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Biomedical subjects

S T Fan

Publications and source records attributed to S T Fan.

At least 253 records · Page 14Linked to original sources
PubMed1988

Influence of age on the mortality from acute pancreatitis.

The influence of age on the mortality rate of 268 patients with acute pancreatitis was studied. The hospital mortality rate for patients aged below 50 years was 5.9 per cent. The figure increased to 21.3 per cent in patients aged over 75; the high mortality was accounted for by a higher incidence of deaths related to concomitant medical or surgical diseases in the same hospital admission rather than to complications resulting directly from the pathological process of acute pancreatitis. When only deaths due to complications of acute pancreatitis were analysed, the mortality rate was not significantly different between the young and elderly groups. Moreover, the complication rate and the proportion of patients having severe disease (judged by the number of prognostic signs) were not higher in the elderly. Thus acute pancreatitis was intrinsically not more serious were it not for the presence of concomitant diseases with advanced age.

Acute Disease↗
PubMed1988

Predictive value of surveillance skin and hub cultures in central venous catheters sepsis.

In a prospective study of septic complications of central venous catheters used for total parenteral nutrition, daily surveillance catheter hub cultures and twice weekly skin cultures at the catheter entry site were evaluated for their predictive value for catheter sepsis, i.e. bacteraemia with an identical species as that recovered from the catheter tip, or catheters which grew greater than or equal to 15 cfus by a semiquantitative method and/or greater than or equal to 10(3) cfus by a quantitative method. Of 142 catheters studied, 29 were identified to have catheter sepsis. For these the sensitivity of the surveillance hub culture was 34.5% and the sensitivity of the skin culture was 37.9%. When either the hub or the skin culture result was considered as an indication of catheter sepsis, the sensitivity increased to 79.3%. The positive and negative predictive value of the combined result was 44.2% and 93.3% respectively. This study suggests that simultaneous hub and skin cultures are required for a satisfactory surveillance.

Bacteria↗
PubMed1988

Limitations and dangers of gastrografin swallow after esophageal and upper gastric operations.

In a series of 135 patients who underwent esophageal and upper stomach surgery, the incidence of anastomotic leakage was 20.4 percent. One hundred four patients had either Gastrografin swallow or the methylene blue test to evaluate anastomotic integrity before resumption of oral feeding. Both tests were disappointing in that methylene blue failed to detect any case of leakage and Gastrografin swallow could only detect three cases of subclinical leakage. The high false-negative detection rate of Gastrografin swallow might be related to the inferior radiographic detail provided by this contrast medium. Aspiration of Gastrografin is potentially dangerous and could be fatal. We believe that barium sulfate, which provides better radiographic detail and is not so hazardous when aspirated, should be the contrast medium of choice.

Anastomosis, Surgical↗
PubMed1988

Influence of surgeons' experience on postoperative sepsis.

A prospective study was performed on 635 patients with appendicitis operated on by 7 trainees and 119 patients operated on by 6 senior surgeons with more than 8 years of surgical experience. In patients with normal appendices, postoperative sepsis was extremely low. For early and late appendicitis, the infection rates of the trainees decreased as experiences accumulated, but they were still higher than that of the senior surgeons. The difference in infection rates in acute appendicitis did not reach statistical significance between any of the training stages and between the various stages and the rate of the senior surgeons. The differences in infection rates in late appendicitis between stage 1 and stage 3 was significant, as was the difference in infection rates between stage 1 and the infection rate of the senior surgeons. Therefore, we have concluded that overall, the limited experience of trainees is related to the rate of postoperative sepsis in late appendicitis, although the infection rates of individual trainees vary a lot.

Appendectomy↗
PubMed1988

Once daily administration of netilmicin compared with thrice daily, both in combination with metronidazole, in gangrenous and perforated appendicitis.

The safety and efficacy of a single daily dose of netilmicin plus metronidazole after appendicectomy for gangrenous and perforated appendicitis was compared with the traditional thrice daily dosage. Twenty patients were enrolled in each group. The antibiotics were given intramuscularly for seven days after operation. Eradication of infection was observed in all patients and the postoperative wound sepsis was the same for each group. A significantly higher peak serum netilmicin level was achieved in the group receiving a single daily dose but nephrotoxicity was not observed. We concluded that the single daily dose of netilmicin was well tolerated and was as efficacious in this small series as the thrice daily regimen. The single-dose regimen has the advantage of simplicity and potentially increased bactericidal activity.

Adolescent↗
PubMed1988

Optimal irrigation pressures in operative choledochoscopy.

