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Biomedical subjects

F F Chou

Publications and source records attributed to F F Chou.

At least 19 recordsLinked to original sources
PubMed2003

Minimal invasive surgery for resection of parathyroid tumor in the aortopulmonary window.

Video-assisted thoracoscopic surgery for parathyroid glands deep in the mediastinum is a safe and successful procedure, but its success depends on accurate localization before operation. Recently, a variety of minimally invasive techniques to approach cardiovascular disease have been proposed to eliminate the morbidity of standard sternotomy. We describe a case involving a 71-year-old woman with persistent hyperparathyroidism resulting from an ectopic mediastinal parathyroid gland, which was removed through an upper sternotomy. The technique has proved safe, effective, and aesthetically acceptable to the patient.

Adenoma↗
PubMed2001

Parathyroidectomy can improve bone mineral density in patients with symptomatic secondary hyperparathyroidism.

HYPOTHESIS: The recovery of osteoporosis or bone mineral density (BMD) after parathyroidectomy and autotransplantation can be improved in patients with symptomatic secondary hyperparathyroidism. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Forty-five patients with symptomatic secondary hyperparathyroidism who underwent total parathyroidectomy and autotransplantation were included. They were divided into an osteoporotic group (n = 20) and a nonosteoporotic group (n = 25) according to preoperative T scores less than -2.5 at either the lumbar spine (L1-L4) or the femoral neck (FN). INTERVENTIONS: Serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were checked before surgery and 1 day, 1 week, and 3 months after surgery. The BMDs of the FN and L1-L4 were measured using dual-energy x-ray absorptiometry before surgery and 6 months after surgery. RESULTS: Patients with osteoporosis were older (mean +/- SD, 50.2 +/- 14.0 years) than those without osteoporosis (42.7 +/- 9.1 years) (P =.04). Except for bone fractures found in 2 women in the osteoporotic group, there were no significant differences between the 2 groups in sex, clinical manifestations, duration of dialysis, weight of removed parathyroid tissue, and types of dialysis. Also, serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were similar in both groups. Both 1 day and 1 week after total parathyroidectomy and autotransplantation, serum levels of calcium and intact parathyroid hormone decreased rapidly and then gradually increased 3 months later; however, serum levels of alkaline phosphatase increased rapidly and then gradually decreased 3 months later. Six months after parathyroidectomy, BMD, T score, and Z score at L1-L4 and the FN increased significantly (P<.001). The increment was much better in the osteoporotic group than in the nonosteoporotic group (P<.001). Also, osteopenia or osteoporosis improved significantly after parathyroidectomy at both L1-L4 and the FN (P<.001 for both). CONCLUSION: Parathyroidectomy and autotransplantation can improve BMD of symptomatic secondary hyperparathyroidism at L1-L4 and the FN.

Absorptiometry, Photon↗
PubMed2001

Paget disease of the breast--an easily overlooked disease?

BACKGROUND AND OBJECTIVES: Paget disease of the breast has long been recognized as a distinct clinical disease. The clinical manifestations and outcomes of Paget disease of the breast were reviewed to understand its earlier diagnostic clues and achieve an optimal treatment plan. Patients and Methods Thirty-one patients with Paget disease of the breast were included in this study. The postoperative outcomes and possible related prognostic factors were reviewed and analyzed. RESULTS: The 5-year overall survival was 69%. Nineteen patients (61%, Group A) did not have a palpable breast mass and 12 patients (39%, Group B) had a palpable breast mass. There was significant difference (P < 0.01) in the 5-year overall survival between Group A (94%) and Group B (19%). Group A patients had significantly higher incidences of underlying noninvasive breast carcinoma (73% vs. 8%, P < 0.01) and n0 lymph nodes status (84%vs. 50%, P = 0.043) than those of Group B. CONCLUSIONS: Paget disease of the breast without a palpable breast mass carries a more favorable prognosis. Patients with any nipple complaints deserve a detailed evaluation even in the absence of a palpable breast mass in order not to overlook a favorable disease.

