Search PubMed⌕ Search

Biomedical subjects

S T Fan

Publications and source records attributed to S T Fan.

At least 163 records · Page 9Linked to original sources
PubMed1997

Adult-to-adult living donor liver transplantation using extended right lobe grafts.

OBJECTIVE: The authors report their experience with living donor liver transplantation (LDLT) using extended right lobe grafts for adult patients under high-urgency situations. SUMMARY BACKGROUND DATA: The efficacy of LDLT in the treatment of children has been established. The major limitation of adult-to-adult LDLT is the adequacy of the graft size. A left lobe graft from a relatively small volunteer donor will not meet the metabolic demand of a larger recipient. METHODS: From May 1996 to November 1996, seven LDLTs, using extended right lobe grafts, were performed under high-urgency situations. All recipients were in intensive care units before transplantation with five having acute renal failure, three on mechanical ventilation, and all with hepatic encephalopathy. The median body weight for the donors and recipients was 58 kg (range, 41-84 kg) and 65 kg (range, 53-90 kg), respectively. The body weights of four donors were less than those of the corresponding recipients, and the lowest donor-to-recipient body weight ratio was 0.62:1. The extended right lobe graft was chosen because the left lobe volume was <40% of the ideal liver mass of the recipient. RESULTS: Median blood loss for the donors was 900 mL (range, 700-1600 mL) and hospital stay was 19 days (range, 8-22 days). Homologous blood transfusion was not required. Two donors had complications (one incisional hernia and one bile duct stricture) requiring reoperation after discharge. All were well with normal liver function 5 to 10 months after surgery. The graft weight ranged from 490 g to 1140 g. All grafts showed immediate function with normalization of prothrombin time and recovery of conscious state of the recipients. There was no vascular complication, but six recipients required reoperation. One recipient died of systemic candidiasis 16 days after transplantation and 6 (86%) were alive with the original graft at a median follow-up of 6.5 months (range, 5-10 months). CONCLUSIONS: When performed by a team with experience in hepatectomy and transplantation, LDLT, using an extended right lobe graft, can achieve superior results. The technique extends the success of LDLT from pediatric recipients to adult recipients and opens a new donor pool for adults to receive a timely graft of adequate function.

Acute Kidney Injury↗
PubMed1997

Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study.

OBJECTIVE: To evaluate whether vascular inflow occlusion by the Pringle maneuver during hepatectomy can be safe and effective in reducing blood loss. SUMMARY BACKGROUND DATA: Hepatectomy can be performed with a low mortality rate, but massive hemorrhage during surgery remains a potentially lethal problem. The Pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but there is a potential harmful effect on the metabolic function of hepatocytes. There has been no prospective randomized study to determine whether the Pringle maneuver can decrease blood loss during hepatectomy, improve outcome, or affect the metabolism of hepatocytes. METHODS: From July 1995 to February 1997, we studied 100 consecutive patients who underwent hepatectomy for liver tumors. The patients were randomly assigned to liver transection under intermittent Pringle maneuver of 20 minutes and a 5-minute clamp-free interval (n = 50), or liver transection without the Pringle maneuver (n = 50). The surface area of liver transection was measured and blood loss during transection per square centimeter of transection area was calculated. Routine liver biochemistry, arterial ketone body ratio (AKBR), and the indocyanine green (ICG) clearance test were done. RESULTS: The two groups were comparable in terms of preoperative liver function and in the proportion of patients having major hepatectomy. The Pringle maneuver resulted in less blood loss per square centimeter of transection area (12 mL/cm2 vs. 22 mL/cm2, p = 0.0001), a shorter transection time per square centimeter of transection area (2 min/cm2 vs. 2.8 min/cm2, p = 0.016), a significantly higher AKBR in the first 2 hours after hepatectomy, lower serum bilirubin levels in the early postoperative period, and, in cirrhotic patients, higher serum transferrin levels on postoperative days 1 and 8. The complication rate, the hospital mortality rate, and the ICG retention at 15 minutes on postoperative day 8 were equal for the two groups. CONCLUSION: Performing the Pringle maneuver during liver transection resulted in less blood loss and better preservation of liver function in the early postoperative period. This is probably because there was less hemodynamic disturbance induced by the bleeding.

