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Fan ST, Poon RTP, Yeung C, Lam CM, Lo CM, Yuen WK, Ng KKC, Liu CL, Chan SC. Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg 2011; 98:1292-300. [PMID: 21656513 DOI: 10.1002/bjs.7583] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a trend to offer liver transplantation to patients with hepatocellular carcinoma (HCC) with tumour status within the Milan criteria but with preserved liver function. This study aimed to evaluate the outcome of such patients following partial hepatectomy as primary treatment. METHODS A retrospective analysis was performed on all adult patients with HCC and tumour status within the Milan criteria undergoing partial hepatectomy at a single centre from 1995 to 2008. Their outcomes were compared with those of similar patients having right-lobe living donor liver transplantation (LDLT) as primary treatment. RESULTS A total of 408 patients with HCC were enrolled. Some 384 patients with a solitary tumour 5 cm or less in diameter had a better 5-year survival rate than 24 patients with oligonodular tumours (2-3 nodules, each 3 cm or less in size) (70·7 versus 46 per cent; P = 0·025). Multivariable analysis identified younger age (65 years or less), lack of postoperative complications, negative resection margin, absent microvascular invasion and non-cirrhotic liver as predictors of favourable overall survival. The 5-year survival rate of 287 younger patients with chronic liver disease and R0 hepatectomy was 72·8 per cent, comparable to that of 81 per cent in 50 similar patients treated by LDLT (P = 0·093). CONCLUSION Partial hepatectomy for patients with HCC and tumour status within the Milan criteria achieved a satisfactory 5-year survival rate, particularly in younger patients with solitary tumours and R0 hepatectomy. Patients with oligonodular tumours have a worse survival and might benefit from liver transplantation.
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Affiliation(s)
- S T Fan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, 102 Pok Fu Lam Road, Hong Kong, China.
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Leung GKK, Chang A, Cheung FC, Ho HF, Ho W, Hui SM, Kam CW, Lai A, Lam KW, Leung M, Liu SH, Lo CB, Mok F, Rainer TH, Shen WY, So FL, Wong G, Wu A, Yeung J, Yuen WK. The First 5 Years Since Trauma Center Designation in the Hong Kong Special Administrative Region, People's Republic of China. ACTA ACUST UNITED AC 2011; 70:1128-33. [DOI: 10.1097/ta.0b013e3181fd5d62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Law TT, Suen DTK, Tam YF, Cho SY, Chung HP, Kwong A, Yuen WK. Telephone pre-anaesthesia assessment for ambulatory breast surgery. Hong Kong Med J 2009; 15:179-182. [PMID: 19494372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To review the efficacy of telephone preoperative anaesthesia assessment in patients undergoing ambulatory breast surgery. DESIGN Retrospective study. SETTING Day Surgery Centre, Tung Wah Hospital, Hong Kong. PATIENTS Patients with breast lumps to be excised were seen by dedicated breast surgeons and informed of day procedures and preoperative anaesthesia assessment. Those who fulfilled the selection criteria of age (18-45 years) and American Society of Anesthesiologists grade I were recruited for telephone anaesthesia assessment preoperatively. The patients were contacted by senior day surgery nurses via telephone before the scheduled operation date, and information was retrieved using a standard assessment form. Prospective data from January 2002 to December 2007 were analysed. MAIN OUTCOME MEASURES Proportion of patients who successfully underwent day surgery after telephone preoperative anaesthesia assessment. RESULTS Of 482 patients receiving ambulatory surgery for breast lumps during the study period, 283 patients were selected for preoperative telephone anaesthesia assessment. Five (2%) patients with problems identified by this method underwent further assessment at the Day Surgery Centre; the remaining 278 (98%) required no further assessment and proceeded to have a successful day surgery procedure. CONCLUSION Preoperative anaesthesia assessment by telephone is an effective means of preoperative assessment in selected patients undergoing ambulatory breast surgery.
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Affiliation(s)
- T T Law
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong
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Ho P, Poon JTC, Cho SY, Cheung G, Tam YF, Yuen WK, Cheng SWK. Day surgery varicose vein treatment using endovenous laser. Hong Kong Med J 2009; 15:39-43. [PMID: 19197095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To examine the safety and efficacy of endovenous laser obliteration to treat varicose vein in a day surgery setting, using sedation and local anaesthesia. DESIGN Prospective study. SETTING Day surgery centre in a regional hospital in Hong Kong. PATIENTS A total of 24 patients with duplex-confirmed long saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment from July to November 2007 in a single day surgery centre. Adjuvant phlebectomy and injection sclerotherapy were performed in the same session if indicated. All patients had postprocedural venous duplex scan and clinic assessment on day 7 and day 10 respectively. MAIN OUTCOME MEASURES Procedure success rate, unplanned hospital admissions and re-admissions, major complications, and long saphenous vein obliteration rate. RESULTS A total of 31 limbs of the 24 patients were treated with endovenous laser varicose vein treatment under local anaesthesia and sedation. The procedural success rate was 100%. All but two patients were admitted on the day of treatment and none were re-admitted. The patients' mean visual analogue pain score for the whole procedure was 2.3 (standard deviation, 1.5; range, 0-5). Post-procedural duplex scans showed 100% thrombosis of the treated long saphenous veins with no deep vein thrombosis. There were no skin burns or instances of thrombophlebitis. Induration of the treated long saphenous vein was relatively common (54%). The majority of the patients (54%) experienced mild discomfort in the early postoperative period. CONCLUSION Endovenous laser varicose vein treatment performed under local anaesthesia and sedation in a day surgery setting is safe, and yields satisfactory clinical and duplex outcomes.
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Affiliation(s)
- P Ho
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
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Yeung JHH, Chang ALM, Ho W, So FL, Graham CA, Cheng B, Cheung NK, Ho HF, Yuen WK, Kam CW, Rainer TH. High risk trauma in older adults in Hong Kong: a multicentre study. Injury 2008; 39:1034-41. [PMID: 18667201 DOI: 10.1016/j.injury.2008.03.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 03/18/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma is the eighth leading cause of death in Hong Kong. In 2002, 18.5% of the population of Hong Kong was aged 55 years or above, which increased to 22.1% in 2006. The increasing older population in Hong Kong presents a challenge to the health care system yet there is little local data on older trauma patients. The objectives of this study are firstly to describe the epidemiology of high risk trauma in older patients in Hong Kong, and secondly to identify predictors of trauma mortality. METHOD Retrospective analysis of prospectively collected data from a centralised trauma database; data collected from 2002 to 2004 from four trauma centres in Hong Kong. RESULTS Between 2002 and 2004, the four trauma centres had a total of 2,124,175 emergency department attendances of which 376,021 (17.7%) were trauma patients, and 80,827 (3.8%) were aged 55 years or older. 810 injured older patients met the inclusion criteria for this study. 380 (46.9%) patients had co-morbidity at the time of injury. Common causes of injury were falls (50.0%, 405/810) and motor vehicle crashes (33.6%, 272/810) of which (77.2%, 210/272) were pedestrians. Mortality was 24.4% (198/810) and increased with advancing age (p<0.0001). 53.5% (433/810) of patients had major trauma (ISS>15). Head injury contributed to 80.3% (159/198) of deaths. 38.4% (311/810) of patients required operations. Most patients were discharged home (40.5%, 328/810) and one-third (270/810) required rehabilitation. Significant predictors of mortality included co-morbidity, injury severity score, age and decreasing Glasgow Coma Score. CONCLUSION Pedestrians struck by motor vehicles and falls are the principal causes of trauma in older patients in Hong Kong. Mortality increased with advancing age. The independent indicators of trauma mortality in older patients are co-morbidity, age, ISS and GCS.
