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Biomedical subjects

T K Choi

Publications and source records attributed to T K Choi.

At least 55 records · Page 3Linked to original sources
PubMed1986

Injection sclerotherapy of oesophageal varices with the free-hand technique: experience in Hong Kong.

A prospective study of the efficacy of injection sclerotherapy with the free-hand technique for acute bleeding oesophageal varices was conducted, to evaluate its use in the control of acute variceal bleeding and to assess long-term sclerotherapy as the definitive treatment. Between July 1981 and January 1985, a total of 108 patients (96 men, 12 women with mean age of 54.4 years) had intravariceal injection of 5 per cent ethanolamine oleate. The majority had non-alcoholic cirrhosis and alcoholism accounted for only 18.5 per cent. There were 22 Child's A, 42 Child's B and 44 Child's C patients. During the 411 sessions of injection, major complications occurred in 12 patients (11.1 per cent) with 3 deaths. Of the 145 episodes of acute variceal bleeding 91.7 per cent were successfully controlled. In episodes which required more than one injection to control the bleeding, there was a high mortality of 75 per cent. Over the three and a half year period, 33 out of the 93 patients on long-term sclerotherapy had re-bled (35.5 per cent). Varices were obliterated in 27 patients with a mean of 5.4 injections. From our experience, the procedure is safe and effective. However, its status as a definitive treatment when compared with conventional surgical treatment requires further controlled evaluation.

Adult↗
PubMed1986

Prostaglandin E1 (misoprostol) overcomes the adverse effect of chronic cigarette smoking on duodenal ulcer healing.

Chronic cigarette smoking adversely affects duodenal ulcer healing despite treatment by potent gastric acid-reducing agents. Prostaglandins of the E series possess antisecretory and cytoprotective properties and theoretically offer advantages over existing therapeutic agents. A double-blind randomized study was performed to compare complete duodenal ulcer healing as assessed by endoscopies every two weeks for up to 12 weeks. Two hundred twenty-nine patients were randomized to receive misoprostol, an orally stable synthetic derivative of prostaglandin E1, in 200-micrograms or 300-micrograms qid dosages, or placebo. Life-table analysis showed that (1) both regimens of misoprostol were significantly more effective than placebo, achieving healing rates of 61% and 71%, respectively, at four weeks, and (2) cigarette smoking significantly impaired healing by placebo but not by misoprostol. In fact, the time-healing curves of smokers and nonsmokers on the higher dose of misoprostol completely overlapped. Furthermore, delayed treatment and large ulcer diameter adversely affected healing by misoprostol in smokers, whereas in nonsmokers, high basal and maximal acid output were unfavorable. Misoprostol is recommended for the treatment of duodenal ulcer, particularly in chronic smokers early in a given period of symptoms.

Adult↗
PubMed1986

Hepatolithiasis in East Asia. Retrospective study.

Hepatolithiasis is a major disease in Asia but differences in operative incidence between countries have not been examined. A retrospective study was conducted in Taiwan, Hong Kong, and Singapore, and the results were compared with those in Japan with the aim of defining factors involved in the etiology of the condition. In order to ensure uniformity of the data collected, the same form was used throughout the study and was completed by the same personnel after reviewing the patient's record and radiographs in each case. The years 1976-1980 were chosen for the study, since the newer methods of diagnosis such as ultrasound, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography became available during that period. The most significant finding was the difference in the relative prevalence of hepatolithiasis as a proportion of all gallstone cases in Taiwan, Hong Kong, and Singapore, where the majority of the population consisted of patients of Chinese descent. The highest prevalence, 53.5%, was found in Taiwan, while in Hong Kong it was 3.1% and in Singapore 1.7%. Environmental rather than ethnic factors are implicated in the cause of hepatolithiasis.

Adult↗
PubMed1986

Postoperative flexible choledochoscopy for residual primary intrahepatic stones.

Postoperative flexible choledochoscopy was carried out in 103 patients with residual biliary calculi. Forty-one patients had residual stones in the common duct, and 63 patients had residual stones in the intrahepatic ducts with or without stones in the common duct. The majority of the intrahepatic stones were primary stones. Postoperative choledochoscopy was very effective in removing residual common duct stones (95% removed, no morbidity). For intrahepatic stones, removal was more difficult and was associated with a higher morbidity (11.2%). Stone extraction through the stenotic intrahepatic ducts was made possible by the balloon dilatation of the ducts. Repeated endoscopic access to the biliary system was made easier by the construction of a hepatico-cutaneous-jejunostomy, which also provides a route to the biliary tree for future stone removal if stone reformation occurs. Complimented by these procedures, postoperative choledochoscopy was successful in removing the residual intrahepatic stones in 82.3% of the patients. At a median follow-up of 17 months, the majority of the patients who had all the stones removed as well as those who had stones left behind were symptom free.

Adolescent↗
PubMed1986

Endoscopic retrograde cholangiopancreatography and endoscopic papillotomy in recurrent pyogenic cholangitis.

