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Biomedical subjects

C Y Lo

Publications and source records attributed to C Y Lo.

At least 19 recordsLinked to original sources
PubMed1996

Acute diverticulitis of the right colon.

BACKGROUND: Acute diverticulitis of the right colon is a rare condition with a higher incidence in Oriental populations than in Occidental populations. PATIENTS AND METHODS: A retrospective review was conducted between 1982 and 1993 on 22 surgically treated Chinese patients (14 men, 8 women; mean age 47 years) with documented right colon diverticulitis. RESULTS: Most patients presented with right lower quadrant pain and local peritoneal signs. Acute appendicitis was the preoperative diagnosis in 82% (18/22) of the patients. Only one diagnosis subsequently proved correct. The pathology was easily recognized in 4 patients during surgery, while examination of the resected specimen confirmed the intraoperative suspicion in 13 patients. The right colon was resected and an ileocolonic anastomosis performed in 21 patients; the remaining patient underwent diverticulectomy and drainage of a pericolic abscess. There was no postoperative mortality, and 4 patients developed wound infection. CONCLUSIONS: Our results showed that acute diverticulitis of the right colon was encountered once in 180 cases of acute appendicitis. Local resection or colectomy with primary anastomosis without bowel preparation is the procedure of choice.

Acute Disease↗
PubMed1995

Follicular carcinoma of the thyroid gland in Hong Kong Chinese.

A total of 64 Chinese patients (eight men, 56 women) undergoing primary treatment for follicular thyroid cancer between 1961 and 1986 were studied retrospectively to report the local experience in treatment of this condition and to identify the risk factors for mortality. The minimum follow-up was 7 (median 14) years. The mean tumour size was 3.0 (range 0.1-11.0) cm. The majority of patients (91 per cent) underwent total or near-total thyroidectomy. Distant metastases were detected in ten patients at the time of initial diagnosis and in three during follow-up. Locoregional recurrence had developed in six patients at follow-up. There were 13 deaths, with a median survival of 45 months. The 5- and 10-year survival rates were 87 and 80 per cent respectively. Six risk factors for mortality were selected for multivariate analysis using logistic regression; the presence of distant metastasis was the only significant risk factor for survival.

Adenocarcinoma, Follicular↗
PubMed1995

The role of one-stage surgery in acute left-sided colonic obstruction.

BACKGROUND: One-stage surgery with primary anastomosis is not widely accepted for acute left-sided colonic obstruction. PATIENTS AND METHODS: Forty-four patients representing our total admission for acute left-sided colonic obstruction over a 3-year period were evaluated with regard to their suitability for one-stage surgery and primary anastomosis. RESULTS: Thirty-five patients (80%) were found to be suitable for this approach and the failures were mainly due to either the advanced nature of the malignant lesions or to their distal location, which precluded an anastomosis. The overall in-hospital mortality was 11%, but only 2 patients (6%) died in the one-stage surgery group, and these deaths were unrelated to anastomotic leakage. This latter complication occurred in 1 patient representing a leak rate of 3%. CONCLUSIONS: We recommend, based on our results, the one-stage approach as an alternative to the more conventional primary resection and staged anastomosis.

Acute Disease↗
PubMed1995

Mouse monoclonal antibodies to human immunodeficiency virus glycoprotein 120 generated by repeated immunization with glycoprotein 120 from a single isolate, or by sequential immunization with glycoprotein 120 from three isolates.

Mouse hybridomas were isolated that produce monoclonal antibodies (MAbs) to several regions of the HIV envelope, gp120, which may be used to map immunogenic regions in animal and human immunity. One series of MAbs was generated by repeated immunization with recombinant gp120 (rgp120) from a single isolate, and a second series by sequential immunization with rgp120 from three isolates. All MAbs bound to rgp120IIIB, but only one bound well to cell surface-expressed gp160. Synthetic peptides spanning much of the length of gp120 were used to map MAb reactivity. Two MAbs were mapped to the C1 region, one to the C2 region, and three to the C5 region by this approach. Six distinct epitopes were detected by competitive binding analysis. One MAb binding the C1 region blocks binding of CD4 to rgp120IIIB, binds by ELISA to rgp120MN (an isolate not used during immunization), and binds to cell surface-expressed gp160. These hybridomas will be made available to the scientific community through a hybridoma culture facility.

