Biomedical subjects

Sheung-Fat Ko

Publications and source records attributed to Sheung-Fat Ko.

At least 73 records · Page 4Linked to original sources

PubMed2002

Pancreatitis in children: clinical analysis of 61 cases in southern Taiwan.

BACKGROUND: The purpose of this study was to analyze the characteristics of the clinical presentations, etiologies, diagnoses, and treatment of pediatric pancreatitis in southern Taiwan. METHODS: Sixty-one patients, ranging in age from 2 to 18 years (mean, 8.8+/-4.8 years old), with diagnoses of pancreatitis were studied from July 1986 through June 2000. RESULTS: Twenty-eight pancreatitis cases resulted from physical trauma, 13 cases of which were from traffic accident (53.8% from motorcycle accident). Other pathogenic factors included systemic diseases (N=9), pancreaticobiliary-tree anomalies (N=7), toxin ingestion or drug use (N=4), Ascaris infection (N=1), and idiopathic (N=12). Symptoms included abdominal pain (N=58), vomiting (N=23), fever (N=18), and jaundice (N=2). Hyperamylasemia was found in 51 children (83.6%). Twenty-seven patients (90.0%) had elevated serum lipase levels (>190 U/L) of 30 evaluated. The amylase to creatinine clearance ratio was assayed for 35 cases, of which 28 (80.0%) were elevated (>6%). Ultrasonography revealed inflammatory changes of the pancreas in 40 of 51 patients evaluated, while computed tomogram demonstrated evidence of pancreatic inflammation for all 21 patients evaluated. Fifteen cases required surgery, while the other 46 were managed conservatively. One patient died because of acute necrotizing pancreatitis 3 days after L-asparaginase treatment for leukemia. The other patients survived well during long-term follow up. CONCLUSION: Pancreatitis in children is more common than generally believed. Physical trauma, especially because of motorcycle accidents, was the leading cause of pediatric pancreatitis in southern Taiwan. The mortality rate was low. Only one patient who had undergone chemotherapy with L-asparaginase died of the disease.

Adolescent↗

PubMed2002

Adenocarcinoma of the colon in children presenting as abdominal pain: report of two cases.

Adenocarcinoma of the colon is an unusual disease in patients under 30 years of age, and generally presents as advanced disease because of a lack of awareness of its occurrence, especially in the pediatric age group. The authors report on 2 cases of colon cancer in children less than 17 years old, whose initial presentations were abdominal pain of unclear etiology and non-specific abdominal complaints. No other abnormal laboratory results were found except that 1 patient had anemia. Barium studies revealed the typical colon lesions in both patients, and colonoscopic pathologic examination disclosed mucinous adenocarcinoma. The first patient was rather unusual in that 2 separate tumors were found simultaneously in the large intestine. The therapeutic approach included surgery and adjuvant chemotherapy, but both patients ultimately died due to poor response and early recurrence. Survival obviously depends on the extent of the disease at diagnosis; the earlier the diagnosis is, the better the prognosis will be. Clinical characteristics, diagnosis, and treatment of colon cancer in pediatric patients are discussed.

Abdominal Pain↗

PubMed2002

Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases.

Hepatic hemangioendothelioma is rare. We report on hepatic hemangioendotheliomas in 2 young infants, with initial manifestations of respiratory distress and congestive heart failure. Serum alpha-fetoprotein (alphaFP) level was as high as 26,343 microg/l at 14 days old in 1 case, but was only 18 microg/l in the other case. The 2 patients were treated with prednisolone and hepatic artery ligation, respectively, with no residual sequelae after 12 months of follow-up. In this article, the clinical courses of these 2 young infants are reviewed, and the management of infantile hepatic hemangioendothelioma complicated with heart failure is discussed. In our experience, early heart failure caused by infantile hepatic hemangioendothelioma can be well controlled, especially with prednisolone therapy or by hepatic artery ligation. Spontaneous regression has been reported. However, without early recognition and therapeutic intervention, progression to decompensated heart failure may lead to death. Furthermore, it is necessary to differentiate infantile hepatic hemangioendothelioma (IHH) from hepatic malignancies.

Female↗

PubMedDate not supplied

Obstruction of the aorta and left pulmonary artery after Gianturco coil occlusion of patent ductus arteriosus.

We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

Aorta, Thoracic↗

PubMedDate not supplied

Catheter-malposition-induced cardiac tamponade via contrast media leakage during computed tomography study.

We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status.

Blood Vessel Prosthesis Implantation↗

PubMedDate not supplied

Imaging findings of retroperitoneal lymphangiomyomatosis in a patient with lymphoma.