Adult↗
PubMed1997

Review: nutritional support for patients with cirrhosis.

Nutritional support is indicated when cirrhotic patients undergo surgery because they are malnourished, hypercatabolic and immunocompromised. However, the choice of nutrient may be problematic as the liver itself is the central organ of protein, fat and glucose metabolism. Branched chain amino acid-enriched solution may be the choice of protein source, as it is anticatabolic and it stimulates liver regeneration. Excessive glucose is undesirable as it may suppress endogenous fat utilization, which may be the preferred pathway of metabolism after hepatectomy. Medium chain triglycerides are preferred to long chain triglycerides as they are readily utilized and are not deposited in the liver; however, the tendency of cirrhotic patients to accumulate free fatty acids and glycerol after infusion of triglycerides dictates their use intermittently. Clinical studies have shown that perioperative nutritional support is beneficial in cirrhotic patients undergoing major hepatectomy or liver transplantation. The judicious choice of nutrient, care of the catheter and a limitation of the fluid infused are all prerequisites for the efficient use of perioperative nutritional support, which is complementary to a technically perfect operation.

Food, Formulated↗
PubMed1997

Treatment of biliary atresia by portoenterostomy and liver transplantation: The Queen Mary Hospital, Hong Kong experience.

Ninety three out of 96 patients with biliary atresia (BA) underwent Kasai 1 portoenterostomy and 11 children subsequently underwent 12 liver transplantation (LTX) procedures which included 8 living related liver transplants (LRLT), 3 reduced-size liver transplants (RSLT) and 1 orthotopic liver transplantation (OLT). During a follow-up period of 3-206 months (mean, 73 months) after portoenterostomy and 3-63 months after LTX, 50% of 96 patients are alive and well with total clearance of jaundice while 12% are mildly jaundiced, 10% are deeply jaundiced and 28% have died. Two of the 3 patients who did not undergo portoenterostomy and 25 from the portoenterostomy group have died. Of the latter group, 22 deaths occurred before, and 3 after the introduction of LTX therapy respectively. Of the 68 long-term survivors, 32 are less than 5, and 36 are 6-17 years old. Complete clearance of jaundice was achieved in 55% of patients irrespective of whether portoenterostomy was initially performed at < 10 or between 10 and 12 weeks. Portoenterostomy performed beyond 13 weeks was associated with declining results. We conclude that (1) portoenterostomy combined with liver transplantation, when indicated, has given patients with BA a much better prognosis and (2) pediatric LTX in our institute is a well established procedure with 100% patient and 88% primary graft survival.

Age Factors↗
PubMed1997

Infectious complications of liver transplantation.

Sixteen (50%) of the 32 patients who received liver transplantations from October 1991 to March 1993 at Queen Mary Hospital, Hong Kong, developed viral, bacterial, or fungal infections. The viral infections were largely a result of immunosuppression while accidental bowel perforation, bile leak at the anastomosis, and delayed onset of stricture of the bile duct anastomosis were responsible for the intra-abdominal bacterial or fungal infections. Although the incidence of infectious complications was high, all patients were managed effectively and only one patient with lymphoproliferative disorder died. Infectious complications can lead to a prolonged hospital stay and a substantially increased hospital cost. The adoption of new immunosuppressive regimes that can better prevent acute graft rejection and adherence to meticulous surgical technique will help to reduce the infectious complications of liver transplantation in the future.

Journal Article↗
PubMed1997

The changing epidemiology of recurrent pyogenic cholangitis.

Recurrent pyogenic cholangitis is prevalent in Hong Kong and East Asia. While the recent influx of Asian immigrants has resulted in more cases appearing in the West, over the past three decades, the overall incidence in East Asia has been in decline. The experience of the Queen Mary Hospital and other hospitals in the region has been confirmed by comprehensive surveys. The decline in incidence has been attributed to the improved economic situation and living standards with the associated westernisation of diet.