AIDS Vaccines↗
PubMed1995

Penicillium marneffei infection in a patient with SLE.

We describe a patient with SLE who was infected by the fungus Penicillium marneffei. She was initially misdiagnosed as having disseminated tuberculosis. The correct diagnosis was finally made by bone marrow culture and she responded to a prolonged course of amphotericin B, flucytosine and itraconazole. The clinical presentation and histology of penicilliosis are very similar to those of Mycobacterium tuberculosis. In Southeast Asia, penicilliosis should be considered as a differential diagnosis in patients with SLE who present with fever and lymphadenopathy.

Adult↗
PubMed1994

Obturator hernia presenting as small bowel obstruction.

Obturator hernia is a rare but important cause of small bowel obstruction that is associated with difficult diagnosis and high mortality. In the past 7 years, 16 patients with small bowel obstruction due to obturator hernia diagnosed at operation were seen at the Department of Surgery, the University of Hong Kong, Queen Mary Hospital. They represented 1% (16 of 1,554) of all hernia repair performed and 1.6% (16 of 1,000) of mechanical intestinal obstruction encountered during the same period. Elderly emaciated women with chronic disease were commonly affected. All patients presented with partial or complete mechanical small bowel obstruction. Right-sided obturator hernia outnumbered left-sided hernia, and bilateral hernia was found in only one patient. The majority of patients required resection of their strangulated small bowel. Most of the hernial orifices were closed with interrupted nonabsorbable sutures. Morbidity and mortality rates were significantly high for this group of debilitated patients with chronic disease who underwent late operation for this elusive diagnosis.

Age Factors↗
PubMed1994

Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients.

Twenty-one episodes of fungal peritonitis occurred over 35 months among 290 patients on CAPD, accounting for 6.3% of all peritonitis episodes. Patients with more frequent bacterial peritonitis were at higher risk of developing fungal peritonitis, and 28.6% of cases followed antimicrobial therapy. Candida species accounted for 85.7% of cases. Oral fluconazole was used as initial therapy in all patients, which was followed by catheter removal if peritonitis failed to improve. The cure rate with fluconazole therapy alone without catheter removal was 9.5%. Fluconazole plus catheter removal, the latter necessitated in 85.7% of cases, resulted in a cure rate of 66.7%. The remaining 3 (14.3%) patients responded to intravenous amphotericin given as salvage therapy. Disease-related mortality was 14.3%. Reinsertion of dialysis catheter was attempted in 15 patients and CAPD was successfully resumed in 13 (86.7%). We conclude that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD. Although catheter removal was necessary in the majority of patients, this sequential approach resulted in a relatively low prevalence of peritoneal adhesions and subsequent CAPD failure.

Administration, Oral↗
PubMed1994

Small bowel phytobezoars: an uncommon cause of small bowel obstruction.

Phytobezoars are an uncommon but important cause of mechanical small bowel obstruction. Seventeen Chinese patients with small bowel obstruction due to phytobezoars underwent 19 operations at the Department of Surgery, The University of Hong Kong at Queen Mary Hospital, accounting for 2% of mechanical small bowel obstruction treated in the past decade. There were ten men and seven women with an average age of 58 years. All except five patients had previous gastric outlet surgery. The diagnosis depends on a high index of suspicion in patients with partial or complete intestinal obstruction. The bezoars were broken down and milked through the ileocaecal valve in seven cases, whereas enterotomy to retrieve the bezoars or resection of small bowel together with the bezoars was performed on ten and two patient, respectively. There was no postoperative mortality but pneumonia and wound infection occurred in four patients. Because of its potential mortality and associated morbidity, patients with previous gastric surgery should be warned about this preventable complication and be given dietary advice. Phytobezoars should be considered in the differential diagnosis of all patients presenting with mechanical small bowel obstruction.

Adolescent↗
PubMed1994

Delayed recurrent thromboembolism of the allograft kidney.

