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Biomedical subjects

F F Chou

Publications and source records attributed to F F Chou.

At least 55 records · Page 3Linked to original sources
PubMed1995

Ductal dilatation and stenting make routine hepatectomy unnecessary for left hepatolithiasis with intrahepatic biliary stricture.

BACKGROUND: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture. METHODS: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledochoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered. RESULTS: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months. CONCLUSIONS: Postoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.

Adult↗
PubMed1995

Rupture of pyogenic liver abscess.

OBJECTIVE: Our objective was to study the clinical manifestations, course, treatment, and results obtained in 23 patients with ruptured pyogenic liver abscess and compare these findings with those of nonruptured cases. METHODS: Four hundred twenty-four patients with clinical diagnoses of pyogenic liver abscess were enrolled in the study. Among these, 23 patients had ruptured pyogenic liver abscess. The clinical manifestations, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, etiology of abscess, and results of the treatment were recorded. Qualitative data were analyzed by chi 2 test, and quantitative data were analyzed by Student's t test. RESULTS: Except for abdominal pain and septic shock, other symptoms, such as fever, chills, and jaundice, were similar in ruptured and nonruptured groups. Laboratory findings indicated that the group with ruptured liver abscess had higher levels of bilirubin, blood glucose, and aspartate aminotransferase than the non-ruptured group. Of the patients with ruptured abscess, 14 (60.9%) had diabetes mellitus and 15 (65.2%) were cryptogenic. Klebsiella pneumoniae was the bacteria most often isolated in both blood cultures and liver aspirates. Surgical intervention--draining the abscess and cleaning the abdominal cavity--was the only means of saving the patients' lives. The overall mortality rate was higher in this group (43.5%) than in the nonruptured group (15.5%). CONCLUSIONS: Ruptured pyogenic liver abscess should be suspected if septic shock and diffuse abdominal pain are found in a patient with pyogenic liver abscess, concurrent with high levels of bilirubin, aspartate aminotransferase, and blood glucose. Surgery is the only treatment for this condition.

Female↗
PubMed1995

Spontaneous rupture of hepatobiliary cystadenoma: a case report.

Hepatobiliary cystadenoma is a rare hepatic neoplasm which has a high tendency to recur and has malignant potential. We review the literature and report a case of intrahepatic cystadenoma presenting with abdominal pain and ascites following spontaneous rupture. Complete excision of the tumor offers the best chance of cure and avoids recurrence, secondary infection or malignant change.

Adenoma, Bile Duct↗
PubMed1994

Adjuvant chemotherapy for resectable gastric cancer: a preliminary report.

In this prospectively random study, the effect of oral Ftorafur as an adjuvant chemotherapy was compared with that of oral placebo in patients with Stage II and Stage III gastric cancer. Patients had undergone a subtotal gastrectomy with a resection margin that should have been free of tumors. Ftorafur (10 mg/kg) was given daily to 59 Group A patients. Multiple vitamins were given twice a week to 56 Group B patients. We found that there was no statistical significance in Stage II patients with regard to survival. In Stage III patients, those treated with oral Ftorafur had better 3-year and 5-year survival rates than those receiving oral placebo. This preliminary report on this ongoing study seems to indicate that long-term postoperative Ftorafur treatment may be beneficial to Stage III gastric cancer patients.

Adenocarcinoma↗
PubMed1994

The presence of higher levels of thyroglobulin, but not thyroid autoantibodies, in the thyroid vein in Graves' disease.

To investigate the possible major source of thyroid autoantibodies production, blood samples were obtained from thyroid vein, jugular vein and peripheral vein during subtotal thyroidectomy in 12 patients with Graves' disease (11F, 1M; age 16-39 yr). Among them, 7 were treated preoperatively by methimazole, 4 by iopanoic acid and 1 by propranolol. All blood samples were assayed for thyroglobulin (Tg), thyrotropin binding inhibition immunoglobulin (TBII), antithyroglobulin antibody (TgAb) and antimicrosomal antibody (McAb). Tg, a native product of thyroid gland, was markedly elevated in the thyroid veins, over 4 to 6 folds that of jugular veins or peripheral veins. However, the level of thyroid autoantibodies including TBII, TgAb and McAb in the thyroid veins were not significantly different from that in the jugular or peripheral veins. Our preliminary data suggest that it is thyroglobulin, and not thyroid antibodies that is present at higher level in the thyroid vein than the periphery.

