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Biomedical subjects

C G Ker

Publications and source records attributed to C G Ker.

At least 19 recordsLinked to original sources
PubMed2000

Centrosome abnormalities in human carcinomas of the gallbladder and intrahepatic and extrahepatic bile ducts.

During mitosis, 2 centrosomes ensure accurate assembly of bipolar spindles and fidelity of the chromosomal segregation. The presence of more than 2 copies of centrosomes during mitosis can result in the formation of multipolar spindles, unbalanced chromosome segregation, and aneuploidy. Recent studies have provided evidence that centrosome hyperamplification plays a pivotal role in carcinogenesis. Using immunofluorescence analysis with gamma-tubulin and pericentrin antibodies, paraffin-embedded sections from 40 malignant biliary diseases including gallbladder cancers (GC; n = 13), intrahepatic cholangiocellular carcinoma (CCC; n = 19), and extrahepatic bile duct cancers (BDC; n = 8) were examined. Thirty-seven benign biliary diseases including chronic cholecystitis, gallbladder adenoma, hepatolithiasis, and choledochal cyst were included as benign controls. The frequencies of the centrosome abnormalities were 70% for GC, 58% for CCC, and 50% for BDC, respectively. The frequencies of centrosome abnormalities in malignant biliary diseases were significantly higher than in their benign counterparts (GC, CCC, BDC; P =.001,.002, and.001, respectively). The results of current study also indicated that biliary malignancy in the advanced stage (III-IV) displayed a higher frequency of centrosome abnormalities than in the early stage (I-II) (P <.001). We conclude that abnormalities in size, number, and shape of the centrosome are frequently observed in biliary tract malignancy. Centrosome abnormalities started to occur in the early stage of biliary malignancy and became very frequent in the advanced stage. This implies that centrosome abnormality might relate to the transition from early to advanced malignancy in biliary malignancy.

Adenocarcinoma↗
PubMed2000

Laparoscopic subsegmentectomy for hepatocellular carcinoma with cirrhosis: a case report.

Laparoscopic liver resection is feasible for both benign and malignant disease with present laparoscopic techniques and technology. Laparoscopic liver tumor resection is indicated instead of the conventional hepatectomy if the tumor is located in the peripheral part of the liver. Here, we reported a case of a 73-year-old woman who accepted laparoscopic subsegmentectomy for hepatocellular carcinoma of segment 6. After traditional laparoscopic trocar was settled down under the low pneumoperitoneal pressure of 8 mm Hg, laparoscopic ultrasound allowed exact localization of lesions first and then transection line was marked. Then, dissection the liver parenchyma was carried out with laparoscopic microwave coagulator and ultrasonic aspirator gradually. After operation, she resumed full diet on the second day and was discharged on the 5th post-operative day with no complications and high patient satisfaction. She had follow-up study regularly in our clinic and was disease free at nine months. With the improvement of laparoscopic techniques and the development of new and dedicated technologies, laparoscopic hepatectomy has become feasible.

Aged↗
PubMed1998

Ultrasound-guided percutaneous cholecystostomy as an initial treatment for acute cholecystitis in elderly patients.

BACKGROUND/AIMS: Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of severe co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. METHODS: Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy's signs and distended gallbladders were candidates for ultrasound-guided PC. RESULTS: Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. CONCLUSION: Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.

Acute Disease↗
PubMed1998

Ultrasound-guided percutaneous transhepatic drainage of gallbladder followed by cholecystectomy for acute cholecystitis--10 years' experience.