Renal artery thromboembolism is a rare event in native kidneys and has never been reported to occur in allograft kidney. We report a case of allograft kidney infarction secondary to embolisation from thrombus in the hypogastric artery supplying the allograft on two separate occasions 1 and 2 years after transplant. Anticoagulation therapy alone was given and the patient responded well with partial recovery of renal function.

Adult↗
PubMed1994

Palliation for extrahepatic biliary obstruction by metastatic colorectal carcinoma.

OBJECTIVES: Extrahepatic biliary obstruction due to metastatic colorectal carcinoma, though rare, can account for the occurrence of obstructive jaundice even in the presence of hepatic metastases. The present report aims at reviewing our experience with the palliative treatment of these patients. METHODS: During a 5-yr period, 11 patients with obstructive jaundice had documented extrahepatic biliary obstruction secondary to metastatic colorectal carcinoma. Their clinical records were retrospectively analyzed. RESULTS: Nonoperative drainage was performed in eight patients by either the endoscopic (n = 5) or percutaneous (n = 3) route. Palliation was achieved in six patients with a mean hospital stay of 24.5 days (14% of survival). Three patients died of hepatorenal failure before a drainage procedure could be performed. Blocked stent and cholangitis were noted in two patients. The mean survival was 5 months in the drainage group. CONCLUSIONS: The occurrence of obstructive jaundice in patients with metastatic colorectal carcinoma deserves routine investigation to exclude extrahepatic biliary obstruction. Endoprosthesis insertion by nonoperative means should be considered for palliation.

Aged↗
PubMed1994

[Care of visual impairment in children and adolescents].

Visual impairment refers to a loss of visual acuity or one or more functions of the eye and visual system. It is not necessarily a disability or a handicap for the individual. The majority of visually impaired children are multihandicapped. Diagnostic and treatment centers have been introduced in an attempt to resolve present difficulties in providing health care to the multihandicapped. Pseudoretardation can occur in blind children if adequate opportunities are not provided for learning. Early diagnosis of visual impairment is important for obvious medical reasons. Early referral of blind children and their families to agencies for help is crucial. Almost invariably, mothers are the first to suspect that something is wrong with their infants' eyes. An ophthalmological examination, rather than simple reassurance, is needed. How an ophthalmologist leads parents through the period after diagnosis and the following next few weeks will affect the child's life much more than is generally realized. There is a need for a multidisciplinary team approach to evaluation and treatment of blind children. Cerebral palsy and profound visual impairment are a bad combination. Visual impairment alone does not predispose to a specific learning disability. Partially sighted students can be helped in various ways to function in their class.

Adolescent↗
PubMed1993

Isoniazid induced encephalopathy in dialysis patients.

Three dialysis patients with extrapulmonary tuberculosis developed confusion 4-14 days after commencement of treatment with anti-tuberculosis drugs, despite the use of prophylactic pyridoxine. Full recovery of conscious state resulted within 1 week in all patients after stopping isoniazid. In 2 patients confusion recurred on rechallenge of the drug. The risk factors of isoniazid induced encephalopathy and the dosage of isoniazid in uraemic patients were discussed.

Adult↗
PubMed1992

Choice of palliation for malignant hilar biliary obstruction.

Clinical data from 50 consecutive patients with unresectable hilar tumors situated at or proximal to the common hepatic duct were retrospectively analyzed to aid in the selection of appropriate palliative measures. Thirty-four patients had cholangioenteric bypass (CEB) to either left (28 patients), right (3 patients), or both (3 patients) intrahepatic ductal systems. Sixteen patients had nonoperative drainage (NOD) established either endoscopically (4 patients), percutaneously (9 patients), or using a combined endoscopic-percutaneous approach (3 patients). When compared with patients with CEB, patients with NOD had more frequent medical problems (p less than 0.03) and lower serum albumin levels on admission (p less than 0.03). While comparable postprocedural complications (13 CEB patients versus 4 NOD patients) were observed, patients with NOD had a significantly higher hospital mortality (9 CEB patients versus 9 NOD patients, p less than 0.05). Excluding the 12 patients (6 CEB patients versus 6 NOD patients) who died within 30 days after drainage, the quality of survival of the remaining 38 patients was analyzed with reference to 6 objective parameters. Although patients with NOD had significantly more frequent admissions relating to their catheters (p less than 0.02), there was no qualitative difference in the survival rate between the two groups of patients. For selected high-risk patients with limited life expectancy, NOD should be offered. However, additional prospective studies are required to decide the best choice of palliation for patients who are not at such high risk.

