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Biomedical subjects

E C Lai

Publications and source records attributed to E C Lai.

At least 73 records · Page 4Linked to original sources
PubMed1996

Pyogenic liver abscess. An audit of experience over the past decade.

OBJECTIVES: To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality. DESIGN: Retrospective review. SETTING: A tertiary referral center. PATIENTS: Eighty-three patients with pyogenic liver abscesses were studied to determine demographic characteristics; clinical features, laboratory, imaging, and microbiologic findings; methods of treatment; and final outcome. The median follow-up period was 9.8 months. INTERVENTION: All patients were treated with intravenous antibiotic drugs. Fifty-three patients were to image-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in 27 patients. Laparotomy was performed in 27 patients; seven of them underwent an elective operation. MAIN OUTCOME MEASURE: Hospital mortality, defined as death within the same hospital admission for management of liver abscess. RESULTS: Biliary tract disease was the most frequently identifiable cause. The right lobe abscess was more frequently cryptogenic, while the left lobe abscess was more frequently related to intrahepatic stones (P < .001). The overall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, management without aspiration or catheter drainage, presence of malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time, and elevated activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis, presence of malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time were found to be independent risk factors. CONCLUSIONS: Pyogenic liver abscess is still a disease with significant mortality. Early diagnosis and prompt treatment are necessary to further improve our results of management.

Adult↗
PubMed1996

Pathologic features and patient survival in hepatocellular carcinoma in relation to age.

For hepatocellular carcinoma, the peak age of patients is at the sixth decade. However, the influence of age on the tumor biologic behavior and long-term patient survival is controversial. We retrospectively studied 278 patients whose hepatocellular carcinomas were surgically resected to analyze the pathologic and clinical features of the tumors and patient survival in relation to age. The patients were divided into two groups, younger than 50 years of age and older than 50 years. Ninety-seven patients were 50 years of age or under, and 181 were older than 50 years. The younger patients had: (1) more frequent hepatitis B surface antigen positivity (P = 0.022), (2) less cirrhosis (P = 0.050), (3) less tumor encapsulation, (4) a more advanced tumor stage in terms of more venous permeation (P = 0.012), more liver invasion (P = 0.010) and larger tumor (P = 0.002), and (5) a more frequently raised serum alpha-fetoprotein level (P = 0.035). In spite of the more advanced stage of the tumors, both the actuarial and disease-free survival rates did not differ significantly from those of the older group. The operative mortality rates also were similar in both groups. To conclude, there were distinct differences in the clinical and pathologic features of the tumors of patients < 50 years and those older. Although the tumors were more advanced in the younger group, the less frequently associated cirrhosis in this group might have partly compensated to result in survival rates similar to those of the older group. Because of the comparable survival rates, the treatment policy in the older group should not differ greatly from that in the younger group.

Adult↗
PubMed1996

Hepatectomy with an ultrasonic dissector for hepatocellular carcinoma.

This study compared the results of hepatectomy for hepatocellular carcinoma (HCC) using an ultrasonic dissector with those of a combination of the crushing clamp and finger fracture techniques. The crushing clamp and finger fracture method was used from 1989 to 1992 in 96 patients (group 1) and the ultrasonic dissector from 1993 to 1994 in 69 patients (group 2). Data from these two sets of patients were collected prospectively. The groups were comparable in terms of preoperative liver function, tumour size and stage, and the incidence of cirrhosis. Major hepatectomy was performed in 69 patients (72 per cent) of group 1 and in 52 (75 per cent) of those in group 2. Use of the ultrasonic dissector resulted in lower mean (s.e.m.) blood loss (group 1 3.4(0.4) litres versus group 2 2.4(0.2) litres, P = 0.02), lower mean (s.e.m.) blood transfusion requirement (2.2(0.2) versus 1.2(0.2) litres, P = 0.001) and more patients not requiring blood transfusion (8 per cent of group 1 versus 32 per cent of group 2, P = 0.0001). Postoperative complications occurred in 45 patients (47 per cent) of group 1 and 19 (28 per cent) of those in group 2 (P = 0.012). There were no deaths in group 2 whereas the hospital mortality rate in group 1 was 16 of 96 (17 per cent) (P = 0.0004). A wider tumour-free resection margin (mean(s.e.m.) 1.2(0.1) versus 0.9(0.1) cm, P < 0.05) and lower serum bilirubin level throughout the postoperative period were also observed in group 2 patients. The ultrasonic dissector is better than the crushing clamp and finger fracture technique in hepatectomy for HCC.

