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Biomedical subjects

S T Fan

Publications and source records attributed to S T Fan.

At least 181 records · Page 10Linked to original sources
PubMed1996

Laparoscopic cholecystectomy for acute cholecystitis in the elderly.

This study reviewed the results of laparoscopic cholecystectomy for acute cholecystitis in the elderly. Among 557 patients who underwent laparoscopic cholecystectomy, 70 (12.6%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. There were 28 men and 42 women with a mean age of 59.9 years (range 20-87 years). Thirty patients >/= 65 years of age were compared to 40 patients < 65 years old. Elderly patients had a higher female predominance (p < 0.05), a higher incidence of intercurrent diseases (p < 0.05), and a higher serum urea level (p < 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%;p < 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation (p < 0.05) and resumption of normal diet (p = 0. 08) with resulting prolonged postoperative (p = 0.08) and total hospital stay (p < 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.

Acute Disease↗
PubMed1996

Cutaneous stoma in the roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy): useful access for intrahepatic stone extraction.

A cutaneous stoma in the Roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy) was used for stone extraction in two children who had hepatolithiasis (14.5 and 15.5 years, respectively) after operation for choledochal cysts. In constructing the hepaticocutaneous jejunostomy, a short, straight proximal limb from the skin to the bilioenteric anastomosis is mandatory. It provides a pathway, superior to the T-tube tract, for repeated stone extraction, which can be performed under sedation, thus obviating repeat laparotomies. The stoma allows flexible choledochoscopy, balloon dilatation of intrahepatic duct strictures, and extraction of intrahepatic stones using grasping forceps, baskets, and balloons. The electrohydraulic lithotriptor may be applied to fragment larger stones.

Adolescent↗
PubMed1996

Combined laparoscopic and endoscopic approach in patients with cholelithiasis and choledocholithiasis.

BACKGROUND: The Optimal management of common bile duct stones in patients undergoing laparoscopic cholecystectomy remains controversial. METHODS: A prospective study was conducted in 145 of the 481 patients who had a preoperative endoscopic retrograde cholangiogram before their laparoscopic cholecystectomy. RESULTS: Endoscopic retrograde cholangiogram was successful in 138 patients (95%), and common duct calculi were found in 72 (50%) of them. Endoscopic sphincterotomy with ductal clearance was achieved in 62 of 67 patients during a mean of 1.4 sessions (range, 1 to 5). Five (3.4%) patients had complications after endoscopic intervention, all of which resolved uneventfully . Fourteen patients underwent laparoscopic common duct exploration, five had failed endoscopic extraction, five had their common duct stones left intentionally for laparoscopic intervention, and, in addition, four of the seven patients who had a failed endoscopic retrograde cholangiogram had stones identified by intraoperative cholangiogram. Ten of these 14 patients underwent a successful laparoscopic common duct exploration. Laparoscopic cholecystectomy was successfully completed in 134 of the 145 patients, and none had major intraoperative or postoperative complications. The mean postoperative stay was 2.7 days for those patients who underwent a successful laparoscopic procedure. The overall mean number of admissions for completing the treatment was 2.3. CONCLUSIONS: Combined laparoscopic and endoscopic approach is a viable option for patients with gallstones and choledocholithiasis.

Adult↗
PubMed1996

Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.

OBJECTIVE: The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. SUMMARY BACKGROUND DATA: Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results. METHOD: Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment. RESULTS: The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001). CONCLUSIONS: Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming, this procedure provides the economic advantage of a markedly reduced total hospital stay.

Acute Disease↗
PubMed1996

[Liver transplantation report of 23 cases].

OBJECTIVE: To explore the experience of liver transplantation in patients with terminal liver failure. METHOD: From October 1991 to July 1995, 17 adults and 6 children underwent orthotopic liver transplantation. Preoperative diagnosis showed biliary atresia (n = 5), Alagille syndrome (n = 1), primary biliary cirrhosis (n = 2), cryptogenic cirrhosis (n = 2), alcoholic cirrhosis (n = 4), Wilson's disease (n = 1), fulminant hepatic failure (n = 3), polycystic liver (n = 2), secondary biliary cirrhosis (n = 1), hepatitis B cirrhosis (n = 1), and autoimmune hepatitis associated with a small hepatocellular carcinoma (n = 1). One paediatric patient suffered from hepatitis of unknown aetiology which progressed to liver failure after liver transplantation. She received retransplantation using a living graft from her mother. The liver grafts were obtained from 17 brainstem dead donors and 7 living donors. RESULTS: The overall patient survival rate was 92% and graft survival rate was 88%. There were only 2 deaths, one was due to primary graft nonfunction and the other was due to persistent graft rejection not responding to pulse steroid and OKT3. The other patients are alive and well. CONCLUSIONS: Liver transplantation is a feasible and viable treatment for patients with terminal liver failure in Hong Kong. The only limitation is lack of brainstem dead donor. Promotion of concept of brainstem death and organ donation in the society is the key to wide use of liver transplantation for patients with terminal liver failure in Asia.

Adult↗
PubMed1995

Prognostic significance of pathologic features of hepatocellular carcinoma. A multivariate analysis of 278 patients.

