Long-term immunoprophylaxis for hepatitis B virus reinfection after liver transplantation.
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Adult↗
Biomedical subjects
L B Jeng
Publications and source records attributed to L B Jeng.
Cotransplantation of microencapsulated hepatocytes and islets for acute hepatic failure in rats.
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Animals↗
Impaired endothelial-dependent relaxation by acetylcholine after preservation of the human hepatic artery with UW solution.
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Acetylcholine↗
The accuracy of ultrasonography and 201Tl-99mTc subtraction scan in localization of parathyroid lesions.
We reviewed 27 patients who received preoperative localization using both parathyroid ultrasonography and parathyroid 201Tl-99mTc subtraction (TTS) scan from March 1986 to July 1993 in Chang Gung Memorial Hospital, Linkou. These 27 patients were diagnosed hyperparathyroidism by the pathological reports. There were 16 patients with primary hyperparathyroidism [PHPT; 9 males, 7 females; (mean age: 56.3 +/- 4.6 yrs)] and 11 patients with secondary hyperparathyroidism [SHPT; 8 males, 3 females; (mean age: 38.3 +/- 2.5 yrs)] due to end stage renal disease. The diagnostic accuracy was compared, and the results were as follow: (1) in localization of PHPT, the sensitivity and specificity of ultrasonography were 75.0% and 95.8% respectively, whereas the sensitivity and specificity of TTS were 87.5% and 100.0% respectively. The differences were not statistically significant; (2) the sensitivity and specificity of ultrasonography and TTS for patients with SHPT were 32.4% and 85.7% vs. 32.4% and 100.0%; and (3) higher sensitivity and specificity were achieved when both methods were chosen for localizing either PHPT or SHPT.
Adult↗
Parathyroid carcinoma with postoperative prolonged hypocalcemia in a patient with chronic renal failure.
Parathyroid carcinoma is a rare disease that usually presents with severe hypercalcemia and marked elevation of parathyroid hormone level. A 64-year-old male patient with repeated episodes of renal stones sustained chronic renal failure. Subsequently, he developed acute uremic symptoms and underwent a left upper parathyroidectomy. Parathyroid carcinoma was diagnosed after surgery. Asymptomatic hypocalcemia was the initial presentation. Protracted symptomatic hypocalcemia developed 8 months postoperatively, accompanied by an extremely high parathyroid hormone level. Delayed "bone hunger" syndrome concomitant with down-regulation of the parathyroid hormone receptors or production of parathyroid hormone with diminished bioactivity may have been the possible causes.
Humans↗
Comparison of membrane proteins from benign and malignant human thyroid tissues by two-dimensional polyacrylamide gel electrophoresis.
In this study two-dimensional (2D) polyacrylamide gel electrophoresis with silver staining was used to analyze cellular membranous proteins of various normal and pathological human thyroid tissues. The aim was to understand the differences in cellular membranous proteins between these tissues, which would aid in the differential diagnosis of thyroid malignancy. Characteristic protein spots had a molecular mass of 50-64 kDa and a pI of 5.7-6.5. There were two groups of isoform protein spots in this area. The higher-molecular-mass group was found in follicular thyroid cancer tissues which and was not visible in normal thyroid tissues. The low-molecular-mass group was found in follicular carcinoma or adenoma tissues and was detected in one to three spots. The papillary thyroid carcinoma tissues gave different 2D gel maps. There were few spots of papillary thyroid carcinoma tissue membranous proteins within the examined area. The 2D gel maps may be used for differential diagnosis of follicular neoplasm. The characteristics of these protein spots require further investigation.
Adenocarcinoma, Follicular↗
Hepatocellular carcinoma in a pregnant woman detected by routine screening of maternal alpha-fetoprotein.
A 26-year-old pregnant woman was diagnosed as having hepatocellular carcinoma at 16 weeks of gestation when extremely high levels of alpha-fetoprotein were found on a routine screening examination. The pregnancy was terminated, and a right hepatectomy was performed. Although such cases are rare, this one suggests that early measurement of maternal serum alpha-fetoprotein in a pregnant woman with hepatitis B surface antigenemia may allow the timely detection of a hepatocellular carcinoma.