A prospective study was conducted on 20 consecutive patients who underwent elective exploration of common bile-ducts for stones to determine the optimal irrigation pressures in choledochoscopy. Ten patients had rigid choledochoscopy and 10 patients had flexible choledochoscopy. Choledochoscopic views were assessed at low irrigation pressure (irrigant delivered at hydrostatic pressure of 1 m of water or 80 mmHg) and high irrigation pressure (irrigant delivered at cuff pressure of 300 mmHg plus hydrostatic pressure of 80 mmHg). Choledochoscopic views were better with high than low irrigation pressures for rigid choledochoscopy. However, there was little difference in the views for flexible choledochoscopy. Common bile-duct pressures were measured with irrigant delivered at pressures 80-380 mmHg at intervals of 50 mmHg. With increasing irrigation pressures, the common duct pressures rose and they were consistently higher in flexible than rigid choledochoscopy. The common duct pressures in rigid choledochoscopy never exceeded the recommended safety limit, even at the high irrigation pressure of 380 mmHg. With flexible choledochoscopy, the common duct pressure was below the recommended safety limit only with low irrigation pressure of 80 mmHg. Therefore, it is recommended that a high irrigation pressure of 380 mmHg for rigid choledochoscopy and a low irrigation pressure of 80 mmHg for flexible choledochoscopy be used.

Common Bile Duct↗
PubMed1988

Acute pancreatitis in the aged.

Forty-seven patients aged more than 75 years with acute pancreatitis were studied. The most common cause of acute pancreatitis was biliary tract stones. The clinical presentation and severity of the disease as judged by the number of poor prognostic factors were not different from the group of patients aged less than 75 years. The mortality rate in the older group was thrice that of the younger group (21.3% versus 7.24%). The higher mortality rate was explained by a higher incidence of deaths related to complications of biliary stones and coincidental diseases. Significantly more aged patients with mild disease died, indicating the limitation of predictive ability of the scoring system in acute pancreatitis of the aged.

Acute Disease↗
PubMed1988

Healing of esophageal fistulas after surgical treatment for carcinoma of the esophagus and the upper part of the stomach.

In a series of 132 patients who had undergone surgical treatment for carcinoma of the esophagus and upper part of the stomach, anastomotic leakage occurred in 29. We retrospectively studied the factors that could influence the healing of the fistulas in the management of this condition. Despite adequate supportive treatment, including total parenteral nutrition, five patients died from unrelenting infection. Fifteen fistulas closed spontaneously after an average of about four weeks of conservative treatment and full nutritional therapy. Those patients who had persistent fistulas after similar treatment were found to have either residual tumor after palliative operation or preoperative serum albumin levels that were lower than those of the other group. Prolonged conservative treatment for persistent fistulas may not be warranted if such risk factors are identified, and surgical repair should be considered.

Carcinoma↗
PubMed1988

Malignant hilar biliary obstruction treated by segmental bilioenteric anastomosis.

Segmental bilioenteric anastomosis procedures were performed on 22 patients with malignant hilar biliary obstructions. The majority of the bypasses were done to the segment 3 duct and a single anastomosis was performed in each patient. The operative mortality rate was 13.6% and morbidity, 27.3%. The biliary obstruction was completely relieved in 5 patients, partially but satisfactorily relieved in 11 patients, and not relieved in 3 patients. The mean survival was 8 months, and the median survival was 6 months. Late complications were seen in 42% of the patients, and these complications included cholangitis, liver failure, and duodenal obstruction. An analysis of the operative results with respect to the presence of right and left ductal system communication showed that when communication was absent, there was a greater incidence of unsuccessful relief of the biliary obstruction. When communication was present, the incidence of late cholangitis that involved the undrained side was greater.

Aged↗
PubMed1987

Prediction of postoperative pulmonary complications in oesophagogastric cancer surgery.

In a series of 102 patients with cancer of the oesophagus or gastric cardia in whom surgery had been performed, postoperative respiratory infection, respiratory failure and mortality secondary to respiratory complication occurred in 55.8, 34.3 and 21.6 per cent respectively. The incidence of complications correlated well with the pre-operative peak expiratory flow rate when it was less than 65 per cent of the predicted normal value. However, the predictive ability of peak expiratory flow rate was much less than the patient's age, pre-operative serum albumin level, pre-operative Pa,O2 and number of surgical wounds when all risk factors were considered. Significantly more complications occurred when the patient was greater than 65 years old, Pa,O2 was less than 10 kPa, serum albumin was less than 39 g/l and when the operation required three incisions. These findings may serve as guidelines for identification of high-risk patients in the future.

Adult↗
PubMed1987

Surgical management of strictures of the major bile ducts in recurrent pyogenic cholangitis.

Definitive surgical procedures were performed on 46 patients with strictures of the major bile ducts: dilatation of strictures was undertaken in 6 patients, hepatotomy and plastic repair in 2, biliary-enteric anastomosis in 18, and liver resection with or without drainage for the rest of the biliary tree in 20 patients. The overall operative morbidity was 21.7 per cent. Two patients died within 30 days of operation. One patient died of septicaemia after emergency dilatation of stricture while another died of sepsis from a leakage after hepatotomy and plastic repair. The median follow-up for the 44 patients who survived the operation was 43 months. All strictures reformed after dilatation within 2 months. Acute cholangitis occurred in six patients, two after dilatation of strictures (with documented recurrent stone formation in one), two after biliary-enteric anastomosis and two after liver resection. Thus, good clinical results were obtained in 38 out of 44 patients (86.4 per cent).