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Affiliation(s)
- Janice H H Yeung
- Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China
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Lau H, Loong F, Yuen WK, Patil NG. Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 2007; 21:1612-6. [PMID: 17762958 DOI: 10.1007/s00464-007-9205-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Herniation of retroperitoneal adipose tissue into the inguinal canal, traditionally called cord lipoma, is frequently encountered during endoscopic totally extraperitoneal inguinal hernioplasty (TEP). Failure to recognize and manage the cord lipoma accounted for 30%-50% of recurrent hernia after TEP. The present study was undertaken to evaluate the incidence, risk factors, and management of herniated retroperitoneal adipose tissue during TEP. METHODS Between December 2002 and November 2005 all patients who underwent TEP were prospectively evaluated for the presence of cord lipoma. Clinical outcomes of patients who were treated for their cord lipoma were compared with those without cord lipoma. Risk factors for the occurrence of cord lipoma were also examined. RESULTS A total of 498 patients underwent unilateral (n = 386) or bilateral (n = 112) TEP. The overall incidence of cord lipoma was 26.5% (n = 132). A higher body weight, a higher body mass index, and a larger hernial defect were significantly associated with the presence of cord lipoma. Most of the cord lipoma cases (n = 119) were reduced to pelvic peritoneal reflection line after division of the feeding vessels from surrounding structures, while the rest (n = 13) were resected. Early postoperative outcomes, including pain score, morbidities, and other recovery variables, showed no significant difference between the two groups. No recurrence occurred in the present series. CONCLUSIONS Herniation of retroperitoneal adipose tissue into the inguinal canal occurred in more than one-fifth of the patients with inguinal hernia. Awareness and appropriate treatment of the cord lipoma helped to reduce the risk of recurrence. During TEP, the internal inguinal ring and inguinal canal should always be cleared of any herniated adipose tissue by either reduction or resection. This clearing posed no adverse effects on postoperative outcome.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital & Tung Wah Hospital, Hong Kong, SAR.
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Chim CS, Yuen WK, Loong F, Hu WH, Ooi GC. Primary large B-cell lymphoma of the ampulla of Vater. Haematologica 2006; 91:ECR06. [PMID: 16533733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Primary lymphoma of the ampulla of Vater is rare. The clinico-pathological and interesting endoscopic and radiological features of a patient with this disorder is presented.
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Affiliation(s)
- C S Chim
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Lau H, Patil NG, Yuen WK. Is endoscopic totally extraperitoneal hernioplasty justified for the repair of groin hernia in female patients? Surg Endosc 2005; 19:1544-8. [PMID: 16308798 DOI: 10.1007/s00464-005-0101-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 07/12/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Groin hernia is an uncommon surgical pathology in females. The efficacy of the endoscopic approach for the repair of female groin hernia has yet to be examined. The current study was undertaken to compare the clinical outcomes of female patients who underwent open and endoscopic totally extraperitoneal inguinal or femoral hernioplasty (TEP). METHODS From July 1998 to June 2004, 108 female patients who underwent elective repair of groin hernia were recruited. The patients were divided into TEP (n = 30) and open groups (n = 78) based on the type of operation. Clinical data and outcome parameters were compared between the two groups. RESULTS The mean ages and hernia types were comparable between the two groups. All TEPs were successfully performed. The mean operative times were 52 min for unilateral TEP and 51 min for open repair. The difference was not statistically significant. Comparisons of the length of hospital stay, postoperative morbidity, pain score, and time taken to resume normal activities showed no significant differences between the two groups. A single patient in the TEP group experienced recurrence of hernia. CONCLUSIONS The findings show equivalent postoperative outcomes after TEP and open repair of groin hernia in female patients. Because the wound scar after open repair is well concealed beneath the pubic hair and no superior clinical benefits are observed after TEP, open repair appears to be the technique of choice for the management of primary groin hernia in females. The TEP approach should be reserved for female patients with recurrent or multiple groin hernia.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Sheung Wan, Hong Kong, SAR, PR, China.
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Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. Surg Endosc 2005; 20:76-81. [PMID: 16247575 DOI: 10.1007/s00464-005-0203-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 06/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Endoscopic totally extraperitoneal inguinal hernioplasty (TEP) is an accepted technique for the repair of recurrent and bilateral inguinal hernia, but its role in the management of unilateral primary inguinal hernia remains controversial. The current randomized trial was undertaken to compare the postoperative and 1-year outcomes of day-case TEP and open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. METHODS From January 2002 to January 2004, a total of 200 male patients were randomized to undergo either day-case unilateral TEP or open Lichtenstein hernioplasty under general anesthesia. The primary outcome measures included postoperative pain score, time until return to work, incidence of chronic groin pain, and recurrence rate 1 year after the operation. RESULTS All TEP procedures were successfully performed without conversion. The mean operation time for TEP (50 +/- 13.2 min) was significantly shorter than for open Lichtenstein hernioplasty (58 +/- 17.6 min) (p < 0.001). The pain score at rest was significantly lower in the TEP group than in the open group on postoperative days 0, 1, 4, 5, and 6. On the average, the patients returned to work 8.6 days after TEP and 14 days after Lichtenstein hernioplasty (p = 0.006). Postoperative recovery and morbidity rates were otherwise comparable between the two groups. The incidence of chronic groin pain 1 year after TEP (9.9%) was significantly lower than after open surgery (21.7%) (p = 0.032). None of the patients in either group showed recurrence at the last follow-up assessment. CONCLUSIONS Day-case TEP was superior to open Lichtenstein hernioplasty for the repair of unilateral primary inguinal hernia in males. The benefits of day-case TEP included less postoperative pain, a faster return to work, and a lower incidence of chronic groin pain.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong SAR, People's Republic of China.
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Lau H, Lo CY, Patil NG, Yuen WK. Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 2005; 20:82-7. [PMID: 16247580 DOI: 10.1007/s00464-005-0100-2] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 07/06/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND Early laparoscopic cholecystectomy has been advocated for the management of acute cholecystitis, but little evidence exists to support the superiority of this approach over delayed-interval operation. The current systematic review was undertaken to compare the outcomes and efficacy between early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis in an evidence-based approach using metaanalytical techniques. METHODS A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1988 and June 2004. Only randomized or quasi-randomized prospective clinical trials in the English language comparing the outcomes of early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis were recruited. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio or weighted mean difference where feasible and appropriate. RESULTS A total of four clinical trials comprising 504 patients met the inclusion criteria. Failure of conservative treatment requiring emergency cholecystectomy occurred for 43 patients (23%) in the delayed group. Metaanalyses demonstrated a significantly shortened total length of hospital stay in the early group (weighted mean difference, -1.12; 95% confidence interval [CI], -1.42 to -0.99; p < 0.001). Pooled estimates did not show any significant differences between the two approaches in terms of operation time, conversion rate, overall complication rate, incidence of bile leakage, and intraabdominal collection. CONCLUSIONS The safety and efficacy of early and delayed-interval laparoscopic cholecystectomy for acute cholecystitis were comparable. Because evidence suggested that early laparoscopic cholecystectomy reduced the total length of hospital stay and the risk of readmissions attributable to recurrent acute cholecystitis, it is therefore a more cost-effective approach for the management of acute cholecystitis.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
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Lee A, Cheng FFK, Yuen HSK, Ho M, Ngan WP, Suen YP, Au SMY, Li SN, Tso CY, Ng PPY, Wong YP, Keung MW, Lo ASC, Wong WS, Siu DCH, Yuen WK, Mok KK, Fung WY, Wong KK. Significance of the Hygiene Charter towards different sectors in Hong Kong. Asia Pac J Public Health 2005; 16 Suppl:S12-6. [PMID: 15828504 DOI: 10.1177/101053950401600s04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The occurrence of SARS in March 2003 has resulted in an increased interest, worldwide in emerging infectious diseases. The SARS experience provided us a lesson on the importance of promoting hygienic practices among individuals and different working sectors. In Hong Kong, a voluntary organization called the UNITE proposed a Hygiene Charter which aimed at taking hygiene to new levels. This action has been supported by individuals and different sectors including the Personal and Family, Management, Buildings, Catering, Education, Finance and Commercial, Industrial, Medical and Health, Public Transportation, Social Welfare, Sports and Culture and Tourism. As promotion and maintenance of environmental health requires input from different sectors, the signing of the Hygiene Charter provides an opportunity for individuals and the public to show their pledge and commitment to good hygiene practices. As a result, with environment improvement and good infectious disease control measures, prevention of epidemics of infectious diseases is deemed to be possible.
