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Biomedical subjects

M J Hsieh

Publications and source records attributed to M J Hsieh.

69 records · Page 4Linked to original sources
PubMed1993

Gastro-pleural fistula related with penetrating stab injuries of the chest and abdomen: laparotomy or thoracotomy.

A 30-year-old male presented with left side empyema due to gastro-pleural fistula following repair of penetrating stab injuries of left lower chest and abdomen. Exploratory thoracotomy was done due to persistent moderate amount of purulent discharge. However, fistula tract was not detected through this approach. The small fistula tract was repaired finally through laparotomy. We recommended the abdominal approach if the disease is not combined with diaphragmatic hernia. Transabdominal approach showed superiority in this rare entity.

Abdominal Injuries↗
PubMed1993

Gastrojejunal disconnection in the presence of purulent peritonitis as an alternative approach in gastroduodenal operations.

A two stage operation is presented, for example, a life-saving procedure that halts further leakage and drainage of abscess by a modification of the gastrojejunal disconnection and reconstruction. It may be considered as an alternative approach in gastroduodenal operations in the presence of purulent peritonitis, especially in delayed surgical treatment.

Duodenum↗
PubMed1992

One-stage operation for treatment after delayed diagnosis of thoracic esophageal perforation.

Perforation of the thoracic esophagus can be fatal unless diagnosed promptly and treated effectively. The high mortality with delayed treatment is due principally to an inability to effectively close the perforation and prevent leakage. From 1982 to 1988, 7 consecutive patients (aged 16 to 73 years) were treated after a delayed diagnosis (26 hours to 25 days) of thoracic esophageal perforation. In all patients, the perforation was closed after debridement with total exclusion of the esophagus (T-tube cervical esophagostomy plus absorbable ligatures applied to the esophagogastric junction and the cervical esophagus distal to the esophagostomy). Radical decortication and wide mediastinal and pleural drainage were also done. Nutritional supply was given through a feeding gastrostomy. Antibiotics were administered according to the results of cultures. All patients survived. Continuity of the esophagus was established by removal of the T tube and spontaneous absorption of the ligatures. Endoscopy and esophagography performed 4 weeks after the initial operation showed a well-healed esophagus without stenosis or leakage in all patients. No secondary thoracotomy or esophageal reconstruction was necessary. No dysphagia was noted during follow-up (range, 12 to 50 months; mean follow-up, 23 months). We conclude that primary closure of the perforation and total esophageal exclusion with the use of absorbable ligatures and T-tube esophagostomy can provide a one-stage operation with good results for repair of thoracic esophageal perforation diagnosed late.

Adolescent↗
PubMed1992

Carcinosarcoma of esophagus. Report of one case and review of the literature.

Esophageal carcinosarcoma is a rare malignant tumor. The tumor is composed of both carcinomatous and sarcomatous elements. The multiple designations of names such as pseudosarcoma, pseudosarcomatous carcinoma, polypoid carcinoma etc. reflect the controversy on the nature of sarcomatous component of this lesion. We report a case of carcinosarcoma of esophagus occurred in a 67 year old male with progressive dysphagia. Esophageal polypoid tumor was found by endoscopy and was resected by esophagectomy. Carcinosarcoma was proved by demonstrating both carcinomatous and sarcomatous components in the tumor. Immunohistochemical studies revealed positive keratin stain in the sarcomatous area and positive vimentin stain in the sarcomatous area. The tumor was reported to have a better prognosis than that of the squamous cell carcinoma of esophagus in the literatures, especially in the survival rate.

Aged↗
PubMed1992

[Valve replacement for aortic stenosis].

We retrospectively reviewed 122 consecutive patients with aortic stenosis from January 1977 to December 1990. There were 68 male and 54 female patients. Their age ranged from 5 to 73 years old (47 +/- 16, mean +/- SD). Sixty eight patients also had associated mitral valve lesion, 13 patients had tricuspid valve lesion, and 3 patients had coronary artery disease. Aortic valve replacement was performed on all patients. Mechanical valves were implanted in 86 cases and tissue valves in 36 cases. Associated procedures were performed in 54 cases: mitral valve replacement in 34 cases, mitral valve repair in 18 cases and coronary artery bypass grafting in 2 cases. A bicuspid aortic valve was found in 20 cases (16.4%). Hospital mortality was 4.9% (6 cases). Follow-up was completed in 95% of the surviving cases (110 cases). The survival rate was 82 +/- 3% at 13 years and redo-free rate was 73 +/- 8% at 13 years. Seven cases required redo operation, due to tissue valve degeneration in 5 and thrombosis of the mechanical valve in 2. All 7 patients survived. Late death occurred in 6 cases: 3 from malignancy, 2 from stroke and 1 from ventricular arrhythmia. We concluded that valve replacement for aortic stenosis is a safe and satisfactory procedure with good long-term results.

