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Biomedical subjects

H Saing

Publications and source records attributed to H Saing.

At least 37 records · Page 2Linked to original sources
PubMed1997

Liver transplantation in children: the experience of Queen Mary Hospital, Hong Kong.

Seven living-related liver transplants (LRLT) and two reduced-size liver transplants (RSLT) were performed on eight children who suffered from end-stage liver disease, having previously undergone one to three abdominal operations. Their ages at initial transplantation ranged from 8 months to 11 years (mean 35 months, median 12 months). Excluding the two older children aged 7 and 11 years, respectively, the rest of the children weighed 6 to 9.5 kg (mean 7.3 kg) at the time of the initial transplantation. Seven left lateral segments (S2 + 3) and two left lobes (S2 + 3 + 4) were used; of these the smallest graft had a graft-to-recipient body weight ratio of 0.9%. The volunteer living donors were four mothers, two fathers and one sister who were selected after medical and psychiatric evaluations, and their suitability was confirmed by hematological, biochemical, and radiological criteria. During a follow-up period of 3 to 30 months, all eight children are alive and well with normal liver function, one of them having undergone a retransplant LRLT because of hepatitis of undetermined etiology following a RSLT 1.5 years earlier. All seven donors had an uneventful postoperative course and were discharged on day 4 to 7 postoperatively. They have all resumed normal day-to-day activities. There were no complications in the donor group. A variety of complications occurred in the recipients, all of which were overcome. Operating microscope was used to perform all the arterial anastomoses using microvascular techniques. This method has proven to be a major factor in preventing arterial thrombosis even with the smallest of arterial anastomosis where a 1.5-mm diameter recipient artery was anastomosed to a 2.5-mm diameter donor hepatic artery.

Activities of Daily Living↗
PubMed1997

Early and late results of excision of choledochal cysts.

BACKGROUND/PURPOSE: Reports on the late results of choledochal cyst excision with hepaticojejunostomy in children are relatively few. METHODS: Of the 84 patients who had choledochal cyst who came under our care, 79 have had definitive surgery, three are awaiting surgery, one is being observed with Caroli's disease, and the parents of one child have refused surgery. Thirty-eight patients treated decades ago had internal drainage procedures. Since 1972, 41 patients have had cyst excision with hepaticojejunostomy using a 40-cm Roux loop without an antireflux procedure. Early complications in those who underwent cyst excision with hepaticojejunostomy included anastomotic leak in three patients who required reoperation, cholangitis in two, and fluid collection in the gall-bladder bed that required no intervention in one. RESULTS: During a follow-up period ranging from 4 months to 17 years (mean, 8.5 years), anastomotic stricture, cholangitis, and intrahepatic stone formation developed in two children after being well for 8 years and over 11 years. These children required additional surgical procedures to overcome their problems. Asymptomatic intrahepatic stones 2 years after cyst excision with hepaticojejunostomy developed in a third child. There was no mortality in the entire group that underwent cyst excision and they are all enjoying a good quality of life. CONCLUSIONS: Careful, long-term follow-up is important in children who have choledochal cyst excision with hepaticojejunostomy.

Adolescent↗
PubMed1997

Long-term follow-up of childhood duodenal ulcers.

PURPOSE: This study reports the long-term results in children who have duodenal ulcers diagnosed by endoscopy who were treated with H2-receptor antagonist. METHODS: The medical records of 32 children admitted into The Queen Mary Hospital with endoscopically proven duodenal ulcers between 1975 and 1988 were reviewed to evaluate the long-term outcome of childhood duodenal ulcers after initial treatment with H2-receptor antagonist (H2RA). Follow-up details were updated and patients who had been lost to follow-up were recalled. The age of the 22 boys and 10 girls at the time of diagnosis of the ulcers ranged from 3 to 16 years (mean, 11.8 yrs). The duration of follow-up ranged from 8.5 to 21 years (mean, 11.6 yrs). RESULTS: Their primary presentations included epigastric pain (n = 9, 28.0%); nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB, n = 6, 18.7%); unprovoked GIB (n = 12, 37.5%); perforation (n = 4, 12.5%); and pyloric obstruction (n = 1, 3.0%). All 13 patients who had NSAID-induced ulcers (pain and bleeding) responded to H2RA therapy and required no further treatment. All 14 patients who had unprovoked ulcers who presented with pain or bleeding did not respond to H2RA treatment. Ulcer healing was achieved only after eradication of Helicobacter pylori with antibiotics (n = 8) or definitive surgery involving either truncal vagotomy and pyloroplasty (VP, n = 4) or proximal gastric vagotomy (PGV, n = 2). The patient who had gastric outlet obstruction had vagotomy and antrectomy. All four patients who had perforation were initially treated with patch repair, but two had persistent ulceration despite H2RA treatment and required PGV. Complications developed in none of the four patients who had PGV, whereas two of the four patients with VP had problems (diarrhea, n = 1; bezoar obstruction, n = 1). CONCLUSIONS: Unprovoked childhood duodenal ulcer is associated with significant long-term morbidity and requires continued follow-up. The majority of the ulcers are resistant to H2RA treatment alone and ultimately require either eradication of H. pylori or surgery. In the absence of obstruction, PGV may be enough to resolve the ulcer diathesis.