Journal Article↗
PubMed1997

Better survival in women with resected hepatocellular carcinoma is not related to tumor proliferation or expression of hormone receptors.

OBJECTIVE: There is a well known male predominance in hepatocellular carcinoma (HCC). Moreover, female patients with HCC have better survival and lower recurrence rates after surgical resection. We previously showed that the better prognosis in female patients is related to a higher incidence of tumor encapsulation and less invasive tumors. However, the underlying mechanism is still obscure. METHODS: In this study, we examined the cell proliferative indices (expression of proliferative cell nuclear antigen (PCNA) and Ki-67 antigen using MIB1 antibody) and expression of the estrogen and progesterone receptors (ERs and PRs, respectively) in 71 patients with resected HCC. These were correlated with the pathological features of the tumors and the survival rates of patients. RESULTS: Female patients with HCC had significantly better actuarial and disease-free survival rates than male patients (p = 0.010 and 0.004, respectively). Tumor PCNA scores, represented by positively stained nuclei per 1000 tumor cells, were significantly higher in tumors showing venous permeation (p = 0.034), positive resection margins (p = 0.011), and absence of bile production (p = 0.008). Higher tumor MIB1 scores were seen in tumors that had poorer cellular differentiation (p = 0.002) and no tumor capsules (p = 0.042). However, both tumor PCNA and MIB1 scores did not differ significantly between female and male patients. ERs were detected in the tumor cells in 23.9% of tumors, and PRs were detected in 14.3%. Expression of both ER and PR was not influenced by gender. CONCLUSIONS: Women with HCC had significantly better survival and lower tumor recurrence rates. However, significant differences in cellular proliferation indices and expression of ER and PR were not observed between men and women to explain the difference in survival rate.

Adult↗
PubMed1997

Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy.

BACKGROUND: Postoperative hepatic failure is the leading cause of hospital mortality following hepatectomy for hepatocellular carcinoma (HCC). This prospective study was performed to identify the best test for assessment of the adequacy of hepatic functional reserve in patients with HCC before hepatectomy. METHODS: Between April 1989 and June 1993, 127 patients with HCC underwent hepatectomy. Each patient was evaluated before operation with the indocyanine green (ICG) clearance test, the aminopyrine breath test and the amino acid clearance test. RESULTS: Fourteen patients (11 per cent) died after hepatectomy. ICG retention at 15 min showed significant differences between patients who survived or died. By discriminant analysis, the safety limit of ICG retention at 15 min for major hepatectomy was 14 per cent and the relative risk of hospital mortality was 3. CONCLUSION: The ICG clearance test, expressed as the percentage of ICG retained at 15 min, is the best discriminating preoperative test for evaluating hepatic functional reserve in patients with HCC before hepatectomy.

Adult↗
PubMed1997

Management of fulminant hepatic failure at Queen Mary Hospital.

OBJECTIVE: To evaluate the strategy of the management of patients with fulminant hepatic failure at Queen Mary Hospital. METHODS: In the period 1994 through 1996, 30 patients with fulminant hepatic failure were managed by active supportive treatment in the Intensive Care Unit in preparation for liver transplantation. Liver transplantation was performed in 14 patients (aged 17-47), 3 of whom received liver grafts from brain-stem dead donors and 11 received live-related grafts from family members. The median duration from admission to liver transplantation was 3 days (range: 1-6 days). RESULTS: Thirteen patients (93%) survived the liver transplantation and are well after a median period of follow-up of 7 months. The only mortality was in a patient with pre-exiting renal transplantation and hepatitis B infection, who died from intra-abdominal candidiasis. CONCLUSION: The strategy of active supportive treatment and early liver transplantation using live-related liver graft is probably the key to the success of the management of fulminant hepatic failure in our series.

Adolescent↗
PubMed1996

Minimum graft volume for successful adult-to-adult living donor liver transplantation for fulminant hepatic failure.

