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Biomedical subjects

S T Fan

Publications and source records attributed to S T Fan.

At least 289 records · Page 16Linked to original sources
PubMed1984

The treatment of urinary tuberculosis.

During the last 7 years we treated 92 patients with tuberculosis of the urinary tract. Patients with tuberculous infection were divided into 3 groups according to treatment: group 1--no surgical treatment (18 patients), group 2--ablative surgery (45 patients) and group 3--reconstructive surgery (29 patients). Antituberculous drugs, consisting of rifampin, pyrazinamide, isoniazid and ethambutol, were given according to the severity and extent of the infection process. The results of medical and surgical treatment were most gratifying. Surgical morbidity was low and there was no immediate mortality.

Adult↗
PubMed1984

The bacteriology and septic complication of patients with appendicitis.

A detailed bacteriologic study was done on 161 patients operated for appendicitis. Aerobic and anaerobic cultures were taken from the blood, the appendicular lumen, mucosa, serosa, fossa, and from the wound after closure of the peritoneum. There is no correlation between the degree of appendicitis and the incidence of positive blood culture. The infection spread through the appendicular wall as the disease progressed. Aerobic infection was common in early appendicitis but a mixed aerobic and anaerobic infection was predominant in late cases. Late appendicitis, a positive wound culture at the end of the operation, the duration of symptoms of over 36 hours before operation and the age of the patient over 50 years were all associated with an increased incidence of septic complication. From the antibiotic sensitivity on the bacteria isolated, the most effective agent against anaerobes was metronidazole. Effective agents against the aerobes were aminoglycosides and cephalosporins. The best single agent against both anaerobes and aerobes was moxalactum.

Anti-Bacterial Agents↗
PubMed1984

The management of urinary tuberculosis--a logical approach.

The chemotherapy of urinary tuberculosis is controversial as far as choice of drug regimen and duration of treatment are concerned. We propose a course of treatment that is tailored to the pathological state of infection and the type of surgical procedure performed. One hundred and ten patients with tuberculous infection were divided into three groups. Group I comprised 27 patients in whom surgery was not necessary; Group II contained 48 patients where ablative surgery was carried out; Group III consisted of 35 patients who underwent reconstructive surgery. Anti-tuberculous drugs (rifampicin, pyrazinamide, isoniazid and ethambutol) were given according to this tailored regimen. Patient compliance and results of treatment were excellent.

Adult↗
PubMed1983

Prophylaxis of post-appendicectomy sepsis by metronidazole and ampicillin: a randomized, prospective and double-blind trial.

Two hundred and eighty-three patients were admitted to a randomized, prospective and double-blind trial of the effect of the addition of ampicillin to metronidazole in the prophylaxis of post-appendicectomy wound sepsis. Nineteen out of 142 patients in the metronidazole and ampicillin group developed wound sepsis compared with 33 out of 141 patients in the metronidazole group. The difference is statistically significant. Early cases, including normal, acutely inflamed and gangrenous appendices, received 2 doses of antibiotics. In late cases with perforation and abscess formation, the antibiotics were continued for 1 week. The difference in wound infection in each of these 2 subgroups was also statistically significant. The commonest organisms isolated from the appendicular fossa and the infected wounds were Escherichia coli and Bacteroides fragilis.

Ampicillin↗
PubMed1983

Prophylaxis of postappendicectomy sepsis by metronidazole and cefotaxime; a randomized, prospective and double blind trial.

A randomized, prospective and double blind trial was conducted on 308 patients. Thirty-one out of 102 patients receiving metronidazole developed wound infection compared with 13 out of 103 patients receiving cefotaxime and 14 out of 103 patients receiving metronidazole and cefotaxime. The reduction in the wound sepsis by the use of cefotaxime or a combination of metronidazole and cefotaxime was statistically significant when compared with patients who received metronidazole only. For early cases including normal, acutely inflamed and gangrenous appendices, we gave a single dose of antibiotics just before operation. For late cases with perforation and abscess formation, the antibiotics were continued for 5 days. There was no statistical difference in wound infection between patients who received cefotaxime alone and these who received a combination of metronidazole and cefotaxime.

Appendectomy↗
PubMed1982

Acute torsion of the gall bladder in the aged: a re-emphasis on clinical diagnosis.

Three cases of torsion of the gall bladder in the aged are presented. From a review of the clinical features of these cases and the cases reported in the literature, a definite clinical pattern emerged. The clinical features can be grouped into three triads: a triad of the patient's characteristics which consists of a thin, old patient with chronic chest disease or a deformed spine; a triad of symptoms which consists of typical abdominal pain, early onset of vomiting and a short history; and a triad of physical signs which consists of an abdominal mass, a lack of toxaemia or jaundice and a discrepancy in the pulse and temperature. If most, if not all, of these features are present, torsion of the gall bladder should be presented. We re-emphasize that a clinical suspicion or diagnosis of torsion of the gall bladder is possible. The treatment is early cholecystectomy.

