Long term survival after obstruction of the common bile duct by ductal hepatocellular carcinoma.
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Carcinoma, Hepatocellular↗
Biomedical subjects
M F Chen
Publications and source records attributed to M F Chen.
Factors that influence the operative mortality after blunt hepatic injuries.
OBJECTIVE: To analyse causes of death and possible factors that influenced the operative mortality in patients with blunt hepatic injuries. DESIGN: Retrospective case study. SETTING: Medical center, Taiwan. PATIENTS: 109 adult patients with blunt hepatic injuries were treated surgically over the four year period from September 1987 to August 1991. MAIN OUTCOME MEASURE: Mortality. RESULTS: 36 patients (33%) had hepatorrhaphy or no repair, complex repairs were done for 73 patients (67%) and the overall mortality was 22% (24/109). Of those deaths, however, 4 were not liver-related, giving us a liver-related mortality of 19% (20/105). Fourteen of the liver-related deaths occurred within 24 hours of injury of hemorrhagic shock or coagulopathy. Six occurred after 24 hours of sepsis and multiple system organ failure. Multivariate analysis showed that higher initial aspartate aminotransferase (AST) and Injury Severity Score as well as increasing operative blood loss resulted in a worsening prognosis. CONCLUSION: The initial AST activity and Injury Severity Score as well as the total operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Prompt, expeditious, and appropriate surgical management to control operative loss is the only way for the surgeon to reduce the mortality of blunt hepatic injuries.
Adolescent↗
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↗
Actions of a long-acting somatostatin analog SMS201-995 (sandostatin) on rat locus coeruleus neurons.
The actions of sandostatin involving rat locus coeruleus (LC) neurons were examined using an intracellular recording in a brain slice preparation. Bath application of sandostatin (5-100nM) reversibly decreased the firing rate of all neurons tested in a dose-dependent manner. Sandostatin was 9.5 times more potent than somatostatin in light of an inhibition of the spontaneous firing rate. In addition to the inhibition of spontaneous firing, larger concentrations of sandostatin (30-100nM) also hyperpolarized the neurons of the locus coeruleus and simultaneously caused a reduction in input resistance. At the highest concentration (100nM) applied, sandostatin produced complete inhibition of firing of all neurons tested (n = 49); the inhibition was associated with a 11.6mV hyperpolarization (range 2.2-26.4 mV, n = 49) and a 21.8% reduction in input resistance (range 2.6-55.2%, n = 39). The voltage-current relationship of the resting cell revealed an inward-going rectification that became enhanced after the perfusion of sandostatin (100nM) for 5 min. The reversal potential for the sandostatin-induced hyperpolarization was -111 +/- 1 mV (n = 10), which is approximately the potassium equilibrium potential. This hyperpolarization was blocked by both caesium chloride and barium chloride. Our results also showed that sandostatin displayed an antagonistic action on mu opiate receptors. Both the somatostatin-agonistic and opiate-antagonistic activities of sandostatin were conclusively found to be stronger than those of somatostatin; in addition, the inhibitory actions of sandostatin on LC neurons were due to an opening of the inward-going rectification potassium channels.
Animals↗
Effects of acute exercise on the changes of lipid profiles and peroxides, prostanoids, and platelet activation in hypercholesterolemic patients before and after treatment.
The effects of acute exercise on the changes of plasma lipid profiles and peroxides, prostanoids and platelet activation in hypercholesterolemic patients before and after pravastatin 5 mg twice daily treatment for 4 weeks was studied in 30 (M/F = 21/9, age = 52 +/- 7, Mean +/- SD) patients with plasma total cholesterol level > 240 mg/dl. Pravastatin significantly reduced plasma total and low density lipoprotein cholesterol levels as expected. All patients before and after treatment and 30 healthy controls performed a treadmill exercise test using the standard Bruce protocol. The cardiac performance was similar in all groups. Treadmill exercise did not influence lipid levels after plasma volume correction. Hypercholesterolemic patients had significantly higher pre-exercise levels of malondialdehyde, thromboxane beta 2 and beta-thromboglobulin than after treatment or than pre-exercise levels in the control group. Treatment with lipid lowering drug pravastatin lowered the levels of these three parameters. At peak exercise, superoxide dismutase activity and 6-keto-PGF1 alpha were elevated. At 10 min post exercise only malondialdehyde returned to pre-exercise levels. The superoxide dismutase, thromboxane B2 and beta-thromboglobulin remained significantly higher. In the control subjects plasma beta-thromboglobulin and thromboxane 2 returned to pre-exercise levels. These results suggest that hypercholesterolemia may induce lipid peroxidation and platelet activation in resting status. Lowering of plasma cholesterol of pravastatin causes a concomitant decrease in plasma malondialdehyde, thromboxane and beta-thromboglobulin suggesting a decrease in lipid peroxidation and platelet activation. These changes were more pronounced in the hypercholesterolemic patients. Pravastatin treatment attenuated the increase in both malondialdehyde, beta-thromboglobulin and the prostanoids, but not to the level of normal subjects.