The major limitation of adult-to-adult living donor liver transplantation is the adequacy of the size of the graft that can be safely harvested from the donor. The present report describes a 22-year-old woman with stage 4 hepatic coma due to fulminant hepatic failure who was successfully treated using a small-for-size left lobe graft from her father. The graft weight was 0.6% of the recipient's body weight, or 25% of her ideal liver weight. Avoidance of warm ischemia, short cold ischemic time, and early treatment of rejection are important elements in optimizing small-for-size graft function. Since the left lobe represents 23-36% of the total liver volume of an adult, it is possible, in most cases, to harvest a left lobe graft of adequate size from a donor of similar size as the recipient.

Adult↗
PubMed1996

Factors affecting conversion of laparoscopic cholecystectomy to open surgery.

OBJECTIVE: To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery. DESIGN: Demographic, ultrasonographic, and operative data of patients who underwent laparoscopic cholecystectomy were analyzed. Factors affecting conversion to open surgery were identified with statistical analysis. SETTING: A tertiary referral center. PATIENTS: Five hundred patients who underwent laparoscopic cholecystectomies at our institution between March 1991 and July 1994. The patients' data had been prospectively collected. INTERVENTION: Standard laparoscopic techniques with selective preoperative endoscopic retrograde cholangiopancreatography. MAIN OUTCOME MEASURE: Conversion of laparoscopic cholecystectomy to open surgery for management of technical difficulties or intraoperative complications. RESULTS: Increased risk of conversion with statistical significance was found in patients older than 65 years, obese patients, patients who underwent interval elective laparoscopic cholecystectomy for acute cholecystitis, patients with ultrasonographic findings of thickened gallbladder wall, patients seen during the early learning phase of the series, and patients whose surgery was performed by senior surgeons. Increased risk of conversion was not found with patients' sex, previous lower abdominal surgery, history of acute pancreatitis or cholangitis, impaired liver function on presentation, or emergency laparoscopic cholecystectomy for acute cholecystitis. CONCLUSIONS: Risk factors, including patient factors, presentation, preoperative ultrasonography, and surgical experience, all contributed to the possibility of conversion. Knowledge of these factors may help in arranging the operating schedule, psychological preparation for the procedure, and planning of the duration of convalescence.

Adult↗
PubMed1996

Pyogenic liver abscess. An audit of experience over the past decade.

OBJECTIVES: To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality. DESIGN: Retrospective review. SETTING: A tertiary referral center. PATIENTS: Eighty-three patients with pyogenic liver abscesses were studied to determine demographic characteristics; clinical features, laboratory, imaging, and microbiologic findings; methods of treatment; and final outcome. The median follow-up period was 9.8 months. INTERVENTION: All patients were treated with intravenous antibiotic drugs. Fifty-three patients were to image-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in 27 patients. Laparotomy was performed in 27 patients; seven of them underwent an elective operation. MAIN OUTCOME MEASURE: Hospital mortality, defined as death within the same hospital admission for management of liver abscess. RESULTS: Biliary tract disease was the most frequently identifiable cause. The right lobe abscess was more frequently cryptogenic, while the left lobe abscess was more frequently related to intrahepatic stones (P < .001). The overall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, management without aspiration or catheter drainage, presence of malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time, and elevated activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis, presence of malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time were found to be independent risk factors. CONCLUSIONS: Pyogenic liver abscess is still a disease with significant mortality. Early diagnosis and prompt treatment are necessary to further improve our results of management.

Adult↗
PubMed1996

Pathologic features and patient survival in hepatocellular carcinoma in relation to age.