Abortion, Induced↗
Critical, acutely poisoned patients treated with continuous arteriovenous hemoperfusion in the emergency department.
STUDY OBJECTIVE: To investigate the efficiency of a new non-pump hemoperfusion technique, continuous arteriovenous hemoperfusion, in the treatment of critical, acutely poisoned patients. SETTING: Emergency department of a general hospital. PARTICIPANTS: Acutely poisoned patients who failed to respond to intensive supportive treatment and needed hemoperfusion therapy. INTERVENTIONS: All patients received continuous arteriovenous hemoperfusion therapy for 4 to 8 hours. Toxicant clearances were determined by obtaining serial theophylline and phenobarbital levels every 2 hours before, during, and after continuous arteriovenous hemoperfusion. Platelet counts, whole-blood activated clotting time, and vital signs were monitored. RESULTS: The clinical condition of these patients improved rapidly after continuous arteriovenous hemoperfusion was started. The treatments were performed easily, and no significant complications occurred. The clearances of theophylline and phenobarbital were 192.79 +/- 1.55 mL/min and 290.25 +/- 25.33 mL/min, respectively, similar to those of conventional hemoperfusion. CONCLUSION: Continuous arteriovenous hemoperfusion is a simple, safe, effective, and less costly alternative to conventional hemoperfusion, especially in the EDs of hospitals without hemoperfusion facilities immediately available.
Acute Disease↗
Surgical management of juxtahepatic venous injuries in blunt hepatic trauma.
The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.
Adolescent↗
Necrosis of the colon as a complication of cardiac injury: case report.
Necrosis of the colon as a complication of cardiac injury is very rare. A 21-year-old young man was sent to the emergency room with shock status because of a stabbing wound penetrating into the heart. The patient survived after cardiopulmonary resuscitation, emergency sternotomy, and cardiac repair. Necrosis of the colon occurred 11 days after the accident.
Adult↗
Clinical experience with hepatic resection for ruptured hepatocellular carcinoma.
BACKGROUND: Spontaneous rupture of a hepatocellular carcinoma (HCC) is an uncommon but fatal complication of this disease. Surgical treatment is aimed at controlling the intraperitoneal hemorrhage, which has been achieved by hepatectomy, hepatic arterial ligation, packing and suturing. However, hemostasis obtained by hepatic arterial ligation, packing and suturing is not particularly effective, and the rebleeding rate is high. Information on hepatectomy for ruptured HCC is sparse, and we therefore reviewed our experience with hepatic resection for this potentially fatal complication. METHOD: The clinicopathological features of 23 patients with ruptured HCC who underwent hepatectomy during the past 15 years were reviewed. Morbidity, mortality and survival rates were analyzed. RESULTS: Effective hemo-stasis was achieved by hepatectomy. Indications for operative treatment were acute abdomen necessitating immediate laparotomy in 12, and spontaneous hemoperitoneum in 11. Types of hepatectomy included left hemihepatectomy in 3, lateral segmentectomy in 6 and local excision in 14. Liver cirrhosis was the concomitant disease in 13 (56.5%). Hospital mortality rate was 4.3%. 1, 2, 3, and 5 year survival rates were 60%, 52%, 40.5% and 26.5%, respectively. CONCLUSIONS: Hepatic resection is the treatment of choice for ruptured HCC. Long-term survival can be observed in a few patients without recurrence.
Adolescent↗
Duodenal variceal bleeding--successfully treated by mesocaval shunt after failure of sclerotherapy.
A 68-year-old male patient with liver cirrhosis and bilateral diffuse hepatoma presented with massive upper gastrointestinal bleeding caused by rupture of duodenal varices. Surgery had to be performed after sclerotherapy failed to stop the bleeding. A mesocaval shunt with graft interposition controlled the hemorrhage. Follow-up endoscopic examination showed complete disappearance of the varices. After surgery, the patient had two episodes of mild hepatic encephalopathy, which easily responded to treatment. There was no rebleeding, and he died of hepatic malignancy ten months after the shunt procedure.
Aged↗
Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.