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Affiliation(s)
- A Lee
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong 2D Union Court, 18 Fu Kin Street Tai Wai, N.T., Hong Kong
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Lee A, Li SW, Au BMY, Yuen WK, Loong MC, Ng FYH, Suen YP, Ho CML. Parent training: experience of the New Territories West School Health Promotion Project of Hong Kong. Asia Pac J Public Health 2005; 16 Suppl:S22-6. [PMID: 15828506 DOI: 10.1177/101053950401600s06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents' participation in school life is an important element of a health-promoting school. To maximize the potential of parents as partners in health education and take on a leading role in promoting health in the school, family and community, a parental health education programme using the empowerment model had been launched in partnership between academic and health sectors. A total of 28 parents selected from eight schools in the New Territories West region of Hong Kong participated in the programme. Evaluation of the programme revealed that the programme had matched well with the expectation of most participants. All respondents had reported an increase in health awareness and knowledge, and confidence to promote health concepts in familiar environments, such as the home and school. They also showed interest to participate in further training in health related issues. Parental health education is recommended to enhance active involvement for building a greater sense of belonging and to put through individual empowerment to community empowerment. Parental involvement in school health promotion would be an effective way to facilitate the paradigm shift.
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Affiliation(s)
- A Lee
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, 2D Union Court, 18 Fu Kin Street, Tai Wai, New Territories, Hong Kong
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Lau H, Patil NG, Yuen WK, Lee F. Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 2003; 17:1620-3. [PMID: 12874688 DOI: 10.1007/s00464-002-8798-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Accepted: 03/31/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chronic groin pain after open inguinal hernia repair is a common long-term morbidity, but its incidence after endoscopic totally extraperitoneal inguinal hernioplasty (TEP) has not been studied in detail. The objective of this study was to evaluate the prevalence and severity of chronic groin pain after TEP. METHODS Between June 1999 and September 2001, 313 consecutive patients who underwent TEP at our institution were recruited. To evaluate the incidence and severity of chronic pain, a cross-sectional telephone survey using a standardized questionnaire was conducted by a research assistant. Clinical data between the chronic pain group and the pain-free group were compared to identify any clinical factors that had a significant association with the subsequent development of chronic groin pain. RESULTS The prevalence of chronic groin pain was 9.2% ( n = 24). The severity of the pain was mild ( n = 18), moderate ( n = 5), or severe ( n = 1). In more than half of the patients, the groin pain occurred less often than once a month and its duration did not exceed 1 min. Only one patient reported an impairment of functional activities as a result of the pain. Multivariate analyses identified a significant association between a high postoperative pain score on coughing on postoperative day 6 and the subsequent development of groin pain. CONCLUSIONS The prevalence of chronic groin pain in patients after TEP was low. The pain was mostly mild and transient without associated sensory symptoms. The occurrence of pain had a negligible impact on daily activities.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong.
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Lau H, Patil NG, Yuen WK, Lee F. Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: prospective study. Hong Kong Med J 2002; 8:413-7. [PMID: 12459597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVE To evaluate the early outcomes of laparoscopic incisional hernioplasties using on-lay GORE-TEX DualMesh. DESIGN Prospective study. SETTING Medical centre of a regional hospital, Hong Kong. SUBJECTS AND METHODS Between June 2000 and October 2001, 11 consecutive patients underwent attempted laparoscopic incisional hernioplasties at the University of Hong Kong Medical Centre. A prospective collection of perioperative data and assessment of postoperative outcomes was performed. RESULTS Laparoscopic incisional hernioplasty was successfully performed for 10 (91%) patients. One patient was converted to open repair because of extensive adhesions within the peritoneal cavity. The overall mean operative time was 107 minutes. Five (45%) patients were found to have more than one hernial defect after reduction of the hernial contents. Eight (73%) patients were discharged within 2 days after operation. Postoperative morbidities included wound bruising (n=4), seroma (n=2), and prolonged suture site pain (n=1). All postoperative morbidities resolved spontaneously without intervention. With a mean follow-up of 3 months, no early recurrence was detected. CONCLUSION Early outcomes of laparoscopic incisional hernioplasty utilising GORE-TEX DualMesh were promising. This technique confers the advantages of minimal access surgery and allows clear identification of multiple hernial defects. Extensive adhesion, which does not allow the establishment of pneumoperitoneum, is a condition that precludes the safe performance of laparoscopic repair.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Centre, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong
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Lau H, Patil NG, Yuen WK, Lee F. Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 2002; 16:1724-8. [PMID: 12098025 DOI: 10.1007/s00464-001-8298-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2002] [Accepted: 05/02/2002] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performance of endoscopic totally extraperitoneal inguinal hernioplasty (TEP) requires specialized anatomical knowledge and surgical dexterity. The present study was undertaken to evaluate the learning curve for a general surgeon to master the technique of TEP in the absence of an experienced supervisor. METHODS A retrospective analysis of the first 120 consecutive unilateral TEPs was performed. Medical records were reviewed to evaluate demographic features, perioperative outcome, and follow-up results. The study population was divided into six consecutive groups of 20 patients. Clinical data were compared among the groups to evaluate the impact of operative experience on perioperative outcome. RESULTS Operative time was the only clinical parameter that showed significant improvement with experience; it reached a plateau value of <1 h after the fourth group. Conversions to transabdominal and open approaches were required in only one patient in groups 1 and 6, respectively. Comparison of demographic features, hernia types, postoperative morbidity rates, length of hospital stay, and number of days to resume normal activities showed no significant differences among the groups. All complications were minor and resolved uneventfully. No recurrence was detected during follow-up. CONCLUSIONS The learning curve for unilateral TEP by a general surgeon peaked after performing 80 procedures. In most cases, unilateral TEP can be accomplished safely within 1 h. Even during the learning process, TEP carries a low morbidity and conversion rate.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong.
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Lau H, Patil NG, Yuen WK, Lee F. Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 2002; 16:1547-50. [PMID: 12042905 DOI: 10.1007/s00464-001-8292-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2001] [Accepted: 03/19/2002] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of preperitoneal mesh after endoscopic totally extraperitoneal inguinal hernioplasty (TEP) on voiding function has not been previously examined. The objectives of the present study were to evaluate the incidence of and risk factors for urinary retention following TEP. METHODS Three hundred consecutive patients who underwent TEP between June 1999 and September 2001 were recruited. Patient records were reviewed retrospectively to identify those who developed postoperative urinary retention. For each case patient, five age-matched control patients were randomly selected. We then compared the clinical data for the case and control groups. A prospective study of uroflowmetry in patients who underwent bilateral TEP was conducted to evaluate the effect of preperitoneal mesh on voiding function. RESULTS The overall incidence of urinary retention following TEP was 4% (n = 12). Patients who developed urinary retention stayed in hospital for a significantly longer period than the control group. No significant association was found between the clinical data and postoperative urinary retention. Bilateral TEPs were not associated with significant deterioration in uroflowmetry. CONCLUSIONS Urinary retention is a frequent morbidity after TEP and significantly prolongs the length of hospital stay. Preperitoneal Prolene mesh did not cause outflow obstruction or alter bladder contractility. No specific clinical factors were identified that might predict postoperative urinary retention, which was probably multifactorial in causation in our patient population.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Centre, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong SAR.
