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Biomedical subjects

C Tsang

Publications and source records attributed to C Tsang.

10 recordsLinked to original sources
PubMed2000

Stapled hemorrhoidectomy--cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months.

PURPOSE: Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared with a conventional open diathermy technique. METHODS: A total of 119 consecutive patients with prolapsed irreducible hemorrhoids were randomly assigned (conventional open diathermy technique = 62; stapled hemorrhoidectomy = 57). Preoperative fecal incontinence scoring, anorectal manometry, and endoanal ultrasound were performed. Postoperatively, these were repeated at up to three months with pain scores, analgesic requirements, quality of life assessment, and total related medical costs. RESULTS: Conventional open diathermy technique was quicker to perform (mean, 11.4 (standard error of the mean, 0.9) vs. 17.6 (3.1) minutes). Hospitalization was similar, but conventional open diathermy technique patients felt more pain during defecation (5.1 (0.4) vs. 2.6 (0.4); P < 0.005) at two weeks, and analgesic requirements were more for up to six weeks (P < 0.05). Up to the latter, 85.5 percent conventional open diathermy technique wounds remained unhealed, with more bleeding (33 (53.2 percent) vs. 19 (33.3 percent); P < 0.05) and pruritus (27 (43.5 percent) vs. 9 (15.8 percent); P < 0.05). Total complication rates were similar (conventional open diathermy technique 16 (25.8 percent) vs. stapled hemorrhoidectomy 10 (17.5 percent)), including mild strictures and bleeding in both groups. Minor incontinence occurred postoperatively in two conventional open diathermy technique and two stapled hemorrhoidectomy patients at six weeks. Endoanal ultrasound internal anal sphincter defects were found in the incontinent conventional open diathermy technique patients, but were asymptomatic in another one conventional open diathermy technique and one stapled hemorrhoidectomy. Only one patient (conventional open diathermy technique with internal sphincter defect) remained incontinent at three months. Changes between preoperative and postoperative anorectal manometry were similar in the two groups. Patients' satisfaction scores and quality of life assessments were also similar. Conventional open diathermy technique patients resumed work later (mean 22.9 (1.8) vs. 17.1 (1.9) days; P < 0.05), but the total costs incurred were less ($921.17 (16.85) vs. $1,283.09 (31.59); P < 0.005). CONCLUSIONS: Stapled hemorrhoidectomy is a safe and effective option in treating irreducible prolapsed piles. It is more expensive but less painful, with less time needed off work. Nonetheless, long-term results are still awaited.

Adult↗
PubMed2000

Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry.

PURPOSE: Injury sustained from the transanally introduced stapling technique was assessed by comparison with biofragmentable anastomotic ring anastomosis, which excluded anal manipulation. METHODS: A randomized, controlled trial was conducted on consecutive patients undergoing sigmoid colectomy (where pelvic nerve injury was avoided). A bowel function questionnaire was administered six months after surgery. Anorectal manometry and endoanal ultrasonography were performed preoperatively and at six months postoperatively. The observers were blinded to the randomization. RESULTS: There were 18 patients in the transanally introduced stapling technique group and 17 patients in the biofragmentable anastomotic ring group, with no differences in age, gender, Dukes staging, and follow-up. Three of the transanally introduced stapling technique patients had occasional liquid soiling, which was absent in biofragmentable anastomotic ring patients. Mean change in resting anal pressures was also significantly impaired when compared with patients with biofragmentable anastomotic ring (P = 0.007). Endosonographic internal sphincter fragmentation was found in five transanally introduced stapling technique patients but none after biofragmentable anastomotic ring anastomosis (P = 0.046). Internal sphincter fragmentation was associated with the impaired resting pressures (P = 0.007). External sphincter deficiencies were found after transanally introduced stapling technique in two patients (biofragmentable anastomotic ring = 0), and these were associated with the soiling (P = 0.005). CONCLUSIONS: The transanally introduced stapling technique may result in anal sphincter defects and impaired anal pressures when assessed at six months of follow-up.