A 31-year-old female with lymphoma was incidentally found to have a left retroperitoneal lymphangiomyomatosis (LAM). The tumor was proved by pathology and immunohistochemical study of the tissue specimen obtained by ultrasound-guided core needle biopsy. The characteristic sonographic, computed tomographic, magnetic resonance imaging, and positron emission tomographic (PET) features of this unusual lesion were described. It was managed conservatively and remained stable on 2-year follow-up study. LAM should be considered in the differential diagnoses in cases of a retroperitoneal solid mass with cystic components.

Adult↗

PubMedDate not supplied

Bronchogenic cyst of the esophagus: clinical and imaging features of seven cases.

Seven unusual cases of esophageal bronchogenic cyst (EBC) are presented. Different from mediastinal or pulmonary bronchogenic cysts, EBCs predominately affect young women (six out of seven cases; mean age, 29.9 years), and clinically, such cases were characterized by dysphagia and chest pain, especially during exercise. On radiographs and computed tomographs, EBCs typically appeared as 3- to 4-cm midthoracic cystic masses close abutting to the midthoracic esophagus. Rarely, exophytic lower thoracic EBC may mimic lung nodule. Total cyst excision usually offers satisfactory outcome with no recurrence in long-term follow-up.

Adult↗

PubMedDate not supplied

Clinically occult isolated right iliac mycotic aneurysm with duodenal involvement in a diabetic elderly man: multislice CT diagnosis.

A diabetic old man presented with vague abdominal discomfort and intermittent tarry stools for 2 days and gastric ulcers with bleeding was diagnosed after endoscopy. Multislice computed tomography (MSCT) clearly depicted an isolated right iliac mycotic aneurysm with retroperitoneal extension and duodenal involvement. Timely operation and effective antibiotic treatment resulted in complete recovery. To our knowledge, this is the first report of an isolated mycotic iliac artery aneurysm (IAA) complicated with an aneurysmo-duodenal fistula induced by Klebsiella pneumoniae.

Abdominal Pain↗

PubMedDate not supplied

Imaging features of atypical thoracic Castleman disease.

The imaging features of 16 cases of pathologically proven atypical thoracic Castleman disease (CD) were retrospectively reviewed. Thirteen out of 16 tumors originated from atypical locations, including eight from the pleura and one each from the axilla, supraclavicular fossa, intercostal space, pericardium, and lung. Six out of 16 tumors revealed atypical enhancement, including poor CT enhancement in three tumors, target-like CT enhancement in two tumors, and concentric MR enhancement pattern in one tumor. These atypical enhancement patterns were histopathologically corresponded to various degrees of degeneration, necrosis, and fibrosis.

Adult↗

PubMedDate not supplied

Sudden cardiac arrest during computed tomography examination: clinical findings and "dense abdominal veins" on computed tomography.

We report imaging findings in five patients who had sudden cardiac arrest during contrast-enhanced computed tomography (CT). We observed strikingly dense abdominal veins, variable degrees of arterial enhancement, and poor abdominal visceral enhancement. Comparison with a control group of 30 patients revealed a statistically significant increase in mean enhancement of the abdominal veins (including the inferior vena cava, bilateral renal veins, and major tributaries of the hepatic vein) (Kruskal-Wallis test, P< 0.05). These patients lacked any clear cause of cardiac arrest, and the arrest may have been related to an adverse reaction to contrast medium. Despite resuscitation, two patients died and three convalesced. In summary, sudden cardiac arrest is characterized by "dense abdominal veins" on CT in the absence of the cardiac pump function. This effect was presumably the result of forced reflux and stagnation of contrast medium in the abdominal veins without any dilution with the circulating blood, leading to a markedly dense appearance of these venous structures.

Abdomen↗

PubMedDate not supplied

Massive hemobilia.