Acute cholecystitis is a common disease which may carry the risk of complications, including empyema, perforation, abscess, peritonitis and sepsis. Percutaneous transhepatic drainage of the gallbladder (PTGBD) with antibiotics can provide prompt decompression of gallbladder in acute cholecystitis and interrupt the natural history of the disease effectively. From July 1986 to June 1996, 154 patients with acute cholecystitis were reviewed retrospectively in Kaohsiung Medical College Hospital. The chief symptoms and signs were pain (98.1%), fever (57.1%) and jaundice (37.7%). WBC count more than 10,000 was noted in 116 (75.3%) patients. Associated diseases included empyema: 42 (27.3%), septic shock: 14 (9.1%), diabetes mellitus: 13 (8.4%), pancreatitis: 10 (6.5%), perforation: 7 (4.5%), liver cirrhosis: 6 (3.9%) and respiratory failure: 1 (0.6%). All of them underwent ultrasound-guided PTGBD immediately after the diagnosis was established. The symptoms and signs disappeared soon after this procedure. Bacterial culture was found positive in 104 (67.5%) of 154 patients in which Escherichia coli (51.9%) was the most common organism, followed by Klebsiella pneumonia (20.2%). After acute stage, 138 patients obtained the cholangiography via PTGBD tube. Gallbladder stones were only noted in 56 (40.6%) patients, gallbladder stone concomitant with common bile duct stone in 26 (18.8%), cystic duct obstruction in 25 (18.1%), acalculous cholecystitis in 21 (15.2%), gallbladder perforation in 1 (0.7%), choledochocyst in 1 (0.7%), and cholecystocolonic fistula in 1 (0.7%). There were 135 patients to undergo surgery after the clinical condition was stable. The operative findings included gallbladder stones only in 88 (65.2%), gallbladder stone concomitant with common bile duct stone in 34 (25.2%), acalculous cholecystitis in 13 (9.6%), choledochocyst in 1 (0.7%), and cholecysto-colonic fistula in 1 (0.7%). The postoperative complications included wound infection 8 (5.9%), UGI bleeding 3 (2.2%), acute renal failure 1 (0.7%) and acute respiratory failure 1 (0.7%). The postoperative mortality rate was 0.7% (1/135), which was much lower than those of previous reports, which not undergoing PTGBD initially. It led us to conclude that PTGBD, as an initial preoperative modality to treat acute cholecystitis, is effective in decreasing postoperative morbidity and mortality.

Acute Disease↗
PubMed1998

Pancreatic pseudocyst involving the spleen.

The pseudocyst of the pancreas is a frequent complication of acute pancreatitis. The splenic involvement from the pancreatic pseudocyst is an uncommon entity. A 40-year-old man, who had a five-year history of alcohol consumption, was referred to our hospital for treatment of throbbing pain over left upper quadrant (LUQ) of the abdomen. Except for LUQ tenderness, physical examination was essentially normal. MRI showed two cystic lesions in splenic hilum and pancreatic tail, and prominent vessels in left infrasplenic area and gastrosplenic ligament. Angiography revealed splenic vein thrombosis. Because of persistent LUQ pain, he underwent laparotomy. During the operation, we found the cysts in pancreatic tail and splenic hilum. The cystic content was aspirated to check amylase, which showed the level of amylase being as high as 20,000 IU/L. The diagnosis of a pancreatic pseudocyst involving the spleen was established. Splenectomy and distal pancreatectomy were performed to remove both cysts. The pathologic examination of the resected spleen showed splenic infarction with cyst formation and pancreatic pseudocyst. The patient recovered uneventfully after operation.

Adult↗
PubMed1997

Silver-binding nucleolar organizer regions in hepatolithiasis and bile duct cancer.

Hepatolithiasis and bile duct cancer have usually been linked together especially in Asian countries. Epithelium cells of bile duct or ductal glands had proliferative changes in patients with hepatolithiasis usually. The numbers and shape of the nucleoli were studied with special staining of AgNOR (Nucleolar Organizer Regions) on bile ducts without calculi (n = 11), with calculi (n = 21), and hepatolithiasis with bile duct carcinoma (n = 14). The patterns of AgNOR were classified into a dotted type and a cluster type under light microscopic examination. AgNORs scores were found to be 2.7 +/- 1.2 (M +/- SD) and 3.6 +/- 1.2 for intramural glandular cells and extramural glandular cells in hepatolithiasis (p < 0.05). In the cases of bile duct carcinoma, the percentage of the cluster form of AgNOR was 28.1 +/- 4.4%, and the scores were 4.7 +/- 2.4 for bile duct cancer, which was significantly different from intramural glands, but not different from the extramural glands in hepatolithiasis. High scores of the dotted type and high percentage of cluster type have high potentiality of malignant changes. From this study, unknown substances for malignant transformation might be secreted from the inner epithelium and or intramural glandular epithelium both of which are usually in contact with the infected bile and have chronic irritation from the stones. Extramural glands of the bile duct had higher potential for proliferation or malignant transformation in our study. Hence, long-term follow-up study of those patients with hepatolithiasis should be done very carefully especially due to the possibility of a combination of neoplastic changes in hepatolithiasis.

Bile Duct Diseases↗
PubMed1997

Laparoscopic fenestration for giant liver cyst.