Adult↗
PubMed2001

Improvement of sexual function in male patients after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: Clinically, the severity of uremia is known to be inversely proportional to sexual desire and activity in patients with chronic renal failure. We studied sexual function and sex hormones in male patients with symptomatic hyperparathyroidism before and 3 months after parathyroidectomy. STUDY DESIGN: From October 1998 to December 2000, 20 male patients with symptomatic secondary hyperparathyroidism were enrolled in this study. They underwent total parathyridectomy and autotransplantation of 90 mg of tissue to the subcutaneous tissue of the forearm or thigh. They all had regular sexual partners and were sexually active. Preoperatively, hemoglobin, hematocrit, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), prolactin, testosterone, leutenizing hormone (LH), and follicle stimulation hormone (FSH) were checked routinely. Three months after operation those data were checked again. Sexual function was evaluated with the International Index of Erectile Function (IIEF). Monthly frequency of attempted sexual intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse were individually analyzed preoperatively and 3 months postoperatively. RESULTS: Hemoglobin, hematocrit, testosterone, and LH were noted to have not significantly changed 3 months after surgery. Serum levels of calcium, phosphorus, alkaline phosphatase, FSH, and iPTH were significantly reduced, as were the levels of prolactin. But preoperative and postoperative FSH levels were within normal limits, and 70% of the postoperative alkaline phosphatase levels were above normal. Sexual function increased significantly 3 months after parathyroidectomy, as did monthly frequency of attempted intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse. CONCLUSIONS: Sexual function of male patients with symptomatic hyperparathyroidism can possibly be improved by parathyroidectomy and autotransplantation. Decreases in the levels of prolactin, calcium, phosphorus, and iPTH are also noticed after parathyroidectomy.

Adult↗
PubMed2001

Progesterone receptor in patients with hepatolithiasis.

Altered gallbladder motility by progesterone has been recognized as an important factor in the development of gallstones. There are two types of hepatolithiasis, that occurs de novo in the intrahepatic ducts with an intact gallbladder (primary hepatolithiasis) and that which originates in the gallbladder and the stones migrate into the intrahepatic duct (secondary hepatolithiasis). This study was designed to evaluate the possible role of the progesterone receptor of gallbladder in the pathogenesis of hepatolithiasis. Eighty-four patients with hepatolithiasis (34 patients had primary hepatolithiasis and the other 50 patients secondary hepatolithiasis) were included. Paraffin-embedded specimens of gallbladder were processed to have an immunohistochemical staining for progesterone receptor. Positivity for progesterone receptor of gallbladder specimens was noted in eight patients (23.5%) with primary hepatolithiasis and in 23 patients (46%) with secondary hepatolithiasis. There is significant difference (P = 0.031) in positive rate for progesterone receptor between the primary hepatolithiasis and secondary hepatolithiasis groups. In conclusion, many more patients (46%) with secondary hepatolithiasis show positivity for progesterone receptor of gallbladder specimens than patients with primary hepatolithiasis (23.5%) (P = 0.031). This phenomenon is intriguing and should be of further evaluation and elucidated.

Bile Ducts, Intrahepatic↗
PubMed2000

A study on pruritus after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: The effective therapy for uremic pruritus remains a clinical challenge, and the factors affecting the pruritus before and after parathyroidectomy have not been defined. STUDY DESIGN: Thirty-seven patients were operated on for secondary hyperparathyroidism. Their ages ranged from 14 to 73 years, and the duration of dialysis from 12 to as long as 168 months. Indications for surgery were skin itch in 22 patients and other reasons in 15 patients. Serum levels of calcium, phosphorus, intact PTH (i-PTH), and alkaline phosphatase were checked at two different intervals-before surgery and 1 week after operation. Immunohistochemical stain of mast cells, antihuman macrophage (CD68), antihuman dendritic reticulum cell (CD35), and i-PTH (IHPTH) were performed on skin specimens. Skin samples were prepared into tissue homogenates and analyzed for concentrations of interleukin-2 (II-2) and tumor necrosis factor-alpha (TNF-alpha). II-2 and TNF-alpha were measured by sandwich enzyme-linked immunosorbent assay. The extent of pruritus was evaluated on a visual analog scale (VAS) ranging from 0 to 10 and a behavior rating scale (BRS) ranging from 0 to 5, at a preoperative stage and 1 week after operation. RESULTS: Serum levels of calcium, phosphorus, the product of calcium and phosphorous (Ca x P), alkaline phosphatase, and i-PTH changed significantly after parathyroidectomy. The VAS decreased from 5.4 +/- 3.2 to 1.8 +/- 1.5 (p < 0.001). Significant improvement of BRS was achieved 1 week after surgery (p < 0.001), and in the followup period. Before surgery, there was no correlation between serum levels of calcium, phosphorus, Ca x P, alkaline phosphatase, i-PTH, number of mast cells, CD68, CD35, and IHPTH, and the scale of itch estimated with either VAS or BRS. The tissue levels of Il-2 and TNF-alpha were not detectable in any of them. We noted that high levels of phosphorus and Ca x P affected the postoperative extent of pruritus. But a linear regression test showed Ca x P was the only factor affecting postoperative itch. CONCLUSIONS: Pruritus in patients with secondary hyperparathyroidism can be reduced by parathyroidectomy. Apparently, high-level Ca x P is the only factor that seems to affect the postoperative extent of pruritus.