BACKGROUND/AIMS: Massive hemobilia is a relatively rare, but potentially life-threatening cause of upper gastrointestinal hemorrhage. We report our experiences in the treatment of 15 cases of massive hemobilia with different underlying pathologies. METHODOLOGY: Massive hemobilia is defined as a patient with blood discharge from the biliary tree and requiring whole blood transfusion for at least 4 u (1 u = 250 cc). Fifteen such patients were collected during an 8.5-year period (from January 1986 to July 1994), and the clinical courses of these patients were retrospectively reviewed. RESULTS: Among these 15 patients, 11 were males and 4 were females. Age distribution was from 33 to 78 years old. Mean age was 59.7 years. The cause of hemobilia included: percutaneous transhepatic biliary drainage in 7 patients, surgical trauma in 3, choledochoscopic extraction of biliary calculi in 1, pancreatic cancer in 1, radiotherapy for cholangiocarcinoma in 1, after operation for biliary lithiasis in 1, and rupture of the pseudoaneurysm in 1. In 11 patients, hemobilia was first noted by bleeding from percutaneous transhepatic biliary drainage tube (n = 10) or T-tube (n = 1). Three patients had hemobilia during choledocholithotomy. The other one was diagnosed by choledochoscopy. Treatment included pitressin infusion from angiographic catheter in one patient, transarterial embolization in 1, hepatic artery ligation in 1, hepatic artery ligation and transarterial embolization in 1, choledochotomy or choledocholithotomy in 2, and blood transfusion only in 9. Two of the four mortality cases had underlying malignancy. CONCLUSIONS: The most common cause of massive hemobilia was percutaneous transhepatic biliary drainage procedures. Eight cases were successfully treated with blood transfusion only. Transarterial embolization, hepatic artery ligation and open drainage were effective non-surgical and surgical procedures, but the former two procedures might not be successful if sudden and severe hemobilia developed, or when an aberrant hepatic artery existed. Main hepatic artery had better been isolated before removal of the percutaneous transhepatic biliary drainage tube during operation.

Adult↗

PubMedDate not supplied

Hepatic focal nodular hyperplasia: the "star sign" on gadolinium-enhanced magnetic resonance angiography.

BACKGROUND/AIMS: This study aimed at presenting the three-dimensional gadolinium-enhanced magnetic resonance angiography findings of hepatic focal nodular hyperplasia with angiographic correlation. METHODOLOGY: Three patients (one had abdominal pain, two were asymptomatic) with liver mass or nodules in the liver revealed on ultrasound underwent three-dimensional gadolinium-enhanced magnetic resonance angiography. Catheter angiography was available for correlation in all three cases. Other imaging studies including conventional magnetic resonance imaging in three patients, computed tomography in two and scintigraphy scan in one were reviewed. Surgical resection and biopsy were performed in one and two patients respectively. RESULTS: The ultrasound, computed tomography, magnetic resonance and scintigraphy findings were non-specific for focal nodular hyperplasia in all three patients. However, gadolinium-enhanced magnetic resonance angiography demonstrated tumor vessels radiating from its center to the periphery, which corresponded to the spokes of the characteristic "spoke-wheel" pattern on catheter angiography, producing the so called "star sign," that may suggest the diagnosis of focal nodular hyperplasia. Histopathologic examinations revealed focal nodular hyperplasia. CONCLUSIONS: This report highlights the usefulness of gadolinium-enhanced magnetic resonance angiography in the diagnosis of hepatic focal nodular hyperplasia by demonstrating the "star sign" and that computed tomography, scintigraphy, and catheter angiography may thus be obviated in such instances.

Adolescent↗

PubMedDate not supplied

Primary pleomorphic rhabdomyosarcoma of the liver: a case report.

Primary intrahepatic rhabdomyosarcoma is extremely rare in children. We describe a case of pleomorphic rhabdomyosarcoma originating from the liver in an eight-year-old boy presenting with abdominal pain, spiking fever and a rapidly growing abdominal mass for one week. Preoperative imaging studies revealed a large solid tumor in the right lobe of the liver without any tumor elsewhere in the body. Serological study was negative for HBsAg and positive for anti-HBs. Biochemical tests including serum glutamic-oxalacetic and glutamic-pyruvic transaminase, alkaline phosphatase, bilirubin and alpha-fetoprotein were all within normal limits. The tumor was removed by an extended right hepatectomy. Histological and immunohistochemical examination confirmed a pleomorphic rhabdomyosarcoma. The patient eventually succumbed to tumor recurrence with massive internal hemorrhage two months after resection of the tumor. This is the first report of primary pleomorphic rhabdomyosarcoma of the liver in children. Abdominal ultrasonography, computed tomography scan and angiography are valuable for preoperative planning but the imaging findings are non-specific. Pathological examination with immunohistochemical stains remains the most important method in arriving at the exact diagnosis. The poor prognosis and early death of most previously reported cases imply the need for investigation of a more effective treatment method of this uncommon tumor.

Child↗

PubMedDate not supplied

Duplication of transverse colon: report of one case.

Alimentary tract duplications are very rare, with a reported incidence of 1 in 5000 live births. However, it rarely affects the transverse colon. We reported a case of duplication of the transverse colon in a 12-year-old boy with an unusual presentation mimicking megacolon. Barium enema revealed a large sac with massive fecal material retention in the left side of abdomen. Barium filling of the sac displacing bowel loops was noted on the post-evacuation film. He received a segmental resection of the transverse colon including the duplicated colon and end-to-end colo-colostomy. Pathology revealed whole muscle layer of colon compatible with duplication. No other associated anomaly was noted in this case. The case demonstrates three relatively uncommon presentations, including transverse colon location, late manifestation and dilated colon mimicking megacolon radiologically. It also emphasizes that barium enema with post-evacuation film aids in the preoperative diagnosis of duplication.

