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Biomedical subjects

J Wong

Publications and source records attributed to J Wong.

At least 685 records · Page 38Linked to original sources
PubMed1982

Arterial malformation of stomach: a cause of massive bleeding.

Fatal gastrointestinal bleeding is rarely caused by a ruptured abnormal intramural gastric artery, and in such cases the nature of the abnormality in the ruptured artery has not been clearly defined. In this report, a case of fatal haemorrhage from a ruptured artery in the stomach of a 34-yr-old male is presented. The arterial lesion was demonstrated and appeared similar to the berry aneurysms of the Circle of Willis--which are probably the result of developmental defects in the media of the arterial wall. Phlebosclerosis due to portal hypertension was a coincidental finding. Previously reported cases are considered and compared with the present case.

Adult↗
PubMed1982

Fine-needle aspiration versus drill-needle biopsy of thyroid nodules: a controlled clinical trial.

Percutaneous needle biopsy by two different methods was evaluated in a prospective controlled study of 167 consecutive patients with dominant thyroid nodules. Fine-needle aspiration was superior to high-speed drill-needle biopsy because of its higher diagnostic yield (93.9%). When a sample sufficient for diagnosis was obtained, the accuracy rate for both methods was comparable. Diagnostic errors were due to inadequate samples, difficulties in interpreting hypercellular adenomas, and geographic sampling problems. In the detection of thyroid cancer, neither technique alone appears completely adequate because of occasional false negative errors. The selection of patients for operation should depend on clinical parameters as well as the findings on fine-needle aspiration of thyroid nodules.

Adenocarcinoma↗
PubMed1982

Jejunal loop bypass and fundoplication for malignant esophagobronchial fistula.

A new operation was designed to supplement the Kirschner operation for patients with locally advanced carcinoma of the esophagus and who, in addition, had had a gastrectomy for peptic ulcer disease. Bypass of the esophageal obstruction was by jejunal loop, and gastroesophageal reflux was prevented by fundoplication. Eighteen patients underwent this operation with a mortality of 27.8 per cent. Death occurred in one of the three patients with leakage of the esophagojejunal anastomosis. One patient had gangrene of the jejunal loop develop. Severe bronchopneumonia was the cause of death in all five. The functional result in the surviving patients was satisfactory and they lived for a mean period of 3.6 months postoperatively. It is not advocated that this operation replace the Kirschner operation, which we consider the operation of choice for locally advanced carcinoma of the esophagus, but as an alternative procedure in those patients in whom a previous gastric resection precluded a Kirschner operation.

Aged↗
PubMed1982

Selective coating of gastric ulcer by tripotassium dicitrato bismuthate in the rat.

Controlled clinical trials have shown that tripotassium dicitrato bismuthate healed duodenal and gastric ulcers significantly better than placebo. One mechanism suggested is that it forms a protective coat at the ulcer base. We studied this coating action in rats with chronic gastric ulcers produced by a standardized technique for mucosal wounding at the fundoantral junction. Bismuth was identified by histochemical staining using Castel's reagent, the specificity of which was verified in vitro against 13 other metallic compounds and chemicals. Our results showed that tripotassium dicitrato bismuthate had a coating affinity for the ulcer base, but not for the adjacent normal mucosa. All rats treated with tripotassium dicitrato bismuthate 1, 2, 4, and 6 h previously, but not the control rats treated with water or those treated with four other bismuth compounds, manifested a layer of bismuth that coated the ulcer base. Light and electron microscopy of the tripotassium dicitrato bismuthate-treated ulcers--but not their controls-revealed an abundance of macrophages, which had ingested the bismuth. This unique bismuth coat may insulate the ulcer base from acid-pepsin digestion, while the influx of macrophages may expedite reparative processes.

Animals↗
PubMed1982

Choledochojejunostomy in the treatment of primary cholangitis.

