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Biomedical subjects

Y L Wan

Publications and source records attributed to Y L Wan.

At least 19 recordsLinked to original sources
PubMed1992

Early gastric cancer in southern Taiwan.

Between January 1986 and November 1990, 231 patients underwent resection for primary gastric adenocarcinoma at Chang Gung Memorial Hospital in southern Taiwan. Thirty-nine (17%) of these patients had early gastric cancer (limited to the mucosa or submucosa regardless of nodal metastases). Epigastric pain was the most frequent symptom (71.8%). The lesions were located in the lower third of the stomach in 84.6% of the patients and in the middle third in 15.4%. A preoperative diagnosis of gastric cancer was achieved in 94% of patients by endoscopic examination with biopsies. All of the patients underwent distal subtotal gastrectomy without mortality. Macroscopically, 84.6% of cases were included in types IIc, III, and IIc-III. One patient died of multiple liver metastases 3.2 years after operation. The cumulative survival rate at 5 years is 92.9%. We comment on these matters and place early gastric cancer in Taiwan into a more global context.

Adenocarcinoma↗
PubMed1992

Abscess of urachal remnant mimicking urinary bladder neoplasm.

Three cases of urachal abscess with extensive interstitial inflammation and fibrosis are reported. Clinically, all patients had a lower abdominal mass and CT scan and ultrasonic examination revealed a large tumour located anterior or superior to the bladder. They all underwent laparotomy and had either a partial cystectomy or an en bloc resection of the bladder and adjacent organs due to severe adhesions. Microscopic examination of the specimens revealed no evidence of carcinoma and only abscess formation with extensive chronic interstitial inflammation and fibrosis were seen. In one case, residual columnar epithelium suggestive of urachal origin was identified in the abscess cavity. Urachal abscess should be considered when dealing with lower abdominal masses.

Abscess↗
PubMed1992

Computed tomography in diagnosis of septic sacroiliitis: report of three cases.

Disorders of the sacroiliac joint are often overlooked during an initial physical examination because the patient is usually in a supine position and the posteriorly located joint is not accessible. Local pain and tenderness at the sacroiliac joint on lateral compression of the pelvis, together with Gaenslen and Fabere maneuvers, may direct the physician's attention to the joint. However, these symptoms are not specific or pathognomonic. Unusual presentation of septic sacroiliitis, which does not show radiologic changes during the early stages, may mimic gluteal, lumbar disc or intra-abdominal syndromes, leading to unnecessary abdominal exploration or lumbar discectomy. Computed tomography (CT), with its superb delineation of osseous, synovial and peri-articular structures, was applied to diagnose septic sacroiliitis in three patients. In Patient 1, septic arthritis and juxta-articular osteomyelitis with sequestrum formation were demonstrated by CT four weeks before abnormalities were shown on a roentgenogram. In Patients 2 and 3, inflammatory processes affected the synovium and peri-articular muscles; thus, abnormalities were shown by CT but not by a roentgenogram. We consider CT to be helpful and superior to conventional radiography in the diagnosis of septic sacroiliitis.

Arthritis, Infectious↗
PubMed1992

Sciatica caused by piriformis muscle syndrome: report of two cases.

The diagnosis of piriformis muscle syndrome, an unusual cause of sciatica, is difficult. However, with the advancement of imaging techniques, it has become clear that the condition is not just clinical speculation, but is a definite entity. We report on two cases with piriformis muscle syndrome, diagnosed on the basis of: a history of sciatica; physical findings, such as a tender point at the sciatic notch and around the piriformis muscle by palpation of the gluteal region, and by a digital pelvic examination; and computed tomography (CT) to demonstrate hypertrophy of the piriformis muscle. In both cases, a tenotomy of the piriformis muscle at the greater trochanter relieved entrapment of the sciatic nerve and gave satisfactory results. Since local tenderness at the piriformis muscle is the most reliable physical finding, a pelvic examination is recommended in the evaluation of suspected cases of piriformis muscle syndrome. CT is helpful in showing hypertrophy of the piriformis muscle. Detailed history taking, a careful physical examination, and versatile use of CT or magnetic resonance imaging can lead to an early, accurate diagnosis and proper treatment.

