Biomedical subjects

C P Hsu

Publications and source records attributed to C P Hsu.

At least 19 recordsLinked to original sources

PubMed1997

Surgical treatment and its long-term result for caustic-induced prepyloric obstruction.

OBJECTIVE: To present our long-term results of the treatment of caustic-induced prepyloric obstruction, and to set out guidelines for the management of such patients. DESIGN: Retrospective study. SETTING: General hospital (medical centre), Taiwan. SUBJECTS: 30 patients (8 male and 22 female, mean age 34 years, range 13-62) who developed prepyloric obstruction out of 271 treated for caustic injuries of the upper gastrointestinal tract. INTERVENTIONS: Gastrojejunostomy (n = 24), antrectomy and Billroth I reconstruction (n = 4), and antrectomy and Billroth II reconstruction (n = 2). Four patients required second operations: oesophageal reconstruction for stricture (n = 3), and gastrojejunostomy for restenosis of Billroth I anastomosis (n = 1). MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: No patient died postoperatively, and there were three complications--wound infection, internal bleeding, and stenosis of the Billroth I anastomosis. 21 patients were able to enjoy their normal diet postoperatively, 5 required periodic dilatation of oesophageal strictures, and 4 required further operations. CONCLUSIONS: Gastrojejunostomy gives good long term results as long as there is no oesophageal stricturing, and morbidity and mortality are low. The long term outcome is dependent on the degree of oesophageal involvement.

Adolescent↗

PubMed1996

Surgical experience in treating T4 lung cancer: its resectability, morbidity, mortality and prognosis.

Extensive experience in the treatment of locally advanced lung cancers is rare. The aim of this study is to show the rationality and effectiveness of an aggressive surgical approach in T4 lung cancers. Between 1984 and 1994, 111 consecutive cases of T4 lung cancers were operated on. The patients included 91 males and 20 females, with mean ages of 61.8 years and 55.3 years, respectively. The cell types included 57 squamous cell carcinomas, 42 adenocarcinomas, and 12 miscellaneous malignancies. Fifty-three (47.7%) procedures were non-resectional. The remaining 58 (52.3%) procedures had various extents of pulmonary resection. These surgical procedures included 24 (21.6%) pulmonary resections with gross residual tumour (R2), nine (8.1%) pulmonary resections with microscopic residual tumour (R1), and 25 (22.5%) curative pulmonary resections without residual tumour (R0). Post-operative adjuvant therapy included radiotherapy ( > or = 3000 rads) in 53 patients (47.7%), and cisplatin-based chemotherapy in 15 patients (13.5%). The overall median survival time of these 111 patients was 9.1 months. The overall cumulative survival rates at 1, 2, 3 and 5 years were 38.0%, 20.4%, 15.3%, and 5.5%, respectively. There were 24 (21.6%) complications and eight (7.2%) hospital mortalities. Most of the pleural seedings were caused by adenocarcinomas, while most of the curatively resected tumours were squamous cell carcinomas. Our data demonstrate that: (1) Almost a quarter (22.5%) of T4 lung cancers could be curatively resected, and the cumulative 5-year survival rate was 23.4%; (2) squamous cell carcinoma had a higher curative resection rate (P = 0.0381), while adenocarcinoma showed higher possibility of pleural seeding (P = 0.0000); (3) the prognosis of T4 lung cancers did not relate to their nodal status (P = 0.7978), and cell type (P = 0.4169); (4) complete surgical resection provided the best rates for long-term survival (P = 0.0263); (5) the complication rate was higher in the resectional group (P = 0.0221); (6) post-operative irradiation did not lengthen survival times (P = 0.1720); and (7) post-operative chemotherapy did not improve survival (P = 0.1577). We conclude that surgery to T4 lung cancers should only be performed in highly selected patients due to their poor prognosis, and the associated high complication and mortality rates.

Adult↗

PubMed1996

Pleural non-Hodgkin's lymphoma arising in a patient with a chronic pyothorax.