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Lau H, Patil NG, Yuen WK, Lee F. Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 2002; 16:1474-7. [PMID: 12072988 DOI: 10.1007/s00464-001-8299-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2001] [Accepted: 04/17/2002] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty (TEP) results in pneumoperitoneum and loss of extraperitoneal space. To avoid bowel adhesions, internal herniation, and mesh migration, closure of the peritoneal opening is preferred. The present study was conducted to evaluate the efficacy of various operative techniques for the closure of peritoneal laceration. METHODS Between April 2000 and May 2001, 100 consecutive patients undergoing 123 TEPs were recruited for the present study. The incidence of peritoneal tear and techniques for the closure of peritoneal opening were documented. Operative time and postoperative morbidity were compared among groups for which different closure methods of peritoneal laceration were used. RESULTS The incidence of peritoneal tear was 47%. The mean operative times of unilateral TEPs with and without peritoneal laceration were 66 min and 53 min, respectively (p<0.05). Techniques for the closure of the peritoneal opening included endoscopic stapling (n = 12), endoscopic suturing (n = 14), and pretied suture loop ligation (n = 21). The mean operative times for unilateral TEPs with endoscopic stapling, pretied suture loop ligation, and endoscopic suturing of peritoneal tear were 53, 64, and 82 min, respectively (p<0.05). Comparison of postoperative morbidity showed no significant differences among the three groups. CONCLUSION Peritoneal tear is a frequent and challenging intraoperative event during TEP. Its occurrence significantly prolongs the length of operation. Endoscopic stapling and pretied suture loop ligation are safe and quick techniques for the closure of peritoneal tear during TEP.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong.
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Lau H, Patil NG, Lee F, Yuen WK. A prospective trial of analgesia following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 2002; 16:159-62. [PMID: 11961629 DOI: 10.1007/s00464-001-8106-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2001] [Accepted: 06/01/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND The extraperitoneal instillation of bupivacaine has been shown to be superior to the use of a placebo for postoperative analgesia following endoscopic extraperitoneal inguinal hernioplasty. The objective of the present study was to compare the efficacy of postoperative analgesia by local wound infiltration to instillation of the extraperitoneal space with bupivacaine. METHODS Between 1 September 1999 and 2 June 2000, a total of 100 patients who underwent unilateral endoscopic extraperitoneal inguinal hernioplasties were recruited to receive either local wound infiltration with 10 ml of 0.5% bupivacaine (group I, n = 50) or instillation of the extraperitoneal space with 40 ml of 0.25% bupivacaine after mesh placement (group II, n = 50). Daily postoperative pain was assessed by visual analogue pain score on a scale from 0 to 10 at rest and upon coughing. Total amount of oral analgesic consumed and clinical outcomes of the two groups were compared. RESULTS A comparison of daily pain scores of the two groups at rest and upon coughing showed no significant difference (p = ns). The mean number of oral analgesic tablets consumed were 3.2 +/- 0.5 (SEM) and 3.3 +/- 0.5 (SEM) in groups I and II, respectively (p = ns). During follow-up, asympatomatic groin collections were more common in group II (n = 4) than group I (n = 2) (p = ns). CONCLUSIONS Compared to local wound infiltration with bupivacaine, the extraperitoneal instillation of bupivacaine did not bestow any additional analgesic benefits. Therefore, the routine infiltration of skin incisions with bupivacaine is recommended after endoscopic extraperitoneal inguinal hernioplasty.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong SAR.
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Abstract
Glutathione S-transferase (GST) has been implicated in the process of biotransformation of polycyclic aromatic hydrocarbons and of other organic pollutants by Chironomidae larvae. We have purified and characterized GST from cytosolic fractions of Chironomidae larvae. GST with an M(r) of 23 kDa has been purified to homogeneity from larvae by centrifugation, size exclusion chromatography on Sephadex G25, and glutathione affinity and anion exchange chromatography. The purified enzyme exhibited moderate activity towards 1,2-dichloro-4-nitrobenzene, 1-chloro-2,4-dinitrobenzene, 4-nitropyridine-N-oxide, p-nitrobenzyl chloride, ethacrynic acid, and cumene hydroperoxide. The enzyme was homogeneous on gel isoelectric focusing and on SDS gel electrophoresis. Its isoelectric point was estimated to be 5.5. The enzyme had a maximum activity at approximately pH 8 and showed activity between 30 and 40 degrees C. It became inactive at higher temperature (>50 degrees C) for 5 min. The N-terminal sequence analysis of the amino acids shows a high % of conserved regions in the enzyme. The enzyme activity was comparable to levels of metabolism observed by animal GST involved in the detoxification of xenobiotics.
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Affiliation(s)
- W K Yuen
- Department of Biochemistry and Environmental Science program, The Chinese University of Hong Kong, Shatin, Hong Kong
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Poon RT, Liu CL, Lo CM, Lam CM, Yuen WK, Yeung C, Fan ST, Wong J. Management of gallstone cholangitis in the era of laparoscopic cholecystectomy. Arch Surg 2001; 136:11-6. [PMID: 11146767 DOI: 10.1001/archsurg.136.1.11] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
HYPOTHESIS The combined endoscopic and laparoscopic approach is safe and effective in managing gallstone cholangitis in the era of laparoscopic cholecystectomy (LC). DESIGN Retrospective case series. SETTING University teaching hospital. PATIENTS One hundred eighty-four consecutive patients with gallstone cholangitis treated between January 1995 and December 1998. INTERVENTIONS The main treatments were endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval LC. Open or laparoscopic common bile duct exploration (OCBDE or LCBDE) was used when ERCP or ES failed. MAIN OUTCOME MEASURES Success of various interventions, morbidity and mortality, and long-term incidence of recurrent biliary symptoms. RESULTS Endoscopic retrograde cholangiopancreatography was successful in 175 patients (95%), with bile duct stones found in 147 (84%). Endoscopic stone clearance by ES was achieved in 132 patients (90%). Morbidity rate after ERCP or ES was 4.0% (n = 7), and overall mortality rate from cholangitis was 1.6% (n = 3). After bile duct stone clearance, 82 patients underwent LC with a conversion rate of 9.8% (n = 8) and a morbidity rate of 3.6% (n = 3). Eighteen patients underwent OCBDE with a morbidity rate of 33% (n = 6), and 3 underwent LCBDE with 1 conversion and no morbidity. There was no operative mortality. Seventy-eight patients were managed conservatively after endoscopic clearance of bile duct stones. Follow-up data were available in 101 patients with cholecystectomy and 73 patients with gallbladder in situ. During a median follow-up of 24 months, recurrent biliary symptoms occurred in 5.9% (n = 6) and 25% (n = 18), respectively (P =.001). In both groups, the most common recurrent symptom was cholangitis (n = 5 and n = 14, respectively). Gallbladder in situ (risk ratio, 4.16; 95% confidence interval, 1.39-12.50; P =.01) and small-size papillotomy (risk ratio, 2.94; 95% confidence interval, 1. 07-8.10; P =.04) were significant risk factors for recurrent biliary symptoms. CONCLUSIONS Endoscopic sphincterotomy for biliary drainage and stone removal, followed by interval LC, is a safe and effective approach for managing gallstone cholangitis. Patients with gallbladder left in situ after ES have an increased risk of recurrent biliary symptoms. Laparoscopic cholecystectomy should be recommended after endoscopic management of cholangitis except in patients with prohibitive surgical risk.33333333333333333333333
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Affiliation(s)
- R T Poon
- Department of Surgery, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China