Aged↗
PubMed1992

Surgery for malignant obstructive jaundice: analysis of mortality.

Surgery on patients with malignant obstructive jaundice carries formidable morbidity and mortality rates. Clinical records of 120 consecutive patients who had a serum total bilirubin levels of 100 mumol/L or greater before exploration were analyzed retrospectively to provide guidelines for better management. Although most patients underwent bilienteric bypass to either the extrahepatic (n = 45) or intrahepatic ductal system (n = 28), resection was possible in 32 (26.7%). Complications developed in 42 patients (35%), among whome 12 (10%) required reexploration and 32 (26.7%) died within the same hospitalization. Identification of risk factors associated with hospital deaths after surgery was conducted on 84 of the 120 (group A) patients randomly selected from the entire study period. Based on multivariate analysis, age greater than 65 years, a raised serum aspartate transaminase value greater than 90 IU, and serum urea level greater than 7 mmol/L before surgery were the risk factors selected from 39 different clinical (n = 6), laboratory (n = 26), and operative (n = 7) parameters studied. The predictive value was validated in the remaining 36 patients (group B), and a high-risk patient population had been isolated. Because both serum urea and aspartate transaminase values correlated significantly with the necessity of urgent exploration, aggressive nonoperative treatment should be used to control the emergency. Alternative therapeutic options or perioperative management should be considered for the selected high-risk patients before definitive surgical biliary decompression.

Adult↗
PubMed1990

A new enzyme immunoassay specific for blastomycosis.

A highly specific enzyme immunoassay (EIA) was developed for the serodiagnosis of blastomycosis. Among the earliest sera available from eight active cases of blastomycosis, seven were reactive by EIA, three by immunodiffusion, and three by complement fixation. The one seronegative case was associated with acquired immunodeficiency syndrome (AIDS). No cross-reaction was observed with sera from 12 patients with active histoplasmosis or from five patients with active coccidioidomycosis or from 23 healthy persons. In contrast, all patients' sera cross-reacted in conventional EIAs based on commercial immunodiffusion antigens. The blastomycosis-specific EIA seems to offer sensitivity without compromising specificity. Rheumatoid factors, which could cause false-positive reactions, were controlled for.

Antigens, Fungal↗
PubMed1989

Hyperproliferation of conjunctival fibroblasts from patients with cicatricial pemphigoid.

The characteristic conjunctival scarring in cicatricial pemphigoid is a consequence of subepithelial fibrosis. The fibroblast is the cellular element responsible for fibrosis. To increase the understanding of the pathogenesis of abnormal fibrosis in cicatricial pemphigoid, the growth characteristics of conjunctival fibroblasts, from untreated patients with cicatricial pemphigoid (n = 9) and normal controls (n = 6), were studied in tissue culture. The latent period until fibroblast outgrowth began from the conjunctival explant was determined, as were the plating efficiency and doubling time of cells from first-passage cultures. Outgrowths of fibroblasts from patients with cicatricial pemphigoid appeared significantly sooner than from controls, 8.1 +/- 3.8 vs 19.3 +/- 6.4 (mean +/- SD) days. While there was no significant difference in the plating efficiency between fibroblasts from cicatricial pemphigoid (mean +/- SD, 116.4% +/- 44.6%) and those from controls (71.0% +/- 39.4%), the doubling time was significantly faster for cicatricial pemphigoid than for controls, 26.5 +/- 8.5 vs 50.7 +/- 7.8 hours. Thus, conjunctival fibroblasts from patients with cicatricial pemphigoid are hyperproliferative in tissue culture when compared with normal controls. Therefore, scarring, which characterizes cicatricial pemphigoid, may be due, in part, to excessive fibroblast proliferation.

Aged↗