Adolescent↗
PubMed1997

A prospective randomized study of wound approximation with tissue glue in circumcision in children.

OBJECTIVE: Bleeding and wound infection are the most common complications of circumcision. Cyanoacrylate tissue glue has been claimed to have the advantage of being haemostatic, bacteriostatic and easy to use. The purpose of this study is to assess the feasibility of using the tissue glue in approximation of circumcision wound in children. METHODOLOGY: A prospective randomized trial was carried out on 86 boys consecutively admitted into the Duchess of Kent Children's Hospital, Hong Kong. The results of wound approximation with cyanoacrylate tissue glue and suturing with interrupted 4/0 plain catgut were compared. The operations were carried out by the same surgeon using identical technique except for the wound approximation. The wound was assessed 1 day, 2 days, 3 days, 1 week and 1 month postoperatively. RESULTS: There was no statistically significant difference between the two groups in the rates of wound inflammation, infection, bleeding, dehiscence and cosmetic appearance, but the duration of operation was longer using tissue glue (19.8 min vs 16.5 min, P = 0.002). CONCLUSIONS: We conclude that tissue glue approximation of circumcision wounds in children is a feasible alternative, but it offers no extra advantage when compared to suturing.

Child↗
PubMed1997

Ileoileocolic intussusception in children: diagnosis and significance.

The ileoileocolic type of childhood intussusception is difficult to diagnose pre-operatively and is associated with increased morbidity. This study describes the clinical and imaging features of 10 consecutive ileoileocolic intussusceptions diagnosed ultrasonically in 10 patients over a 36 month period. Ultrasound-guided hydrostatic reduction using Hartmann's solution was attempted in all 10 patients. Clinical and imaging features were compared with those of 28 ileocolic intussusceptions in 25 patients diagnosed and treated using the same methods during the same period. Most of the clinical and plain radiographic features of the patients with the ileoileocolic and ileocolic types of intussusception were similar. The two types of intussusception had the classical doughnut or pseudokidney, or both, signs on pre-reduction ultrasound scans. During the reduction process, when surrounded by fluid within the caecal lumen, the ileoileocolic type of intussusception had a typical complex appearance due to frond-like loops of intussuscepted small bowel. This finding was present in all cases. The hydrostatic reduction rate was only 10% (1/10) for ileoileocolic intussusception, compared with 92.9% (26/28) for the ileocolic type. All unsuccessfully-reduced cases underwent surgery, with surgical confirmation of the intussusception type in all cases. Only one patient was found to have a lead point, caused by a Meckel's diverticulum. In conclusion, the diagnosis of ileoileocolic intussusception can be made pre-operatively and these patients require surgical management.

Child↗
PubMed1997

Treatment of biliary atresia by portoenterostomy and liver transplantation: The Queen Mary Hospital, Hong Kong experience.

Ninety three out of 96 patients with biliary atresia (BA) underwent Kasai 1 portoenterostomy and 11 children subsequently underwent 12 liver transplantation (LTX) procedures which included 8 living related liver transplants (LRLT), 3 reduced-size liver transplants (RSLT) and 1 orthotopic liver transplantation (OLT). During a follow-up period of 3-206 months (mean, 73 months) after portoenterostomy and 3-63 months after LTX, 50% of 96 patients are alive and well with total clearance of jaundice while 12% are mildly jaundiced, 10% are deeply jaundiced and 28% have died. Two of the 3 patients who did not undergo portoenterostomy and 25 from the portoenterostomy group have died. Of the latter group, 22 deaths occurred before, and 3 after the introduction of LTX therapy respectively. Of the 68 long-term survivors, 32 are less than 5, and 36 are 6-17 years old. Complete clearance of jaundice was achieved in 55% of patients irrespective of whether portoenterostomy was initially performed at < 10 or between 10 and 12 weeks. Portoenterostomy performed beyond 13 weeks was associated with declining results. We conclude that (1) portoenterostomy combined with liver transplantation, when indicated, has given patients with BA a much better prognosis and (2) pediatric LTX in our institute is a well established procedure with 100% patient and 88% primary graft survival.