BACKGROUND: In patients with hepatocellular carcinoma, surgical resection may offer a chance of cure. However, tumor recurrence is not infrequent after resection. METHODS: To identify the pathologic factors that are of prognostic significance and predictive value in tumor recurrence, the authors studied 278 patients (243 men, 35 women) who had hepatectomy for hepatocellular carcinoma. Disease free and actuarial survival were correlated with 20 pathologic parameters of the resected specimens using multivariate analysis. RESULTS: The median follow-up period was 23.6 months. The overall disease free survival rates at 1, 3 and 5 years were 42%, 23%, and 17%, respectively, and the overall actuarial survival rates for the corresponding time periods were 70%, 39%, and 28%, respectively. The results indicated that tumor encapsulation (P = 0.004) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors related to tumor recurrence. Negative resection margins (P = 0.001) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors correlated with survival. CONCLUSIONS: From this analysis, it was determined that detailed histologic examination of resected specimens of hepatocellular carcinoma is important in assessing long term prognosis and stratification of patients for treatment.

Actuarial Analysis↗
PubMed1995

Integrin regulation of an inflammatory effector gene. Direct induction of the tissue factor promoter by engagement of beta 1 or alpha 4 integrin chains.

Inflammatory genes are regulated in cells of monocyte (Mo) lineage by a variety of cellular encounters, including adhesion mediated by integrins. The role of the beta 1 family of integrins in the direct induction of immediate early gene expression was analyzed by using the tissue factor (TF) gene. Engagement of alpha 4 or beta 1 on Mo, but not members of the beta 2 integrin family, with specific mAbs as surrogate ligands immediately and directly induced high level surface expression of TF, and accumulation of TF mRNA, as well as production of TNF-alpha and HIV-1 virus. The mechanism responsible for induction of TF gene transcription mediated by the engagement of alpha 4 or beta 1 was elucidated by using THP-1 monoblastic leukemia cells. Functional analysis of plasmids containing the TF promoter expressing the luciferase reporter gene identified a cis-acting integrin-responsive element (InRE), which contained two AP-1 sites as well as a single kappa B-like site. Mutation of either the AP-1 sites or kappa B-like site greatly diminished responsiveness to integrin engagement. This InRE also conferred responsiveness to a heterologous promoter in the same reporter plasmid. Binding of mAbs to either alpha 4 or beta 1 led to nuclear translocation of the c-Rel/p65 heterodimer that preferentially bound to the TF kappa B-like site. In contrast, constitutive binding of AP-1 proteins to the two AP-1 sites was not increased by alpha 4 or beta 1 integrin engagement. These studies expand knowledge of integrin regulation of immediate early gene expression in Mo and molecular encounters that are inferred to play an active role in Mo effector functions.

Base Sequence↗
PubMed1995

Better survival in female patients with hepatocellular carcinoma. Possible causes from a pathologic approach.

BACKGROUND: Hepatocellular carcinoma is notably more prevalent in men than in women. METHODS: To examine the sex-related characteristics of patients with primary hepatocellular carcinoma, 35 women were compared with 243 men, both groups having undergone surgical resection of the tumor. RESULTS: Women had a lower incidence of tumor recurrence, with median disease free survival of 19.5 months compared with 4.5 months for men (P < 0.001). Women also had more favorable actuarial survival than men [36.5 months for women compared with 12.4 months for men (P = 0.002)]. Women had a significantly higher incidence (80%) of tumor encapsulation than men (45%) (P < 0.001). Furthermore, the tumors in women were frequently less invasive in terms of lower incidence of tumor microsatellites, liver invasion, and positive histologic margin. Tumor microsatellite formation was present with 16% of tumors in women, compared with 60% for men (P < 0.0001). Liver invasion was found in 37% of tumors in women and 61% in men (P = 0.03). Only 6% of tumors in women had a positive histologic margin, compared to 24% in men (P = 0.04). There was no statistical significance in the incidence of cirrhosis in the nontumorous liver, hepatitis B surface antigen positivity, mean age, or tumor size, between women and men. CONCLUSIONS: Women who had hepatocellular carcinoma and hepatic resection had better survival rates and a lower rate of tumor recurrence than male patients. The better prognosis in women with hepatocellular carcinoma appeared to be related to the pathobiologic characteristics of the tumor (i.e., frequent encapsulation and lower tumor invasiveness).

Adult↗
PubMed1995

Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis.

OBJECTIVE: To define the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality. DESIGN: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survey was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994. SETTING: A tertiary referral center. PATIENTS: The preoperative, intraoperative, and postoperative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected. INTERVENTION: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. MAIN OUTCOME MEASURE: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy. RESULTS: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P = .01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was the cutoff level that could maximally separate the patients with cirrhosis with and without mortality. CONCLUSION: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

Adult↗
PubMed1995

Ki-67 antigen expression in hepatocellular carcinoma using monoclonal antibody MIB1. A comparison with proliferating cell nuclear antigen.