Adolescent↗
PubMed1987

A scientific evaluation of operative choledochoscopy in acute cholangitis.

A prospective study to determine the safety and effectiveness of choledochoscopy in acute cholangitis and acute suppurative cholangitis due to common bile duct stones was conducted on 70 patients. Common bile duct pressures determined on the first 20 patients showed that choledochoscopy was unlikely to cause cholangiovenous reflux. Laboratory and clinical parameters revealed that choledochoscopy did not cause septicemia, worsen cholangitis, or provoke acute pancreatitis. There was no iatrogenic injury during choledochoscopy, and the choledochoscopic views were minimally affected by cholangitis. Choledochoscopy detected overlooked stones after conventional methods of exploration of common bile ducts in 14.3% of patients and it helped to remove impacted stones in 2.9% of patients. As a result, the incidence of retained stones after choledochoscopy was 1.4%. Time spent in choledochoscopy was short, and the total postoperative septic complication rate was only 10%. There was no operative mortality. It is concluded that choledochoscopy is safe and effective in cholangitis.

Acute Disease↗
PubMed1987

Acute appendicitis in children.

A prospective study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis. Most children presented with typical features of acute appendicitis (70%) or peritonitis (28%). Atypical presentation was uncommon and occurred only in seven young children, masquerading as intestinal obstruction, gastroenteritis or urinary tract infection. Prolonged delay in surgery was associated with a rise in incidence of late appendicitis (gangrenous and perforated appendicitis). This rise was especially marked 37 h after onset of symptoms. The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early. Surgeons contributed very little to the delay. High risk factors for postappendectomy sepsis were young children under 6 years old, late appendicitis, obese patients, inferior systemic antibiotic regimes and inexperienced surgeons. Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly. They were not especially prone to postappendectomy sepsis; they had the same degree of appendicitis compared with older children. Measures to decrease the postappendectomy morbidity are suggested.

Acute Disease↗
PubMed1987

Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin.

In the past six years, 37 patients with gastrointestinal bleeding of obscure origin had their bleeding sites localised preoperatively or intraoperatively. Preoperative investigations followed a regime consisting of endoscopy, barium meal and follow through, small bowel enema, 99mTc pertechnetate scan, 99mTc-labelled red blood cell scan and selective coeliac and mesenteric angiography. Bleeding lesions were localised preoperatively in 36 patients. In one patient, diagnostic laparotomy had to be carried out immediately before any investigation because the bleeding was severe. At operation, angiosarcoma of ileum was found. Unless preoperative investigations showed the lesions to be in anatomically fixed organs like the duodenum or colon, the lesions had still to be found at operation. Palpation and transillumination detected the lesion intraoperatively in 21 patients while only some lesions were found in three patients with multiple lesions. Sigmoidoscopy through enterotomies was required in one patient. Intraoperative enteroscopy was done for small lesions not found grossly at operation in nine patients, to detect additional lesions in three patients or to rule out suspicious lesion shown on preoperative tests in one patient. In another patient with diffuse lymphoma of small bowel with bleeding from only a small segment of jejunum, injection of methylene blue intraoperatively through a previously placed angiographic catheter stained the bleeding segment of jejunum blue. This segment was identified easily and resected. These preoperative and intraoperative localisation procedures were simple and effective and we recommend them to be used more freely.

Adolescent↗
PubMed1987

Enzyme-linked immunosorbent assay (ELISA) of antibodies to purified protein derivative (PPD) in the diagnosis of active tuberculosis: evaluation of its potential and limitation in a high prevalence area.

Sera from patients with active tuberculosis were assayed for IgG antibodies to purified protein derivative (PPD) by an enzyme-linked immunosorbent assay (ELISA) technique. Eighty seven of the 112 patients (78%) with sputum culture-positive, and 57 of 78 patients (73%) with sputum culture-negative, pulmonary tuberculosis had positive serology. Seventeen of 19 patients (89%) with renal tuberculosis (demonstrable lesion on intravenous pyelography) had antibody to PPD, whereas only 3 of 9 patients (33%) with urinary tuberculosis (positive urine culture only, without abnormality on intravenous pyelography) and 8 of 21 patients (38%) with tuberculous cervical lymphadenitis had positive serology. Seropositivity rate in paediatric patients was also low, only 2 out of 8 patients gave positive serology. Thus, the diagnostic value of this test is limited as a positive result is obtained only when the disease is relatively long-standing or extensive.

Adult↗