A 69 year old man with a chronic left pyothorax was treated by decortication. Although the treatment rapidly improved respiratory function, histopathological examination revealed a diffuse large B cell non-Hodgkin's lymphoma. Subsequent bone marrow biopsy samples disclosed bone marrow involvement. It is possible that non-Hodgkin's lymphoma may develop from a chronic pyothorax.

Aged↗

PubMed1996

Color Doppler ultrasound signals of thoracic lesions. Correlation with resected histologic specimens.

Sixty-eight patients with thoracic lesions (48 with lung cancer and 20 with benign lesions) underwent color Doppler ultrasound (US) examinations. Of those, 21 patients (13 with lung cancer and eight with benign lesions) also received resections, and the correlation between color Doppler US signals and resected histologic specimens was evaluated. Our results showed that three patterns of color Doppler US signals could be detected and confirmed: pulsatile flow (artery), constant flow, and triphasic flow (pulmonary vein). Among the 48 patients with lung cancer, pulsatile flow, constant flow, and/or triphasic flow were detected in 34 (71%), 24 (50%), and 14 (29%), respectively. Among the 20 patients with benign lesions, only pulsatile flow and/or triphasic flow were detected in nine (45%) and eight (40%), respectively. From the correlation between color Doppler US signals and histologic specimens, constant flow was representative of the true neovascularity of lung cancers, and it was valuable for differentiating lung cancers from benign lesions (p = 0.00008, sensitivity = 0.50, and specificity = 1.0). Although color Doppler US still had some limitations in detecting blood vessels in thoracic lesions, the correlation between the vascularity represented by color Doppler US signals and histologic specimens was excellent. We conclude that color Doppler US is a valuable method for assessing blood flow in thoracic lesions and differentiating lung cancers from intrapulmonary benign lesions.

Adult↗

PubMed1996

Oesophageal squamous cell carcinoma after gastrectomy for benign ulcer disease.

Of 684 patients treated for squamous cell carcinoma of the oesophagus in 1982-1993, 19 (2.8%) had previously undergone partial gastrectomy for benign ulcer disease. The average interval between gastrectomy and diagnosis of oesophageal carcinoma was 14 years. In six of the 19 (31.6%) cases the carcinoma was in the lower thoracic oesophagus, an incidence not significantly higher than the 25% in the total series. The oesophageal resectability rates were 52.6% in the gastrectomized patients and 44.4% in the total series (intergroup difference not significant). Of the ten gastrectomized patients who underwent oesophageal resection, only one had oesophagitis at the oesophagogastric junction, without significant histologic characteristics. The relationship between oesophageal squamous cell carcinoma and previous gastrectomy for benign ulcer disease may be incidental.

Adult↗

PubMed1996

Change of lower esophageal sphincter pressure in rabbits by Teflon injection.

BACKGROUND: The mechanically incompetent lower esophageal sphincter (LES) plays a key role in patients with gastroesophageal reflux disease. The purpose of the study was to assess the pressure changes of LES in rabbits by intraabdominal injection of Teflon paste (Polytetrafluoroethylene) at the gastroesophageal junction. METHODS: New Zealand white breed of rabbits were used in these studies. The anesthetized rabbit was injected with a 21-gauge needle and a syringe loaded with Teflon paste. The injection sites were around the gastroesophageal junction. LES pressure was measured by conventional methods using a water-filled infused system. The pressure gradient was measured immediately before and after the injection as well as by a weekly measurement over four weeks. The histologic characteristics of the injection sites were studied four weeks later. RESULTS: The mean pressure gradient of LES of twelve rabbits of immediate preinjection and post-injection was 29.71 +/- 8.10 mmHg and 37.58 +/- 10.69 mmHg (mean +/- S.D.), respectively (p value, 0.0329) Animals were followed upifor from one to four weeks, and were then sacrificed. The mean pressure gradient of LES of the twelve rabbits in the first week, the second week, the third week and the fourth week was 37.80 +/- 11.36 mmHG, 35.77 +/- 3.54 mmHg, 33.42 +/- 4.95 mmHg and 32.68 +/- 4.62 mmHg (mean +/- S.D.), respectively. Compared to pre-injection data, a significant difference was found in the first week and the second week (p value, 0.0342 and 0.0281, respectively). Gross examination of the gastroesophageal regions showed a welldefined Teflon mass of firm consistency at the site of the injection. Histological examination showed encapsulation of the implant by a thin layer of fibrous tissue and a benign foreign body granulomatous reaction with round cells surrounding the implant. CONCLUSIONS: It is technically feasible to produce experimentally pressure changes of LES in rabbits by intraabdominal injection of Teflon paste. Nevertheless, the clinical validity on patients with gastroesophageal reflux induced by the incompetence of LES remains to be verified.