Adult↗
PubMed1991

The role of sonography in the diagnosis and management of urachal abscesses.

Eighteen cases of urachal abscess were studied with sonography. Their configurations were cone shaped in 11 cases, tubular in 4, curved club shaped, and oval and irregular in one each. Their complications, such as intraperitoneal spread, chronic cystitis, and adhesion to the omentum or the colon, could also be suggested by ultrasonography. Gas was found in 50% of the lesions, which were all larger than 1 cm in diameter. An abscess smaller than 1.2 cm in diameter (which can be as long as 5 cm) can be treated with antibiotics or incision and drainage without total excision. A lesion within the extraperitoneal fat space of abdominal wall at the midline below umbilicus suggests the diagnosis of urachal abscess in cases of umbilical discharge and/or when the lesion extends to the umbilicus.

Abscess↗
PubMed1991

Ultrasonography of adrenal lesions.

A total of 98 adrenal glands in 49 patients were prospectively investigated by ultrasonography (US). The US had a sensitivity of 76.7%, a specificity of 92.7%, and an accuracy of 85.7%. It is mainly the smaller lesions (0.5 to 2.8 cm, mean 1.2) which decrease the sensitivity of US. Large tumors in or near the glands and anatomical variants may decrease the accuracy of US as well. The ultrasound detection of a large and solid adrenal tumor, especially one with irregular border, or a tumor with invasion to the inferior vena cava, suggests the high possibility of malignancy. While a tumor with central necrosis may be suggestive of pheochromocytoma, despite its large size. US is a good primary screening modality for patients with suspected adrenal lesions; and it may help to differentiate malignant from benign tumors of the adrenal.

Adrenal Gland Diseases↗
PubMed1991

Acinar cell carcinoma of the pancreas: a rare cause of left-sided portal hypertension.

Isolated splenic vein obstruction with left-sided portal hypertension is a rare clinical condition. Owing to the close relationship of the splenic vein and the pancreas, this rare phenomenon is usually secondary to pancreatic inflammation or neoplasm. Acinar cell carcinoma has long been recognized as a distinctive, rare type of pancreatic carcinoma. A case of isolated splenic vein obstruction with left-sided portal hypertension secondary to acinar cell carcinoma of the pancreas, which we are reporting here, is thought to the first documented in the literature.

Carcinoma↗
PubMed1990

[Pyogenic liver abscess--report of 72 cases].

Seventy-two patients with pyogenic liver abscess treated from Jan. 1986 through June 1988 were reviewed retrospectively. The average age was 55 years with a male to female ratio of 1.4:1. Most patients presented with the typical fever, chills and RUQ pain, but unusual signs and symptoms were also common. The right lobe was more commonly involved than left lobe. Biliary tract stone was the most frequent etiology (44.4%) and association with DM was common (37.5%). An elevated alkaline phosphatase and leukocytosis were useful clues to a liver abscess, but diagnosis depended on imaging of an abscess cavity either by echo or CT scan. The average time from onset of Symptoms to diagnosis was 9.3 days and a delay in diagnosis by the doctors was common. The most common complication was septicemia and factors with poor prognosis were old age (greater than or equal to 60 yrs), septicemia, cancer, peritonitis, and serum bilirubin greater than or equal to 5 mg/dl. The overall mortality was 29% with no difference between the group with surgical drains (28.5%) and the group with percutaneous transhepatic aspiration or drains (29.4%).

Adolescent↗
PubMed1990

Choledochal cyst mimicking gallbladder in Tc-99m disofenin radionuclide cholescintigraphy.

A 6-year-old girl suffered from intermittent abdominal pain and bile-stained vomiting after undergoing cholecystectomy for perforated gallbladder and bile peritonitis when she was 2 years old. The interesting finding of her choledochal cyst, which was visualized 5 minutes after the injection of Tc-99m disofenin and contracted well after an egg meal, is reported. This finding is inconsistent with those of early reports, which emphasized delayed filling and stasis of radioactivity in the dilated cyst. This case, together with more recent reports in this field, suggests that nuclear images of choledochal cyst, like its clinical presentation, may be quite variable.