Adolescent↗
PubMed1994

Prognostic factors after hepatectomy for hepatocellular carcinoma.

During a seven and a half year period from 1985 through June 1992, hepatic resection was carried out on 84 patients with hepatocellular carcinoma. Their ages ranged from 10 to 79, with an average of 55 years. Hepatitis B surface antigen (HbsAg) was positive in 83%, an alfafetoprotein level of more than 20 ng/dl was found in 71%, and cirrhosis was noted in 64%. Surgical mortality was 3.6% and hospital mortality 1.2%. The 1-, 3- and 5-year actuarial survival rates, excluding in-hospital deaths, were 74%, 56% and 49%, respectively. The large number of patients operated on in the early stage (52%), and Child's class A (61%) might account for the low surgical mortality and high survival rate. The favorable conditions were identified as follows; no cirrhosis, surgery in the early stage, tumor size less than 5 cm, negative HbsAg and freedom from vascular involvement. Multivariate analysis showed that only negative HbsAg had better survival.

Adolescent↗
PubMed1994

Gastric leiomyosarcoma: a clinicopathological review.

OBJECTIVE: To report our experience of eight patients with primary gastric leiomyosarcoma. DESIGN: Retrospective study. SETTING: Teaching hospital, Taiwan. SUBJECTS: 8 patients who presented with primary gastric leiomyosarcoma between 1986 and 1990. MAIN OUTCOME MEASURES: Endoscopic, radiological, and histopathological features, DNA ploidy, and outcome. RESULTS: Abdominal pain and gastrointestinal bleeding were the most common presenting symptoms. In 5 of the 7 patients who had endoscopy preoperatively a diagnosis of submucosal tumour was made, but a definite diagnosis of leiomyosarcoma was made in only 3. A provisional diagnosis of leiomyosarcoma was made in 3 of the 4 patients who had computed tomography. All patients underwent some form of gastric resection ranging from palliative resection to total gastrectomy. Patients in whom the tumour had invaded adjacent organs had a poor prognosis. Histopathological grading of tumours correlated well with DNA ploidy. CONCLUSION: Both histopathological grading and DNA ploidy could be helpful objective prognostic criteria in patients with primary gastric leiomyosarcoma.

Aged↗
PubMed1994

Suprahepatic gallbladder with agenesis of the right lobe of the liver: report of a case.

An unusual case of suprahepatic gallbladder with agenesis of the right lobe of the liver is reported. The anomalous position of the gallbladder was detected by ultrasonography. It was shown to be distended and to contain sludge. The suprahepatic location with agenesis of the right lobe of the liver was preoperatively confirmed by computed tomography. The patient underwent cholecystostomy with drainage and had an uneventful recovery. The postoperative follow-up examinations, including endoscopic retrograde cholangiopancreatography, ultrasonography, arteriography and portography, all added information rarely reported in the literature and helped in the understanding of this uncommon case. Laparoscopic cholecystectomies are widely used but such a procedure was contraindicated in this case because of the ectopic position and inaccessibility of the gallbladder.

Congenital Abnormalities↗
PubMed1994

Prognostic factors for pyogenic abscess of the liver.

BACKGROUND: Percutaneous drainage and antibiotics for pyogenic abscess are well established therapeutic modalities. However, the mortality rate for hepatic abscess of liver remains high. STUDY DESIGN: Three hundred fifty-two cases of pyogenic hepatic abscesses were studied to evaluate prognostic factors. RESULTS: Using univariate analysis, the following factors were associated with a high mortality rate: patient age, gas-forming abscess, rupture of abscess, bilobe involvement, clinical sepsis, bilirubin (more than 2 mg per dL), blood urea nitrogen (more than 20 mg per dL), serum creatinine (more than 2 mg per dL), aspartate aminotransferase (more than 100 U per L), and albumin (less than 2.5 gm per dL). Using multivariate analysis, the following were independent significant factors in predicting mortality: patient age (more than 60 years), blood urea nitrogen (greater than 20 mg per dL), serum creatinine (greater than 2 mg per dL), total bilirubin (greater than 2 mg per dL), and albumin (less than 2.5 gm per dL). CONCLUSIONS: Systemic effects of hepatic abscess with sepsis and multiple organ failure were significant factors in predicting mortality. Local findings, such as rupture of the abscesses, multiple abscesses, and gas-forming abscesses, were not independent factors. Percutaneous drainage is always considered if the condition of the patient can not be improved with antibiotic therapy. Operative treatment is indicated if the patient is unresponsive to medical treatment and percutaneous drainage or if the patient has complications of biliary tract stone or rupture of the abscess.