Laparoscopic fenestration for treatment of the non-parasitic cyst of the liver has been rarely reported, but sporadic cases appeared elsewhere in the literature. Here we report four cases with symptomatic giant nonparasitic liver cysts which were treated by a laparoscopic fenestration procedure that allowed the successful removal of the cyst dome. Before starting to excise the wall of the cyst, laparoscopic-quided needle aspiration of the cyst fluid was done first in order to clean the visual field for laparoscopic intervention where possible. The cyst wall was usually slightly transparent and somewhat smooth in the external and internal surface of the cysts. It was necessary to lysis the omental adhesion sometime before starting to remove the dome of the cyst. The cyst wall of the exposed part could be removed first with heat-probe instrument through laparoscopy. Those patients were discharged and revealed an uneventful post-operative course in three cases but in one case we had to convert to the traditional laparostomy to perform resection of the multiple cystic lesions. Post-operative echographic study showed that the giant cyst had collapsed. Therefore, we believe laparoscopic fenestration for the liver cyst is simple and effective, if the patient is a candidate who requires operation to remove the dome of the giant cyst.

Adult↗
PubMed1997

Changes of insulin and somatostatin and their relationship to liver regeneration in experimental obstructive jaundice.

The liver is a parenchymal organ that has a substantial capacity to regenerate after damage. Obstructive jaundice is a common surgical disease and potentially risky. A successful outcome of operations depends upon the hepatic regeneration reserve. Insulin is one of factors responsible for hepatotrophic regeneration and somatostatin has a reversal suppressive action. Experimental obstructive jaundice was introduced and relieved. In addition, serum insulin and somatostatin concentrations were measured. We used immuno-histochemical study of pancreatic tissue by immunogold to express the tissue relative insulin and somatostatin concentrations. Nucleolar organizer regions (NORs) were used to predict the nucleolar activity of liver cells. In our studies, we observed the serum concentrations of insulin and somatostatin were similar to the relative tissue concentration in pancreatic tissues. The relative tissue gold-particle score of insulin in group A (rats with common bile duct tied), was CONT: T4: T7: T14 = 100%: 90.5%: 68.3%: 46.2%; of somatostatin was 100%: 120%: 118.2%: 115.5% respectively. In group B (common bile duct tied for 4 days then relieved), the gold-particle score of insulin was T4: T4R4: T4R7: T4R14 = 90.5%: 62.8%: 72.2%: 95.4%; of somatostatin was 120.2%: 114.3%: 108.1%: 106.2% respectively. In group C (common bile duct tied for 7 days then relieved), the gold-particle score of insulin was T7: T7R4: T7R7: T7R14 = 68.3%: 53.3%: 73.5%; of somatostain was 118.2%: 109.4%: 104.6%: 102.1% respectively. The mean numbers of AgNORs in group A revealed CONT: T4: T7: T14 = 2.24 +/- 0.24: 3.02 +/- 0.96: 3.26 +/- 1.02:3.08 +/- 0.84, group B was T4: T4R4: T4R7: T4R14 = 3.02 +/- 0.96: 3.03 +/- 0.73: 3.36 +/- 1.12: 3.72 +/- 1.46, and group C showed T7: T7R4:T7R7: T7R14 = 3.26 +/- 1.02: 3.26 +/- 0.84: 3.31 +/- 1.24: 3.54 +/- 1.24. In conclusion, our studies suggested: (1) liver regeneration appeared promptly after obstructive jaundice developed, but prolonged cholestasis inhibited this process. (2) Insulin levels gradually fell during the process of obstructive jaundice. Those levels elevated when cholestasis was improved. Nevertheless, both insulin and hepatic regeneration power could not reflect the initial improvement of cholestasis simultaneously. It took a longer time for the improvement of cholestasis and the recovery of the liver function. (3) Patho-physiologically, somatostatin had a weak influence on hepatic regeneration during obstructive jaundice. (4) Our studies provided clues that early biliary drainage might improve hepatic regeneration capacity. Supplement of insulin during the obstructive jaundice might be helpful for the improvement of hepatic regeneration power.

Animals↗
PubMed1996

Changes of bile duct mucosa after choledochoduodenostomy in rats.

