[Evaluation of operative choledochofiberscopy].
Explore the source record for details and available documents.
Bile Duct Diseases↗
Biomedical subjects
L B Jeng
Publications and source records attributed to L B Jeng.
[Treatment of bleeding esophageal varices by esophageal transection with E.E.A. instrument].
Explore the source record for details and available documents.
Adolescent↗
Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer.
This series retrospectively reviewed 3657 patients who received thyroid ultrasonography with fine-needle aspiration cytological (FNAC) examinations at Chang Gung Memorial Hospital during the period from January 1, 1993 to December 31, 1993. Thyroid ultrasonography studies were performed using a real-time ultrasonographic machine with a 10 MHz transducer. The aspirates were air dried and stained by the Romanowsky-based Liu method. Three hundred seventy-eight cases (10.3%) received surgical treatment after the ultrasonographic and FNAC examinations. Benign lesions were diagnosed in 269 patients. Thyroid malignancy was confirmed histopathologically in 109 cases including 76 papillary thyroid carcinomas, 17 follicular carcinomas, 5 medullary thyroid carcinomas, 3 anaplastic carcinomas, 3 Hürthle cell carcinomas, and 3 lymphomas. Another 2 cases were metastatic cancer to thyroid. The results demonstrated that 28.8% of the surgically treated patients had histopathologically proven malignancies. The incidence of thyroid malignancy was 2.98% in this study. The sensitivity of the cytological diagnosis was 79.80% and the specificity was 98.66%. The positive predictive value was 96.34%. Negative predictive value was 91.70%. The false negative index was 20.20%. The diagnostic accuracy was 92.89%. Thyroid ultrasonography with the FNAC can provide high specificity and sensitivity in differentiating malignant lesions from benign.
Biopsy, Needle↗
Reoperative thyroid surgery.
Reoperative thyroid surgery is an uncommon operation associated with a high complication rate. We retrospectively reviewed the data of 115 patients to study the incidence of complications after reoperative thyroid surgery. There were 107 women and 8 men (13.4:1.0) with an average age of 42.8 years (range 18-80 years). The most frequent indication for reoperation was completion thyroidectomy for a carcinoma identified by permanent sections (50 patients, 43.5%). Reoperative surgery was performed on 13 (11.3%) patients with recurrent thyroid cancer. The remaining 52 patients underwent reoperation for recurrent thyrotoxicosis (12 patients, 10.4%), recurrent nodular goiter (28 patients, 24.3%) or recurrent multinodular goiter (12 patients, 10.4%). Seven patients with recurrent nodular goiter and one patient with recurrent thyrotoxicosis underwent total thyroidectomy for the presence of malignancies that were identified by frozen sections. Overall, the interval between the initial and reoperative procedures ranged from 1 day to 33 years (2335 +/- 272 days). The length of hospital stay was 5.8 +/- 0.5 days. The length of time needed for reoperative thyroid surgery was 122.0 +/- 6.2 minutes. There was no 30-day perioperative mortality. The postoperative complications consisted of transient hypoparathyroidism in six patients (5.2%), permanent hypoparathyroidism in two patients (1.7%), transient RLN palsy in 3 patients (2.6%), and permanent recurrent laryngeal nerve palsy in two patients (1.7%). Reoperative thyroid surgery can be performed safely with little morbidity to the patient.
Adolescent↗
Intraoperative fiberoptic choledochoscopy for malignant biliary tract obstruction.
A prospective study to determine the safety and effectiveness of intraoperative fiberoptic choledochoscopy in the management of malignant obstruction of the biliary tree was conducted in 44 patients. There were 12 patients with cancer of the pancreatic head, 9 with adenocarcinoma of the distal common bile duct, 4 with adenocarcinoma of the ampulla of Vater, 8 with cholangiocarcinoma of the common hepatic duct, 9 with intrahepatic bile duct carcinoma, and 2 with hepatocellular carcinoma. Five patients with intrahepatic bile duct carcinoma and two with hepatocellular carcinoma were found during a search for intrahepatic duct stones in patients with recurrent cholangitis. In nine patients with bile duct carcinoma (seven extrahepatic and two intrahepatic), histopathological diagnosis was made at operative endoscopy. Treatment strategy was altered in seven patients based on findings at operative choledochoscopy. Complications were few with no mortality. Intraoperative fiberoptic choledochoscopy was safe and useful in the management of malignant obstruction of the biliary tree.