Choledochojejunostomy was performed upon 128 patients with primary cholangitis with an operative mortality of 2.3 per cent. Evaluation of 106 patients at a median of eight years reveals that 78 patients or 73.6 per cent have good, 14 or 13.2 per cent have fair and 14 or 13.2 per cent have poor results. All 14 patients with poor results required reoperation, and the findings showed that the two most common causes of recurrent symptoms are the reformation of stones, despite a patent choledochojejunostomy and the stricturization of the choledochojejunostomy. When performed with the proper indications, choledochojejunostomy is a safe and effective procedure for managing patients with primary cholangitis.

Adolescent↗
PubMed1982

Perforations in acute duodenal ulcers.

To determine the clinical characteristics and outcome of perforated acute ulcers of the duodenum, we prospectively studied 60 patients, 28.3 per cent of all perforations, after closure only. Patients with acute ulcers were significantly older and had a higher hospital mortality than did those with perforated chronic ulcers. Within the first three years following closure, chronic ulcers recurred significantly more often than did acute ulcers. Nevertheless, relapses in patients with acute ulcers were usually symptomatic and, on occasion, necessitated reoperation for complications. Among the acute ulcer group, individuals who had perforated ulcers by the age of 30 years had a significantly increased risk of early recurrence. Due to the higher risk, we suggest that an immediate, definitive operation be evaluated in younger patients with a perforated acute ulcer of the duodenum.

Acute Disease↗
PubMed1981

Late result of sphincteroplasty in the treatment of primary cholangitis.

Sphincteroplasty is one of the surgical procedures used in the treatment of primary cholangitis. We performed this operation on 342 patients over a 13-year period, with an operative mortality of 4.7%. Postoperative examination of 271 patients (average follow-up, seven years four months) showed that a good result was achieved in 226 patients, a fair result in 23 patients, and a poor result in 22 patients. Analysis of the reoperations in 17 patients showed that stone reformation is the most common finding, followed by sphincteroplasty stricture, liver abscess, and empyema of the gallbladder. When performed with proper indications in the management of primary cholangitis, sphincteroplasty is a safe procedure, and the majority of patients can expect good results.

Adult↗
PubMed1981

Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus.

Gastrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphagia for carcinoma of the oesophagus. More recently, total parenteral nutrition has proved to be efficient and safe, offering an alternative to gastrostomy feeding. Twenty-four patients were randomly selected into two groups to compare the efficacy of total parenteral nutrition and gastrostomy feeding with respect to nitrogen balance and weight gain. Total parenteral nutrition was found to be superior to gastrostomy feeding in achieving an earlier positive nitrogen balance and greater weight gain during a 4-week period. However, gastrostomy feeding is still preferred as it is cheap, simple and safe, and allows patients to be active, mobile and self dependent. Total parenteral nutrition is reserved for those patients in whom an earlier operation is advisable.

Adult↗
PubMed1981

Carcinoma of the gallbladder.

A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the University Surgical Unit, University of Hong Kong, over a 20-year period was undertaken. The female to male ratio was 1.4 to 1. The peak incidence was in the seventh decade for the females and the sixth decade for the males. Preoperative diagnosis was made in 10 patients. "Curative" cholecystectomy was performed in 20 patients with a 5-year survival rate of 10 per cent. Palliative procedures were performed in 44 patients with a median survival of 8 weeks, which was not significantly different from that in the 30 patients who were not operated upon or had laparotomy and biopsy only. Radical resection was carried out in 6 patients, all of whom died in hospital. Gallstones were found in only 26 patients. The gallbladders of 3 patients had associated benign tumours, one of which had malignant transformation at multiple sites. One patient had chronic typhoid infection. The incidence of clonorchis infestation and primary pyogenic cholangitis in these 100 patients was not different from that of our general hospital population.

Adult↗
PubMed1981

Preparation, characterization, and primate testing of monoclonal antithymocyte globulin.