This study investigated the changes of bile duct mucosa in rats after choledochoduodenostomy. Wistar rats were divided into three groups: group I (n = 6) was treated with sham operation as control; group II (n = 10) was treated with common bile duct ligation without choledochoduodenostomy, and group III (n = 12) had both common bile duct ligation and choledochoduodenostomy creation 4 days after common bile duct ligation. From our observations, retrograde induced cholangitis due to enteric reflux into the common bile duct is the possible cause of chronic inflammation after choledochuduodenostomy. At the end of the study, Choledocholithiasis developed in 5 of 12 rats. Severe dysplasia was present in the bile duct mucosa in 6 of 12 rats in group III, but not in group I or II. A technique for silver staining of nucleolar organizing regions (AgNOR) was applied. This technique demonstrated differences in AgNOR counts between normal mucosa and dysplasia. Under AgNOR stain, the number of AgNOR was significantly greater than in the normal or benign counterparts and gradually increased from the normal bile duct mucosa group to the severe dysplasia group (group I 2.1 +/- 0.8, group II 3.2 +/- 1.0, group III 5.3 +/- 1.1). All of these observations suggest that 'sump syndrome' and bile stasis could occur after choledochoduodenostomy in rats and can result in chronic inflammation of the bile duct. It has been well established that calcium bilirubinate is the major type of choledocholithiasis in Orientals. beta-Glucuronidase from bacteria, such as Escherichia coli present in the biliary tree, hydrolyzes bilirubin diglucuronide to bilirubin. Bilirubin combines with calcium in the bile flow to form calcium bilirubinate. Bacterial infection plays a key role in calcium bilirubinate stone formation. Since choledochoduodenostomy did increase reflux cholangitis, and bacterial infection would increase mucin overproduction, bile deconjugation and eventually new calcium bilirubinate stones would be formed. The dysplastic changes in the bile duct mucosa could possibly be related to the prolonged exposure to the biochemically altered infected bile. Thus choledochoduodenostomy might not be the perfect choice in treating calcium bilirubinate choledocholithiasis in Orientals.

Animals↗
PubMed1995

Dead on arrival study in Kaohsiung area.

Dead on arrival (DOA) is a distressful situation for most medical personnel and families. There are few papers about this topic in Taiwan though most DOAs are unexpected and sudden with or without underlying disease as predisposing factors. From January 1, 1993 to December 31, 1993, 487 DOA patients were sent to 4 large hospitals in the Kaohsiung area (including Kaohsiung City and Kaohsiung County). A retrospective study was carried out through questionnaires. The incidence was 0.22%, the male to female ratio was 2.25, and the largest age group was 61 to 75 years old. Most patients were sent to nearby hospitals and sent by non-medical personnel with non-ambulance motor vehicles. It is hard to define the exact time from arrest to arrival at the hospital, but the initial cardiac rhythm was mostly asystole. Only 1.44% of DOA patients survived and only 9.24% responded to resuscitation. About 31.42% of patients had no evident cause of death, 40.04% non-trauma deaths, and 28.54% trauma deaths. Most of the underlying diseases were treated regularly by medical specialists if past history could be traced. Though our emergency medical service system (EMSS) has been active since 1990, there are still several drawbacks. Public education of cardiopulmonary resuscitation, easy access to EMSS, and appropriate management in hospitals must be stressed. With the improvement of prehospital care, EMSS, and in-hospital care, there will be a decrease in DOA patients.

Adolescent↗
PubMed1994

[How should high concentration oxygen be provided with a resuscitator during resuscitation?].

Oxygen is essential to life. When one is suffering from illness or trauma, the oxygen demand increases because of catabolic response. High concentration oxygen is therefore required in resuscitation. In Taiwan, as well as in other countries, medical personnel usually provide artificial ventilation with a resuscitator. However, the percentage of oxygen delivered from the bag varies significantly in different conditions. To provide high-concentration oxygen during resuscitation, it is necessary to use a resuscitator with an oxygen reservoir and sufficient supplemental oxygen flow.

Humans↗
PubMed1994

Alterations of nucleolar organizer regions of smooth muscle cells in bile duct following biliary ligation in rat.

Clinical experience indicates that bile duct dilatation is often associated with patients presenting with cholestasis. The purpose of this study is to propose a hypothesis that such a biliary dilatation, resulting from extra-hepatic obstruction, partially contributes to the rapidly occurring hypertrophy and hyperplasia of the smooth muscle cells in the bile duct; and that such an alteration could possibly lead to the development of neoplastic tissue. Twenty seven male Wistar rats were divided into 4 groups: Control Group (n = 7) with sham operation, Day 4 Group (n = 6) with common bile duct ligated for 4 days, Day 7 Group (n = 7) with common bile duct ligated for 7 days, and Day 14 Group (n = 7) with common bile duct ligated for 14 days. Complete extrahepatic biliary obstruction was induced in Wistar rats by distal ligation of the common bile duct (CBD). The CBD specimens were stained by H & E and argyrophilic techniques (AgNOR method), and the smooth muscle cells were identified and studied with light microscopy and an image analyzer. To determine maximum width of cell size, the widths of smooth muscle cells were found to be 2.82 +/- 0.07 microns, 3.05 +/- 0.06 microns, 4.53 +/- 0.10 microns, and 4.89 +/- 0.12 microns (Mean +/- S.E.) for the Control Group, Day 4 Group, Day 7 Group and Day 14 Group, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Risks of bloodborne diseases to emergency personnel in traumatic wound management.