Blood Loss, Surgical↗
PubMed1996

Laparoscopic cholecystectomy for acute cholecystitis in the elderly.

This study reviewed the results of laparoscopic cholecystectomy for acute cholecystitis in the elderly. Among 557 patients who underwent laparoscopic cholecystectomy, 70 (12.6%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. There were 28 men and 42 women with a mean age of 59.9 years (range 20-87 years). Thirty patients >/= 65 years of age were compared to 40 patients < 65 years old. Elderly patients had a higher female predominance (p < 0.05), a higher incidence of intercurrent diseases (p < 0.05), and a higher serum urea level (p < 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%;p < 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation (p < 0.05) and resumption of normal diet (p = 0. 08) with resulting prolonged postoperative (p = 0.08) and total hospital stay (p < 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.

Acute Disease↗
PubMed1996

Substituted glycals as probes of glycosidase mechanisms.

D-Glucal and a series of substituted derivatives have been tested as substrates, inhibitors and inactivators of the Agrobacterium faecalis beta-glucosidase in order to probe structure/function relationships in this enzyme. D-Glucal is shown to be a substrate (kcat = 2.3 min-1, Km = 0.85 mM) undergoing hydration with stereospecific protonation from the alpha-face to yield 2-deoxy-beta-D-glucose. 1-Methyl-D-glucal surprisingly serves as only a poor substrate (kcat = 0.056 min-1, Km = 57 mM), also undergoing protonation from the alpha-face. 2-Fluoro-D-glucal, however is completely inert, as a result of inductive destabilisation of the oxocarbenium ion-like transition state for protonation, and functions only as a relatively weak (Ki = 24 mM) inhibitor. Similar behaviour was seen with almond beta-glucosidase and yeast alpha-glucosidase and for the interaction of 2-fluoro-D-galactal with Escherichia coli beta-galactosidase. A series of of alpha, beta-unsaturated glucal derivatives was also synthesised and tested as potential substrates, inhibitors or inactivators of A. faecalis beta-glucosidase. Of these only 1-nitro-D-glucal functioned as a time dependent, irreversible inactivator (ki = 0.011 min-1, Ki = 5.5 mM), presumably acting as a Michael acceptor. Electrospray mass spectrometric analysis revealed multiple labeling of the enzyme by this inactivator, lessening its usefulness as an affinity label. Less reactive Michael acceptor glycals which might have been more specific (1-cyano-, 2-cyano-, 1-carboxylic acid, 1-carboxylic acid methyl ester) unfortunately did not function as inactivators or substrates, only as relatively weak reversible inhibitors (Ki = 3-96 mM).

Calcium Gluconate↗
PubMed1996

Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.

OBJECTIVE: The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. SUMMARY BACKGROUND DATA: Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results. METHOD: Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment. RESULTS: The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001). CONCLUSIONS: Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming, this procedure provides the economic advantage of a markedly reduced total hospital stay.

Acute Disease↗
PubMed1996

Accuracy of clinical criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome).

We assessed the validity and interrater reliability of neurologists who, using four different sets of previously published criteria for the clinical diagnosis of progressive supranuclear palsy (PSP), also called Steele-Richardson-Olszewski syndrome, rated 105 autopsy-proven cases of PSP (n = 24), Lewy body disease (n = 29), corticobasal ganglionic degeneration (n = 10), postencephalitic parkinsonism (n = 7), multiple system atrophy (n = 16), Pick's disease (n = 7), and other parkinsonian or dementia disorders (n = 12). Cases were presented in random order to six neurologists. Information from each patient's first and last visits to the medical center supplying the case was presented sequentially to the rater, and the rater's diagnosis was compared with the neuropathologic diagnosis of each case. Interrater agreement for the diagnosis of PSP varied from substantial to near perfect, but none of the criteria had both high sensitivity and high predictive value. Because of these limitations, we used a logistic regression analysis to identify the variables from the data set that would best predict the diagnosis. This analysis identified vertical supranuclear palsy with downward gaze abnormalities and postural instability with unexplained falls as the best features for predicting the diagnosis. From the results of the regression analysis and the addition of exclusionary features, we propose optimal criteria for the clinical diagnosis of PSP.

Aged↗
PubMed1995

Prognostic significance of pathologic features of hepatocellular carcinoma. A multivariate analysis of 278 patients.

