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Biomedical subjects

M K Li

Publications and source records attributed to M K Li.

At least 37 records · Page 2Linked to original sources
PubMed1999

Clinics in diagnostic imaging (38). Post-ESWL perinephric haematoma.

A 57-year-old man presented with urosepsis related to urinary calculi. He underwent multiple sessions of ESWL and developed a perinephric haematoma that was treated conservatively and monitored by serial imaging. However, the haematoma became infected, necessitating percutaneous drainage 2 months after the initial ESWL. The risk factors and sequelae of post-ESWL perinephric haematoma, as well as its diagnosis and imaging, are discussed.

Abscess↗
PubMed1999

Preliminary results of heart-beating and non-heart-beating donor kidney transplants--the Singapore experience.

Renal transplantation is the ideal renal replacement therapy for treatment of end stage kidney failure but its limitation is the constant shortage of cadaveric donors. While the traditional source of cadaveric kidneys is procurement from heart-beating donors, organ procurement from non-heart-beating donors (NHBD) would help in coping with the rising demand for organs. However various important legal, logistic and technical constraints have limited the implementation of such a procurement programme. Nevertheless, prolonged warm ischaemic times in procuring kidneys from NHB donors may affect the viability of these organs and adversely affect overall outcome after transplant. Fifty-three consecutive patients who underwent renal allotransplantation (Tx) between January and December 1994 at the Singapore General Hospital were retrospectively reviewed. Outcomes after renal transplantation among 25 heart-beating donor (HBD) and 28 NHBD were compared. Despite significant differences in donor age (23.7 +/- 11.0 and 34.1 +/- 7.9, P = 0.001), first warm (0 and 22.2 +/- 9.0 minutes) and cold ischaemic times (12.8 +/- 6.7 and 5.2 +/- 5.0 hours, P = 0.001) between the HBD and NHBD groups, the two-year patient and graft survivals were very similar in both groups (100% versus 98% and 98% versus 96%). The incidence of delayed graft function (DF) was also comparable between the HBD (41%) and the NHBD (50%) Tx. These results suggest that NHBD is a viable source for kidney transplants and comparable patient and graft survivals can be achieved if the first warm and cold ischaemic times are kept to the minimum.

Adolescent↗
PubMed1999

Inferior vena cava thrombectomy for renal cell carcinoma with thrombus.

Up to 10% of patients with renal cell carcinoma have intracaval neoplastic extension. The results of nephrectomy and caval cavotomy to remove the renal tumour and caval thrombus were reviewed. From September 1991 to October 1997, 16 consecutive patients (13 males, 3 females) with a mean age of 59 years (range 45 to 75 years) underwent radical nephrectomy together with cavotomy and thrombectomy (15) or caval resection (1). The tumour thrombi extended to the infrahepatic vena cava in 9 patients, intrahepatic cava in 5 and suprahepatic cava in 2. The surgical approaches included abdominal (8), right thoraco-abdominal (5) and abdominal with median sternotomy (3), respectively; cardiac bypass was not required. The mean cava clamp time was 15 minutes and the average operative time was 127 minutes (range 70 to 190 minutes). There was no operative mortality but the complication rate was 31%. The mean hospital stay was 12 days (range 7 to 23 days). Ten patients had Robson's stage IIIa disease, 4 had stage IIIc disease and 2 had stage IV disease. During a mean follow up of 20 months (range 1 to 54 months), 6 patients were alive with no recurrence and 10 patients had died of the disease. The survival of stage IIIa patients was significantly better than stage IIIc and IV patients. In summary, caval thrombectomy is associated with acceptable operative morbidity and mortality; however, advanced staged disease dictates a short survival.

Aged↗
PubMed1999

Renal cell carcinoma in patients with chronic renal failure.