Adenocarcinoma↗
Hepatocellular carcinoma after kidney transplantation.
Explore the source record for details and available documents.
Adult↗
The different manifestation and outcome between pancreatitis and pancreatic malignancy with left-sided portal hypertension.
Left-sided portal hypertension can be induced by isolated splenic venous obstruction due to various etiologies, such as chronic pancreatitis and pancreatic malignancy. The patients may present with bleeding isolated gastric varices and hypersplenism in addition to their pancreatic lesions. In the past 3 years, we have encountered 24 patients with left-sided portal hypertension. They were diagnosed with an abdominal echogram, CT or splenoportography. Twelve patients had histories of acute pancreatitis for a few months to years. Eleven of them were found to have isolated gastric varices. Six of them underwent operation due to hypersplenism or pseudocyst. The postoperative courses were smooth and the gastric varices subsided after splenectomy. The other 12 patients with left-sided portal hypertension were diagnosed as having pancreatic malignancy. Only two of them were found to have isolated gastric varices. Seven of them received operations and only two patients with their tumors located at the pancreatic body and tail could be resected. The other 5 patients were diagnosed with abdominal CT and high serum CA 19-9. We concluded that the patients with left-sided portal hypertension can be suspected by isolated gastric varices without liver cirrhosis. The diagnosis can be confirmed by abdominal CT or splenoportography. The incidence of isolated gastric varices are significantly lower in the patients with pancreatic malignancy than those with chronic pancreatitis. The gastric varices subsided after splenectomy. The prognosis of pancreatic malignancy is poor and most of them are inoperable.
Adenocarcinoma↗
p16INK4 gene mutation and allelic loss of chromosome 9p21-22 in Taiwanese hepatocellular carcinoma.
BACKGROUND: The p16INK4 (MTS1/CDNK2A) gene, located on chromosome 9p21, is an inhibitor of cyclin-dependent kinase 4. Various data have shown that it is frequently inactivated in several types of cell lines and primary human cancers. MATERIALS AND METHODS: Thirty cases with hepatocellular carcinoma were studied for possible p16INK4 gene mutation in Taiwan. Homozygous deletion was determined using polymerase chain reaction (PCR). The p16INK4 gene mutation was first screened by single strand conformation polymorphism, then direct DNA sequencing was performed on the cases with mobility shifts. Deletion mapping of chromosome 9p21-22 was also carried out with two polymorphic microsatellite markers (D9S925 and D9S168) using PCR. RESULTS: One of the 30 cases had homozygous deletion at exon 3 of the p16INK4 gene. Another tumor had altered electrophoresed mobility in exon 2 with G to T transversion in the first nucleotide of codon 61 by direct sequencing causing a stop codon (GAG-->TAG). At the D9S925 and D9S168 loci, six out of 24 (25%) and three out of 19 (16%) informative cases showed loss of heterozygosity, respectively. CONCLUSION: Point mutation and homozygous deletion of the p16INK4 gene are present in a subset of hepatocellular carcinomas in Taiwan. The patterns of the p16INK4 gene alteration are, however, different from those from other regions. In addition, allelic loss on chromosome 9p21-22 is not an uncommon event in hepatocellular carcinomas. Therefore, the significance of chromosome 9p loss deserves to be extensively investigated.
Adult↗
Pancreaticoduodenal necrosis due to caustic burns.