Adenocarcinoma↗
PubMed1999

Salivary lysozyme and related parameters of a predominantly Chinese, HIV-infected cohort in Hong Kong.

OBJECTIVES: To evaluate the salivary lysozyme concentration, flow rate and pH of a predominantly Chinese, HIV-infected group in Hong Kong, and to compare with an equal number of age and gender-matched HIV-free individuals. STUDY DESIGN: A prospective longitudinal study over a 12-month period of 32 predominantly Chinese, male, HIV-infected group in a hospital setting in Hong Kong. Whole saliva collection by expectoration, lysozyme evaluation by 'lysoplate method'; pH and flow rate evaluation using standard methods and correlation with other clinical parameters using regression analysis. RESULTS: The flow rate and the pH of saliva were lower compared with HIV-free, healthy individuals (both P < 0.0001) and salivary lysozyme concentration of the HIV-infected group was 23% higher compared with the HIV-free group (P < 0.001), though there was no significant difference between the lysozyme output (P > 0.05) expressed as microg min-1. On multiple regression analysis, intravenous drug users had a higher salivary lysozyme concentration compared with the homosexual group (P = 0.0015) though other variables investigated were not significantly related to the salivary lysozyme concentrations. CONCLUSIONS: The significant changes in the flow rate, pH value and lysozyme concentration of whole saliva of the HIV-infected individuals as compared with the HIV-free, healthy individuals, may be due to the disease itself or a combination of factors including the medications used in the disease management.

Adult↗
PubMed1999

Skin stapled bowel anastomosis in a canine model.

AIM OF STUDY: The aim of this study is to compare the safety and cost effectiveness of the use of staples designed for skin closure in the construction of colonic anastomoses. METHOD: Twenty healthy dogs were prospectively randomised to either skin stapled or sutured anastomosis. The ascending colon was transected and reanastomosed. This segment was excised and used to test early bursting strength. There was no significant difference between the two groups. The ends of the colon were reanastomosed. RESULTS: The time taken to perform the anastomosis and the cost of the suture or staples were noted. The time taken for the stapled anastomosis was significantly faster (p < 0.001) with a mean of 7.95 minutes versus a mean of 23.5 minutes for the handsewn anastomosis. The cost was also significantly less (p = 0.18) with a mean of SGD17.85 compared to a mean of SGD21.15 for the handsewn anastomosis. Two weeks later, the dogs were sacrificed and the late bursting pressures were tested and no significant difference was found between the two groups. The anastomotic site was then sent for histological examination. The four animals, one in the handsewn group and 3 in the skin stapled group, dying prior to sacrifice, were subjected to post-mortem. CONCLUSION: The results show that skin stapled anastomoses are easy to learn and perform and may constitute a viable alternative to hand suture techniques.

Anastomosis, Surgical↗
PubMed1998

Prospective, randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy.

PURPOSE: The aim of this study was to assess pain and complication rates after closed hemorrhoidectomy with the use of either scissors or diathermy excision. METHODS: Ninety-one consecutive patients were prospectively randomly assigned by use of sealed envelopes to Group A (diathermy dissection; n = 44) or Group B (scissors dissection; n = 47). The resulting hemorrhoidal pedicle after hemorrhoidal dissection was transfixed and buried under the mucosa, which was closed with 3-0 chromic catgut. RESULTS: The median time taken for surgery was ten minutes in both groups. The range for Group A was 5 to 25 minutes, and the range for Group B was 5 to 20 minutes. There were no statistically significant differences in the pain scores between the two groups for any of the seven postoperative days studied. The median number of pethidine injections in Group A was 1 and in Group B was 0 (P < 0.009). The number of oral analgesic tablets used was 8 (range, 4-10) and 14 (range, 0-10) for Groups A and B, respectively (P < 0.001). The number of tubes of topical lignocaine jelly used was 14 (range, 0-22) and 14 (range, 7-88) in Groups A and B, respectively. Two patients in each group developed secondary hemorrhage, but no patient had anal stricturing. CONCLUSION: No excessive complications are seen with closed hemorrhoidectomy, and diathermy seems to require less postoperative analgesic medicine than scissors for closed hemorrhoidectomy except in the first 24 hours.