It has been found that patients suffering from chronic renal failure (CRF) are prone to develop acquired cystic kidney disease, which may subsequently lead to the development of renal cell carcinoma (RCC). We reviewed 250 consecutive cases of RCC diagnosed between January 1990 and June 1998 in our department and found 19 had associated CRF (7.6%). Their clinical presentation, mode and duration of dialysis, diagnostic evaluations, pathological stage and surgical outcome were reviewed. Sixteen had CRF with chronic glomerulonephritis and 3 with adult polycystic kidney disease. Three patients were on continuous ambulatory peritoneal dialysis (CAPD), 5 were on haemodialysis (HD) and 3 had renal transplant (2 on HD, 1 on CAPD previously). The remaining 8 patients were not on renal replacement therapy at the time of diagnosis. Ten patients were asymptomatic with incidental radiological findings while 9 had specific urological symptoms, most commonly haematuria. Ultrasonography (USG) and computed tomography (CT) scan were the main modalities of imaging employed. Nine out of the 10 asymptomatic patients had suspicious lesions detected incidentally by USG. All had subsequent preoperative CT scans confirming the presence of these lesions. All patients had single focus RCC except for 1 with multi-focal disease involving both kidneys. Sixteen patients had early stage (T1 or T2) and low grade (G1 or G2) RCC. The remaining 3 patients had advanced stage (T3a or T3b) and high grade (G3) tumours. Since half of the patients were asymptomatic, USG may be a useful tool in the outpatient review of patients with CRF and allow early diagnosis and surgical treatment of early stage, low-grade tumours and therefore may have better survival.

Carcinoma, Renal Cell↗
PubMed1998

Potassium channels participate in gastric mucosal protection in rats with partial portal vein ligation.

Glybenclamide, an adenosine triphosphate-dependent potassium (K+(ATP)) channel blocker, lowered portal pressure and attenuated the hyperdynamic splanchnic circulation in rats with partial portal vein ligation (PPVL). The purpose of this report was to confirm these observations and to test the hypothesis that glybenclamide could reduce acidified ethanol-induced gastric mucosal injury in rats with PPVL. Gastric mucosal blood flow (hydrogen gas clearance), systemic blood pressure, and portal pressure were monitored in rats with PPVL or sham operation (SO). Intravenous glybenclamide (20 mg/kg) or vehicle was administered, followed by intragastric acidified ethanol (0.15 N HCl and 15% ethanol). The area of gastric mucosal lesions was assessed by image analysis. In contrast to published findings, there was no significant elevation of portal pressure after glybenclamide administration in rats with PPVL. Glybenclamide did not alter the gastric mucosal hyperemia in these rats. Glybenclamide significantly increased mucosal injury. The data are consistent with the hypothesis that K+(ATP) channels play a role in protecting the gastric mucosa in rats with PPVL.

Animals↗
PubMed1998

Quantitative analysis on the localization of chondroitin sulfate proteoglycan in renal tissues of patients with calcium nephrolithiasis.

Previous studies have shown a significant decrease of heparin sulfate proteoglycan (HSPG) in the basement membrane of the glomerulus and the mucosa of the ureter/renal pelvis in patients with calcium nephrolithiasis. In this study, we looked at the localization of another influential proteoglycan, chondroitin sulfate (CSPG), using similar study groups by indirect immunofluorescence staining. Microscopic images were digitized and image analysis was used to quantitate the staining intensity of CSPG present in the basement membrane of the nephron. Our data showed significant loss of CSPG in the Bowman's capsule and the basement membrane of the mucosa of the ureter/renal pelvis using Mann-Whitney U-Wilcoxon Rank Sum W test with P-values of 0.0043 and 0.0041, respectively. However, absence of staining was noted in the basement membrane of the glomerulus and no significant change in the basement membrane of the tubular epithelium was observed. In conclusion, our results showed changes in the localization of CSPG in the basement membrane of the nephron, accompanied with HSPG, which may contribute to the pathological condition of calcium nephrolithiasis.

Adult↗
PubMed1998

Laparoscopic gastropexy for chronic gastric volvulus.

Gastric volvulus is an infrequently encountered clinical entity characterized by abnormal rotation of the stomach around an axis made by its two fixed portions, the cardia and pylorus. Surgical treatment by anterior gastropexy is usually indicated for chronic gastric volvulus to prevent complications and treat the underlying pathology. We report a patient with chronic gastric volvulus who was treated with laparoscopic anterior and diaphragmatic gastropexy. Laparoscopy not only identifies underlying predisposing conditions but also allows effective fixation for gastric volvulus. Laparoscopic approach minimizes the access trauma and is superior for benign upper gastrointestinal lesions.

Adult↗
PubMed1998

Long-term follow-up of transurethral microwave thermotherapy.