In recurrent pyogenic cholangitis (RPC), there is primary bacterial cholangitis resulting in the formation of strictures and stones in the intrahepatic as well as the extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) is a very useful investigation in the study of RPC. The location of stones and strictures and the morphology of the bile ducts are well delineated. Moreover, cholangitis liver abscesses and biliary-enteric fistulas, which are frequently encountered in RPC, are demonstrated. ERCP can also be used to differentiate RPC from ascariasis, clonorchiasis, hepatocellular carcinoma and cholangiocarcinoma, which sometimes have quite similar clinical pictures and can be confused with RPC. ERCP should be performed in every patient with RPC in order to plan surgical treatment. Endoscopic papillotomy (EPT) is indicated in RPC patients with residual common bile duct stones or papillary stenosis, and as primary treatment in selected high-risk patients. More studies are necessary to establish additional indications for EPT.

Ampulla of Vater↗
PubMed1986

Endoscopic retrograde cholangiopancreatography after acute pancreatitis.

To assess the usefulness of endoscopic retrograde cholangiography (ERCP) in the study of acute pancreatitis, 101 of a possible 114 patients (89 per cent) with acute pancreatitis underwent ERCP after recovery from acute illness. In 81 per cent, ERCP was performed within two weeks of recovery. The biliary tract was successfully demonstrated in 87 per cent of the patients and the pancreatic duct in 73 per cent. Roentgenograms of the biliary tract showed stones in the gallbladder in 40 per cent of the patients and in 36 per cent in the biliary ducts. In addition, the gallbladder was not visualized in nine patients. In eight of those patients, the gallbladder was subsequently shown to be abnormal. Other findings of the biliary system included one patient each with clonorchiasis, ascariasis and malignant disease. Changes in the pancreatic duct were detected in 11 per cent of the patients. Most of the changes were consistent with acute or chronic pancreatitis. Minimal morbidity was encountered. ERCP is very accurate in identifying the biliary causes of pancreatitis. In areas where a significant proportion of acute pancreatitis has biliary causes, it should be performed upon all patients soon after resolution of the acute illness to identify those patients who will benefit from early operation upon the biliary tract.

Acute Disease↗
PubMed1984

Chemotherapy for advanced hepatocellular carcinoma. Adriamycin versus quadruple chemotherapy.

In a prospective clinical trial, 39 patients with advanced hepatocellular carcinoma were randomized to receive either Adriamycin (20 patients) or a combination of 5-fluorouracil, methotrexate, cyclophosphamide, and vincristine (19 patients). Five patients receiving Adriamycin and none receiving quadruple chemotherapy responded (P less than 0.05 in favor of Adriamycin). A further 25 patients were treated with Adriamycin, making a total of 45. The overall objective response rate was 24% (11 patients), with 3 complete remissions and 8 partial remissions. The median survival for Adriamycin-treated patients (13.0 weeks for the first 20 patients and 14.4 weeks for all patients) was longer than those treated by quadruple chemotherapy (6.5 weeks). The difference, however, was not significant by the Wilcoxan test as modified by Gehan. Patients with positive HbsAg had a significantly higher chance of having a response, while serum alpha-fetoprotein levels did not correlate with response.

Adult↗
PubMed1984

Bronchoscopy and carcinoma of the esophagus I. Findings of bronchoscopy in carcinoma of the esophagus.

Tracheobronchial involvement frequently occurs in patients with carcinoma of the esophagus. A study of the results of 525 bronchoscopies performed on patients with carcinoma of the esophagus who were evaluated for surgery revealed that abnormalities were found in 33.9 percent. The incidence was highest for those with cervical and upper-third thoracic tumors; however, a significant number of lower-third thoracic and abdominal tumors also showed abnormalities (12.5 and 5 percent, respectively). The incidence was also higher with large tumors, but again, a significant number of apparently small tumors also showed abnormalities. The abnormalities could be broadly classified into two groups: those showing only impingement and those showing actual invasion. Further studies are needed to determine whether the tumors with impingement are resectable.

Adult↗
PubMed1984

Bronchoscopy and carcinoma of the esophagus II. Carcinoma of the esophagus with tracheobronchial involvement.

Involvement of the tracheobronchial tree, as observed through the bronchoscope, was in the form of impingement or invasion. Bronchoscopy was performed on 525 patients with carcinoma of the esophagus. Impingement was found in 91 patients and invasion in 87 patients. Forty-eight of the 63 patients with impingement and 7 of the 51 patients with invasion were found to have resectable tumors. Bypass operations were performed on the rest of the patients. The operative mortality was high for both bypass and resection procedures. The median survival for bypassed patients and resected patients were 4 months and 9 months, respectively. Four resected patients survived 3 years or more, 2 of whom had no evidence of recurrence. Most patients with impingement have resectable tumors and long-term survival is possible if the tumor can be resected.

Adult↗
PubMed1984

Cholangiographic appearance in clonorchiasis.

Clonorchiasis may lead to cholangitis. Clonorchis sinensis infiltration of the biliary system produces an easily recognisable cholangiographic picture. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic ducts. The filling defects are usually small and irregular and the size is uniform. The change in the intrahepatic ducts consists of ductal dilatation involving especially the smaller ducts, apparent elongation, tortuosity and duct wall irregularities. The changes in the extrahepatic ducts consist mainly of duct wall irregularities and a mild degree of dilatation. The recognition is important as the management may have to be modified if cholangitis is the result of clonorchiasis alone.

Bile Ducts, Intrahepatic↗
PubMed1984

Sphincteroplasty.

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Ampulla of Vater↗