Child↗
PubMed1990

Exotic obstruction.

Explore the source record for details and available documents.

Anesthesia, Inhalation↗
PubMed1989

[Congenital cystic adenomatoid malformation of the lung--a case report].

Congenital cystic adenomatoid malformation of the lung is a rare but potentially lethal variety of congenital pulmonary defect. This is a multicystic mass of dysplastic pulmonary tissue in which there is proliferation of bronchial structure at the expense of alveoli. We report a newborn infant with respiratory distress. The chest X-ray showed multicystic lesions with air-fluid level and shift of mediastinum. The patient was successfully treated with segmentectomy. The clinical manifestations, radiographic and pathologic features were summarized and the literature reviewed.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1989

Salmonella cholerasuis bacteremia and mycotic aneurysm of abdominal aorta--report of five cases.

From August 1986 to October 1987, there were 5 cases of primary mycotic aneurysm of the lower abdominal aorta in Chang Gung Memorial Hospital at Kaoshiung. All patients were proved to have Salmonella cholerasuis (Sal. chol.) septicemia by blood culture. The ages ranged from 60 to 80 years old, the mean age was 71.6 years old. The male to female ratio was 4 to 1, 3 patients had diabetes mellitus (DM) and 3 had hypertension. The duration of symptoms lasted from 1 week to 2 months before diagnosis. Clinically, all patients had sepsis with fever, chills, leucocytosis, and complained of pain in the lower abdomen (80%), at flank (20%) or low back (20%). Abdominal tenderness was present in 3 (60%). Two patients underwent surgery, 1 expired during the operation, the other expired 1 month after operation because of retroperitoneal abscess and sepsis. Three were discharged in septic shock and expired within 1 day. The mortality rate was 100%. The diagnosis of complicated aneurysm of the lower abdominal aorta was established in all by computed tomography (CT). In conclusion, when there are clinical manifestations of sepsis, positive blood culture for Sal. chol., and pain or tenderness in the lower abdomen, flank area or back, one should consider the possibility of mycotic aneurysm of the lower abdominal aorta. Although the prognosis is poor, early surgical intervention may improve the outcome. And the diagnosis is best established by CT.

Aged↗
PubMed1989

Actinomycosis of the greater omentum.

A case of histologically proven actinomycosis of the greater omentum is reported. Computed tomography (CT) showed a mass at the greater omentum near the left flank area; it was hypervascular on angiograms and was supplied by the omental artery originating from the splenic artery. Sonography showed that the echogenecity of the lesion was complex. Actinomycosis of the greater omentum, although rare, should be included in the differential diagnosis of omental mass.

Actinomycosis↗
PubMed1989

[Polypoid lesions of the gallbladder].

26 cases of polypoid lesions of the gallbladder are reported. 19 were benign lesions, among them, there were 12 (63%) cholesterol polyp, 4 adenoma, 1 inflammatory polyp, and 2 others. 95% of benign lesions were less than 1 cm in diameter, 63% of which were less than 0.5 cm in diameter, 15 cases were multiple lesions; all cases were not associated with gallstones. 7 cases were carcinoma of the gallbladder, of which, 5 were more than 1 cm in diameter, 2 were less than 1 cm which were carcinoma in situs; 3 were associated with gallstones. The accuracy of preoperative diagnosis of polypoid lesions of the gallbladder made by B-mode ultrasonography, cholecystography, CT, endoscopic ultrasonography were 84%, 53%, 80% and 75% respectively. It is concluded that preoperative diagnosis of polypoid lesions on the gallbladder mainly depends on the B-mode ultrasonography; the lesions less than 0.5 cm in diameter should not be treated by operation for the time being; the lesions between 0.5-1 cm should be followed up by B-mode ultrasonography; the operation may be considered if stones present; the lesions more than 1 cm should be resected since malignancy could not be excluded.

Adenocarcinoma, Papillary↗