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Lo CM, Fan ST, Liu CL, Poon RT, Lam CM, Yuen WK, Yeung C, Wong J. Determining resectability for hepatocellular carcinoma: the role of laparoscopy and laparoscopic ultrasonography. J Hepatobiliary Pancreat Surg 2000; 7:260-4. [PMID: 10982624 DOI: 10.1007/s005340070046] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We reviewed our experience with preoperative determination of resectability in patients with hepatocel-lular carcinoma (HCC) over the last 10 years, and evaluated the role of laparoscopy with laparoscopic ultrasonography (USG) since we instituted this technique in June 1994. From January 1989 to December 1998, 500 of 1741 patients with HCC (28.7%) were considered suitable for hepatic resection after preoperative assessment. Significantly more contrast-enhanced computed tomography (CT) scans and fewer percutaneous USGs or hepatic arteriograms were performed in the 299 patients managed since June 1994 (group 2) than in the 201 patients managed before then (group 1). One hundred and ninety-eight patients in group 2 (66%) underwent laparoscopy with laparoscopic USG. Unresectable disease was found in 41 patients in group 1 (20.4%) (all at laparotomy), and in 68 patients in group 2 (22.7%) (16 at laparotomy without laparoscopic examination, 31 at laparoscopic examination alone, and 21 at laparotomy after an inconclusive laparoscopic examination) (P = 0.5). The most common features of unresectable disease were the presence of bilobar intrahepatic metastases and an inadequate liver remnant with cirrhosis. The adoption of the laparoscopic examination after June 1994 improved the overall resection rate at laparotomy in group 2 from 77.3% to 86. 2%, which was better than that in group 1 (79.6%, P = 0.057). For patients with unresectable disease, the operation time and hospital stay were significantly shorter in group 2. The postoperative morbidity and mortality rates were 9.8% and 4.9%, respectively, in group 1, and 5.9% and 2.9% in group 2. There was no operative morbidity in the 31 patients who had unresectable disease detected by the laparoscopic examination alone. Laparoscopy with laparoscopic USG avoids unnecessary laparotomy, and has a definite role in determining resectability in patients with HCC.
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Affiliation(s)
- C M Lo
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Lau H, Lee F, Patil NG, Yuen WK. Laparoscopic totally extraperitoneal inguinal hernioplasty: an audit of the early postoperative results of 100 consecutive repairs. Ann Acad Med Singap 2000; 29:640-3. [PMID: 11126701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION With the establishment of a hernia specialist service at our medical centre in 1999, laparoscopic inguinal hernia repair was offered to all patients who presented with inguinal hernias. This is a report of our early experience of 100 consecutive laparoscopic totally extraperitoneal inguinal hernioplasties. MATERIALS AND METHODS Between June 1999 and January 2000, a total of 82 patients with 100 inguinal hernias underwent laparoscopic totally extraperitoneal hernioplasties. The mean age of the study population was 64 +/- 16 (SD) years with a male to female ratio of 79:3. A prospective evaluation and analysis of perioperative outcomes were performed. RESULTS A total of 97 laparoscopic extraperitoneal inguinal hernioplasties were successfully performed. Three patients required conversion to transabdominal preperitoneal repair because of adhesion (n = 1), large peritoneal defect (n = 1) and the presence of bowel within hernial sac (n = 1). There were no other intraoperative complications. Postoperative morbidity included retention of urine (n = 4), asymptomatic groin collection (n = 4) and wound bruising (n = 2). All complications resolved uneventfully. The visual analogue pain score at rest was 2, 1 and 1 on postoperative days 0, 1 and 2, respectively. The mean length of hospital stay was 2 +/- 1 (SD) days. Forty-seven patients (57%) returned to normal activities within one week. CONCLUSIONS The early outcomes of laparoscopic extraperitoneal inguinal hernioplasties were encouraging. It confirmed the early success of laparoscopic repairs of inguinal hernias at our centre. Laparoscopic approach is a safe technique for repair of inguinal hernia in specialised centres.
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Affiliation(s)
- H Lau
- Department of Surgery, Tung Wah Hospital, University of Hong Kong Medical Centre, Hong Kong SAR.
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Abstract
BACKGROUND Somatostatin is a potent inhibitor of pancreatic secretion and has been studied for its prophylactic effect on post-ERCP pancreatitis. However, results of previous trials have been inconclusive. METHODS A prospective double-blind controlled study was performed to evaluate the effectiveness of somatostatin in preventing post-ERCP pancreatitis. Post-ERCP enzyme elevation, abdominal pain and pancreatitis were evaluated and compared between 109 patients randomized to receive somatostatin infusion and 111 patients randomized to receive normal saline infusion (placebo); both started 30 minutes before ERCP and continued for 12 hours. RESULTS Post-ERCP elevation of serum amylase and lipase levels at 6 and 24 hours after ERCP was less frequent in the group given somatostatin but not statistically significant. There was a tendency toward lower mean serum amylase and lipase levels at 24 hours in patients given somatostatin, although the difference was not statistically significant either. Eight patients given somatostatin (7%) and 18 patients given placebo (16%) had significant abdominal pain after ERCP requiring analgesia (p = 0.04). The frequency of clinical pancreatitis was significantly lower in patients given somatostatin (3%) than in those given placebo (10%) (p = 0.03). CONCLUSIONS Prophylactic treatment with somatostatin reduced the frequency of post-ERCP pancreatitis.
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Affiliation(s)
- R T Poon
- Endoscopy Unit, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Abstract
OBJECTIVE The authors report on the surgical techniques and protocol for perioperative care that have yielded a zero hospital mortality rate in 110 consecutive patients undergoing hepatectomy for hepatocellular carcinoma (HCC). The hepatectomy results are analyzed with the aim of further reducing the postoperative morbidity rate. SUMMARY BACKGROUND DATA In recent years, hepatectomy has been performed with a mortality rate of <10% in patients with HCC, but a zero hospital mortality rate in a large patient series has never been reported. At Queen Mary Hospital, Hong Kong, the surgical techniques and perioperative management in hepatectomy for HCC have evolved yearly into a final standardized protocol that reduced the hospital mortality rate from 28% in 1989 to 0% in 1996 and 1997. METHODS Surgical techniques were designed to reduce intraoperative blood loss, blood transfusion, and ischemic injury to the liver remnant in hepatectomy. Postoperative care was focused on preservation and promotion of liver function by providing adequate tissue oxygenation and immediate postoperative nutritional support that consisted of branched-chain amino acid-enriched solution, low-dose dextrose, medium-chain triglycerides, and phosphate. The pre-, intra-, and postoperative data were collected prospectively and analyzed each year to assess the influence of the evolving surgical techniques and perioperative care on outcome. RESULTS Of 330 patients undergoing hepatectomy for HCC, underlying cirrhosis and chronic hepatitis were present in 161 (49%) and 108 (33%) patients, respectively. There were no significant changes in the patient characteristics throughout the 9-year period, but there were significant reductions in intraoperative blood loss and blood transfusion requirements. From 1994 to 1997, the median blood transfusion requirement was 0 ml, and 64% of the patients did not require a blood transfusion. The postoperative morbidity rate remained the same throughout the study period. Complications in the patients operated on during 1996 and 1997 were primarily wound infections; the potentially fatal complications seen in the early years, such as subphrenic sepsis, biliary leakage, and hepatic coma, were absent. By univariate analysis, the volume of blood loss, volume of blood transfusions, and operation time were correlated positively with postoperative morbidity rates in 1996 and 1997. Stepwise logistic regression analysis revealed that the operation time was the only parameter that correlated significantly with the postoperative morbidity rate. CONCLUSION With appropriate surgical techniques and perioperative management to preserve function of the liver remnant, hepatectomy for HCC can be performed without hospital deaths. To improve surgical outcome further, strategies to reduce the operation time are being investigated.