To evaluate the prognostic significance and clinicopathologic correlation of proliferative activity in patients with hepatocellular carcinoma, Ki-67 antigen expression was examined using immunohistochemical staining with monoclonal antibody MIB1. Seventy-two patients (65 men, 7 women; age range 24-77 years, mean, 52 years) having hepatocellular carcinoma surgically resected were studied. Tumor and nontumorous tissues were stained with monoclonal antibody MIB1 with microwave oven pretreatment. Tumor and nontumor MIB1 (T-MIB1 and NT-MIB1) scores were assessed by counting the positive staining nuclei per 1,000 cells. The T-MIB1 score ranged from 5-630 per 1,000 cells (mean +/- standard deviation [SD] = 145 +/- 162). It was found to be significantly higher in less well-differentiated tumors (Edmondson's grades III and IV) than in well-differentiated ones (Edmondson's grades I and II) (P = .017). The T-MIB1 score was also higher in nonencapsulated tumors than in encapsulated ones, although it did not reach statistical significance (P = .069). It had no influence on tumor size, tumor invasiveness, the background disease in the nontumorous livers, patients' HBsAg status, or serum alpha-fetoprotein levels. Diseases in the nontumorous livers or patients' HBsAg status had no influence on the NT-MIB1 scores. When the tumors were stratified into two groups with T-MIB1 score < or = 20 and T-MIB1 score > 20, those patients with score < or = 20 had significantly longer disease-free survival (DFS) than those with scores > 20 (median DFS: 34 months and 4.7 months, respectively; P = .011). In addition, MIB1 and PCNA were closely correlated (P < .01). The authors conclude that proliferative activity in hepatocellular carcinoma, as defined by MIB1 immunohistochemical analysis, is significantly related to tumor cellular differentiation. It is also a potentially valuable prognostic factor in patients with this tumor.

Adult↗
PubMed1995

Hepatic resection for hepatocellular carcinoma. An audit of 343 patients.

OBJECTIVE: The authors summarize the results of patients who had hepatectomy for hepatocellular carcinoma over a 22-year period. SUMMARY BACKGROUND DATA: Recent reports showed improved perioperative results and long-term prognosis. METHODS: The perioperative outcome of 343 patients was studied according to three different time periods: before 1987 (n = 149); 1987 to 1991 (n = 128); and 1992 to present (n = 66). Survival analysis was made by stratifying patients into two categories--either before or after 1987. The majority of patients had large tumors (78%), cirrhosis (73%), and a major hepatectomy (73%). RESULTS: Besides an increased resectability rate (23%), there was a marked reduction of the recent morbidity (32%; p < 0.001), operative (4.5%; NS) and hospital (6%; p < 0.02) mortality rates. The recent surgical approach was identified as a significant contributory factor to the lowered hospital mortality rate. Patients in the latter part of the study had significantly better survival, with a 1-, 3- and 5-year survival rate of 68%, 45%, and 35%, respectively. Early detection and effective treatment of recurrences contributed to the improved prognosis. CONCLUSIONS: The recent management strategy and technological advances improved the results of surgical treatment for patients with hepatocellular carcinoma.

Adult↗
PubMed1995

Case report: variable imaging appearances of angiomyolipomas of the liver.

Angiomyolipomas of the liver are rare benign tumours. We describe the variable imaging appearances of these tumours in three women. The first two patients underwent ultrasound, computed tomography (CT) and angiography, which demonstrated lesions resembling focal nodular hyperplasia and hepatocellular carcinoma, respectively. Both had histologically-proven liver angiomyolipomas surgically resected. The third patient was incidentally found to have typical features of multicomponented liver angiomyolipoma on CT. Variable proportions of fatty tissue in these tumours are the most likely explanation for their different imaging appearances on CT.

Adult↗
PubMed1995

Primary lymphoma presenting as intra-abdominal mass and obstructive jaundice.

We reported a 67-yr-old man presenting with right hypochondrial pain, obstructive jaundice, and hepatic hilar mass. Biliary stenting relieved the jaundice. Percutaneous aspiration cytology of the mass was suspicious of lymphoma. He had no evidence of the disease, including lymphadenopathy, elsewhere in the body. Excision of the mass en bloc with cholecystectomy and right hemicolectomy confirmed the diagnosis of B-cell lymphoma. The patient recovered uneventfully and received nine courses of systemic chemotherapy afterward. Up to the time of writing, the patient remained disease-free 20 months after the initial presentation. This is the first case report of a primary lymphoma arising in and remaining localized to the hepatic hilar region. Moreover, it illustrates the importance of obtaining tissue diagnosis in patients with malignant jaundice.

Abdominal Neoplasms↗
PubMed1994

Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma.

BACKGROUND: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma. METHODS: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty-four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched-chain amino acids, dextrose, and lipid emulsion (50 percent medium-chain triglycerides) given intravenously for 14 days perioperatively. RESULTS: There was a reduction in the overall postoperative morbidity rate in the perioperative-nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg, P = 0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (-2.8 percent vs. -4.8 percent at 20 minutes, P = 0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatectomy. There were five deaths during hospitalization in the perioperative-nutrition group, and nine in the control group (P not significant). CONCLUSIONS: Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.

Adult↗