BACKGROUND: Hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by floating tumor debris in common bile duct is rare. Taiwan has a high incidence of HCC and cirrhosis. The authors report their clinical experiences and evaluate the results of different treatment modalities for this disease. METHODS: A retrospective study was undertaken to review 20 patients with obstructive jaundice secondary to ruptured HCC into common bile duct during the 12 years period. RESULTS: All patients on initial examination had recurrent episodic jaundice or cholangitis. Jaundice was relieved by nonsurgical, percutaneous transhepatic biliary stenting in 4 patients and surgical intubation with T-tube drainage in 16. Types of treatment for those who were treated nonsurgically were percutaneous transhepatic biliary stenting in two patients, followed by transcatheter hepatic arterial embolization in another two patients. For the 16 patients who were treated surgically, the types of treatment were T-tube or Y-tube drainage in 11, T-tube drainage followed by hepatic resection in 2, T-tube drainage and hepatic arterial ligation in 1, and T-tube drainage followed by transcatheter hepatic arterial embolization in the other 2. Liver cirrhosis was the associated disease in 12 (75%). Four patients (20%) died in the hospital. The mean survival time for 12 patients with only surgical or nonsurgical biliary stenting was 3.9 months. For the three patients with percutaneous hepatic arterial embolization, the mean survival time was 8.0 months. Two patients who had undergone hepatic resection had a better postoperative survival time, with one surviving for more than 5 years. CONCLUSION: Clinical features, types of management, operative findings, and survival in 20 patients with HCC obstructing the common bile duct by tumor thrombi were reviewed. Not all patients with this disease were terminally ill. With proper management, good palliation and occasional cure are possible.
Adult↗
Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years.
OBJECTIVES: To report the results of our investigation of the postoperative intrahepatic recurrent rates and the patterns of recurrence and to determine the factors that influenced these patterns of recurrence. DESIGN: Case series. SETTING: Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. PATIENTS: Between 1977 and 1991, 162 men and 43 women with hepatocellular carcinoma underwent hepatic resection. RESULTS: The surgical mortality rate was 4.4%. Of the 196 patients who were discharged from the hospital, 114 have since died and 20 were not available for follow-up. The overall cumulative recurrent rates for the last 5 years (1987 through 1991) were 59.7%, 65.0%, 76.5%, 77.0%, and 79.7%, respectively. Eighty patients experienced intrahepatic recurrence. Of these, 21 (26.2%) had recurrence near the resected stump, 43 (53.8%) had a single nodular recurrence in the remnant liver, and 16 (20%) had wide-spread multinodular recurrence. The patients with resected margins of less than 1 cm in diameter had relatively higher recurrence rates than those with resected margins of greater than 1 cm in diameter. All recurrences were noted within 3 years of the resection. The preoperative serum alpha-fetoprotein levels were directly related to the length of time to recurrence (ie, the higher the serum alpha-fetoprotein level, the sooner the recurrence). CONCLUSIONS: The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum alpha-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate.
Carcinoma, Hepatocellular↗
Upper gastrointestinal tract ablation for patients with extensive injury after ingestion of strong acid.
OBJECTIVE: Extensive corrosive injury involving the structures beyond the pylorus caused by ingestion of strong acid has a poor prognosis. We reviewed six cases of patients who underwent total upper gastrointestinal tract ablation to see the effect of this extensive procedure for such an injury. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Six patients who ingested more than 250 mL of 20N hydrochloric acid were treated in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China, from 1986 to 1992. RESULTS: Three patients with preoperative metabolic acidosis and renal failure died of multiple organ failure within the first postoperative month. The other three patients survived the acute stage. While being readied for a late reconstructive procedure, sepsis developed in one patient due to cholecystostomy leakage about 1 year postoperatively. Another patient died of respiratory failure after development of aspiration pneumonia due to poor drainage of a spit fistula, after surviving for 6 months. Only one patient had a good recovery following a full reconstruction procedure and restoration of the continuity of the gastrointestinal tract. CONCLUSIONS: Three of six patients died in the hospital. The risk factors were preoperative metabolic acidosis, renal failure, and an upper jejunal resection greater than 100 cm in length. Early and aggressive approaches to resect all the necrotic tissue certainly provide good chances to survive the acute stage and later reconstruction.
Adult↗
Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment.
