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Biomedical subjects

H Saing

Publications and source records attributed to H Saing.

At least 73 records · Page 4Linked to original sources
PubMed1988

Childhood recurrent pyogenic cholangitis.

Recurrent pyogenic cholangitis (RPC) is characterized by repeated attacks of bacterial infection of the biliary tract by enteric organisms resulting in formation of strictures and stones in the intrahepatic as well as the extrahepatic bile ducts. Between 1973 and 1984, we managed ten children with RPC. Presentation was acute, septicemia being invariably present. Four children responded to vigorous intravenous (IV) fluid and antibiotic therapy; of these, three subsequently required elective transduodenal sphincteroplasty. Six children required emergency biliary tract decompression surgically and three of them also had concomitant definitive drainage procedures (transduodenal sphincteroplasty, two; supraduodenal choledochoduodenostomy, one). The other three had T-tube drainage initially followed by elective drainage procedures (transduodenal sphincteroplasty, one; supraduodenal choledochoduodenostomy, two). At exploration, pigment stones and/or mud were invariably present in the bile ducts. One child required reexploration for hemostasis following sphincteroplasty, and one child died from septicemia and respiratory failure following operation. The rest are well, having been followed for 3 to 12 years. Major advances in recent years include (1) endoscopic retrograde cholangiopancreatography (ERCP) for accurate definition of the biliary tract and confirmation of the presence and location of stones during the quiescent phase, (2) the intraoperative choledochoscopic extraction of intrahepatic and extrahepatic stones, and (3) postoperative stone removal via the T-tube tract.

Bacterial Infections↗
PubMed1988

Inguinal hernia in Chinese children.

Childhood inguinal hernia is as common in Chinese as in Caucasians. From 1980-85, 542 Chinese children with this condition were treated; important differences as well as similarities were found in the clinical features in the two patient populations. Incarceration was the major management problem (23.6%). It was found that enforcement of a management policy of enthusiastic reduction altered outcome significantly. Before the introduction of this policy (in the first five years), 39% of incarcerated cases resulted in emergency operation. In 1985, after its introduction, no emergency surgery was required. The move towards more vigorous attempts at reduction allowing surgery to be done electively was supported by two observations. First, the complication rate of emergency herniotomy (25.6%) was higher than that of elective herniotomy (6.5%). Second, in 43 emergency herniotomies, nonviable content (ovary) was found only once. In retrospect, most emergency herniotomies were unnecessary. In general, surgical treatment of the patients in this series could be considered satisfactory. However, better results were achieved by experienced surgeons, particularly those in specialty practice.

Asian People↗
PubMed1987

Diagnosis and evaluation of esophageal atresia by direct sagittal CT.

Direct sagittal CT is possible in newborns because of their small body-size. With this noninvasive investigation, we were able to establish a correct diagnosis in two neonates with esophageal atresia. Moreover, the demonstration of the air-filled proximal pouch and distal tracheoesophageal fistula along their whole lengths allowed exclusion of the possibility of a proximal pouch fistula and gave knowledge of the exact distance of the two segments of the esophagus needed to be bridged to allow anastomosis, thus providing additional valuable information for the surgeon preoperatively.

Esophageal Atresia↗
PubMed1987

Sacrococcygeal teratoma: computed tomography evaluation.

Axial computed tomography, as well as direct sagittal computed tomography in some cases, was used to evaluate five cases of sacrococcygeal tumors, and the findings are presented. Computed tomography greatly assisted in making a correct preoperative diagnosis and in delineating the extent of the tumors. Direct sagittal scans readily staged these tumors, whereas axial scans revealed extension in the transverse plane, especially for intraspinal extension.

Child, Preschool↗
PubMed1987

Pediatric surgeons can and should perform colonoscopy.

We describe our six-year experience in establishing a colonoscopy service in a pediatric surgical center in Hong Kong. A total of 65 colonoscopies on 60 children (aged 1 to 16 years) were performed, with the pediatric surgeon being the collaborator in the first 27 examinations and the endoscopist in the subsequent 38 examinations. Except on two occasions when bowel preparation was inadequate, all examinations were successful. General anesthesia was employed initially but with more experience, sedation alone (37 cases) was found to be adequate in most children and even in infants. Barium enema was available in 20 cases and had a low diagnostic accuracy in comparison to colonoscopy, being incorrect in six cases and inconclusive in one case. Therapeutic procedures with colonoscopy included removal of arteriovenous malformation (1) and polypectomy (37); 24 polyps were situated beyond the reach of rigid sigmoidoscopes and two patients had previous failed polyp removal by laparotomy in another hospital. There were no complications in our series. Our experience suggests that pediatric colonoscopy is a useful procedure that can be safely and effectively performed by pediatric surgeons after adequate training.

Attitude of Health Personnel↗
PubMed1987

Direct sagittal CT scan: a new diagnostic approach for surgical neonates.

Because of their small body size, neonates can be placed in the plane of the CT scanner gantry (aperture diameter 70 cm) instead of across it. This direct sagittal scanning technique allows accurate delineation of surgical lesions, particularly midline ones, unobtainable with conventional axial imaging. In addition, the sagittal image provides a perspective of anatomic arrangement more familiar to the surgeon than that provided by axial sections and therefore allows for easier interpretation. In imperforate anus, sagittal CT identifies the blind rectal end by the meconium tissue interphase and therefore avoids the pitfalls of invertogram, which depends on the bowel gas pattern for interpretation. With this new approach, we correctly classified six cases of imperforate anus into high types (3) and low types (3), visualized the associated fistula and had knowledge of the exact distance of the blind rectal end from the skin level preoperatively. In tracheoesophageal fistula (2), sagittal CT demonstrated the air-filled blind pouch and fistula to allow preoperative classification and assessment of the gap distance. In sacrococcygeal teratoma (3) and laryngeal cyst (1), its use allowed an accurate assessment of possible extension of the lesion into neighboring structures. Our experience with direct sagittal CT scan therefore suggests that this new and noninvasive technique is a useful adjunct in the management of a variety of common neonatal surgical problems.