Age Factors↗
PubMed1996

Iatrogenic gastric volvulus during transposition for esophageal atresia: diagnosis and treatment.

A baby boy had had transhiatal gastric transposition for wide gap esophageal atresia in another hospital. Postoperatively, repeated vomiting, chest infection, and frequent attacks of dyspnea developed. After reexploration, the cause was not identified and he was referred to the authors' institution. The diagnosis of iatrogenic organoaxial volvulus with gastric outlet obstruction was made because barium meal studies and nuclear isotope scanning showed persistent obstruction of the gastric outlet but upper endoscopy showed no stenosis and a flexible scope could be passed easily into the duodenum. The diagnosis was confirmed by thoracotomy. After full mobilization of the stomach, the gastroesophageal anastomosis was divided and the thoracotomy was closed. The stomach was reduced into the abdomen via laparotomy, and it was tubularized and rerouted retrosternally for anastomosis to the cervical esophagus. Since the operation the patient has been asymptomatic.

Anastomosis, Surgical↗
PubMed1996

Cutaneous stoma in the roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy): useful access for intrahepatic stone extraction.

A cutaneous stoma in the Roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy) was used for stone extraction in two children who had hepatolithiasis (14.5 and 15.5 years, respectively) after operation for choledochal cysts. In constructing the hepaticocutaneous jejunostomy, a short, straight proximal limb from the skin to the bilioenteric anastomosis is mandatory. It provides a pathway, superior to the T-tube tract, for repeated stone extraction, which can be performed under sedation, thus obviating repeat laparotomies. The stoma allows flexible choledochoscopy, balloon dilatation of intrahepatic duct strictures, and extraction of intrahepatic stones using grasping forceps, baskets, and balloons. The electrohydraulic lithotriptor may be applied to fragment larger stones.

Adolescent↗
PubMed1996

Associated anomalies in patients with undescended testes.

Out of 252 patients with undescended testes admitted under our care between January 1984 and September 1992, 70 had bilateral undescended testes and 182 had unilateral undescended testes. Fifty-one (20 percent) patients had at least one associated anomaly. Thirteen (25 percent) patients had more than one anomaly. The anomalies included 20 patients with urogenital disorders, eight with gastrointestinal tract anomalies, seven with abdominal wall defects, and seven with cardiovascular anomalies. In addition there were 11 patients with intersexual disorders, six patients with autosomal disorders and six patients with well-recognized syndromes. We found that the incidence of intersexual disorders among the patients with undescended testes was 4.6 percent, but the incidence was much higher (55 percent) in the group of patients with both undescended testes and hypospadias. Patients with bilateral undescended testes had a much higher incidence (46 percent) of associated anomalies than those with unilateral undescended testes (10 percent).

Abnormalities, Multiple↗
PubMed1996

Does the amniotic fluid protein absorption contribute significantly to the fetal weight?

OBJECTIVE: This study was carried out to evaluate the significance of amniotic fluid protein ingestion and absorption on fetal growth. METHODOLOGY: Neonates with small bowel atresia during a 30 year period were studied retrospectively. RESULTS: There were 56 patients enlisted, 17 with duodenal atresia, 18 with jejunal atresia and 21 with ileal atresia. The percentage of mothers with polyhydramnios and the percentage of premature babies decreases as the intestinal atresia becomes more distal. The mean gestational age and the mean birthweight increase as the intestinal atresia becomes more distal. On the other hand, the percentage of the neonates with birthweight below the 50th and the 10th percentiles do not differ significantly as the intestinal atresia becomes more distal. CONCLUSIONS: It appears that the variation of birthweights in babies with different levels of small bowel atresia may be due to the difference in gestation caused by polyhydramnios. The effect of amniotic fluid protein absorption on fetal bodyweight could not be demonstrated clinically in this study.

Analysis of Variance↗
PubMed1996

Horseshoe kidney with bilateral single system ectopic ureters.

A horseshoe kidney, associated with bilateral single system ectopic ureters in a 9-month-old boy, is reported. The right ureteric orifice was located near the midline of a deformed trigone while the grossly dilated left ureter inserted into the posterior urethra. Imaging defined this rare combination of urological anomalies prior to surgical treatment.