This study is a retrospective analysis of 248 thyroid cancer patients who received their primary treatment in the Chang Gung Memorial Hospital during the period January 1979 to December 1992. Among these cases, there were 173 papillary thyroid cancers (69.8%), 52 cases of follicular thyroid cancer (21%), 7 cases of medullary thyroid cancer (2.8%), and 16 cases of anaplastic thyroid cancer (6.5%). The subjects included 184 female patients with a mean age of 40.7 +/- 14.3 years and 64 males patients with a mean age of 49.2 +/- 14.3 years. Most of the cases had a nearly total thyroidectomy after the diagnosis was confirmed by frozen section during the operation. During the follow-up period, 19 (8.2%) patients diagnosed with well-differentiated thyroid cancer died of thyroid cancer in contrast to 12 patients (75%) with anaplastic thyroid cancer. The 1-year Greenwood survival probabilities after the disease is diagnosed in papillary, follicular, and anaplastic thyroid cancer are 0.98, 0.86, and 0.25, respectively. For the analysis of prognostic variables in well-differentiated thyroid cancer patients, 16 factors were entered for univariate and multivariate analysis. Using a log-rank univariate analysis, survival was significantly associated with the cell type of the primary tumor, age, clinical staging, postoperative 131I pattern, tumor size, postoperative thyroglobulin (Tg) level and postoperative x-ray results. In the Cox multivariate regression analysis the combination factors that gave the best prognostic value were the association of x-ray finding (P = .004), age (P = .017), and Tg level (P = 0.19). In conclusion, thyroid cancer is not an unusual disease in Taiwan. As previously reported anaplastic thyroid cancer has a poor prognosis. In this limited period of follow-up study, the patients' age with postoperative first positive x-ray finding and Tg level may provide the prognostic factors for patients with well-differentiated thyroid cancer.
Adenocarcinoma, Follicular↗
Acute suppurative thyroiditis: a ten-year review in a Taiwanese hospital.
12 patients with acute suppurative thyroiditis were treated over a 10-year period. Their ages ranged from 2-81 years. Eight of them had a pre-existing thyroid mass. A piriform sinus fistula was demonstrated in one of the 2 patients with a history of recurrent infections. Cultures of the pus taken from the infected glands grew Gram-positive streptococci in 4 patients, Gram-negative bacteria in 4, and anaerobic bacteria in 1; the other 3 were sterile. Both patients who grew Klebsiella pneumonia were diabetic. Most of the patients received drainage in addition to systemic antibiotics. Only 2 patients had recurrence during the follow-up period. We present a review of our experience with this uncommon infection.
Acute Disease↗
Rupture of the diaphragm after blunt trauma.
OBJECTIVE: To analyse our cases of acute rupture of the diaphragm after blunt trauma to find out how to diagnose it earlier and manage it more promptly in future. DESIGN: Retrospective study of casenotes. SETTING: Division of general surgery, district hospital, Taiwan. PATIENTS: 50 Patients who presented with acute rupture of the diaphragm after blunt trauma during the 10 year period 1982-91. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The left hemidiaphragm was injured in 43 cases (86%), and the right in 7 (14%). The most common cause was road traffic accidents. 48 Patients had associated injuries, mainly to the chest and abdomen, and pelvic fractures. 44 Ruptured diaphragms were diagnosed before operation by chest radiography or upper gastrointestinal contrast examination. The transabdominal approach was the most appropriate, because 23 patients had intra-abdominal visceral injuries as well. 20 Patients (40%) had complications, and the rate was 33% among those treated within 24 hours and 70% among those whose treatment was delayed longer than 24 hours (p = 0.067). There were 3 deaths (6%); one patient died of empyema of the right chest as a result of simultaneous perforation of a hollow viscus. 6 Patients were permanently disabled by head and spinal injuries, and pelvic fractures. CONCLUSION: The prognosis of repairing diaphragmatic hernias is good as the disability rate is low. The diagnosis should be kept in mind in all patients with chest injuries, pelvic fractures, or abdominal injuries with hypoxaemia, as this will result in earlier treatment and improve prognosis. The transabdominal approach is the most appropriate because it makes simultaneous abdominal injuries easier to treat. Correct operative management at an early stage will keep mortality to a minimum.
Adolescent↗