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Biomedical subjects

L B Jeng

Publications and source records attributed to L B Jeng.

At least 91 records · Page 5Linked to original sources
PubMed1994

Resectional therapy for a giant cavernous hemangioma of the liver.

Twelve patients with cavernous hemangiomas of the liver were treated by surgical resection from 1982 to 1991. There were three male and nine female patients. Their ages ranged from 31 to 62 with a mean of 49. All except one with gall bladder polyp had abdominal pain. Preoperatively, dynamic computerized tomographic scans performed on three patients produced accurate diagnoses, while angiography was correct in only 2 out of 7 patients. The indications for operation were suspected hepatoma in five, symptomatic pain in three, intraperitoneal hemorrhage resulting from biopsy in one, intrahepatic stone with suspicion of cholangioma in one, abdominal mass mimicking a gastric leiomyosarcoma in one and incidental laparotomy in a final patient. Surgical treatment resulted in no operative mortalities apart from one delayed death from cirrhotic decompensation occurring four months postoperatively. Morbidity included one patient with a postoperative hemorrhage and one with bile leakage, however, both of them were discharged uneventfully. During the follow up period from 6 to 72 months, no more abdominal pain attacked in those three patients with preoperative symptomatic pain. Three patients developed multiple recurrent hemangiomas. No identifiable causes were readily apparent. We conclude that the preoperative differentiation between hemangioma and hepatoma in a hepatic lesion is very important. When necessary, such as a giant symptomatic hemangioma of the liver can be safely resected without significant complications.

Adult↗
PubMed1994

The use of a small feeding tube for suction drainage after thyroidectomy.

The placement of a drain after thyroidectomy is sometimes necessary. A large-sized drain tube is more effective, but often creates a larger scar. We have used a small feeding tube connected to a vacuum ball in 110 cases from July 1991 to December 1991. The function of this drainage system is good with the average amount of 58 ml during the retained period. There is no patient developed any wound complication such as hematoma, hemorrhage or wound infection. This method is proved to be both effective and cosmetic. Whenever necessary, we suggest to use this drain system.

Adult↗
PubMed1994

Insulinoma--clinical experience in ten cases.

During the period between January 1981 and December 1992, a total of ten patients with pathologically confirmed insulinoma were studied. All patients presented with variable degrees of neuroglycopenic symptoms and Whipple's triad. The ratio of insulin to glucose after an overnight fast was greater than 0.3 in 90% (9/10) of patients. Eight patients who received supervised fasting developed neuroglycopenia with relative hyperinsulinemia within 48 hours of fasting. Four of 8 patients developed hypoglycemia during a 5-hour oral glucose tolerance test (OGTT). Calcium infusion test was more sensitive in patients with an initially higher plasma glucose. The detection rates of various localization studies were 12.5% (1/8) by abdominal ultrasonography, 37.5% (3/8) by abdominal CT scan, 50% (5/10) by selective superior mesenteric and celiac arteriography. Transhepatic portal venous sampling (THPVS) detected insulinomas in 4 of 4 cases. Endoscopic ultrasonography and intraoperative ultrasonography were performed on 1 and 2 cases respectively, and were able to localize the lesions successfully. All patients received surgical treatment including enucleation (n = 2), subtotal pancreatectomy (n = 3) and distal pancreatectomy (n = 5). All patients had single tumors which were all benign islet cell adenomas. The mean size of the tumors was 15.5 +/- 2.0 mm in diameter (range: 8 to 30 mm) and mainly located in the body (50%) and tail (40%), only 1 in the pancreatic head. All symptoms of hypoglycemia subsided after operation. Hyperglycemia was observed in all patients immediately after operation, and most of them resumed normoglycemia within 8 days. However, the 2 patients who had impaired OGTT preoperatively had persistent hyperglycemia after operation and therefore were diagnosed as having diabetes (NIDDM).