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Affiliation(s)
- S T Fan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Abstract
OBJECTIVE The authors report on the surgical techniques and protocol for perioperative care that have yielded a zero hospital mortality rate in 110 consecutive patients undergoing hepatectomy for hepatocellular carcinoma (HCC). The hepatectomy results are analyzed with the aim of further reducing the postoperative morbidity rate. SUMMARY BACKGROUND DATA In recent years, hepatectomy has been performed with a mortality rate of <10% in patients with HCC, but a zero hospital mortality rate in a large patient series has never been reported. At Queen Mary Hospital, Hong Kong, the surgical techniques and perioperative management in hepatectomy for HCC have evolved yearly into a final standardized protocol that reduced the hospital mortality rate from 28% in 1989 to 0% in 1996 and 1997. METHODS Surgical techniques were designed to reduce intraoperative blood loss, blood transfusion, and ischemic injury to the liver remnant in hepatectomy. Postoperative care was focused on preservation and promotion of liver function by providing adequate tissue oxygenation and immediate postoperative nutritional support that consisted of branched-chain amino acid-enriched solution, low-dose dextrose, medium-chain triglycerides, and phosphate. The pre-, intra-, and postoperative data were collected prospectively and analyzed each year to assess the influence of the evolving surgical techniques and perioperative care on outcome. RESULTS Of 330 patients undergoing hepatectomy for HCC, underlying cirrhosis and chronic hepatitis were present in 161 (49%) and 108 (33%) patients, respectively. There were no significant changes in the patient characteristics throughout the 9-year period, but there were significant reductions in intraoperative blood loss and blood transfusion requirements. From 1994 to 1997, the median blood transfusion requirement was 0 ml, and 64% of the patients did not require a blood transfusion. The postoperative morbidity rate remained the same throughout the study period. Complications in the patients operated on during 1996 and 1997 were primarily wound infections; the potentially fatal complications seen in the early years, such as subphrenic sepsis, biliary leakage, and hepatic coma, were absent. By univariate analysis, the volume of blood loss, volume of blood transfusions, and operation time were correlated positively with postoperative morbidity rates in 1996 and 1997. Stepwise logistic regression analysis revealed that the operation time was the only parameter that correlated significantly with the postoperative morbidity rate. CONCLUSION With appropriate surgical techniques and perioperative management to preserve function of the liver remnant, hepatectomy for HCC can be performed without hospital deaths. To improve surgical outcome further, strategies to reduce the operation time are being investigated.
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Affiliation(s)
- S T Fan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lam CM, Lo CM, Yuen WK, Liu CL, Fan ST. Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma. Br J Surg 1998. [PMID: 9752858 DOI: 10.1046/j.1365-2168,1998.00846.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pulmonary metastasis is the commonest site of extrahepatic spread from hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the efficacy of surgical management in patients with solitary pulmonary metastases from HCC. METHODS This was a retrospective study of patients with HCC admitted for hepatectomy from July 1972 to June 1995. The records of patients who had a pulmonary resection for histologically proven pulmonary recurrence after curative hepatectomy were selected for analysis. RESULTS In the study interval, 380 patients with HCC underwent hepatectomy. Some 48 patients (12.6 per cent) developed pulmonary metastases documented pathologically or radiologically. Nine (seven men and two women) were suitable for curative pulmonary resection. The median disease-free survival between hepatectomy and appearance of the lung metastasis was 21 months. The median survival after pulmonary resection was 42 months, and the 1-, 2- and 5-year survival rates were 100, 78 and 67 per cent respectively. CONCLUSION Pulmonary resection for metastases from HCC resulted in long-term survival in these highly selected patients.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Lam CM, Yuen ST, Yuen WK. Hemoperitoneum caused by spontaneous rupture of a true splenic cyst. Hepatogastroenterology 1998; 45:1884-6. [PMID: 9840169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
A 34 year-old man presented with hemoperitoneum from a spontaneously ruptured spleen. At laparotomy, a 5-cm diameter splenic cyst was found to be ruptured. Histological examination confirmed the diagnosis of a true splenic cyst of the mesothelial type. Spontaneous rupture with hemoperitoneum is a rare but potentially lethal complication of a true splenic cyst.
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Affiliation(s)
- C M Lam
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lam CM, Lo CM, Yuen WK, Liu CL, Fan ST. Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma. Br J Surg 1998; 85:1198-200. [PMID: 9752858 DOI: 10.1046/j.1365-2168.1998.00846.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pulmonary metastasis is the commonest site of extrahepatic spread from hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the efficacy of surgical management in patients with solitary pulmonary metastases from HCC. METHODS This was a retrospective study of patients with HCC admitted for hepatectomy from July 1972 to June 1995. The records of patients who had a pulmonary resection for histologically proven pulmonary recurrence after curative hepatectomy were selected for analysis. RESULTS In the study interval, 380 patients with HCC underwent hepatectomy. Some 48 patients (12.6 per cent) developed pulmonary metastases documented pathologically or radiologically. Nine (seven men and two women) were suitable for curative pulmonary resection. The median disease-free survival between hepatectomy and appearance of the lung metastasis was 21 months. The median survival after pulmonary resection was 42 months, and the 1-, 2- and 5-year survival rates were 100, 78 and 67 per cent respectively. CONCLUSION Pulmonary resection for metastases from HCC resulted in long-term survival in these highly selected patients.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Abstract
BACKGROUND AND OBJECTIVES The treatment of choice for recurrent hepatocellular carcinoma (HCC) is repeated resection. However, only a small percentage of patients are suitable for further hepatic resection. The aim of this study was to evaluate the surgical risk and operative outcome of hepatic cryosurgery in patients with recurrent HCC. METHODS A retrospective analysis of patients with recurrent HCC after previous curative hepatectomy treated with cryosurgery. Four patients with recurrent HCC not suitable for further resection were enrolled for cryosurgery, their clinical parameters, the operative details and outcome were studied. RESULTS No intraoperative or postoperative complications were noted. The duration of operation ranged from 3-5.2 hr and the operative blood loss from 173-1,300 ml. All patients are still alive with survival after cryosurgery ranging from 12-23 mo (25-63 mo after the hepatic resection). Three patients showed evidence of recurrent disease and one patient was disease free. CONCLUSIONS Hepatic cryosurgery is a safe therapy for patients with unresectable recurrent HCC.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, China
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Abstract
BACKGROUND AND OBJECTIVES The treatment of choice for recurrent hepatocellular carcinoma (HCC) is repeated resection. However, only a small percentage of patients are suitable for further hepatic resection. The aim of this study was to evaluate the surgical risk and operative outcome of hepatic cryosurgery in patients with recurrent HCC. METHODS A retrospective analysis of patients with recurrent HCC after previous curative hepatectomy treated with cryosurgery. Four patients with recurrent HCC not suitable for further resection were enrolled for cryosurgery, their clinical parameters, the operative details and outcome were studied. RESULTS No intraoperative or postoperative complications were noted. The duration of operation ranged from 3-5.2 hr and the operative blood loss from 173-1,300 ml. All patients are still alive with survival after cryosurgery ranging from 12-23 mo (25-63 mo after the hepatic resection). Three patients showed evidence of recurrent disease and one patient was disease free. CONCLUSIONS Hepatic cryosurgery is a safe therapy for patients with unresectable recurrent HCC.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, China
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Abstract
BACKGROUND AND OBJECTIVES The treatment of choice for recurrent hepatocellular carcinoma (HCC) is repeated resection. However, only a small percentage of patients are suitable for further hepatic resection. The aim of this study was to evaluate the surgical risk and operative outcome of hepatic cryosurgery in patients with recurrent HCC. METHODS A retrospective analysis of patients with recurrent HCC after previous curative hepatectomy treated with cryosurgery. Four patients with recurrent HCC not suitable for further resection were enrolled for cryosurgery, their clinical parameters, the operative details and outcome were studied. RESULTS No intraoperative or postoperative complications were noted. The duration of operation ranged from 3-5.2 hr and the operative blood loss from 173-1,300 ml. All patients are still alive with survival after cryosurgery ranging from 12-23 mo (25-63 mo after the hepatic resection). Three patients showed evidence of recurrent disease and one patient was disease free. CONCLUSIONS Hepatic cryosurgery is a safe therapy for patients with unresectable recurrent HCC.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, China
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Abstract
Abstract
Biliary papillomatosis is a rare clinicopathological condition characterized by multiple papillary adenomas involving extensive areas of the biliary tree1. The pathophysiology, clinical features and management of this condition are not well understood. Experience of six patients with biliary papillomatosis is reported.