Acute Disease↗
PubMedDate not supplied

Hepatectomy for large hepatocellular carcinoma: the optimal resection margin.

The necessary resection margin (RM) for cure during hepatectomy for hepatocellular carcinoma (HCC) remains conjectural. From January, 1972 to June, 1988, a total of 96 patients who had complete macroscopic extirpation of their large tumor (greater than or equal to 5 cm in largest diameter) were studied retrospectively to determine the macroscopic distance of RM required to secure histological disease clearance. Positive histological RM, which was found in 31 (32.3%) patients, had significantly compromised both disease-free survival (p less than 0.04) and overall survival (p less than 0.006) of these patients. Among the 65 patients with detailed measurement of macroscopic RM, a significant reduction of residual histological disease was observed when a 0.5 cm margin had been established (p less than 0.05). Further extension of margin had no additional benefit. The presence of microsatellite (p less than 0.03) and multiple tumor nodules (p less than 0.03) was associated with an increased risk of positive histological margins among the 15 pathological parameters evaluated, including macroscopic RM. Since measurement of RM is an unreliable guide, histological confirmation is the only means for establishing the diagnosis of complete tumor clearance. Within safety limits dictated by anatomical factors and severity of underlying cirrhosis, aggressive surgery should be offered for patients with large HCC; however, resection is not advisable unless a 0.5 cm margin can be secured with certainty, especially for multinodular lesions.

Adult↗
PubMedDate not supplied

Recurrent pyogenic cholangitis: current management.

Successful treatment of recurrent pyogenic cholangitis depends on the ability to delineate the pathology of the entire biliary system and to eradicate all stones, strictures, and destroyed liver segments. Recent advances in imaging techniques and stone fragmentation technology have been applied successfully in the management of this condition. Apart from direct cholangiography and ultrasonography, valuable information can be obtained from computed tomography which is particularly helpful in patients with recurrent disease after previous biliary surgery. Application of electrohydraulic lithotripsy in this disease solves the problem of difficult stone retrieval due to large size, impaction behind relative strictures and inside angulated segmental bile ducts. Together with construction of a hepaticocutaneous jejunostomy serving as a permanent access to the bile duct, it is anticipated that the incidence of recurrence and reoperation in the future can be reduced.

Bacterial Infections↗
PubMedDate not supplied

Bleeding peptic ulcer: a prospective evaluation of risk factors for rebleeding and mortality.

Clinical, endoscopic, and laboratory data were collected prospectively in 701 patients with bleeding peptic ulcer. The overall rebleeding rate was 16.1% and increased the risk of a fatal outcome by 17 fold (1.2% versus 20.6%, p less than 0.001). Rebleeding was documented in more than 75% of the group who did not survive following initial conservative management. Rebleeding was more likely (24.1% versus 14.2%, p less than 0.02) when shock was present on admission and the risk of a rebleed was doubled in patients over 60 years of age (22.1% versus 10.9%, p less than 0.001). Ulcers greater than 1 cm in size carried twice the risk of rebleeding (23.9% versus 12.4%, p less than 0.002). Concomitant medical illness had a significant adverse effect on outcome (p less than 0.05). Shock on admission was associated with a doubling of mortality figures (9.5% versus 3.7%, p less than 0.01). The identification of endoscopic stigmata of recent hemorrhage (ESRH) tripled the risk of mortality (7.5% versus 2.4%, p less than 0.002), ESRH were more frequently encountered when ulcer size was larger than 1 cm (61.4% versus 39.8%, p less than 0.001). Respective mortality rates for ulcers less than or equal to 1 cm and greater than 1 cm in size were 1.6% and 12.5% (p less than 0.001), corresponding mortality figures for patients over 60 years of age being 4.4% and 16.4% (p less than 0.002). The risk of a rebleed tripled (6.7% versus 2.6%, p less than 0.02) when ESRH were evident. There was a 6-fold increase in mortality following emergency surgery when compared with conservative management of patients in whom no surgical intervention was necessary (2.6% versus 14.9%, p less than 0.001). In summary, age over 60 years, previous medical illness, shock on admission, large ulcer size, and ESRH were each associated with an increased risk of rebleeding and mortality.

Female↗
PubMedDate not supplied

Hepatic resection for small hepatocellular carcinoma: the Queen Mary Hospital experience.

