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Biomedical subjects

T K Choi

Publications and source records attributed to T K Choi.

78 records · Page 5Linked to original sources
PubMedDate not supplied

Current management of intrahepatic stones.

A high incidence of intrahepatic stones occurs in East Asia. The surgical management of intrahepatic stones is problematic because it is difficult to locate and remove all the stones and relieve the accompanying biliary strictures. Consequently, the rate of recurrent cholangitis is high. Many new techniques have been introduced to locate, fragment, and retrieve gallstones. Operative procedures to relieve biliary strictures have also undergone development. These new procedures and techniques have been applied to intrahepatic stones. The initial results are good. Whether these good results can be maintained in the long-term remains to be seen.

Bile Ducts, Intrahepatic↗
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

Acute cholangitis after endoscopic sphincterotomy: complications of expectant treatment.

Two elderly patients who had endoscopic sphincterotomy (EST) for their common duct stones developed acute cholangitis and, one of them also developed acute pancreatitis after the procedure. Despite the presence of an adequate sphincterotomy which allows subsequent spontaneous stone elimination, transient ductal obstruction during stone migration through the sectioned papilla is probably accountable for their complications. From the present reported experience, it is clear that expectant treatment of common duct stone after EST can be associated with definite hazards. Immediate biliary decompression with either active instrumental extraction or, when not feasible, insertion of nasobiliary catheter, should be performed to prevent these complications in selected patients.

Acute Disease↗
PubMedDate not supplied

Management of complicated acute pancreatitis: impact of computed tomography.

The usefulness of computed tomography (CT) in guiding the management of 43 patients who had a complicated clinical course of acute pancreatitis was retrospectively studied. The CT scans were performed when patients had persistent fever, leucocytosis, hyperamylasaemia, palpable abdominal masses or when there was organ failure. The CT scans showed normal findings in six patients, features of pancreatic abscess in three patients, pseudocysts in three patients and inflammatory masses (a mixture of sterile inflammation and necrosis) in 31 patients. Patients with pancreatic abscesses underwent emergency laparotomy, drainage and debridement; patients with pseudocysts had delayed drainage unless complication occurred; patients with normal CT scan or findings of inflammatory masses were managed conservatively. For patients undergoing conservative management, repeated CT scanning and percutaneous aspiration of the inflammatory mass was performed when pancreatic sepsis was strongly suspected. By this approach, basing on careful clinical and CT scan surveillance, five patients with pancreatic sepsis (pancreatic abscess and localized abscess collection in pseudocyst) underwent emergency surgery and four survived, while 25 patients with inflammatory masses were successfully managed conservatively and some who may have been operated on clinical grounds were spared unnecessary early debridement surgery.

Abscess↗