

Selective intubation of the afferent loop.

A selective intubation method for examination of the afferent loop is described and brief review of complications involving the afferent loop is outlined. The value of the intubation method in patient management is illustrated by three case reports. We find this a helpful method for studying selected patients with clinical problems related to the afferent loop.

Adult↗

Metoclopramide in gastrointestinal radiology.

Since the late 1960's, metoclopramide has been used in Europe for the treatment of gastrointestinal motility disorders. It is less well known in North America and its application in diagnostic radiology is unfamiliar to most radiologists. By comparing a control group of 103 patients with a study group of 86 patients, we found that intramuscular injection of metoclopramide is effective in reducing both gastric emptying time and small bowel transit time. Side effects were negligible in 125 patients. We also found the drug useful in gastric stasis, to differentiate between mechanical obstruction and motility disorders, in fluoroscopy of the terminal ileum, and in duodenal intubation.

Adolescent↗

Nonoperative removal of retained common-bile-duct stones.

The discovery of retained common-bile-duct stones after operations on the gallbladder continues to be a frustrating experience for the general surgeon. Until recently this problem was solved in most patients by surgical re-exploration of the common bile duct. However, several alternatives to surgery are gradually gaining acceptance because of their lower morbidity and mortality. These methods are discussed with special emphasis on the use of a catheter with a steering mechanism and the Dormia basket (Burhenne's technique). This is the best alternative to surgery as it has no reported mortality, few complications and causes the least discomfort to the patient. It is highly successful and requires no hospitalization.

Catheterization↗

Percutaneous fine needle aspiration biopsy of the pancreas following endoscopic retrograde cholangiopancreatography.

Fine needle aspiration biopsies were performed in 9 patients with suspected pancreatic malignancies demonstrated and localized by endoscopic retrograde cholangiopancreatography (ERCP). The biopsies were positive in 7 of 8 patients with pancreatic carcinoma and there were no complications. ERCP is an accurate method for diagnosing pancreatic cancer which may be confirmed safely and easily by fine needle aspiration biopsy.

Biopsy, Needle↗

The small bowel enema: experience with 150 examination.

Clinical application of the small bowel enema has received waxing and waning enthusiasm since it was first described in 1929. Our experiences with 150 small bowel enema studies is presented. The Sellink method was used for patients without ileostomy, (140), and retrograde studies for those with ileostomy. The merits of the small bowel enema compared to the conventional technique are discussed. The small bowel enema is the preferred method for radiologic assessment of the small bowel in patients whose clinical picture suggests small bowel disease.

Adult↗

The superior QRS axis in ostium primum ASD: a proposed mechanism.

The influence of abnormal hemodynamics, ventricular hypertrophy, and right bundle branch block on the AQRS was studied pre- and post-operatively in 29 patients with OPSD. The AQRS markedly diminishes with the surgical correction of abnormal hemodynamics and the subsequent resolution of RVH or BVH. With the persistence of ventricular hypertrophy postoperatively or the surgical induction of RBBB, the AQRS either remains unchanged or, in the latter instance, becomes more superior and rightward. The dependence of the superior AQRS on these factors suggests that a left anterior hemiblock is not responsible for this AQRS. In OPSD early activation of the posterobasal region of the left ventricle through an abnormally short posterior fascicle results in a minimal superior AQRS which is then exaggerated in the presence of abnormal hemodynamics, ventricular hypertrophy, or RBBB. Thus, the superior AQRS in OPSD with associated RBBB does not represent a true bifascicular block and has a different natural history and clinical significance.

Adolescent↗