BACKGROUND: In patients with hepatocellular carcinoma, surgical resection may offer a chance of cure. However, tumor recurrence is not infrequent after resection. METHODS: To identify the pathologic factors that are of prognostic significance and predictive value in tumor recurrence, the authors studied 278 patients (243 men, 35 women) who had hepatectomy for hepatocellular carcinoma. Disease free and actuarial survival were correlated with 20 pathologic parameters of the resected specimens using multivariate analysis. RESULTS: The median follow-up period was 23.6 months. The overall disease free survival rates at 1, 3 and 5 years were 42%, 23%, and 17%, respectively, and the overall actuarial survival rates for the corresponding time periods were 70%, 39%, and 28%, respectively. The results indicated that tumor encapsulation (P = 0.004) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors related to tumor recurrence. Negative resection margins (P = 0.001) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors correlated with survival. CONCLUSIONS: From this analysis, it was determined that detailed histologic examination of resected specimens of hepatocellular carcinoma is important in assessing long term prognosis and stratification of patients for treatment.

Actuarial Analysis↗
PubMed1995

Better survival in female patients with hepatocellular carcinoma. Possible causes from a pathologic approach.

BACKGROUND: Hepatocellular carcinoma is notably more prevalent in men than in women. METHODS: To examine the sex-related characteristics of patients with primary hepatocellular carcinoma, 35 women were compared with 243 men, both groups having undergone surgical resection of the tumor. RESULTS: Women had a lower incidence of tumor recurrence, with median disease free survival of 19.5 months compared with 4.5 months for men (P < 0.001). Women also had more favorable actuarial survival than men [36.5 months for women compared with 12.4 months for men (P = 0.002)]. Women had a significantly higher incidence (80%) of tumor encapsulation than men (45%) (P < 0.001). Furthermore, the tumors in women were frequently less invasive in terms of lower incidence of tumor microsatellites, liver invasion, and positive histologic margin. Tumor microsatellite formation was present with 16% of tumors in women, compared with 60% for men (P < 0.0001). Liver invasion was found in 37% of tumors in women and 61% in men (P = 0.03). Only 6% of tumors in women had a positive histologic margin, compared to 24% in men (P = 0.04). There was no statistical significance in the incidence of cirrhosis in the nontumorous liver, hepatitis B surface antigen positivity, mean age, or tumor size, between women and men. CONCLUSIONS: Women who had hepatocellular carcinoma and hepatic resection had better survival rates and a lower rate of tumor recurrence than male patients. The better prognosis in women with hepatocellular carcinoma appeared to be related to the pathobiologic characteristics of the tumor (i.e., frequent encapsulation and lower tumor invasiveness).

Adult↗
PubMed1995

Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis.

OBJECTIVE: To define the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality. DESIGN: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survey was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994. SETTING: A tertiary referral center. PATIENTS: The preoperative, intraoperative, and postoperative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected. INTERVENTION: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. MAIN OUTCOME MEASURE: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy. RESULTS: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P = .01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was the cutoff level that could maximally separate the patients with cirrhosis with and without mortality. CONCLUSION: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

Adult↗
PubMed1995

Endoscopic stenting for malignant biliary obstruction.

OBJECTIVE: To evaluate the results of endoscopic stenting in patients with malignant biliary obstruction. DESIGN: Retrospective review. SETTING: Surgical endoscopy unit at a tertiary referral center. PATIENTS AND INTERVENTION: Plastic endoprosthetic stents were inserted for the relief of biliary obstruction in 131 consecutive patients. Among the 104 patients with malignant biliary obstruction, 60 underwent stenting as definitive palliative treatment. MAIN OUTCOME MEASURES: Data on the type and size of stents employed, their effectiveness in relieving jaundice, their complications, and the quality of survival were analyzed. RESULTS: Median survival was 1.93 months. The majority of the stents (88.3%) were placed endoscopically, and single straight stents were most frequently used (96.7%). Jaundice was relieved in 35 patients. Early (< or = 14 days) and late acute cholangitis were found in four and 11 patients, respectively. Early and late stent migration was noticed in two and six patients, respectively. Pancreatitis occurred in one patient, and no papillotomy site bleeding was encountered. When compared with the 18 patients with proximal obstruction at or above the common hepatic duct, the 42 patients with distal ductal obstruction had longer median survival (P = .03) and more effective relief of jaundice (P = .005) and required less antibiotic treatment (P = .03). These 42 patients also enjoyed better quality of survival when it was analyzed with reference to six objective parameters (P = .0018). CONCLUSIONS: Stenting offers palliation of malignant biliary obstruction, and the results are particularly encouraging in distal obstruction.