Exercise↗
Fish oil supplementation attenuates free radical generation in short-term coronary occlusion-reperfusion in cholesterol-fed rabbits.
We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.
Animals↗
Effects of fish oil supplementation on the changes in myocardial cyclic adenosine monophosphate, inositol 1,4,5-triphosphate and mitochondrial calcium levels during acute coronary occlusion-reperfusion in cholesterol-fed rabbits.
We studied the changes in myocardial second messengers and mitochondrial calcium levels during acute coronary occlusion-reperfusion in New Zealand white male rabbits fed a high cholesterol diet with or without fish oil supplementation. Group I, control rabbits, were fed a standard laboratory rabbit chow. In addition to the standard chow, Group II rabbits received a 1% cholesterol-enriched diet for 2 weeks, while Group III rabbits were fed a 1% cholesterol and 10% fish oil supplemented diet for 2 weeks. Acute coronary occlusion for 10 min or 1 h was induced by ligating the marginal branch of the left circumflex coronary artery. The vessel was then reperfused for 1 or 4 h in short- and long-term ischemia studies respectively. In the short-term ischemia study, myocardial samples taken from the cholesterol-fed rabbits had the highest cyclic adenosine monophosphate, inositol 1,4,5-triphosphate and mitochondrial calcium levels among the normal (nonischemic) and the ischemic areas of the three groups. The cholesterol and fish oil treated rabbits significantly suppressed the elevation of cyclic adenosine monophosphate (P < 0.05 compared with the cholesterol-fed rabbits in normal and ischemic areas respectively), but did not significantly attenuate the elevation of inositol 1,4,5-triphosphate and calcium levels. In the long-term ischemia study, the cholesterol-fed rabbits had the highest levels of these three messengers among the normal areas. However, only inositol 1,4,5-triphosphate level reached statistical significance (P < 0.05 compared with control). This group of rabbits had the lowest level of cyclic adenosine monophosphate, but the highest inositol 1,4,5-triphosphate and calcium levels among the ischemic areas.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Relationship between ventricular rate and cardiac output in mimic experimental atrial fibrillation.
In treating atrial fibrillation (AF) the goal of ventricular rate reduction is still not determined. An animal model of AF was developed in which the relationship between ventricular rate and the parameters of cardiac function in AF can be studied. To simulate AF, complete heart block was chemically produced on open-chest dogs. Then, assisted by a portable computer, the ventricles were paced with a series of grossly irregular stimuli of predetermined rates, while atria were paced rapidly (500 beats/min). The resulting electrocardiogram and pressure were indistinguishable from the naturally occurring AF. It was found that in AF with ventricular rates that were lower than that of the control state, cardiac output was decreased. Cardiac output increased and reached a plateau when the ventricular rate increased to the level of the control state and then kept stable up to a rate of 320 beats/min. There was a discrepancy between the effective ventricular rate (rate of beats with pulse pressures > or = 25 mmHg in the femoral artery) and the electrical ventricular rate. When the electrical ventricular rate increased over the control ventricular rate the effective ventricular rate did not increase in a parallel manner. Rather, the effective ventricular rate leveled off at the control ventricular rate. This discrepancy may explain the parallel relationship between the effective ventricular rate and cardiac output.
Animals↗
Absorption of subcutaneous injection of Tc-99m pertechnetate via acupuncture points and non-acupuncture points.