Adolescent↗
PubMed1992

[Migration of Kirschner wire from the right sternoclavicular joint into the main pulmonary artery. A case report].

The use of Kirschner wires (K-wires) for bone and joint fixation carries the risk of migration of the wire from the fixation site over time. However, review of the literatures disclosed rather few reports on this issue. We describe such a case in order to emphasize the potential complication and serious hazard that migration of such metallic devices can result in, especially when the fixation site is close to the thoracic cavity.

Adult↗
PubMed1990

[Construction of a computerized database for gastric cancer patients].

Gastric cancer is one of the most frequent malignant diseases in Taiwan. However, the result of treatment was poor. Since two years ago, we adopted the 'extended radical operation' for gastric cancer, in order to improve the post operative survival of patients with gastric cancer. For evaluating the results and prognosis, we used microcomputer and commercial software to design a computerized database for gastric cancer. The whole system includes three main operations. (1) Basic File Maintenance. (2) Data Analysis and Statistics. (3) Follow-up Data Managements. The operation is under Chinese system with pull-down menu and on-screen help. Rapid and accurate data analysis are the main advantages, and automatic plotting of data to bar/line chart is one of the characteristics by using this computerized database. Other characteristics include error-trapped function, item coding and data transformation.

Adult↗
PubMed1989

Use of a total wash-out method in an open heart operation.

Pathological cold agglutinins may induce hemolysis in patients who need hypothermic cardiopulmonary bypass and blood transfusion. A simple technique, termed the total wash-out method, was used in a patient with high thermal amplitude, moderate-titer cold agglutinin before hypothermic cardiopulmonary bypass. The patient's cold agglutinin titer decreased abruptly after operation. None of the preoperative hemolysis phenomena were found during her 6 months of follow-up.

Agglutinins↗
PubMed1984

Jaundice after open heart surgery: a prospective study.

One hundred and fifty four consecutive adult patients having cardiac surgery for a variety of cardiac lesions were evaluated prospectively for postoperative jaundice, those with a raised preoperative serum bilirubin concentration (greater than 34 mumol/l or 2 mg/100 ml) being excluded. The incidence of early postoperative jaundice, as defined by a serum bilirubin concentration of 50 mumol/l (3.0 mg/100 ml) or greater, was 23.4%. The jaundice was mild (bilirubin concentration 51-100 mumol/l (3.0-6.0 mg/100 ml] in 26 patients (16.9%) and moderate to severe (greater than 100 mumol/l (6.0 mg/100 ml] in 10 patients (6.5%). Important contributing factors were the preoperative severity of right heart failure (raised right atrial pressure at heart catheterisation) and hypotension or hypoxaemia and the amount of blood transfused during or shortly after surgery. Age, sex, underlying cardiac lesion, whether halothane was used, operative procedure, duration of cardiopulmonary bypass, and presence or absence of hepatitis B surface antigen were not predictive of postoperative jaundice.

Adolescent↗
PubMedDate not supplied

Anomalous systemic arterialization to normal basal segments of the left lower lobe: helical CT and CTA findings.

PURPOSE: The purpose of this work was to evaluate the helical CT and CT angiography (CTA) findings of anomalous systemic artery (ASA) to the basal segments of the left lower lobe (LLL). METHOD: Three patients (two had hemoptysis, one was asymptomatic) with blotchy nodular density in the LLL revealed on chest radiographs underwent helical CT and CTA. Bronchoscopy was performed in two of these patients. Angiography and surgery were performed in one patient. RESULTS: All three patients demonstrated characteristic helical CT and CTA findings including 1) a sigmoid-shaped ASA originating from the lower descending thoracic aorta, with a distal bulbous configuration and four arterial branches supplying the basal segments of the LLL; 2) absence of an interlobar pulmonary artery or presence of a small artery lateral to the truncus basalis; 3) engorged vascular markings in the basal segments of the LLL; and 4) normal tracheobronchial tree and lung parenchyma. CONCLUSION: The findings in the present three cases suggest that the use of invasive studies such as angiography or bronchoscopy may be obviated in the diagnosis of ASA to the LLL because diagnosis can be provided through a clear set of criteria on helical CT and CTA.

Adult↗