Adult↗
PubMed2000

Pregnancy complicated by concurrent primary hyperparathyroidism and arrhythmia.

Primary hyperparathyroidism during pregnancy results in a high rate of fetal complications and maternal morbidity. Maternal hypercalcemia in pregnancy results in fetal hypercalcemia, which leads to suppression of fetal parathyroid function. Spontaneous abortion and stillbirth can occur, and the loss of maternal calcium after birth leads to neonatal hypocalcemia. It is essential to detect primary hyperparathyroidism during pregnancy because early diagnosis and management can decrease the rate of fetal and maternal complications. We present the case of a 27-year-old gravida 1, para 0 woman whose pregnancy was complicated by hyperparathyroidism and arrhythmia. The patient complained of dyspnea and palpitations in the seventh and 15th weeks of gestation. Electrocardiography showed ventricular premature contraction bigeminy and trigeminy in association with hypercalcemia (3.3 mmol/L). A parathyroidectomy in the second trimester revealed parathyroid adenoma. Hypercalcemia and arrhythmia resolved completely and the patient delivered a term baby without any maternal or fetal complications. The simultaneous occurrence of arrhythmia with ventricular premature contractions and hyperparathyroidism in pregnancy is rarely reported. Palpitations and dyspnea due to arrhythmia may be associated with primary hyperparathyroidism in pregnancy and should be considered in the differential diagnosis. In the management of symptomatic primary hyperparathyroidism during pregnancy, surgical intervention is preferable in the second trimester when organogenesis is completed and the risk of spontaneous abortion is low.

Adult↗
PubMed1999

General weakness as an indication for parathyroid surgery in patients with secondary hyperparathyroidism.