SC-RNV, a new method of radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3 (Taixi), was developed in our laboratory. To further investigate whether K-3 is the best point for SC-RNV, Tc-99m pertechnetate was subcutaneously injected at K-3 on one foot and at one of the 11 other acupuncture points (APs) or 3 nonacupuncture points (NAPs) on the opposite foot, simultaneously, in 157 subjects without evidence of venous disorder. The absorption of radioisotopes from each injection site was evaluated by analyzing the time-activity curve at a region of interest set upon over the lower leg above the injection site. The results revealed that the absorption of radioisotopes via K-3 (Taixi) was better than that via NAPs, evidenced by higher peak activity and greater absorption rate. However, there was no significant difference between K-3 injection and other APs injections except Liv-2 and Liv-3. These results indicate that absorption of radioisotopes via APs is better than via NAPs. This together with the fact that K-3 is easier to detect than other APs in feet, suggests that K-3 is a good point for SC-RNV.
Absorption↗
Radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture point K-3: a case report.
Recently, we developed a new method of radionuclide venography of lower limbs, namely SC-RNV, by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3. In this study, we applied this method to evaluate the venous drainage of lower limbs in a patient with severe varicose veins and edematous swelling of the left lower extremity. For comparison, an ascending radionuclide venography by intravenous injection of Tc-99m MAA (IV-RNV) was also done. The SC-RNV showed normal venous drainage of the right side but complete obstruction of the left popliteal vein with a prominent collateral flow, compatible to the findings of IV-RNV. The findings in this case again demonstrated that SC-RNV may be useful as an alternative method of venography as previously suggested.
Acupuncture Points↗
Pericardial mesothelioma with intracardiac invasion into the right atrium.
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Heart Atria↗
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↗
Erythrocyte Ca2+ pump is defective during sepsis.
Saturated Ca2+ extrusion rate through the Ca2+ pump of erythrocytes was determined by the cobalt-exposure method in normal subjects and septic patients. From 48 normal subjects, the value of Vmax of erythrocyte Ca2+ pump was 14.83 +/- 0.49 mmol/L cells/hr; from 29 sepsis patients, it was 9.49 +/- 0.59 mmol/L cels/hr, significantly (P < 0.001) lower than that from the erythrocytes of normal subjects. When the severity of sepsis was evaluated by the septic severity score (SSS), a significant correlation (P < 0.0001) was observed between the Vmax of Ca2+ pump and the patient's SSS, indicating that the inhibition of Ca2+ pump depended on the degree of the pathological development of sepsis. Since the ATP-dependent Ca2+ transport in rat liver plasma membrane is also reduced during the late stage of sepsis [Lau et al., Circ Shock 38:238-244, 1992], impairment of the activity of Ca2+ pump appears to have a general pathophysiological significance in the development of severe sepsis.
Adenosine Triphosphate↗
[Cholangiocarcinoma with mucobilia].
Mucobilia is a rare condition, with copious mucus secretion within the extrahepatic bile ducts resulting in obstructive jaundice and cholangitis. Fifteen patients with mucobilia were treated over an 11 year period. Preoperative study included ultrasonography (15), cholangiography (15), liver scanning (2) and computed tomographic (CT) scanning (1). The diagnosis was made preoperatively in 26.6% (4/15) of the patients. The preoperative diagnosis was based on 1) mucinous substance draining out from the papilla after endoscopic cannulation or percutaneous transhepatic biliary drainage fistula 2) multiple amorphous filling defects of the bile duct on cholangiograph 3) biliary duct dilatation with an intrahepatic or liver tumor on image study (sonography or CT scan). The etiology of mucobilia was papillary cholangiocarcinoma in 10 patients, biliary cystadenocarcinoma in three patients, and cystadenocarcinoma of the liver in another two. Intraoperative choledochoscopy revealed an intrahepatic biliary tumor in seven patients, intrahepatic duct stricture or obliteration in six and normal findings in another two. Surgical treatment of the 15 patients included left hepatectomy with choledochotomy in eight and choledochotomy with tumor biopsy in another seven patients. One patient died after T-tube drainage due to septic shock for a 6.6% mortality rate. Postoperative follow-up revealed the continuous drainage of a mucinous substance from the T-tube fistula receiving regular choledochoscopic irrigation in six patients. Four cholangiocarcinoma patients with mucobilia were effectively controlled by external radiation and intraluminal radiation therapy. The overall survival time ranged from 9 months to 11 years 6 months (mean, 46 months). Three patients (20%) are still surviving more than 5 years post diagnosis.
Aged↗
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↗
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↗