Adult↗
PubMed1993

A reappraisal of cholangiocarcinoma in patient with hepatolithiasis.

BACKGROUND: Hepatolithiasis associated with cholangiocarcinoma is not often encountered. During the past 3 years, an increased incidence of patients with hepatolithiasis associated with cholangiocarcinoma was noted. Data were needed to reliably determine the incidence of this disease. METHODS: Data concerning the relationship between cholangiocarcinoma and hepatolithiasis are presented. The treatment modalities and factors that influence long-term survival are discussed. RESULTS: The overall incidence of cholangiocarcinoma in association with hepatolithiasis was 5.0% (55 in 1105). Before 1987, 65% of cholangiocarcinoma in association with hepatolithiasis was diagnosed postoperatively. After 1987, the incidence of accurate preoperative diagnosis increased (22.8%), and in most of the other instances (62.8%), the diagnosis was made at laparotomy. Surgical procedures consisted of common bile duct exploration with T-tube drainage (100%) and hepatectomy (38.2%). Mortality for patients who underwent surgery was 5.4%; they died of recurrent cholangitis. The overall median survival time of patients with cholangiocarcinoma in association with hepatolithiasis was 10.4 months; the 1-, 2-, and 4-year cumulative survival rates were 30.0%, 12.7%, and 3.6%, respectively. Patients with hepatectomy or the presence of mucobilia had better survival rates (P < 0.05). CONCLUSIONS: The overall incidence of hepatolithiasis associated with cholangiocarcinoma was 5%. In most patients with cholangiocarcinoma in association with hepatolithiasis, diagnosis can be made preoperatively and at laparotomy. Patients with hepatectomy or presence of mucobilia had better survival rates.

Adenoma, Bile Duct↗
PubMed1993

Solid and papillary neoplasm of the pancreas. Emphasis on surgical treatment.

Six Chinese females with solid and papillary neoplasms of the pancreas underwent surgery. Mean age was 26 years. The most common clinical sign was a large palpable abdominal mass. One patient presented with shock and acute onset of abdominal pain with positive peritoneal signs due to rupture of the tumor. The surgical procedures included Whipple's operation in one patient with a tumor at the head of pancreas, a 75% distal pancreatectomy in two patients with tumor of the body or tail of the pancreas, a partial pancreatectomy and pancreaticogastrostomy in one patient with a tumor at the neck and body of the pancreas, total excision in one patient with a tumor of the body of the pancreas, and a Roux-en-Y cystojejunostomy in one patient with a huge unresectable tumor of the head and body of the pancreas. During the follow-up period of from 40 to 83 months, four patients had survived and two had died of causes unrelated to the tumor in the differential diagnosis of a pancreatic mass, especially in young women with long histories of epigastric masses. Resection is the treatment of choice when the tumor is resectable. For unresectable tumors, a bypass procedure might be an alternative.

Adolescent↗
PubMed1993

Liver transplantation for a hepatitis B-related cirrhotic patient.

A patient with chronic end-stage liver cirrhosis resulting from a hepatitis B viral infection had a successful liver transplantation performed on 1 July 1991. Preoperative serology revealed that both HBsAg and HBeAg were positive, and the anti-HBs antibody was negative. Immunoprophylaxis included active immunization, as well as injections of large doses of hepatitis B immunoglobulin (HBIG) given perioperatively to reverse the antigen status. The patient has been anti-HBs antibody positive for more than 10 months since the transplantation. The immunoprophylaxis protocol used has been effective in the prevention of hepatitis B viral reinfection.

Adult↗
PubMed1993

Obturator hernia: a report of eight cases.

Obturator hernia is a rare problem that occurs predominantly in elderly, emaciated women. The diagnosis of obturator hernia is difficult to establish in most patients before an operation is performed. Both delayed diagnosis and delayed surgical intervention contribute to high mortality. From 1978 to 1992, eight cases of obturator hernia involved elderly females who had received operations at this hospital. Resection of the incarcerated bowel was required. The often debilitated condition of these patients and the frequent delay of diagnosis combined to produce significant operative mortality.