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Affiliation(s)
- C M Lam
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Ngan H, Lai CL, Fan ST, Lai EC, Yuen WK, Tso WK. Transcatheter arterial chemoembolization in inoperable hepatocellular carcinoma: four-year follow-up. J Vasc Interv Radiol 1996; 7:419-25. [PMID: 8761824 DOI: 10.1016/s1051-0443(96)72881-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate the efficacy of repeated chemoembolization in patients with inoperable hepatocellular carcinoma (HCC). PATIENTS AND METHODS One hundred thirty-two patients with HCC underwent transcatheter arterial chemoembolization with an emulsion of iodized oil and cisplatin. In 104 patients, "light" gelatin sponge embolization was also used. Chemoembolization was repeated every 1.5-3.0 months in most patients (range, one to 18 chemoembolization sessions). RESULTS In 74 patients, the HCCs became smaller or disappeared after chemoembolization. Decreases in size were seen in 55 of 76 HCCs 9 cm or smaller, 17 of 42 HCCs between 9 and 18 cm, and two of 14 HCCs larger than 18 cm. Use of gelatin sponge pledgets enhanced the response in tumors larger than 9 cm. Seven of 74 HCCs that responded to chemoembolization increased in size later. New daughter nodules that appeared at other sites responded to chemoembolization in 24 of 40 patients. Further new nodules appeared in 14 of 24 patients, and in six patients they responded to therapy. Median survival was 26 months for patients with responsive HCCs and 5 months for those with unresponsive lesions. CONCLUSION Tumor size at the start of chemoembolization influenced the response to treatment and survival. The addition of gelatin sponge improved results only in tumors larger than 9 cm. Recurrence after an initial response was due more to the appearance of new daughter nodules in new locations rather than recrudescence of the presenting tumor.
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Affiliation(s)
- H Ngan
- Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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37
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Abstract
A 53 year old man with a large mesenchymal hamartoma is reported. Only a few bile ducts could be found in the periphery of the lesion and no hepatocytes were identified within the lesion. As far as is known, this is the only adult male patient reported to date. On the basis of the reported findings of mesenchymal hamartoma in other adults, it is suggested that there could be changes in the morphology of this lesion with age: progressive loss of hepatocytes; degeneration of bile duct epithelium; and cystic change of the mesenchymal component. The haematopoietic element is considered to be part of the fetal hepatic haematopoiesis that occurs in the hamartoma.
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Affiliation(s)
- K Y Chau
- Department of Pathology, University of Hong Kong
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38
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Ngan H, Lai CL, Fan ST, Lai EC, Yuen WK, Tso WK. Treatment of inoperable hepatocellular carcinoma by transcatheter arterial chemoembolization using an emulsion of cisplatin in iodized oil and gelfoam. Clin Radiol 1993; 47:315-20. [PMID: 8389682 DOI: 10.1016/s0009-9260(05)81446-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Eighty patients with inoperable hepatocellular carcinoma (HCC) were treated by transcatheter arterial chemoembolization using an emulsion of Lipiodol and Cisplatin. In 59 patients, gelfoam embolization was also given. The tumour size ranged from 0.5 cm to 33 cm in maximum diameter with the median diameter being 8 cm. The chemoembolization sessions were repeated every 1 1/2 to 3 months. The number of sessions the patients underwent varied from 1 to 11, with the mean number of sessions being 3.7. The HCC either disappeared completely or decreased in size in 44 patients (55%). In patients having an HCC of 12 cm or less in size, 31 out of 41 (75.6%) who had the addition of gelfoam demonstrated decrease in tumour size, while seven out of 11 (63.6%) without the addition of gelfoam demonstrated decrease in tumour size. In patients having an HCC of more than 12 cm in size, only six out of 18 (33.3%) who had the addition of gelfoam demonstrated reduction in tumour size and none of the 10 patients without the addition of gelfoam responded. Thus, HCCs of 12 cm or less in size responded better than larger ones to chemoembolization (P < 0.0001) while the addition of gelfoam enhanced the response (P = 0.039). The 1 year survival rate for the 80 patients was 53% and the 2 years survival rate was 38%. The median survival was 13 months. For patients having an HCC of 12 cm or less in size, the 1 year and 2 year survival rates were 69% and 47% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Ngan
- Department of Diagnostic Radiology, University of Hong Kong
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39
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Abstract
Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre-operatively and to locate intra-operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre-operative investigations and intra-operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin. The median follow-up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleeding source.
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Affiliation(s)
- W Y Lau
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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40
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Lau WY, Yuen WK, Chu KW, Poon GP, Li AK. Obscure bleeding in the gastrointestinal tract originating in the small intestine. Surg Gynecol Obstet 1992; 174:119-24. [PMID: 1734569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the past 12 years, we operated upon 49 patients with bleeding lesions of the small intestine. After endoscopic examination and barium studies of the upper and lower gastrointestinal tract excluded esophagogastroduodenal and lesions of the colon and rectum, preoperative examinations consisted of technetium-99m pertechnetate scan, technetium-99m labeled erythrocyte scan, barium studies of the small intestine and selective visceral angiogram. In one patient, diagnostic laparotomy had to be done before any procedure because of severe bleeding and angiosarcoma of the ileum. The results of gross examination at operation revealed bleeding lesions in 40 patients. Special intraoperative localization procedures consisting of methylene blue injection through superselectively prepositioned angiographic catheter was done on eight patients, and intraoperative enteroscopy was done on 17 patients. These two procedures were complementary, having their own indications and limitations. Our regimen of preoperative and intraoperative localization procedures was effective in the management of bleeding small intestinal lesions.
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Affiliation(s)
- W Y Lau
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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41
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Abstract
A prospective, randomized evaluation of operative choledochoscopy was carried out during emergency surgery in patients with acute cholangitis or acute suppurative cholangitis when conservative management had failed. After common bile duct exploration, 79 patients were randomized to have choledochoscopy and 78 patients to the control group. Laboratory and clinical parameters showed that choledochoscopy did not increase the incidence of septicaemia, acute pancreatitis, persistent cholangitis, postoperative wound sepsis, intraperitoneal sepsis and hospital mortality. The incidence of retained common bile duct stones detected by T tube cholangiography performed in the second postoperative week was significantly reduced (P less than 0.01) after choledochoscopy. Choledochoscopy detected stones missed by conventional common bile duct exploration in ten patients. It is concluded that choledochoscopy is a safe and effective technique in patients with acute cholangitis and acute suppurative cholangitis.