BACKGROUND AND METHODS: Fourteen patients with caustic necrosis of the digestive tract extending beyond the pylorus were included in a multicenter retrospective study to define a surgical strategy. Twelve patients underwent esophagogastrectomy. Two patients had total gastrectomy without esophagectomy. In addition, all patients underwent duodenal stripping (n = 7) or pancreaticoduodenectomy (n = 7). Immediate biliopancreatic reconnection was performed in ten patients. Four patients had biliary diversion and/or pancreatic duct ligation. RESULTS: Seven in-hospital deaths occurred after a mean delay of 27 days (range 16-45 days). There were two late deaths occurring 6 and 12 months postoperatively. Morbidity was noted in 86% of survivors. Acute or chronic airway tract injuries were incurred by 57% of patients. Among the five long-term survivors two were able to feed orally and had preserved voice function. One long-term survivor could resume oral feeding only, another was considered psychologically unfit for digestive reconstruction but had normal voice function and the last patient was deprived of oral feeding and phonation. CONCLUSIONS: Early radical debridement is capable of saving patients with gastrointestinal necrosis extending beyond the pylorus. Necrosis of the duodenum can be managed by pancreaticoduodenectomy or by duodenal stripping, with similar results. Immediate reconnection of the bile and pancreatic ducts to a small bowel Roux-en-Y loop appears preferable to biliary diversion and pancreatic duct ligation. Normal oral feeding and the preservation of voice function can sometimes be achieved but depends on late scarring of the airway-alimentary tract junction. Quality of life is often compromised by prolonged hospital stays, staged surgical procedures and the handicap of a feeding jejunostomy and tracheal tube.
Adult↗
Hepatic resection for 28 patients with small hepatocellular carcinoma.
Twenty-eight patients with hepatocellular carcinoma (HCC) of not larger than 5 cm diameter were surgically treated during the 12 years from 1977 to 1988, twenty-five of them since 1983. Half of the patients were admitted for check up because of elevated serum AFP and were high risk subjects. Serum HBsAg were positive in 24 (85.7%). Serum AFP was less than 10 ng/ml in 2 (7.1%) and greater than or equal to 200 ng/ml in 14 (50%). Coexistent liver cirrhosis was found in 21 (75%). Local resection or partial hepatectomy played a major surgical role in small HCC, especially in the presence of cirrhosis and tumor in right liver. The cumulative survival rates for the 28 patients treated by hepatic resection at 1, 2 and 5 years were 60.6, 42.5 and 42.5 percent. The survival rate of patients with tumor size not larger than 3 cm diameter is not better than those with tumor size between 3 cm and 5 cm. The small HCC patients with AFP less than or equal to 200 ng/ml had better survival than those with AFP greater than 200 ng/ml.
Adolescent↗
Femoro-arterial bypass using Gott shunt in liver transplantation following severe hepatic trauma.
The heparinized-coated tube is widely used for arterial bypass, mainly in patients with aneurysms or trauma of the thoracic aorta. Its application in venous bypass was less frequent. We report a 26-year-old woman who sustained blunt abdominal injury which resulted in complete severance of the suprahepatic hepatic vein and multiple partial lacerations of the inferior vena cava. For hemostasis, total hepatectomy with interruption of the inferior vena cava was performed. During the anhepatic phase, end-to-end portocaval anastomosis and a bypass shunt using 9 mm Gott tube from the right femoral vein to the right atrium were set up for veno-venous bypass. Orthotopic liver transplantation was performed later. Gott tube was placed for 18 hours with good venous return. We concluded that heparinized-coated tube is good for veno-venous bypass with the following advantages: 1) simple operative procedure, 2) enough flexibility to be kept out of the operative field, 3) no anticoagulant is necessary, consequently less bleeding resulted.
Adult↗
Circumferential suture technique for esophageal transection to treat esophageal variceal bleeding.
The EEA stapler has been used routinely for esophageal transection to treat esophageal variceal bleeding for some time. It carries the risk of postoperative leakage and is not suitable in those cases receiving recent sclerotherapy. The circumferential suture technique presented in this paper can be used in any situation requiring esophageal transection. It has been utilized by us in twenty-two emergent cases with good results.
Combined Modality Therapy↗
Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma.