HYPOTHESES: There are factors that affect patients with general weakness owing to secondary hyperparathyroidism and as reported by results noted after parathyroidectomy and autotransplantation. DESIGN: Case series and consecutive samples. SETTING: Tertiary care center. PATIENTS: From July 1996 to June 1998, 56 patients with secondary hyperparathyroidism underwent total parathyroidectomy and autotransplantation. Their ages were 45 +/- 13 years (mean +/- SD) and preoperative duration of dialysis was 75 +/- 37 months. Prior to surgery the patients were divided into 2 groups: group A comprised 2 men and 19 women who had some general weakness; and group B, 15 men and 20 women who reported no general weakness. The etiologies of renal failure, such as diabetic nephropathy (n = 3) or hypertensive nephropathy (n = 3), were found only in group A patients. INTERVENTIONS: Serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (intact) were checked preoperatively and 1 day, 1 week, and 3 months after surgery. Extension force of the quadriceps femoris muscle was measured at 60 degrees of right knee flexion preoperatively and 3 months after surgery. The extension force was expressed as newtons (N) in 2 different quantities: peak force and average force. The degree of general weakness was classified into 4 groups: 0, no weakness; 1, some subjective weakness and/or walking with assistance; 2, the patient was wheelchair bound; and 3, the patient was bedridden. MAIN OUTCOME MEASURES: The t test was used for paired and unpaired data; Wilcoxon signed rank and Fisher exact tests were incorporated for nonparametric data. Any values of P<.05 were considered significant. RESULTS: Prior to surgery, 2 patients in group A reported degree 3 weakness; 5, degree 2 weakness; and 14, degree 1 weakness. Three months after surgery, the peak force was noticed to have increased from 185 +/- 56 N to 249 +/- 82 N (mean +/- SD) (n = 11, P = .003), and the average force showed an increase from 136 +/- 45 N to 202 +/- 69 N (n = 11, P = .003). Postoperatively, only 5 patients had degree 1 weakness, 1 had degree 2 weakness, and none had degree 3 weakness. The patient with degree 2 weakness after surgery had diabetes mellitus and a femoral neck fracture prior to parathyroidectomy. Improvement in condition of general weakness was found (P<.001) between preoperative and postoperative periods. Serum levels of calcium were higher in group A (2.82 +/- 0.23 mmol/L [11.3 +/- 0.9 mg/dL]) than in group B (2.64 +/- 0.27 mmol/L [10.6 +/- 1.1 mg/dL]) (P = .013), and serum levels of parathyroid hormone (intact) were lower in group A (108.9 +/- 39.2 pmol/L) than in group B (139.8 +/- 39.6 pmol/L) (P = .006). Except for sex, other data such as phosphorus and alkaline phosphatase levels, age, and duration of dialysis were not significantly different between the 2 groups. CONCLUSIONS: General weakness that is commonly observed in patients with secondary hyperparathyroidism is found more frequently in women and only in patients with diabetic nephropathy or hypertensive nephropathy. Patients with general weakness had relatively higher levels of calcium and lower levels of parathyroid hormone (intact). We found that improvement of muscle power and general weakness can be achieved by parathyroidectomy and autotransplantation. In addition to itchy skin, bone pain, and soft tissue calcification, general weakness that may cause disability is also an indication for surgery in secondary hyperparathyrodism.

Female↗
PubMed1999

Muscle force and bone mineral density after parathyroidectomy and subcutaneous autotransplantation for secondary hyperparathyroidism.

The object of this study was to determine the muscle force and bone mineral density (BMD) of patients with secondary hyperparathyroidism before and 3 months after operation. Thirty-nine patients with secondary hyperparathyroidism and regular dialysis were operated. Their ages were 47 +/- 12 (mean +/- SD) years and duration of dialysis was 70.5 +/- 35.8 months. The clinical symptoms included bone pain in 23 patients (59%), skin itching in 21 (53.8%), general weakness in 13 (33.3%), conscious disturbance in 2, chest tightness in 1, and failure to thrive in 1. Total parathyroidectomy and autotransplantation of 60 mg of parathyroid gland into subcutaneous tissue was done routinely. BMD was measured in the lumbar spine (L2-L4) and left proximal femur, expressed as grams per square centimeter and as fracture risk. The extension force of the quadriceps muscle was measured at 60 degrees of right knee flexion, expressed as newtons (N) in a peak force and an average force. Three months after operation the BMD of the study group increased (in g/cm2) from 1.063 +/- 0.181 to 1.148 +/- 0.149 (p < 0.001) in L2-4 (n = 25), from 0.792 +/- 0.14 to 0.875 +/- 0.161 (p < 0.001), in femoral neck (n = 25), from 0.672 +/- 0.171 to 0.754 +/- 0.21 (p < 0. 001) in Ward's triangle (n = 25), and from 0.69 +/- 0.149 to 0.738 +/- 0.143 (p < 0.001) in trochanter (n = 25). Fracture risk also was reduced significantly 3 months after operation at L2-4 (p = 0.003), femoral neck (p = 0.001), Ward's triangle (p= 0.003), and trochanter (p = 0.005). Muscle force (in newtons) increased from 264.8 +/- 110. 5 to 326 +/- 110.9 (p = 0.023) in peak force (n = 18) and from 195.3 +/- 90.4 to 258 +/- 99 (p = 0.012) in average force (n = 18). The patients with general weakness had improved muscle force more prominently than those without general weakness. In addition to skin itching, bone pain, and soft tissue calcification, general weakness that causes disability is an indication for surgery in secondary hyperparathyroidism. After parathyroidectomy and autotransplantation, the muscle force tends to increase, especially in those with general weakness. An increment of BMD and reduction of fracture risk are also found after surgery.