Animals↗

PubMed1996

Detection of k-ras point mutations in codons 12 and 13 in non-small cell lung cancers.

Point mutations of the K-ras gene have been reported in a wide variety of human tumors. By using polymerase chain reaction followed by direct DNA sequencing, we screened for point mutations at codons 12 and 13 of the K-ras gene in specimens obtained from fresh frozen tumors in 38 patients with non-small cell lung cancers. Point mutations were detected in two of 38 (5.3%) resected non-small cell lung cancers. Both of them were G to T transversions. One patient was found to have a K-ras codon 13 point mutation (GGC to TGC, gly to cys), while the other had a codon 12 point mutation (GGT to GTT, gly to val). Based on the limited numbers in this study, we found that the frequency of K-ras point mutations in codons 12 and 13 among Asian patients with lung adenocarcinomas was lower than that detected among Caucasian patients.

Adult↗

PubMed1995

Bronchioloalveolar carcinoma.

Bronchioloalveolar carcinoma is a subtype of adenocarcinoma of the lung with a relatively better prognosis. We reviewed the cases of 50 consecutive patients with bronchioloalveolar carcinoma treated during a 10-year period and attempted to analyze factors related to prognosis. During the 10-year study period, the prevalence of bronchioloalveolar carcinoma relative to adenocarcinoma of the lung remained steady. The subjects included 32 male and 18 female patients with mean ages of 64.7 years and 55.1 years, respectively (p = 0.0030). The preoperative radiographic findings included 40 cases of localized and 10 cases of diffuse bronchioloalveolar carcinoma. The clinicopathologic TNM staging included 20 patients with stage I cancer, 4 with stage II cancer, 11 with stage IIIa cancer, 3 with stage IIIb cancer, and 12 with stage IV cancer. Forty patients with clinical stage I, II, or III disease underwent operation (operability 80%). The resectability rate was 90% (36 of 40). Thirty-four procedures were considered as curative. The overall cumulative survival at 5 years was 22.2% (46.4% for stage I). Different TNM stages showed significant differences in survival time (p = 0.0001). The median survival times were 64.6 months for stage I, 48.0 months for stage II, 24.7 months for stage IIIa, 9.0 months for stage IIIb, and 4.5 months for stage IV disease. The median survival time for localized bronchioloalveolar carcinoma was 27.5 months, and the median survival time for diffuse bronchioloalveolar carcinoma was 4.3 months (p = 0.0002). The median survival time for the curative resection group was 30.6 months, and the median survival time for the noncurative resection or nonresection group was 5.8 months (p = 0.0001). On the basis of this study we conclude that (1) the prevalence of bronchioloalveolar carcinoma is quite steady, (2) bronchioloalveolar carcinoma presents at an earlier age in women, (3) bronchioloalveolar carcinoma frequently presents with lymphatic spread or systemic metastasis at diagnosis, (4) most localized bronchioloalveolar carcinomas are resectable and the prognosis with this type is better than that of the diffuse type, and (5) long-term survival correlates closely with initial roentgenographic appearance, TNM stage, and completeness of surgical resection.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMed1995

Diagnostic video-assisted thoracoscopic procedures.