Aged↗
PubMed1994

Complications of splenectomy for splenic injury.

From March 1986 to October 1991, there were 97 patients undergoing splenectomy for traumatic spleen injury at Chang Gung Memorial Hospital at Kaohsiung. Their ages ranged from 6 to 73 years with a mean of 39. The most common cause was blunt abdominal trauma (94/97). Sixty-five patients received splenectomy only and thirty-two patients had other operative procedures in addition to splenectomy. The most common complication in this study was intraabdominal abscess (7/97); followed by respiratory problems (5/97); postoperative hemorrhage (3/97) and wound infection (3/97). Postsplenectomy sepsis occurred in one case. There were nine cases of in-hospital mortality. Sepsis, prolonged shock and severe head injury were the main causes of death.

Adolescent↗
PubMed1994

An evaluation of the prognostic significance of HLA-DR expression in axillary-node-negative breast cancer.

BACKGROUND: Adjuvant treatment for node-negative breast cancer remains controversial. It is important to pick out the high-risk groups who may benefit from adjuvant systemic therapy and avoid the unnecessary additional therapy for the favorable prognostic groups. METHODS AND MATERIAL: Retrospective study of immunohistochemical staining for HLA-DR on tumor cells from paraffin-embedded tissue specimens of 32 patients with node-negative invasive breast cancer at this hospital from 1986 to 1991 was performed with the aim to investigate its prognostic significance. RESULTS: HLA-DR staining was positive in nine (28%) patients and negative in twenty-three (72%) patients. One (11%) was a recurrence, and no (0%) death occurred in the positive group, compared with nine (39%) recurrences and five (22%) deaths in the negative group. The multivariate analysis failed to show that HLA-DR expression is an independent prognostic factor. However, with univariate analysis, the 5-year disease-free survival rate (87%) of the positive group was significantly better than that (35%) of the negative group (p = 0.04). The 5-year overall survival rate (100%) of the positive group was also better than that (66%) of the negative group, but the difference was not statistically significant. Furthermore, when combination of the HLA-DR expression and estrogen receptor status was used, both the 5-year disease-free and overall survival rate (81% and 100%, respectively) of group A (positive staining for either HLA-DR or estrogen receptor and positive staining for both) were significantly better than those (33% and 58%, respectively) of group B (negative staining for both HLA-DR and estrogen receptor). CONCLUSIONS: We believe HLA-DR expression may be a promising, additive predictive factor to node-negative breast cancer and deserves further investigation based on these preliminary results.

Adult↗
PubMed1994

Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?--A prospective randomized study.

BACKGROUND: Postoperative choledochoscopy-related infection has been reported in the literature. We performed a prospective randomized trial to investigate the value of antibiotic prophylaxis for the prevention of such endoscopy-related infection. METHODS: In a 2-year period from 1990 to 1991, 84 patients with biliary lithiasis were included in the study and randomized. Forty-four patients received antibiotic prophylaxis (1 gm cephalothin intravenously 30 minutes before the procedure and 500 mg cephalexin orally every 6 hours for 3 days afterward). Forty patients in the control group did not receive any antibiotics. RESULTS: There was no significant difference between the groups in age, sex, preprocedure liver function, serum amylase level, white cell count, and duration of the procedure. The results of bacteriologic studies of the bile were also comparable in the two groups. One patient in the control group had transient chill and fever after the procedure. Two patients in the antibiotic group and one patient in the control group had mild abdominal pain. Mild hemobilia was noted in one patient in the antibiotic group. These complications were treated conservatively without any event. No difference was evident in the complications and the success of postoperative choledochoscopy between the two groups. CONCLUSIONS: This prospective randomized study showed that routine antibiotic prophylaxis for postoperative choledochoscopy may be not necessary in selected conditions.

Administration, Oral↗
PubMed1993

Primary hyperparathyroidism in children: report of a case and a brief review of the literature.