Adult↗
PubMed1995

Ki-67 antigen expression in hepatocellular carcinoma using monoclonal antibody MIB1. A comparison with proliferating cell nuclear antigen.

To evaluate the prognostic significance and clinicopathologic correlation of proliferative activity in patients with hepatocellular carcinoma, Ki-67 antigen expression was examined using immunohistochemical staining with monoclonal antibody MIB1. Seventy-two patients (65 men, 7 women; age range 24-77 years, mean, 52 years) having hepatocellular carcinoma surgically resected were studied. Tumor and nontumorous tissues were stained with monoclonal antibody MIB1 with microwave oven pretreatment. Tumor and nontumor MIB1 (T-MIB1 and NT-MIB1) scores were assessed by counting the positive staining nuclei per 1,000 cells. The T-MIB1 score ranged from 5-630 per 1,000 cells (mean +/- standard deviation [SD] = 145 +/- 162). It was found to be significantly higher in less well-differentiated tumors (Edmondson's grades III and IV) than in well-differentiated ones (Edmondson's grades I and II) (P = .017). The T-MIB1 score was also higher in nonencapsulated tumors than in encapsulated ones, although it did not reach statistical significance (P = .069). It had no influence on tumor size, tumor invasiveness, the background disease in the nontumorous livers, patients' HBsAg status, or serum alpha-fetoprotein levels. Diseases in the nontumorous livers or patients' HBsAg status had no influence on the NT-MIB1 scores. When the tumors were stratified into two groups with T-MIB1 score < or = 20 and T-MIB1 score > 20, those patients with score < or = 20 had significantly longer disease-free survival (DFS) than those with scores > 20 (median DFS: 34 months and 4.7 months, respectively; P = .011). In addition, MIB1 and PCNA were closely correlated (P < .01). The authors conclude that proliferative activity in hepatocellular carcinoma, as defined by MIB1 immunohistochemical analysis, is significantly related to tumor cellular differentiation. It is also a potentially valuable prognostic factor in patients with this tumor.

Adult↗
PubMed1995

Hepatic resection for hepatocellular carcinoma. An audit of 343 patients.

OBJECTIVE: The authors summarize the results of patients who had hepatectomy for hepatocellular carcinoma over a 22-year period. SUMMARY BACKGROUND DATA: Recent reports showed improved perioperative results and long-term prognosis. METHODS: The perioperative outcome of 343 patients was studied according to three different time periods: before 1987 (n = 149); 1987 to 1991 (n = 128); and 1992 to present (n = 66). Survival analysis was made by stratifying patients into two categories--either before or after 1987. The majority of patients had large tumors (78%), cirrhosis (73%), and a major hepatectomy (73%). RESULTS: Besides an increased resectability rate (23%), there was a marked reduction of the recent morbidity (32%; p < 0.001), operative (4.5%; NS) and hospital (6%; p < 0.02) mortality rates. The recent surgical approach was identified as a significant contributory factor to the lowered hospital mortality rate. Patients in the latter part of the study had significantly better survival, with a 1-, 3- and 5-year survival rate of 68%, 45%, and 35%, respectively. Early detection and effective treatment of recurrences contributed to the improved prognosis. CONCLUSIONS: The recent management strategy and technological advances improved the results of surgical treatment for patients with hepatocellular carcinoma.

Adult↗
PubMed1995

Prospective double-blind placebo-controlled randomized trial on the use of ranitidine in preventing postoperative gastroduodenal complications in high-risk neurosurgical patients.

To determine the efficacy of ranitidine in preventing clinically acute overt gastroduodenal (GD) complications (bleeding and/or perforation) after neurosurgery, 101 patients with nontraumatic cerebral disease considered at high risk of developing postoperative GD complications were randomized in a standard double-blind manner to receive either ranitidine (50 mg every 6 hours) or placebo medication preoperatively. Postoperative serial GD endoscopy was used to document the occurrence of complications: an overt symptomatic complication was defined as bleeding requiring blood transfusion and/or surgery. Fifty-two patients received ranitidine and 49 received a placebo preoperatively; 30 developed overt GD bleeding; nine of these received ranitidine and 21 received a placebo. Ranitidine significantly reduced the incidence of bleeding (p < 0.05). Multivariate logistic regression analysis revealed three factors of independent significance in predicting overt GD bleeding: use of a placebo drug, a gastric pH of less than 4, and a high daily volume of gastric output. The authors conclude that ranitidine is useful in preventing postoperative GD complications in high-risk neurosurgical patients.

Adolescent↗