Adolescent↗
PubMed1999

Results of subtotal thyroidectomy for Graves' disease.

The objective of this study was to find the factors responsible for hypothyroidism after subtotal thyroidectomy for Graves' disease. Two hundred five patients who were operated on from July 1989 to December 1997 were studied. The mean age of patients was 33.4+/-11.0 (mean +/- SD) years, and 175 (85.4%) were female. Patients were prepared with an antithyroid drug and Lugol's solution preoperatively. Triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyrotropin-binding immunoglobulins (TBII) antimicrosomal antibodies (AMA = 100x 4(M-1)), and antithyroglobulin antibodies (ATA = 100x4(T-1)) were measured 1 week before patients were operated on. Operations were performed according to the standard procedure with 2.5x1x1 cm of thyroid tissue remaining on each side before approximating the thyroid capsule and pretracheal fascia. Hypothyroidism was defined by patients with overt hypothyroidism in laboratory data, and or with T4 to maintain T3 and T4. Two hundred two patients were checked 3 months after being operated on. Latent hyperthyroidism was found in 22, euthyroidism in 55, latent hypothyroidism in 91, hypothyroidism in 34 (16.8%) and none were in overt hyperthyroidism. After a follow-up period of 26.9+/-15 (mean +/- SD) months, 199 patients were reevaluated. Overt hyperthyroidism was found in 2 patients, latent hyperthyroidism in 12, euthyroidism in 97, latent hypothyroidism in 72, and hypothyroidism in 16 (8%). Factors having possible effects on hypothyroidism after longterm follow-up were analyzed. Patient's age, gender, body surface, premedicative T3 and T4, preoperative ATA, and TBII, and the weight of removed thyroid had no effect on the occurrence of hypothyroidism. Preoperative AMA levels, and finding more than 10 lymphoid infiltrations per 10 low-power fields (x40) were significantly different between the hypothyroid and nonhypothyroid groups. A high level of preoperative AMA was the only factor independently causing overt hypothyroidism in the follow-up period. Patients with high preoperative AMA levels have a higher risk of hypothyroidism if only 2.5x1x1 cm remnants are left on each side.

Adult↗
PubMed1999

Evaluation of the prognostic value of serum soluble CD 44 in patients with breast cancer.

The outcome of breast carcinoma is usually determined by multiple factors. Aberrant expression of the cell adhesion molecule CD 44 has been claimed to be associated with poor prognosis in various human malignancies. This study was designed to investigate any correlation between the soluble adhesion molecule CD 44 and the clinicopathologic variables and to evaluate the possible prognostic significance of soluble CD 44. Venous blood samples were preoperatively collected from 100 patients with invasive breast carcinoma. The serum levels of different soluble CD 44 molecules (CD 44 standard form and CD 44 splice variant V6) were measured with an enzyme immunoassay method. The data of primary tumor status, age, estrogen receptor status, lymph node status, histologic grading, distant metastases status, TNM staging, S-phase fraction, and ploidy pattern were collected and evaluated simultaneously with the serum levels of soluble CD 44 st and CD 44 V6. Twenty healthy subjects were used as the control group. The serum levels of soluble CD 44 st showed no significant elevation in patient group. The mean value of soluble CD 44 V6 in patient group was 269.2 +/- 94.3 ng/ml and that of the control group was 179.5 +/- 50.7 ng/ml; the difference was significant (p < 0.01). In multivariate analysis, distant metastasis (p < 0.05) and TNM staging (p < 0.01) appeared as independent factors regarding the significant higher serum levels of soluble CD 44 V6. Based on our preliminary results, preoperative serum soluble CD 44 V6 is closely related to distant metastases and TNM staging. The possible role of soluble CD 44 V6 in the prognostic value of breast carcinoma deserves further elucidation and evaluation with long-term patient follow-up.

Adult↗
PubMed1999

Surgical treatment of morbid obesity with vertical banded gastroplasty: a comparison between TA90-4.8 and TA90-B.