BACKGROUND/AIMS: Radical resection for patients with peripheral cholangiocarcinoma is rare. Prognostic factors related to survival with peripheral cholangiocarcinoma after hepatectomy have not yet been reported. MATERIALS AND METHODS: Of 41 hepatectomized patients with peripheral cholangiocarcinoma, a computer analysis of 14 clinicopathological factors on patients survival was performed with univariate and multivariate analysis. RESULTS: Median and mean survival times for patients with peripheral cholangiocarcinoma after hepatectomy were 12.0 and 22.8 months. The 1-, 2-, 3-, 4- and 5-year survival rates were 53.7%, 39.0%, 36.6%, 26.8%, and 26.8% respectively. Univariate analysis of overall survival involving all patients identified 7 factors that were associated with a significantly outcome: mucobilia (p = 0.043), capsular invasion (p = 0.007), tumor spreading type (p = 0.0003), section margin (p = 0.001), histologic type (p = 0.008), macroscopic and microscopic vascular involvement (p = 0.031), and lymphatic invasion (p = 0.004). With multivariate analysis using the COX stepwise proportional hazards model, only mucobilia, tumor spreading type and section margin were significantly related to prognosis. CONCLUSIONS: Intrahepatic bile duct carcinoma patients with mucobilia, intraductal papillomatosis and a tumor-free margin after hepatectomy had a better prognosis.
Bile Duct Neoplasms↗
Surgical treatment of pancreatic adenocarcinoma: Taiwan experience.
A retrospective study of 155 patients with tissue proven ductal adenocarcinoma of the pancreas treated between January 1981 and December 1991 was performed. Locations of the pancreatic tumors were: pancreatic head in 109 cases (70.3%), head and body or diffusely throughout the gland in 24 patients (15.5%), body and/or tail in another 22 (14.2%). All of the patients were stratified by TNM staging (I, 13.6%; II, 8.4%; III, 34.8%; IV, 43.2%). Twenty-eight patients received pancreatectomies (18.1%), 87 patients had biliary-enteric bypass and/or gastrojejunostomies (56.1%), and another 40 received laparotomies with tumor biopsy only (25.8%). The overall operative mortality of pancreatic cancer surgery was 9.0% with the pancreatectomy, bypass, laparotomy group mortalities at 7.1%, 5.7%, and 17.5% respectively. The risk factors of postoperative mortality were age > or = 70 years, serum albumin 3.0 g% and hemoglobulin < 12.0 g% (p < 0.05). The overall long term survival for pancreatic cancer was: 1y, 17.1%; 2y, 8.5%; 3y, 7.6%; 4y, 5.7%; and 5y, 4.8%; respectively. The mean survival time for the resection group was 23.6M (range 1-108M) with survival rates being: 1y, 42.3%; 2y, 34.6%; 3y, 30.8%; 4y, 23.1%; and 5y, 19.2%; respectively. Stage I cancer and radical resection are two important factors related to long-term survival in patients with pancreatic adenocarcinoma.
Adenocarcinoma↗
Surgical treatment of papillary and follicular thyroid carcinoma.
There is limited clinical information about the prognostic factors in survival and distant metastasis for well differentiated thyroid cancer in Chinese patients. Pitfalls were noted when applying the results of published studies to another population. In order to realize the differences of these factors between different areas, we retrospectively analyzed the data of 569 papillary or follicular thyroid carcinoma patients who received their primary treatment at the Chang Gung Memorial Hospital during the period from January 1979 to June 1994. Actuarial survival rates were calculated by the Kaplan-Meier method. For the analysis of prognostic variables, 14 clinical parameters were coded into the computer for the univariate and multivariate analyses. Multivariate analysis was performed to assess the independent effect of these variables using the Cox model. Among these cases, there were 466 papillary thyroid carcinoma (81.9%), 103 cases of follicular thyroid carcinoma (18.1%). The subjects included 440 female patients with mean age of 38.8 +/- 14.4 years and 129 male patients with the mean age of 44.7 +/- 14.4 years (p = 0.0001). Most of the cases received total thyroidectomy treatment after the diagnosis was confirmed by a frozen section during the operation. In the follow-up period, 30 (5.3%) patients died of metastatic thyroid cancer. The one year Greenwood survival probability after the disease diagnosed in papillary and follicular thyroid carcinomas was 0.986 and 0.909 respectively. Using a log-rank univariate analysis, survival was significantly associated with the histological type of primary tumors, age, clinical staging, post-operative 131I pattern, tumor size, postoperative serum thyroglobulin (Tg) level and post-operative X-ray findings. Tumor size larger than 2.5 centimeters could influence both the survival and distant metastases of these well differentiated thyroid cancer patients. In the Cox multivariate regression analysis, the combination factors that gave the best prognostic values were the association of distant metastasis (0.005), age (p = 0.027), and one month postoperative serum Tg level (p = 0.042). Well differentiated thyroid cancer is not an unusual disease in Taiwan. In this limited period of follow-up study, distant metastasis at the time of surgery, the patients' age and one month post-operative serum Tg level may serve as the prognostic factors for the well differentiated thyroid cancer patients.