OBJECTIVE: The authors evaluated the effectiveness and the limitations of video-assisted diagnostic thoracoscopy. SUMMARY BACKGROUND DATA: The initial successes achieved with the use of video-assisted diagnostic thoracoscopic techniques has lead to an enthusiastic propagation of its use by thoracic surgeons as well as by some pulmonologists. However, detailed analyses of the diagnostic yield and potential limitations of this technique in relation to the roentgenographic and pathologic presentations of the patients are necessary to ensure its safe and effective application. METHODS: From July 1991 to December 1993, 102 diagnostic video-assisted thoracoscopic procedures were performed. All patients received other preoperative diagnostic workups without a definitive diagnosis. The initial roentgenographic presentations of these patients included 42 pulmonary nodules, 23 interstitial processes, 11 parenchymal infiltrates, 6 pleural effusions, 10 mediastinal tumors, and 10 mediastinal lymphadenopathies. If the procedure was completed without minithoracotomy or extension of any port site, then it was defined as an exclusive thoracoscopic biopsy (ETB); if the procedure was completed with the assistance of minithoracotomy (4-6 cm), then it was defined as a supplementary thoracoscopic biopsy (STB). RESULTS: Ninety-two of the pathology reports (90.2%) were interpreted as conclusive. Of these, 35 tumors were malignant and 67 benign. Ten pathology reports were inconclusive and on initial roentgenography had presented as pulmonary infiltrates (4 cases), pulmonary nodule (2), pleural effusion (2), interstitial process (1), and mediastinal lymphadenopathy (1). Seventy-six procedures (74.5%) were completed thoracoscopically and were classified as ETB. The remaining 26 procedures (25.5%) were completed with minithoracotomy and were classified as STB. The underlying diseases in the STB group were carcinoma (8 cases), Hodgkin's lymphoma (3), sarcoidosis (3), tuberculosis (2), interstitial pneumonitis (2), organizing pneumonia (2), mesothelioma (1), and miscellaneous disease (5). The reasons given for minithoracotomy were diffuse intrapleural adhesion (10 cases), technical inexperience (8), inability to localize the lesion (5), problems with anesthesia (1), poor patient tolerance (1), and unknown (1). Four patients (3.9%) experienced complications and three (2.9%) died while in the hospital. CONCLUSIONS: Diagnostic thoracoscopy provides high diagnostic yield with very low risk. However, 25.5% of the procedures require minithoracotomy to obtain adequate tissue for definitive diagnosis. This finding supports the assertion that diagnostic thoracoscopy should be performed only by experienced thoracic surgeons who can extend the procedure when indicated.

Adolescent↗

PubMed1994

Prediction of probability of pneumonectomy for lung cancer using Tc-99m MAA perfusion lung imaging.

Pulmonary perfusion scintigraphy with Tc-99m MAA was performed on 182 patients, on whom either pneumonectomy or lobectomy was performed, because of primary nonsmall-cell lung carcinoma. Among them, 76 underwent pneumonectomy, and 106 underwent lobectomy. The mean value of the perfusion fraction (PF) of the affected lung of the patients undergoing pneumonectomy was 32.3 +/- 13.6% (range, 4%-50%) and was less than that of the patients undergoing lobectomy, 43.5 +/- 4.5% (range, 27%-50%). The difference was statistically significant (t-test, t = 6.82; P < 0.001). Among the 28 patients whose PF of the affected lung was equal to or less than 30%, 26 underwent pneumonectomy and only 2 had a lobectomy. Among the 154 patients whose PF of the affected lung was more than 30%, 50 underwent pneumonectomy and 104 had a lobectomy. These result suggest that "30%" can be a cutoff value (Yates correction X(2) test, X2 = 33.09; P < 0.001).

Adult↗

PubMed1994

Video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.