BACKGROUND: In this study, we wanted to determine the results of vertical banded gastroplasty for morbid obesity and compare the results of using the TA90-4.8 with using the TA90-B instrument. METHODS: Patients with body weight over 100% of or 45 kg above their ideal body weight, body mass index (BMI) over 40 kg/m2, or BMI over 35 kg/m2 with osteoarthritis, venous stasis, sleep apnoea, or frequent abortion were selected for surgical intervention. They were purposely divided into two groups. Vertical banded gastroplasty was performed in group A with two applications of TA90-4.8 (N = 26) and in group B with one application of TA90-B (N = 24). The outlet of the gastric pouch was 10 to 12 mm and reinforced with a 1.5 cm strip of Marlex to give a circumference of 5.5 cm. The follow-up body weight, BMI, and percentage of weight in excess of the ideal weight were compared between the two groups. The results were classified as excellent (0 to 25% excess weight), fair (26 to 50% excess weight), good (51 to 75% excess weight), poor (76 to 100% excess weight), and worse (> 100% excess weight). A failure was defined as a body weight of greater than 76% excess weight and a repeated operation being needed regardless of the ultimate outcome. RESULTS: There were no differences between the two groups regarding age, gender, preoperative body weight, BMI, and excess weight. The operative time was longer for group A (175 +/- 39 min) than for of group B (140 +/- 23 min) (p < 0.0001). In the follow-up period, the postoperative body weight, BMI, and excess weight showed no differences between the two groups. Four patients in group A had poor results, three due to staple disruption and one due to sweet-eating. One patient in group B had stenosis of the stomach pouch and needed another operation to release the stenosis. Thus, five failures (10%) were found in this study. CONCLUSION: Vertical banded gastroplasty is an effective modality for treating morbid obesity. Two applications of TA90-4.8 are not recommended because they result in frequent staple disruption.

Adult↗
PubMed1999

Expression of nm23 in the primary tumor and the metastatic regional lymph nodes of patients with gastric cardiac cancer.

Tumor recurrence and distant metastasis are major causes of treatment failure in gastric cardiac cancer (GCC). Rapid growth of tumor cells and reduced expression of nm23, a metastatic suppressor gene, in tumor cells have been suggested as two important mechanisms for disease progression of GCC. Therefore, to determine the prognostic value of nm23 expression in GCC, we used immunohistochemistry to examine the expression of nm23 in the pathological sections of both gastric cancer and metastatic lymph nodes from 24 stage III patients. Twenty-two patients had total gastrectomy, and two patients had proximal subtotal gastrectomy with a D2 dissection. Postoperative adjuvant therapy was provided, and the clinical responses were followed routinely. Clinical correlation was evaluated by chi2 with Fisher's exact test and survival by log-rank test. Our results show that the reduced nm23 expression in the primary tumor and in the nodal metastasis is the most useful marker for the poor prognosis of GCC following surgery.

Adult↗
PubMed1998

Ductal dilatation and stenting for residual hepatolithiasis: a promising treatment strategy.

BACKGROUND AND AIMS: Hepatolithiasis is prevalent in south-east Asia and presents a difficult management problem. Intrahepatic strictures with or without awkward ductal angulation of the biliary tree are the main reasons for the reported high incidence of postoperative residual stones. Without proper treatment, biliary strictures and residual stones can lead to repeated episodes of cholangitis, liver abscess, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. The purposes of our treatment strategy were to achieve complete clearance of the stones and relief of bile stasis. METHODS: From January 1991 to July 1992, 90 patients with residual postoperative hepatolithiasis and intrahepatic strictures were treated. Postoperative ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting through a mature T tube tract was performed. Choledochoscopic electrohydraulic lithotripsy was applied when impacted or large stones were encountered. RESULTS: Complete clearance of stones was achieved in 78 patients (87%). Mild haemobilia occurred in five patients (5.5%) and fever developed in seven patients (7.7%), and these patients recovered after conservative treatment. The rate of stone recurrence after a mean follow up of 43 months was 8%. Intrahepatic cholangiocarcinoma developed in one patient (1.1%). CONCLUSION: Postoperative ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe treatment with a low recurrence rate for complicated residual hepatolithiasis with biliary stricture.

Adult↗
PubMed1998

Primary synovial sarcoma of the gastrocolic ligament.