Aged↗
PubMed1993

Ultrasonography and fine needle aspiration cytology of acute suppurative thyroiditis.

Although acute suppurative thyroiditis is a rare disorder, from January. 1985 to December 1991, we observed 11 cases of acute suppurative thyroiditis in our hospital. All patients underwent thyroid ultrasonography and fine needle aspiration biopsy and cytologic evaluation of the specimens. In eight cases, pus cultures were positive, four of them grew Gram negative bacteria. Ultrasonographic finding showed either local or diffuse low to a very low echo density on both lobes. However, a cystic lesion was also found. Polymorphonuclear cells were the main elements in the smears from the thyroid aspirates. In conclusion, thyroid ultrasound with fine needle aspiration and cytology can assist in confirming the early diagnosis of acute suppurative thyroiditis.

Acute Disease↗
PubMed1991

Influence of age on results of resection of hepatocellular carcinoma.

One hundred and fifty-eight elective hepatectomies carried out between 1976 and 1989 for hepatocellular carcinoma were classified into three groups according to age: group I (n = 20) under 30 years of age; group II (n = 102) 30 to 60; and group III (n = 36) over 60. The number of operations carried out on patients in group III has increased since 1983, and the types of hepatic resection in the three different age groups were slightly but not significantly different. The incidence of small tumours (diameter less than 5 cm) and associated cirrhosis were relatively low in the younger patients. Postoperative complications developed in 4 patients (20%) in group I, 18 (18%) in group II and 8 (22%) in group III, the main ones being hepatic failure and intraabdominal sepsis. Operative mortality was 4%; one patient (5%) died in group I, 4 (4%) in group II, and 2 (6%) in group III, and the principal causes were hepatic failure and massive haemorrhage. Hepatic resection for hepatocellular carcinoma in most patients over 60 years old was associated with slightly higher operative morbidity and mortality, but the risks were such that we recommend that operation should not be denied to selected patients in this age group.

Adult↗
PubMed1991

Pre-operative localization of parathyroid tumor by ultrasonography.

From July 1984 to June 1989, 24 cases with hypercalcemia and surgical proof of parathyroid adenoma or carcinoma received preoperative parathyroid sonographic examination in Chang Gung Memorial Hospital. There were 10 male patients with mean age of 51.5 +/- 12.3, and 14 female patients with mean age of 49.4 +/- 12.6. Parathyroid enlargement was detected by sonography examination in 22 of the 24 cases. The maximal diameter of the enlarged parathyroid in this series ranged from 1 cm to 3 cm. The accuracy of case diagnosis with sonography is 83.3%. In 96 parathyroid glands examined by sonography, the sensitivity is 83.3%, the specificity is 95.8% and the positive predictive value is 87%. From the results, it suggests that parathyroid sonography can be used as the first line localization method to detect parathyroid enlargement in hypercalcemia patients.

Adenoma↗
PubMed1989

Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma.

During the 10-year period from 1978 to 1987, hepatic resections were performed on 20 patients with peripheral cholangiocarcinoma (PCC). Nine of these patients were men and 11 were women (mean age, 48.5 years). Among them, 80% had intrahepatic stones with recurrent cholangitis. The 20 patients were subdivided into the following three groups: Group I (12 patients with surgery for PCC); Group II (4 patients with surgery for chronic cholangitis [but the final pathologic diagnosis confirmed PCC]); and Group III (4 patients with surgery for space-occupying liver lesions). No early postoperative mortality was noticed. The few complications that occurred were related to surgery for hepatolithiasis. Postoperative wound infection was the most common complication. The overall mean survival time was 20.5 months. Four patients survived for more than 3 years; one was even alive for more than 5 years after surgery.

Adenoma, Bile Duct↗