Child↗

PubMedDate not supplied

Double guidewire method: a novel technique for correction of migrated Tenckhoff peritoneal dialysis catheter.

Twenty-two consecutive patients with a continuous ambulatory peritoneal dialysis (CAPD) catheter malfunctioning due to catheter migration were treated with a novel radiological manipulation technique, the "double guidewire method." The first guidewire is used to correct the direction of the catheter tip and the second wire is used to anchor the CAPD catheter so that an ideal course of the catheter can be maintained during removal of the first guidewire. Immediate catheter repositioning was achieved in 19 of 22 patients, and durable repositioning success was achieved in 13 patients. In conclusion, the "double guidewire method" is a simple but effective technique for prolonging CAPD catheter life in patients with malfunction due to catheter migration.

Adult↗

PubMedDate not supplied

Liver abscess in children: a single institutional experience in southern Taiwan.

Liver abscess is uncommon in children. The purpose of this study is to evaluate the predisposing factors, pathogens, duration of hospitalization, and the managements of liver abscess in children. From 1986 to 2001, fifteen children were admitted to our hospital under the diagnosis of liver abscess. Thirteen cases were older than 8 years old and two were younger than one year old. Fever (15/15, 100%) and abdominal pain (13/15, 87%) were the most common symptoms. Twelve patients (80%) had prolonged fever (fever for 7 days or longer before diagnosis). Eleven (73%) cases were cryptogenic in origin. Most of the microorganisms were obtained solely from cultures of pus. Klebsiella pneumoniae was the most common organism isolated (6/15, 40%). Beside administration of antibiotics, percutaneous catheter drainage (PCD) was performed in 11 patients (73%); only one underwent surgical intervention due to poor response to PCD management. All of our patients were surviving after at least one year follow-up. In conclusion, liver abscess should be suspected in the patients with prolonged fever of unknown origin and abdominal pain. PCD combined with adequate antibiotics were sufficient for therapy of liver abscess in most cases. K. pneumoniae was the most common isolated pathogen in southern Taiwan.

Adolescent↗

PubMedDate not supplied

Diffuse xanthogranulomatous pyelonephritis and staghorn calculus: report of one case.

Xanthogranulomatous pyelonephritis and staghorn calculus are rare in children. In this report, we describe a Chinese boy without history of urinary tract infection who developed insidious onset of left flank pain. Urine culture showed Proteus mirabilis infection. Sonography and computed tomography of the abdomen showed typical picture of xanthogranulomatous pyelonephritis and staghorn calculus. Photomicrography showed characteristic lipid-laden macrophage aggregates. After nephrectomy, he was symptom-free. In conclusion, xanthogranulomatous pyelonephritis should be considered in afebrile children with flank pain and staghorn calculus.

Adolescent↗

PubMedDate not supplied

Adenoid cystic carcinoma of the breast: truly uncommon or easily overlooked?

BACKGROUND: Adenoid cystic carcinoma of the breast is an uncommon histologic form of breast cancer, comprising in most series less than 1% of all mammary cancers. Due to the rarity, little information about its presentation on image studies has been noted in the literature. Here we report two additional cases with emphasis on the intriguing image presentations. CASE ONE: A 67-year-old woman came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. Mammography showed a small well-defined nodule in the medial part of the left breast without mammographic evidence of malignancy. Ultrasonography showed a 1.5 cm nodule with well-defined margin and heterogenous echogenicity in the medial part of the left breast. Unusually, a painful sensation was experienced on compression by the probe. The final pathological report was adenoid cystic carcinoma. CASE TWO: A 48-year-old woman also came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. Mammography showed dense mammary tissue with no mammographic evidence of malignancy. Ultrasonography showed two contiguous well-defined nodules with heterogenous echogenicity in the upper, middle part of the left breast. Unusually, a painful sensation was also noted on compression by the probe. Histopathological examination showed typical features of an adenoid cystic carcinoma. CONCLUSION: Adenoid cystic carcinoma of the breast fails to show the typical appearance of invasive ductal carcinoma on both mammogram and ultrasonography, probably due to its relatively well-defined nature with less surrounding architectural disruption and fibrosis. Hence a "negative" finding or a benign-looking breast lesion on mammography cannot completely exclude the existence of this disease. The presence of a painful breast lesion without obvious inflammatory evidence while compressed is a meaningful clue, which should lead to the suspicion of adenoid cystic carcinoma of the breast.

Aged↗