Abnormalities, Multiple↗
PubMed1996

Sonographically guided hydrostatic reduction of childhood intussusception using Hartmann's solution.

OBJECTIVE: Currently, the standard methods for therapeutic reduction of intussusception in children involve considerable ionizing radiation. This study tested the effectiveness of sonographically guided hydrostatic reduction of intussusception using Hartmann's solution, a fluid with near-physiologic composition. SUBJECTS AND METHODS: Between March 1, 1994, and January 31, 1996, all children clinically suspected of having intussusception were evaluated by sonography. Those with positive findings on sonography were entered into the study and underwent confirmatory sonographically guided meglumine diatrizoate enema. During continuous sonographic monitoring, we used Hartmann's solution for attempted reduction of intussusception. Criteria for successful reduction were disappearance of the intussusceptum and passage of fluid through the ileocecal valve. Another sonographically guided meglumine diatrizoate enema was used to confirm successful reduction. RESULTS: We detected 25 consecutive intussusceptions in 22 patients. The patients were 12 girls and 10 boys, with a mean age of 14 months (range, 1-72 months). Sonograms revealed in all patients doughnut or pseudokidney signs or both. The sites of intussusception were the transverse colon (17 of 25), hepatic flexure (4 of 25), ascending colon (2 of 25), splenic flexure (1 of 25), and descending colon (1 of 25). Other findings were dilated fluid-filled small bowel (11 of 25) and free intraperitoneal fluid (9 of 25). The success rate of our sonographically guided attempts at hydrostatic reduction was 76% (19 of 25). Success was proven by meglumine diatrizoate enema in all 19 patients. The mean time of the reduction procedure was 18 min (range, 2-45 min). No complications occurred. All six patients in whom hydrostatic reduction was unsuccessful underwent surgery. Five of these patients had ileoileocolic intussusceptions. On sonography, when surrounded by fluid, ileoileocolic intussusceptions had a typically complex, fronded appearance. The remaining patient in whom hydrostatic reduction was unsuccessful had ileocolic intussusception. Of six ileoileocolic intussusceptions, one was hydrostatically reduced and a second was converted into an ileoileal intussusception before requiring surgery. The other four intussusceptions were surgically treated. CONCLUSION: Our data suggest that sonographically guided hydrostatic reduction with Hartmann's solution can be used to treat ileocolic intussusception and to diagnose ileoileocolic intussusception.

Catheterization↗
PubMed1995

Preoperative chemotherapy for mesoblastic nephroma.

A neonate with extensive stage III mesoblastic nephroma was confirmed at operation to have a tumor that was too infiltrative and too advanced for primary excision. The abdomen was closed after multiple biopsies. Vincristine (1.1 mg/m2) was given intravenously once a week for a total of eight doses. Repeat CT scan confirmed shrinkage of the tumor and a nephrectomy could be performed safely and the tumor removed at the second laparotomy. CT scan repeated 1 year later showed no recurrence. This case illustrates the effective use of a single drug pre-excision chemotherapy which allowed a nephrectomy for extensive stage III mesoblastic nephroma to be carried out safely.

Combined Modality Therapy↗
PubMed1995

Combined flexible endoscopy and fluoroscopy in the assessment of the gap between the two esophageal pouches in esophageal atresia without fistula.

The authors have used the technique of combined retrograde flexible endoscopy and fluoroscopy on two newborn babies with esophageal atresia (EA) without tracheoesophageal fistula (TEF). This technique accurately determined the gap between the two esophageal ends and predicted the feasibility and timing of delayed primary anastomosis. Esophagostomy was not performed, and continuous Replogle tube suction of the upper pouch was maintained during the period of waiting for 10 and 14 weeks, respectively. Gastrostomy feeding allowed satisfactory growth and development during the period of waiting for esophageal growth.

Anastomosis, Surgical↗
PubMed1995

Intestinal volvulus: an experience in a developing country.

Eighty-two children (47 boys and 35 girls) underwent surgery for a variety of causes resulting in volvulus. There were 20 neonates, 13 infants, 34 patients aged 1 to 5 years, and 15 children above 5 years of age. The majority (88%) of the patients were admitted in a state of shock and dehydration. Peritoneal signs were present in 74% of the patients. The resection rate was 61%. A high mortality rate of 38% was encountered, which was attributed to septicemia, shock, and multiorgan failure. The preventive health programs that are being actively implemented together with the improvements made in the transport and referral systems have fortunately resulted in much-improved survival rates in the recent few years.

Child, Preschool↗