Monoclonal antibodies specific for T cells from both the human and rhesus primate species were detected by their ability to inhibit T cell rosette formation with sheep erythrocytes. The antibodies were shown by fluorescence techniques to react with all thymocytes and peripheral blood T cells but not to B cells, monocytes, platelets, or erythrocytes. Rosette inhibition titers of these antibodies were 30-fold lower when rhesus, rather than human T, cells were used as the rosette-forming cell in assay. Nonetheless, two monoclonal antibodies, of the IgG3 isotype, termed antithymocyte monoclonal (ATM) e.1 and 2.2, were shown to depress selectively circulating T cells to nondetectable levels following single dose administration to rhesus primates and to prolong skin allograft survival in a rhesus primate given a 6-dose course of treatment. The rhesus primates suffered no ill effects and no peripheral blood cellular component other than T cells was depressed. Monoclonal antibody secreting hybridoma cells are capable of producing ATM 3.1 and 3.2 in quantity when grown as peritoneal tumors in selected mouse hybrids. Purification of ATM 3.1 or 3.2 is easily accomplished by affinity chromatography on protein A. These properties suggest that ATM antibodies may become useful immunosuppressive agents in clinical transplantation.

Animals↗
PubMed1981

The selection and organization of curricular experience in nursing.

Curriculum is the educational design of learning experiences for the students. Curricular experiences include course content as well as learning activities. The selection and organization of curricular experiences must also reflect the philosophy of the school. The identifying and organizing of curricular experiences begins with the analysis of curriculum objectives. The most commonly used approach in selecting learning experiences is the logical approach in which the process is treated as content in curriculum development. This paper attempts to analyse the selection and organization of the first year curricular experiences of the proposed curriculum by applying the logical approach. The proposed curriculum is designed for a 2-year diploma school of nursing. Nursing is offered as a continuum of increasing complexity throughout the three semesters of each year. The curricular framework is based on the health field concept; curricular experiences are selected and organized in accordance with this concept. Courses related to the four elements of the health field concept become mandatory classes for all students. Similarly clinical experience is organized so that a total integration of knowledge from these four elements is enhanced. The first year students study the general aspects of health and health field concept; the nursing process; helping relationships and selected skills necessary for meeting patient's physiological needs. The last semester of the first year is a synthesis practicum proposed to integrate principles and theories which the students have acquired previously and to apply them to the practice of nursing.

Curriculum↗
PubMed1981

Oesophageal microbial flora in carcinoma of the oesophagus.

In 79 patients, with carcinoma of the oesophagus, oesophageal aspirates obtained at oesophagoscopy were cultured for aerobic and anaerobic organisms in an attempt to identify the microbial flora. The aspirate culture was correlated with the pathogens isolated when infective complications developed after operation. Bacteroides were isolated from the oesophagus in 39.2% of patients, streptococcus in 10.1% and coliform organisms in 7.6%. No growth was obtained in 35.4% patients. Forty-one patients underwent oesophageal resection. Six of these had the complication of empyema thoracis in the postoperative period. Two patients had identical organisms isolated from the oesophagus and the empyema. B. melaninogenicus was cultured from the pleural fluid in two patients whose oesophageal aspirate culture yielded no growth. Six patients developed wound infection, all with anastomotic cutaneous fistula. There was no demonstrable relationship between the organisms isolated from two sources. Prophylactic antibiotic administration should be directed against the bacteroides, since it is the most common organism isolated from within the oesophagus.

Anti-Bacterial Agents↗
PubMed1981

The surgical management of anorectal malignant melanoma.

The biological vagaries of anal malignant melanoma are illustrated by four cases in Chinese patients. All four died within five years. Their poor prognosis emphasizes the value of preoperative studies to detect clinically occult metastases and obviate futile radical surgery. Many patients already have disseminated disease at the time of diagnosis, and local excision of the tumour provides acceptable palliation. For localized disease, abdominoperineal resection prevents local recurrence and removes the mesenteric nodes which are frequently involved. Palpable inguinal nodes necessitate therapeutic groin dissection, but we perform elective resection only when affected nodes are found at laparotomy. Pelvic lymphadenectomy should be performed in conjunction with abdominoperineal resection. The efficacy of chemotherapy for anorectal melanoma remains uncertain.

Adult↗