A case of primary hyperparathyroidism in an 11-year-old boy who presented with bowlegs is reported and the literature is reviewed. From the literature, it appears that the pathologic findings, clinical manifestations and sex distribution of primary hyperparathyroidism is different in adults than in children and young infants. In adults, primary hyperparathyroidism is commonly caused by adenoma and is often found unexpectedly on a biochemical screen of the serum. Elderly women are most at risk. Renal stones or other renal complications are more frequently seen in adults than in children. Neonatal hyperparathyroidism is often genetically transmitted and is fatal unless recognized and treated early. The characteristic pathologic change is chief cell hyperplasia of the parathyroid glands. On the other hand, adenoma is the most common pathologic finding in older children. No case of childhood parathyroid carcinoma was found in our review of the literature. In children, primary hyperparathyroidism is more frequent in boys than in girls and osseous lesions are more common than in adults. Prognosis is good if the disease is recognized early and appropriate surgical treatment is received.

Child↗
PubMed1993

A comparison between scalpel and electrocautery in modified radical mastectomy.

OBJECTIVE: To compare the effects of a conventional cold scalpel and electrocautery in modified radical mastectomy. DESIGN: A non-randomised controlled trial. SETTING: Teaching hospital in Southern Taiwan. SUBJECTS: 101 consecutive patients with primary breast cancer who underwent modified radical mastectomy between July 1987 and June 1989. INTERVENTIONS: The 44 patients during the first year were allocated to have skin flaps fashioned conventionally with a cold scalpel and the 57 patients during the second year, by electrocautery. MAIN OUTCOME MEASURES: Morbidity and mortality among the 101 patients who underwent modified radical mastectomy. RESULTS: The groups were comparable in regard to age, menopause, cancer stage, weight of specimen and histological type of cancer. The mean blood loss was 567 ml when scalpel was used and 150 ml when electrocautery was used (p < 0.001). The postoperative fall in packed cell volume was significantly greater in the scalpel group (0.75 [0.26] compared with 0.28 [0.15], p < 0.001) and more patients in this group required transfusion (9 compared with 0, p < 0.01). There were no deaths in either group. There were no significant differences in operation time, total post-operative Hemovac drainage, postoperative hospital stay, the number of lymph nodes removed, the number of metastatic lymph nodes, and postoperative complications between the groups. CONCLUSION: Electrocautery is a safe, convenient and rational method for constructing skin flaps in modified radical mastectomy, and patients do not need blood transfusions.

Breast Neoplasms↗
PubMed1992

Successful treatment of an impacted common bile duct stone with intraoperative choledochoscopic electrohydraulic lithotripsy.

An impacted distal common bile duct stone which was encountered during supraduodenal common bile duct exploration could not be retrieved using stone forceps, a basket, normal saline flushing or a Fogarty catheter. Using intraoperative choledochoscopic electrohydraulic lithotripsy the stone was fragmented and successfully removed with a basket and normal saline flushing. The patient was well after a follow-up period of 18 months.

Endoscopy, Digestive System↗
PubMed1992

Early gastric cancer in southern Taiwan.

Between January 1986 and November 1990, 231 patients underwent resection for primary gastric adenocarcinoma at Chang Gung Memorial Hospital in southern Taiwan. Thirty-nine (17%) of these patients had early gastric cancer (limited to the mucosa or submucosa regardless of nodal metastases). Epigastric pain was the most frequent symptom (71.8%). The lesions were located in the lower third of the stomach in 84.6% of the patients and in the middle third in 15.4%. A preoperative diagnosis of gastric cancer was achieved in 94% of patients by endoscopic examination with biopsies. All of the patients underwent distal subtotal gastrectomy without mortality. Macroscopically, 84.6% of cases were included in types IIc, III, and IIc-III. One patient died of multiple liver metastases 3.2 years after operation. The cumulative survival rate at 5 years is 92.9%. We comment on these matters and place early gastric cancer in Taiwan into a more global context.

Adenocarcinoma↗
PubMed1992

Primary squamous cell carcinoma of the breast.

We have described three patients with primary squamous cell carcinoma of the breast. All three have remained well after modified radical mastectomy. One patient received postoperative radiotherapy. Estrogen receptor status was determined by monoclonal antibody technology in two cases, and the results were negative.

Adult↗