OBJECTIVES: To evaluate the long-term results of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) with up to 5 years of follow-up at our institution. METHODS: From October 1991 to November 1993, 106 patients were treated for BPH with TUMT using the Prostatron 2.0. Of the 106 patients, 64 were available for evaluation of symptoms (Madsen-Iverson score), uroflow, residual urine, and retreatment rate at a mean follow-up of 50+/-5.4 months (mean+/-SD). RESULTS: The mean age of the patients was 65.2+/-9.8 years. Thirty-two patients (50.0%) were treated with one session of TUMT. Additional treatments were required for 32 patients (50.0%). Three patients had two sessions of TUMT, 14 underwent transurethral resection of prostate, and 3 had laser prostatectomy. Twelve patients received medical therapy. The mean symptom score decreased significantly from 12.9+/-2.5 to 5.7+/-3.6 (P = 0.001). The mean peak flow rates and postvoid residual volume showed little difference before and after TUMT. On the basis of the criteria described by Poincelet and Cathaud the overall clinical efficacy rate was 39.1% (15.6% complete response and 23.5% partial response). No obvious clinical parameter was useful to predict favorable outcome after TUMT. CONCLUSIONS: The present study showed that the efficacy rate of TUMT with the Prostatron 2.0 at 50 months was 39.1 %. None of the preoperative clinical factors was predictive of a favorable outcome.

Aged↗
PubMed1998

The impact of a modified ileal neobladder on the lifestyle and voiding patterns in Asian patients.

OBJECTIVE: To evaluate the impact of the modified ileal neobladder reconstruction on lifestyle, voiding habits and functional outcome in Asian patients. PATIENTS AND METHODS: Twenty-seven Asian patients (25 men and two women, mean age 59 years, range 41-76) underwent modified ileal neobladder reconstruction after radical cystectomy for carcinoma of the bladder. The mean (range) follow-up was 21 (3-75) months. All patients were evaluated retrospectively using case notes, reviews, interviews and voiding charts; 18 patients underwent urodynamic studies. RESULT: Twenty-five patients (93%) achieved diurnal and 23 (85%) nocturnal continence within 6 months. Of the 19 patients who were in employment before surgery, 15 continued to be economically active afterward; 26 patients (96%) reported no change in their daily living activities. Of 16 men who reported being potent pre-operatively only four retained some residual erectile function. Twenty-three patients were interviewed about their voiding habits and satisfaction with the outcome of surgery. Fourteen patients had no sensation of reservoir fullness and of the 21 men, 13 had to squat or sit to void effectively. The mean (range) voiding frequency was 5 (4-8) during the day and 2 (0-4) during sleep. Twenty-two patients were satisfied with the overall outcome. CONCLUSIONS: The modified ileal bladder provides a high urinary continence rate with minimal changes in daily living activities and occupational status. The functional outcome was very satisfactory and accepted well, despite some changes in reservoir sensation, voiding posture and erectile function. The method is a viable option for reconstruction after cystectomy in Asian patients.

Adult↗
PubMed1998

Idiopathic retroperitoneal fibrosis with bilateral lower ureteric obstruction--a case report with literature review.

Whilst prostatic enlargement remains the commonest cause of bilateral hydronephrosis in males greater than 50 years of age, other rarer conditions such as retroperitoneal fibrosis should be borne in mind. We report a case of bilateral hydronephrosis which was eventually diagnosed as idiopathic retroperitoneal fibrosis and treated with open surgical ureterolysis with omental wrapping.

Aged↗
PubMed1998

Repair of complex ureterovaginal and vesicovaginal fistulas with ileal cystoplasty and ureteric reimplantation into an antireflux ileal nipple valve--a case report.

We report a case of a 59-year-old woman with bilateral ureterovaginal and vesicovaginal fistulas after radical total hysterectomy and bilateral salphingo-oophorectomy who failed transvesical repair of the vesicovaginal fistula. The bladder was extensively scarred, half of which had to be excised. This was replaced with an ileal cystoplasty with an antireflux ileal nipple valve into which the ureters were reimplanted. Continuity of the urinary tract was re-established without a urinary diversion or stoma.

Female↗
PubMed1997

Laparoscopic resection of bleeding gastric polyps.