For hepatocellular carcinoma, the peak age of patients is at the sixth decade. However, the influence of age on the tumor biologic behavior and long-term patient survival is controversial. We retrospectively studied 278 patients whose hepatocellular carcinomas were surgically resected to analyze the pathologic and clinical features of the tumors and patient survival in relation to age. The patients were divided into two groups, younger than 50 years of age and older than 50 years. Ninety-seven patients were 50 years of age or under, and 181 were older than 50 years. The younger patients had: (1) more frequent hepatitis B surface antigen positivity (P = 0.022), (2) less cirrhosis (P = 0.050), (3) less tumor encapsulation, (4) a more advanced tumor stage in terms of more venous permeation (P = 0.012), more liver invasion (P = 0.010) and larger tumor (P = 0.002), and (5) a more frequently raised serum alpha-fetoprotein level (P = 0.035). In spite of the more advanced stage of the tumors, both the actuarial and disease-free survival rates did not differ significantly from those of the older group. The operative mortality rates also were similar in both groups. To conclude, there were distinct differences in the clinical and pathologic features of the tumors of patients < 50 years and those older. Although the tumors were more advanced in the younger group, the less frequently associated cirrhosis in this group might have partly compensated to result in survival rates similar to those of the older group. Because of the comparable survival rates, the treatment policy in the older group should not differ greatly from that in the younger group.

Adult↗
PubMed1996

Hepatectomy with an ultrasonic dissector for hepatocellular carcinoma.

This study compared the results of hepatectomy for hepatocellular carcinoma (HCC) using an ultrasonic dissector with those of a combination of the crushing clamp and finger fracture techniques. The crushing clamp and finger fracture method was used from 1989 to 1992 in 96 patients (group 1) and the ultrasonic dissector from 1993 to 1994 in 69 patients (group 2). Data from these two sets of patients were collected prospectively. The groups were comparable in terms of preoperative liver function, tumour size and stage, and the incidence of cirrhosis. Major hepatectomy was performed in 69 patients (72 per cent) of group 1 and in 52 (75 per cent) of those in group 2. Use of the ultrasonic dissector resulted in lower mean (s.e.m.) blood loss (group 1 3.4(0.4) litres versus group 2 2.4(0.2) litres, P = 0.02), lower mean (s.e.m.) blood transfusion requirement (2.2(0.2) versus 1.2(0.2) litres, P = 0.001) and more patients not requiring blood transfusion (8 per cent of group 1 versus 32 per cent of group 2, P = 0.0001). Postoperative complications occurred in 45 patients (47 per cent) of group 1 and 19 (28 per cent) of those in group 2 (P = 0.012). There were no deaths in group 2 whereas the hospital mortality rate in group 1 was 16 of 96 (17 per cent) (P = 0.0004). A wider tumour-free resection margin (mean(s.e.m.) 1.2(0.1) versus 0.9(0.1) cm, P < 0.05) and lower serum bilirubin level throughout the postoperative period were also observed in group 2 patients. The ultrasonic dissector is better than the crushing clamp and finger fracture technique in hepatectomy for HCC.

Blood Loss, Surgical↗
PubMed1996

Spontaneous rupture of hepatocellular carcinoma.

Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening condition; the mechanism is not clear but it is suggested that rupture is usually preceded by rapid expansion of the tumour secondary to bleeding from within its substance. Diagnosis may be made by abdominal paracentesis, ultrasonography, computed tomography or angiography; the positive rates of diagnosis are 86, 66, 100 and 20 per cent respectively. Prognosis is poor. Based on treatment results reported in the literature, the mean survival time for patients who underwent hepatectomy, transcatheter arterial embolization (TAE) and conservative therapy were 247, 98 and 13 days respectively. Judging from the reported results the first choice for emergency treatment of haemostasis is TAE. If laparotomy is undertaken, hepatic artery ligation, preferably of the branch supplying the liver lobe bearing the tumour, should be considered, together with haemostasis of the rupture site by various means (suture plication, packing, argon beam coagulation, use of microwave or absolute ethanol). Emergency hepatectomy should be reserved for patients with an easily resectable lesion who are in a stable cardiovascular condition. Conservative therapy may be used for selected patients in extremely poor condition. The rational treatment for the majority of patients with ruptured HCC is TAE, followed by hepatectomy if the lesion is resectable.

Carcinoma, Hepatocellular↗