The clinico-pathological features and long-term results of 39 patients with resected small hepatocellular carcinoma (HCC) managed over 19 years in Hong Kong were retrospectively studied (mean diameter +/- standard deviation: 3.6 +/- 1.3 cm). Thirty-one patients were symptomatic and the majority (n = 33) of them had cirrhosis. When compared with 182 patients with large HCC operated within the same period, these patients with small HCC had a significantly higher incidence of spontaneously ruptured lesions (p less than 0.03). Following hepatic resection-major lobectomy (n = 19) and limited hepatic resection (n = 20), operative and hospital deaths occurred in 7.7% and 12.8% of patients, respectively. The size of the lesion had little influence on prognosis. The overall survival at 1, 3, and 5 years was 59%, 28%, and 11%, respectively, which was comparable to patients with large HCC greater than or equal to 5 cm. Further stratification of these 39 patients according to a diameter of greater than 3 cm (n = 22) or less than or equal to 3 cm (n = 17) showed no difference in long-term outcome. When compared with large tumors, frequent encapsulation (p less than 0.04) and less venous permeation (p less than 0.03) were encountered in small HCC. As the extent of hepatectomy had no effect on long-term outcome, limited hepatectomy for patients with small HCC is probably the procedure of choice. A 1 cm macroscopic resection margin is apparently adequate to ensure complete histological disease clearance.

Adult↗
PubMedDate not supplied

Anterior approach for difficult major right hepatectomy.

In selected patients with huge right hepatic tumors that had infiltrated the surrounding structures, injudicious mobilization of the liver before transection, as in the conventional manner, may result in excessive bleeding, prolonged ischemia from rotation of the hepatoduodenal ligament, and spillage of cancer cells into the systemic circulation. Alternatively, the "anterior" approach, which involves initial completion of the parenchymal transection before the right hepatic lobe is mobilized, can be adopted for these patients with difficult right hepatic tumors. After hilar control of the inflow vessels, liver parenchyma was transected using an ultrasonic dissector until the anterior surface of the inferior vena cava is exposed. The right hepatic lobe is then mobilized laterally by securing all venous tributaries, including the right hepatic vein. The prospective data of 25 patients who had major right hepatectomy using the "anterior" approach were compared with data from 34 patients who had their operation performed in the conventional manner. Despite the facts that larger tumors (p < 0.004), more extrahepatic structures (p < 0.05), and the caudate lobes (p < 0.03) were resected, the amount of perioperative blood transfusion, fluid replacement, and outcome between the two groups of patients were comparable. There were three hospital deaths, among which one could be attributed to an intraoperative catastrophe during hepatectomy using the conventional approach. The "anterior" approach is a safe, effective option for selected patients undergoing complicated major right hepatectomy.

Adult↗
PubMedDate not supplied

Intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma is an uncommon neoplasm of liver compared with hepatocellular carcinoma. Hepatic resection seems to provide the only chance for therapeutic success. The records of 77 patients with intrahepatic cholangiocarcinoma treated over a 28-year period were studied to determine demographics, clinical features, laboratory findings, diagnostic tests, operative management, and results of therapy. Survival was analyzed according to three treatment groups: conservative management, palliative operation, and hepatic resection. Conservative management was used for 15 patients, and hepatic resections were performed in 39 patients. The remaining 23 patients had laparotomy alone (10 patients), bile duct intubation (4 patients), hepatic artery ligation (3 patients), bilienteric bypass (3 patients), gastrojejunostomy (1 patient), insertion of a hepatic artery port for regional chemotherapy (1 patient), or open drainage of an abscess (1 patient). The median survival after conservative management, palliative operation, and hepatic resection were 1.8, 2.9, and, 12.2 months, respectively. After hepatic resection, patients without lymphatic permeation (p < 0.02) or hilar nodal metastases (p < 0.0003) survived significantly longer. We concluded that hepatic resection is indicated for intrahepatic cholangiocarcinoma when it is deemed resectable.

Bile Duct Neoplasms↗
PubMedDate not supplied

Transcatheter arterial chemoembolization in inoperable hepatocellular carcinoma: four-year follow-up.

PURPOSE: To evaluate the efficacy of repeated chemoembolization in patients with inoperable hepatocellular carcinoma (HCC). PATIENTS AND METHODS: One hundred thirty-two patients with HCC underwent transcatheter arterial chemoembolization with an emulsion of iodized oil and cisplatin. In 104 patients, "light" gelatin sponge embolization was also used. Chemoembolization was repeated every 1.5-3.0 months in most patients (range, one to 18 chemoembolization sessions). RESULTS: In 74 patients, the HCCs became smaller or disappeared after chemoembolization. Decreases in size were seen in 55 of 76 HCCs 9 cm or smaller, 17 of 42 HCCs between 9 and 18 cm, and two of 14 HCCs larger than 18 cm. Use of gelatin sponge pledgets enhanced the response in tumors larger than 9 cm. Seven of 74 HCCs that responded to chemoembolization increased in size later. New daughter nodules that appeared at other sites responded to chemoembolization in 24 of 40 patients. Further new nodules appeared in 14 of 24 patients, and in six patients they responded to therapy. Median survival was 26 months for patients with responsive HCCs and 5 months for those with unresponsive lesions. CONCLUSION: Tumor size at the start of chemoembolization influenced the response to treatment and survival. The addition of gelatin sponge improved results only in tumors larger than 9 cm. Recurrence after an initial response was due more to the appearance of new daughter nodules in new locations rather than recrudescence of the presenting tumor.

Adolescent↗