A case of primary synovial sarcoma of the gastrocolic ligament is reported in a 37-year-old woman. CT showed an encapsulated intraabdominal cystic tumour with an amorphous solid component. Barium studies showed a mass at the gastrocolic ligament which elevated the gastric antrum and displaced the transverse colon downwards. This is the first report of synovial sarcoma formation in the gastrocolic ligament. This tumour may have originated from pluripotential mesenchyme.

Adult↗
PubMed1998

Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal hyperparathyroidism.

BACKGROUND: Autotransplantation of diseased parathyroid glands into subcutaneous adipose tissue has been mentioned previously, but as far as we know there is no previous systemic study concerning parathyroid function after subcutaneous autotransplantation. METHODS: From January 1993 to June 1996, total parathyroidectomy and autotransplantation were carried out in 46 patients with renal hyperparathyroidism. The symptoms and signs before operation were intractable pruritus in 29 patients (63%), bone pain in 27 patients (58.7%), general weakness in 17 patients (37%), soft tissue calcification in 15 patients (32.6%), bone fracture in one patient, and failure to thrive in one patient. Twenty-four patients (group A) underwent autotransplantation of 60 mg of a diffuse hyperplastic parathyroid gland into subcutaneous forearm tissue, and 22 patients (group B) underwent autotransplantation of 15 pieces (60 mg) of 1 mm3 tissue into forearm muscles, as mentioned previously. Four patients in group A and one in group B who had high levels of intact parathyroid hormone (I-PTH) immediately after operation were excluded. After the operation, calcium carbonate, 1.5 to 16 gm daily, and calcitriol, 0.25 to 1.5 micrograms/daily, were prescribed according to the patients' calcium levels. RESULTS: After 6 months, all patients in both groups were given calcium carbonate, 1 gm/day, and calcitriol, 0.25 microgram/day, for parathyroid suppression, and none had to take more medicine to maintain calcium levels. There were no significant differences between the two groups regarding serum calcium, phosphorous, alkaline phosphatase, and I-PTH levels 1 week, 3 to 6 months, and 1 year after operation. Eighteen patients in group A and 19 patients in group B had normal levels of I-PTH 1 year after operation. In the follow-up period from 1 to 3 1/2 years, only one patient in group A had a subnormal I-PTH level and one in group B had graft-dependent hyperparathyroidism. CONCLUSIONS: We therefore suggest that autotransplantation of a parathyroid gland into forearm subcutaneous tissue for renal hyperparathyroidism is as effective as autotransplantation into forearm muscles and can be done easier.

Adolescent↗
PubMed1998

Serum-soluble interleukin-2 receptor concentrations in patients with breast cancer: a preliminary report.

BACKGROUND: The serum-soluble interleukin-2 receptor has been claimed to be a marker of host biological response in patients with solid malignancies. This study was designed to evaluate the biological significance of the preoperative serum-soluble interleukin-2 receptor concentration in patients with invasive breast cancer. MATERIALS AND METHODS: Venous blood samples were collected from 66 patients with invasive breast carcinoma and the serum concentrations of soluble interleukin-2 receptor were measured with an enzyme immunoassay method. Data regarding maximum tumor diameter, age, estrogen receptor status, lymph node status, distant metastasis status, histologic grade, ploidy pattern and S-phase fraction were also collected and evaluated simultaneously with the serum concentration levels of soluble interleukin-2 receptor. Fifteen age-matched healthy subjects were used as a control group. RESULTS: The mean value of serum-soluble interleukin-2 receptor in patients with invasive breast cancer was 621 +/- 145 units/ml and that of the control group was 308 +/- 59 units/ml; and the difference was significant (p = 0.000). With multivariate analysis, lymph node status (p = 0.000), distant metastasis status (p = 0.000) and maximum tumor diameter (p = 0.000) appeared as independent factors in regards to the significantly, higher serum concentrations of soluble interleukin-2 receptor. CONCLUSION: Based on our preliminary results, the preoperative serum-soluble interleukin-2 receptor concentration is closely related to lymph node status, distant metastasis status and tumor diameter in invasive breast carcinoma. This may be an additional valuable predictive factor for the diagnosis of invasive breast cancer.

Adult↗