High prevalence of viral hepatitis, increasing HIV infection and other bloodborne diseases in Taiwan have made the health care provider exposed to an increased risk of disease transmission unless adequate precautions and protections have been undertaken. Furthermore, emergency personnel must face the patient with limited information, and neither a reliable predictor nor appropriate tools have been found to assist in identifying emergency patients who pose a risk. The Centers for Disease Control (CDC) in the United States thus issued a specific caveat advocating all body fluids should be treated as potentially infectious under uncontrolled emergency circumstances. Unfortunately, in Taiwan, personnel in emergency service practice with limited protection, often without mask and only gloves as the only barrier device used. We tried to determine the risk of facial exposure during traumatic wound management. One hundred and fifteen wounds of 107 patients were enrolled. Most of them were not life-threatening and thus could be managed under more controlled conditions. Standard procedures of wound management were applied and facial exposure was assessed after each wound closure. Positive exposure rate in such controlled conditions remained as high as 46/115 (40%). Exposure rate in uncontrolled conditions should be, therefore, much more significant. Therefore, we should put more emphasis on adequate precaution and protection against bloodborne diseases.

Blood-Borne Pathogens↗
PubMed1993

Elevation of carcinoembryonic antigen related to biliary malignancy in hepatolithiasis.

Bile duct neoplasms occur relatively often in patients with hepatolithiasis in Taiwan. In this study, 49 patients with a positive immunoperoxidase stain for carcinoembryonic antigen (CEA) in the bile duct glands were examined in relation to the concentration of CEA in serum and bile. The bile concentrations of CEA in 15 control patients, 16 patients with hepatolithiasis only, 7 with hepatolithiasis and bile duct carcinoma, and 11 with bile duct carcinoma only were 4.09 +/- 4.12, 70.49 +/- 81.62, 137.73 +/- 66.15, and 144.3 +/- 117.31 ng/ml (mean +/- SD), respectively. A positive CEA stain from the bile duct was seen in 13.33%, 81.23%, 85.71%, and 90.91% of each group, respectively. No strongly positive staining, (2+ or 3+) was found in the control group, but it was found frequently in the hepatolithiasis and bile duct carcinoma groups. The findings of this study therefore suggest the probability of a combined neoplasm in patients with hepatolithiasis if the CEA value is unusually elevated in the serum or bile.

Bile↗
PubMed1993

Extracorporeal shockwave lithotripsy for treatment of intrahepatic stones: in vitro and in vivo studies.

In vitro, bile duct stones, mostly comprising calcium bilirubinate, are readily fragmented by extracorporeal shockwave lithotripsy (ESWL). In the case of intrahepatic stones, ESWL is effective if the stones float freely in the bile, but if the stones completely fill, or are impacted within, the hepatic duct or bile duct, attempts at fragmentation will end in failure. Three patients with intrahepatic stones were treated with ESWL, and effectively fragmented. The stone fragments passed out spontaneously through T-tube sinus tract, PTDC sinus tract and the sphincter of Oddi as shown in the second cholangiogram. No specific complication was noted in our experimental and clinical experience. We believe that ESWL for fragmentation of biliary stones is technically reliable. The problem of the passage of these fragmented stones is considered; if necessary, it can be overcome by endoscopic means.

Adult↗
PubMed1992

A simple animal model for inducing and releasing surgical jaundice in rats.

Surgical jaundice can be easily induced by ligation of bile duct, but it is not easy to reverse the ligation in rats. Therefore, a simple method was designed in our laboratory to address the problem. Obstruction of bile duct can be achieved by the compression by two arms of a fine silicon tube enveloped in an outer bigger silicon tube. Both silicon tubes are then fixed and sutured to the abdominal peritoneum. Therefore, if the releasing of the obstruction is required, removal of the inner fine silicon tube by removing off the previous suture tire of silicon tube which had settled under the skin. Thus, the reversing of obstruction could be achieved without extensive exploration into the abdominal cavity. One week after obstruction the bile duct of rats were dialated 6.10 +/- 1.26 mm (Mean +/- SD) in rats. The serum bilirubin and alkaline phosphatase were 6.29 +/- 1.26 mg% and 229.30 +/- 82.22 IU respectively. The dilated bile duct decreased into 3.00 +/- 0.98 mm one week after decompress with this method. Serum bilirubin and alkaline phosphatase were 1.80 +/- 0.79 mg% and 90.50 +/- 19.60 IU respectively. It proved that this animal model was simple and had the benefit of being able to sample the bile without contamination with intestinal contents after decompression.

Alkaline Phosphatase↗