BACKGROUND: Hyperhidrosis palmaris is a functionally and socially disabling problem. Thoracic sympathectomy of the T2 ganglion has proved to be the time-honored treatment modality. STUDY DESIGN: The results of this study demonstrate the effectiveness of video-assisted thoracoscope for treatment of hyperhidrosis palmaris. The possibility to apply different anesthetic techniques and to measure surface temperature change of the hand were documented as well. RESULTS: Eighty consecutive cases (159 procedures) of essential hyperhidrosis palmaris were treated by video-assisted thoracoscopic T2 sympathectomy between January 1991 and December 1992. The surgical results were classified as excellent (much improved, very dry) in 88.1 percent, good (improved, minimal wet) in 9.4 percent, and fair (slightly improved, still wet) in 2.5 percent of the patients. The postoperative complications included one prolonged air leakage, one hemothorax, two wound infections, and 15 cases of facial anhidrosis. There were no recurrent cases (mean follow-up, 14.5 months). Fifty-six patients had concomitant hyperhidrosis pedum. Interestingly enough, through unknown mechanism, 64.3 percent of the patients with concomitant hyperhidrosis pedum were cured after this procedure. CONCLUSIONS: Video-assisted thoracoscopy provides magnified surgical fields, which make thoracoscopic sympathectomy for hyperhidrosis palmaris an effective, safe, easy to use, and time-saving procedure. This technique is also excellent for teaching purposes and allows the assistant to participate in the operation.

Adolescent↗

PubMed1994

Thymic carcinoma. Ten years' experience in twenty patients.

Thymic carcinoma is a rare neoplasm with extremely poor prognosis. To evaluate the outcome of treatment in thymic carcinoma, we reviewed a 10-year (1982 to 1992) experience with 20 consecutive patients in Taichung Veterans General Hospital. There were 9 men and 11 women: ages ranged from 34 to 70 years old (mean 51.4 years). None of these patients had concomitant myasthenia gravis. All of the patients received surgical intervention, and the diagnosis was made by pathologic study. Postoperative staging was made according to the modified Masaoka staging system. None of our patients were in stage I. One patient (5%) had stage II disease, 12 (60%) stage III, and 7 (35%) stage IV. The pathologic subtypes of thymic carcinoma included eight squamous cell carcinomas, seven undifferentiated carcinomas, one lymphoepithelioma-like carcinoma, one clear-cell carcinoma, 1 mucoepidermoid carcinoma, and two carcinoid tumors. Curative resection could be done in seven patients (35%). The overall cumulative survival was 45.9% at 3 years and 34.4% at 5 years. The median survival times for patients with complete and incomplete resection were 39.0 months and 14.3 months, respectively (p = 0.1752). The median survival times of patients with postoperative radiotherapy and without postoperative radiotherapy were 39.3 months and 15.0 months, respectively (p = 0.0738). The median survival times of patients with squamous cell carcinoma and undifferentiated carcinoma were 25.4 months and 11.3 months, respectively (p = 0.1464). Our data show that complete resection, postoperative radiotherapy, and squamous cell carcinoma do not indicate a significantly favorable result, even though they result in longer median survival times. Yet a positive trend of favorable outcome in patients who received postoperative radiotherapy is ambiguously shown.

Adult↗

PubMed1993

Sclerosing hemangioma of the lung: a clinicopathologic study.

The clinical and pathological features of 11 cases with sclerosing hemangiomas of the lung seen between 1982, and 1992 were reviewed. There were 1 male and 10 female patients aged 15 to 74 years (mean age, 53 years) at operation. Among the 11, 4 were asymptomatic, with the tumor discovered only on routine chest roentgenograms. All 11 patients had a solitary tumor showing as a well-defined homogeneous round or oval shadow on chest x-rays. Microscopically, 8 of the 11 tumors consisted of a mixture of the four major patterns: hemorrhagic, sclerotic, papillary and solid. Five patients received enucleation; four, wedge resection; one, segmentectomy and one, lobectomy. Since this tumor is usually clinically benign and surgically curative, thoracotomy and complete removal of the tumor by limited resection is recommended.

Adolescent↗

PubMed1993

[Carcinosarcoma of the esophagus].