Adult↗
PubMed1997

Clinical pathway for pediatric parenteral nutrition.

The nutrition support team at Lucile Salter Packard Children's Hospital at Stanford developed a clinical pathway for infants and children receiving parenteral nutrition (PN). Use of clinical pathways for health care delivery is one way in which clinicians and institutions are responding to pressure from managed care organizations to reduce costs and maintain or improve quality. This pathway was developed to standardize the process for ordering, implementing, and monitoring PN. Specific goals for the pathway are as follows: to decrease the number of patients receiving PN inappropriately, to decrease the duration of PN for those patients who require it, to determine complication rates, and to monitor outcomes of therapy. Such comprehensive monitoring will help identify areas for improvement. By developing and implementing action plans to address these issues, we expect to improve continuously the processes and outcomes associated with PN therapy.

Algorithms↗
PubMed1989

Flow cytometric quantification of rat spermatogenic cells after hypophysectomy and gonadotropin treatment.

DNA flow cytometry was evaluated as a tool to analyze stage-specific changes that occur in absolute cell numbers in the testes. Hypophysectomy was selected as a model system for perturbing testicular cell types, since the cytological sequelae of this treatment post-hypophysectomy in the rat are well documented in the literature. Rat spermatogenic cells in stages II-V, VII, and IX-XIII of the seminiferous epithelial cycle (as defined by Leblond and Clermont, 1952) were quantified in numbers per standard length of seminiferous tubule by DNA flow cytometry after hypophysectomy and subsequent gonadotropin treatment. In agreement with previous histological studies, we found that acrosome- and maturation-phase spermatids disappeared from the seminiferous epithelium after 17 days post-hypophysectomy, whereas meiosis and early spermiogenesis continued at least 164 days. The number of meiotic cells and round spermatids gradually decreased after hypophysectomy. Changes were observed as early as Day 6 post-hypophysectomy. Treatment with human chorionic gonadotropin (hCG) alone maintained most cell numbers within normal limits, and follicle-stimulating hormone (FSH) was needed in addition to hCG to maintain the normal number of cells with the amount of DNA contained in primary spermatocytes and spermatogonia in G2/M-phase (4C) in stages IX-XIII and elongated spermatids (1C') in stages II-V of the epithelial cycle. The absolute numbers of spermatogenic cells at different phases of maturation provide a useful reference for quantitative studies of spermatogenesis. Pathological changes in the seminiferous epithelium can be detected and quantified by DNA flow cytometry.

Acrosome↗
PubMedDate not supplied

Selective sedation for colonoscopy.

A study of selective sedation for colonoscopy was conducted in two parts. All procedures were performed by one experienced colonoscopist. In the first phase, 41 patients received intravenous sedation before colonoscopy and were then prospectively randomized to either a "not-reversed" group, which did not receive flumazenil before withdrawal of the colonoscope, or to a "reversed" group, which received flumazenil before colonoscope withdrawal. None of the 20 patients reversed and 1 of the 21 patients not reversed experienced pain during the withdrawal phase of colonoscopy. Sixty percent of patients in the reversed group and 10% in the not-reversed group remembered the colonoscopic findings being explained during the procedure. Ninety percent and 81% of patients in the reversed and not-reversed groups, respectively, expressed a preference to be awake to watch the withdrawal of the colonoscope. In the second phase of this study, 40 patients underwent colonoscopy without prior intravenous sedation. Sedation was given only if pain was experienced during the procedure. Thirty percent had no pain at all, 55% minimal pain, 8% moderate pain, and 3% severe pain. Twenty-three percent required intravenous sedation, whereas 78% did not receive any sedation. Ninety-three percent were willing to undergo another colonoscopy without prior sedation. Only 8% preferred prior intravenous sedation before any future colonoscopy.

Adult↗