Adenocarcinoma, Follicular↗
Surgical results for severe acute pancreatitis--comparison of the different surgical procedures.
BACKGROUND/AIMS: We compared the outcome of surgery for the patients with severe acute pancreatitis using different surgical procedures to find risk factors for mortality. PATIENTS AND METHODS: Records of eighty six patients with severe acute pancreatitis who underwent different surgical procedures in the past five years were retrospectively reviewed. RESULTS: The patients were found to have severe acute pancreatitis during operation. The morbidity and mortality of three different surgical procedures were compared. The risk factors related to the mortality were analyzed. Thirty one patients considered as group A received debridement and closed sump drainage. Forty patients considered as group B receiving necrosectomy with open packing of the peripancreatic space. The other 15 patients considered as group C received debridement and continuous lavage of the lesser sac. The patients in group A had highest mortality (48.4%) and those in group B had lowest (15%). CONCLUSIONS: The significant risk factors of mortality included high Ranson's signs, peripancreatic necrosis, pancreaticogenic ascites and bacterial infection. The open packing or marsupialization of group B provided an easy way to perform repeated debridement after the first operation, resulting in the lower mortality for severe acute pancreatitis than other surgical procedures. The procedure with closed sump drainage resulted in higher incidence of postoperative bleeding and sepsis. The patients with higher Ranson's signs, peripancreatic necrosis, pancreatic ascites or positive bacterial infection should be treated more aggressively.
Acute Disease↗
Unusual presentation of a small hepatocellular carcinoma: a case report.
Most small hepatocellular carcinomas are asymptomatic. While small hepatocellular carcinomas do have symptoms, these symptoms are usually related to the underlying liver disease, not to the tumor itself. We encountered a 63-year-old male patient with a small hepatocellular carcinoma, 2.5 cm in diameter, presenting with fever, abdominal pain and sensation of abdominal fullness. These were unusual clinical manifestations related to the small hepatocellular carcinoma itself and challenged the diagnosis.
Carcinoma, Hepatocellular↗
Surgical treatment of choledochal cyst in adults: results and long-term follow-up.
BACKGROUND/AIMS: Results of the surgical management of 60 adults with choledochal cysts at Chang Gung Memorial Hospital Taipei are presented. PATIENTS AND METHODS: All patients were diagnosed and surgically managed during the period between March 1979 and December 1992. There were 47 females and 13 males, with ages ranging from 16 to 81 years (mean age = 31.9 years). Of the total, there were 41 Type I, one Type II, 14 Type IV, and four Type V choledochal cysts classified according to Todani's classification system. The definite surgical procedures were cyst excision and hepatico-jejunostomy in 43 cases in type I and IV diseases, one cyst excision in type II disease, two hepatectomy for type V disease, cyst enterostomy in seven cases, and T-tube choledochocystostomy in seven cases. RESULTS: The operative mortality rate was 3.3% and the complication rate related to the surgical procedure was 20%. Early postoperative complications include wound infection, leakage of anastomosis, acute pancreatitis, septic shock, left pleural effusion, and intra-abdominal abscessing. Reoperations were needed in the early postoperative days in two cases due to hepatico-jejunostomy leakage and intraabdominal abscess formation. Long-term surgical outcome, concerning recurrence of symptoms, was related to the following factors, excluding the factors of surgery: presence of bile duct lithiasis, common channel less than 22 mm, presence of preoperative pancreatitis and acute angle type pancreaticobiliary unions. Only common channel less than 22 mm is statistically significant. The percentage of recurrence of the symptoms after resectional surgery was 32.5% in the long term follow-up period. Most of the cases responded well to an antibiotics treatment. Three of the cases required a second operation or PTCD as well as dilatation to treat the recurrent cholangitis. CONCLUSION: Although the recurrence of symptoms is not uncommon and satisfactory explanation of the analysed factors is still the treatment of choice for adult patients with choledochal cysts.
Adolescent↗