Gastric polyps account for a small proportion of gastric neoplasms. Many of them presented with acute or chronic bleeding. Endoscopic polypectomy is the preferred treatment modality. However, endoscopic polypectomy is often incomplete and impossible for large polyps. Large and intramural polyps require laparotomy and excision. From June to October 1995, four patients with bleeding gastric polyps received laparoscopic resection in our unit. All were women, aged 40-78, with polyps 2-6 cm in diameter. One patient underwent emergency surgery for active bleeding. The others received elective operations. Operating time ranged from 90 to 120 min. There was no perioperative morbidity or mortality. Full diet was resumed by the 4th postoperative day. The average postoperative hospital stay was 5. 3 days (4-7). Laparoscopic resection of gastric polyp is a preferable treatment option when endoscopic treatment fails.

Aged↗
PubMed1997

A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissues after simultaneous oral ingestion.

OBJECTIVES: To determine the levels of two quinolones, ofloxacin and ciprofloxacin, potent broad-spectrum antibiotics with very good oral bioavailability and low minimum inhibitory concentrations (MICs) for most pathogens, in the prostates of patients who underwent transurethral resection of the prostate (TURP) after oral ingestion for surgical prophylaxis. PATIENTS AND METHODS: Twenty-eight patients with BPH requiring a TURP ingested 250 mg of both drugs 2-4 h before operation. The levels of the drugs in the serum and prostate were measured using high-performance liquid chromatography and the levels of both drugs determined at the 6 and 9 o'clock positions in the prostate to examine any local variations in drug concentration. RESULTS: Ofloxacin concentrations were significantly higher in the serum and prostatic tissues compared with ciprofloxacin for the same dose, but its penetrance into the prostate was lower. This mainly reflected its higher oral bioavailability. Both drugs were present in concentrations 50% higher at the 6 o'clock than at the 9 o'clock position but both exceeded the MICs for most Gram-negative organisms except Pseudomonas. CONCLUSION: Ofloxacin has the advantage against ciprofloxacin of exceeding the MICs for Staphylococcus and Chlamydia. However, ciprofloxacin has the advantage of having prostate-to-serum ratios of unity, but for the same dose the prostatic concentrations of ofloxacin is significantly higher.

Administration, Oral↗
PubMed1997

Single stitch laparoscopic omental patch repair of perforated peptic ulcer.

The standard treatment for perforated peptic ulcers in most institutions is omental patch repair and lavage. A laparoscopic approach is attractive because of the simplicity of the procedure. Most of the previously described laparoscopic methods required multiple working ports and multiple stitches. We employed three operating ports and applied a single stitch to close small peptic ulcer perforations. Prospective evaluations of the initial 33 cases of laparoscopic patch repair have confirmed its safety. There were five conversions, two for large perforations (> 10 mm), two for perforated gastric ulcers and the remaining one was converted because of bleeding. One patient early in the series with a 10-mm perforation suffered from radiological leakage after repair, which required secondary intervention. The mean operating time was 50 min. Patients, on average, require one dose of intramuscular pethidine (1 mg/kg body weight) for pain relief. The mean hospital stay was 6 days and 97% of them returned to their daily activities within 10 days of the operation. There was no mortality.

Adult↗
PubMed1997

Laparoscopic management of ruptured pyogenic liver abscess.

Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically. The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples. A thorough peritoneal lavage could be also performed. The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.

Aged↗
PubMed1997

Perceptions of effective clinical teaching behaviours in a hospital-based nurse training programme.

Clinical teaching behaviour is a critical determinant for quality clinical learning experiences of student nurses. It is believed that a better understanding of the perceptions of clinical teaching behaviours between student nurses and nurse educators will enhance clinical teaching. This study examined the perceptions of effective clinical teaching behaviours of nurse educators by student nurses (n = 81) and nurse educators (n = 10) in a hospital-based 3-year general nurse training programme in Hong Kong. Knox & Mogan's Nursing Clinical Teacher Effectiveness Inventory (NCTEI) (1985) was adopted. The respondents were asked to rate the importance of each discrete behaviour on a seven-point scale. It was found that there was greater agreement in the 10 most important behaviours than the 10 least important behaviours among the four groups: students, junior students, senior students and nurse educators. No statistically significant difference could be identified in the perceptions between the nurse educators and students as well as between the junior and senior students regarding the five behavioural categories. The nature and the student status of the nursing programme was accountable for most of the discrepancies between the findings of this study and those of past studies.

Adult↗