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Affiliation(s)
- W Y Lau
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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42
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Abstract
A total of 203 patients were randomized into a prospective trial to compare short (SC) versus long courses (LC) of systemic antibiotic for acute cholecystitis treated by early cholecystectomy. The initial pre-operative management was the same and all patients received 2 g of cefamandole intravenously just before operation. Two further doses of cefamandole 500 mg were given 6 and 12 h later for patients on SC while the antibiotic was continued at 500 mg at 6 h intervals for 7 days for patients on LC. Seven patients developed wound infection on SC compared with five patients with wound infection and an additional patient with a subphrenic abscess on LC (P greater than 0.05). Thrombophlebitis related to intravenous antibiotic injections was more common in patients on LC (P less than 0.05). Also, patients on LC had to stay statistically longer in hospital in order to complete the course of antibiotic (P less than 0.05). We therefore recommend a SC to be used, as it is more cost-effective and causes fewer complications.
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Affiliation(s)
- W Y Lau
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories
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43
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Uitti RJ, Rajput AH, Rozdilsky B, Bickis M, Wollin T, Yuen WK. Regional metal concentrations in Parkinson's disease, other chronic neurological diseases, and control brains. Can J Neurol Sci 1989; 16:310-4. [PMID: 2766123 DOI: 10.1017/s0317167100029140] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Metal deficiency or toxicity states have been recognized as a cause of several neurological disorders and are suspected in others. We analyzed four brain regions (frontal cortex, caudate nucleus, substantia nigra, and cerebellum) in 36 human brains for concentrations of 24 metals (Ag, Al, As, B, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Pb, Mg, Mn, Mo, Na, Ni, P, Se, Ti, V, W, Zn). Regional metal concentrations, measured using atomic absorption and atomic emission spectroscopy, were compared between 9 Parkinson's disease (PD) brains, 15 brains from patients with other chronic neurological diseases, and 12 control brains. No significant metal concentration differences were noted between brains from PD and other chronic neurologic disease. However, parkinsonian brains (PD and parkinsonism secondary to neurofibrillary tangle disease) showed lower concentrations of magnesium in the caudate nucleus and copper in the substantia nigra than control brains. These findings may represent an etiologically important clue to parkinsonism.
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Affiliation(s)
- R J Uitti
- Departments of Clinical Neurological Sciences, University of Saskatchewan, Saskatoon, Canada
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44
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Lau WY, Wong SY, Yuen WK, Wong KK. Intraoperative enteroscopy for bleeding angiodysplasias of small intestine. Surg Gynecol Obstet 1989; 168:341-4. [PMID: 2784593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Six patients with angiodysplasias of the small intestine were diagnosed preoperatively with selective angiography during the past eight years. Enteroscopy was used to identify these vascular lesions intraoperatively. Lesions were ulcerated in four patients, had a bleeding vessel tip in one patient and appeared as a nonulcerated reddish patch in the other. Exact localization of these lesions allowed limited segmental resection of the small intestine to be performed. With complete enteroscopy, we were confident that no bleeding lesion was left undetected. The feeding artery and vein to the resected intestinal segment were separately cannulated, and the resected specimen was prepared and injected with hot barium-gelatine. The lesions were confirmed histopathologically to be angiodysplasias in all six patients. There was no recurrence of gastrointestinal bleeding at a median follow-up study of 34 months. There were no operative deaths, and no complications arose from enteroscopy.
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Affiliation(s)
- W Y Lau
- Government Surgical Unit, Queen Mary Hospital, Hong Kong
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45
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Abstract
In the past 9 years, we have operated on 56 patients with gastrointestinal bleeding of obscure origin. Selective visceral angiography demonstrated the bleeding lesions in 24 of the 30 patients who underwent this investigation. Six of these 24 patients, however, had a negative angiogram initially and the lesions were only demonstrated on a repeat angiogram. The negative initial angiograms were due to: (1) slow bleeding from lesions in two patients; (2) a small bleeding tumour that caused only intermittent jejunojejunal intussusception in one patient; (3) technical fault in one patient; and (4) spasm of the bleeding vascular lesions and their feeding arteries in two patients. We advocate repeat angiography the following day in all patients in whom profuse bleeding continues, and during the next intestinal bleeding in those whose bleeding stops after the initial negative angiography. In patients who have repeated episodes of massive bleeding, and in whom full investigations fail to reveal the bleeding source, repeat angiography carried out 4 weeks after the bleeding has stopped can sometimes demonstrate the vascular lesions.
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Affiliation(s)
- W Y Lau
- Surgical C Unit, Queen Elizabeth Hospital, Hong Kong
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46
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Rajput AH, Uitti RJ, Stern W, Laverty W, O'Donnell K, O'Donnell D, Yuen WK, Dua A. Geography, drinking water chemistry, pesticides and herbicides and the etiology of Parkinson's disease. Can J Neurol Sci 1987; 14:414-8. [PMID: 3676917 DOI: 10.1017/s0317167100037823] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 1984 we made the first observation of a correlation between early age exposure to rural environment (and drinking well water) and development of idiopathic Parkinson's disease (IPD). These findings were subsequently confirmed elsewhere (Barbeau, 1985;25 Tanner, 1985). Analysis of all early age onset IPD (EPD) cases born and raised in Saskatchewan revealed that 20 of 22 had exclusively rural exposure during the first 15 years of life. This distribution was significantly different from the general population (p = 0.0141). Further study of the EPD group included sampling and metal analysis of childhood sources of drinking water in 18 cases and 36 age and sex-matched controls. Water collected from the two groups was analyzed for 23 metals (including 7 elements implicated in the etiology of IPD). There was no difference in the metal composition of the water between the two groups. Finally, a review of herbicide and pesticide use in Saskatchewan agriculture was undertaken to determine if there was an increased incidence of EPD following utilization of any particular chemical. No increase was found in the incidence of EPD with the introduction of any pesticide or herbicide, including Paraquat, for agricultural use. We conclude that there is a strong correlation between early age rural environmental exposure and development of IPD. We believe well water is a likely vehicle for the causal agent, but neither water metal concentration nor any of the herbicides and pesticides used in Saskatchewan agriculture are related to the cause.
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Affiliation(s)
- A H Rajput
- Department of Clinical Neurological Sciences, University Hospital, Saskatoon, Saskatchewan, Canada
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47
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Uitti RJ, Rajput AH, Rozdilsky B, Yuen WK. Regional distribution of metals in human brain. CLIN INVEST MED 1987; 10:10-3. [PMID: 3815930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Progress in understanding the role of metals in diseases of the nervous system has been hampered to a large extent by a lack of normal metal concentration values in the human brain. Since several metals interact metabolically, concurrent metal levels are essential for clinical correlation. We are reporting a simultaneous analysis of 24 metals in 4 different areas of 9 human brains. Our data on previously studied metals are comparable to the past observations. Therefore, we suggest the values of all metals reported here should be regarded as "normal" for ages 58-78 years.
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48
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Affiliation(s)
- W. K. Yuen
- Research Centre; Canada Packers, Inc.; 2211 St. Clair Avenue West Toronto Ontario M6N 1K4 Canada
- ; Saskatchewan Research Council; 30 Campus: Drive Saskatoon Sask. S7N OX1 Canada
| | - P. C. Kelly
- Research Centre; Canada Packers, Inc.; 2211 St. Clair Avenue West Toronto Ontario M6N 1K4 Canada
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