Carcinosarcoma of the esophagus is a rare neoplasm of the esophagus, composes both of carcinomatous and sarcomatous elements. From Oct. 1982 to Sept. 1991, there were 516 neoplasms of the esophagus, 2 (0.39%) carcinosarcoma, treated at our hospital. The first patient was a 62-year-old man, pathological stage III (T3N2M0). The second patient was a 68-year-old man, pathological stage I (T1N0M0). The tumors were polypoid and located at the middle portion of the esophagus. They had received subtotal esophagectomy, mediastinal lymph node dissection and cervical esophagogastrostomy, retrosternally. The first patient has still lived disease free for seven years. The second patient died one year after the operation due to intra-abdominal lymphadenopathy, liver metastasis and massive ascites. As epidermoid carcinoma, radical esophagectomy with lymph node dissection is the standard procedure for carcinosarcoma of the esophagus.

Aged↗

PubMed1993

Surgical management of intrathoracic goiter.

Thirty-three consecutive patients of intrathoracic goiters underwent resection at the TCVGH during a nine-year period 1982-1991. The mean age of 21 men and 12 women was 65 years. Six (18 per cent) had undergone prior thyroid surgery. Thirty-one of the 33 patients were euthyroid. Thirty patients underwent transcervical approach for resection; three had cervical incision plus median sternotomy. Pathological examination revealed multinodular goiter in 31 (94 per cent) and follicular carcinoma in two (6 per cent). The mean mass of goiter was 201.25 g and the mean greatest dimension was 10 cm. Thyroidectomy is advisable in all cases of intrathoracic goiter and resection can almost invariably be performed through a transcervical approach.

Adult↗

PubMed1992

Surgical treatment of metastatic lung tumor.

Since the first pulmonary resection for metastatic cancer of the lung in 1939, the following procedure can now be offered to any patient who meets these criteria: 1. a controlled primary tumor, 2. resectable lung lesion, 3. unavailability of a better treatment and 4. a good surgical candidate. From 1982 to 1992, there were 42 patients who underwent an operation for pulmonary metastasis at the Taichung Veterans General Hospital. Their cumulative 3-year and 5-year survival rates were 35% and 25% respectively. The overall estimated median survival time was 23.1 months. The overall operative mortality was 2.4% (1/42). We analyzed the effect of different types of primary tumors, the disease-free interval, and the number of lesions on patient survival. In our series, we concluded that none of the above had an effect on the therapeutic results.

Adolescent↗

PubMed1992

[Multiple primary malignant neoplasms: a case report].

One individual with two or three malignant neoplasms is not uncommon. However, a patient with more than 5 primary malignancies is unusual. We present a 51-year-old female who developed 6 metachronous primary malignant neoplasms in a period of 10 years. The anatomic sites of neoplasms in this patient included the cervix, larynx, skin, left breast, bladder and right lung (middle lobe). All of the tumors were proven by pathologic examination, and each of these tumors was recognized as a distinct primary tumor. Aggressive surgical resection, post-operative irradiation and chemotherapy showed good response in this patient. This patient had no familial or hereditary tendencies but, definite impairment of the cellular immunity had been identified.

Breast Neoplasms↗

PubMed1991

Age factor in compensatory hypertrophy of the kidney evaluated by 99mTc-DTPA renography.

Unilateral nephrectomy initiates a growth response in the contralateral kidney to compensate for the loss of a renal mass. The events which regulate this process are not very clear. We used a newly developed method, 99mTc-DTPA gamma-camera renography, to evaluate the individual kidney function for detection of the change of it. This method is simple, reliable and requires neither blood nor urine samples. Two groups of rabbits were used in the study. Those of 1.5-2 months of age were taken as the young aged group and those of 2 years of age as the old aged group. Kidney weight, glomerular filtration rate (GFR), and effective renal plasma flow (ERPF) were detected both before and 3 weeks after unilateral nephrectomy. After unilateral nephrectomy in both young and old age groups, the kidney weight increased by 119 and 38%, the GFR by 71 and 44%, and the ERPF by 116 and 35%. We conclude that nephrectomy at a young age where there is fast growth would cause the remaining kidney a compensatory hypertrophy which is much better than that in nephrectomy at an old age. The difference of glomerular filtration rate was less apparent than that of the kidney weight and renal plasma flow in both groups of rabbits.

Adaptation, Physiological↗