Anus, Imperforate↗
PubMed1986

Whole-gut irrigation in infants and young children.

In the search for a superior alternative to conventional bowel preparation which often gives unsatisfactory results in children, we have introduced whole-gut irrigation for pediatric use. After a pilot study on 15 children during which adjustments on the technique were made, we settled on an intensive regimen with some notable modifications from conventional adult practice: the use of warm Hartmann's solution, a relatively large fluid load (mean volume 5.3 l/kg body weight, range 3.0 - 12.0 l/kg) and a rapid infusion rate (1.5 ml/kg/min). We then evaluated its safety, effectiveness, and acceptability prospectively on 45 patients undergoing colonoscopy or colorectal surgery, age ranging from 4 months to 11 years, with a mean of 3.9 years. Subjective complaints were mild and included nausea/vomiting, 12 cases (26.7 percent); abdominal colic, two (4.4 percent); and distending discomfort, three (6.7 percent). There was a mean weight gain of 4.0 percent but no gross electrolyte disturbances. Results of bowel preparation were satisfactory in 33 (73.3 percent), adequate in ten (22.2 percent) and poor in two (4.4 percent). Compared with our previous method, in which inadequate preparation occurred in 4/20 patients, (20 percent) by conventional measures, whole-gut irrigation represents a statistically significant improvement (P less than 0.05). In addition, whole-gut irrigation shortened hospital stay and obviated the traditional need of two to three days' dietary restrictions.

Age Factors↗
PubMed1986

Gastric acid secretion and emptying rates in children with duodenal ulcer.

Gastric acid secretion was studied in 30 children with duodenal ulcer and 33 normal children. Both basal (BAO) and maximal (MAO) acid outputs were found to be significantly elevated in patients. In addition, among patients themselves, those with severe disease demonstrated significantly higher MAO than those with mild disease. A concomitant study on gastric emptying rates revealed no difference between patients and normal children.

Adolescent↗
PubMed1986

Diagnosis of peptic ulcer in children: the past and present.

The problem of diagnosis of peptic ulcer in children was analysed in a series of 50 consecutive cases. Atypical symptomatology occurred frequently and resulted in errors in diagnosis in six instances: perforated ulcer was misdiagnosed as appendicitis in five and bleeding ulcer was misdiagnosed as Meckel's diverticulitis in one. Barium meal was the investigation employed in earlier years but had proven unsatisfactory, being incorrect in four out of 22 examinations. Fiberoptic endoscopy was introduced in recent years and having achieved correct diagnosis in 20 patients with no errors, has established itself as the choice of investigation.

Adolescent↗
PubMed1986

Colonoscopy in the diagnosis of abdominal tuberculosis in children.

Childhood abdominal tuberculosis has protean manifestations and remains a difficult diagnosis problem, often requiring surgery for pathological confirmation. Colonoscopy, however, can now be performed with safety in children and appears to offer a new and better alternative to surgery. An earlier experience confirmed its value in the management of ileocaecal tuberculosis as it provided histological proof and bacteriological information to guide chemotherapy, avoiding the need for anaesthesia and laparotomy. However, colonoscopy hasn't been helpful in the diagnosis of the 'exudative' type of abdominal tuberculosis.

Abdomen↗
PubMed1985

Pyloric function five to eleven years after Ramstedt's pyloromyotomy.

Pyloric function after Ramstedt's pyloromyotomy was assessed in seven patients aged five to eleven years and compared to that in sixteen normal children. Gastric emptying (T 1/2) of liquid, as measured by the double sampling test, was faster in patients than in normal children. Duodenal reflux was calculated from the sodium content in gastric aspirates. At rest, it was greater in patients than in normal children. In the poststimulatory state, there was no difference. Gastric acid secretion was similar in both groups. Rapid gastric emptying might explain the high incidence of peptic ulcer reported in several series of long-term follow-up patients. Increased duodenal reflux at rest might account for a similar increased incidence in gastritis and dyspepsia.

Child↗
PubMed1985

Surgical management of choledochal cysts: a review of 60 cases.

Sixty cases of choledochal cysts in children are reviewed. The series comprises 55 cases of Alonso-Lej. Type 1 cysts, two cases whose cysts were infraduodenal and retropancreatic in position, and three cases of choledochal cysts with both proximal and distal atresia of bile ducts. The following five types of operative procedures were employed for the 58 cases: (1) Choledochocystoduodenostomy in 12; (2) Partial excision, choledochorraphy and choledocho-duodenostomy in six; (3) Cyst excision, portal dissection and portojejunostomy in three; (4) Choledochocystojejunostomy Roux-en-Y in 20; and (5) Cyst excision with hepaticojejunostomy Roux-en-Y in 17 cases. Two patients did not receive definitive surgical treatment. Early complications included six cases of leakage, of which one died; and four cases of cholangitis and septicemia, resulting in fatality in all. The overall operative mortality was 5/58 (8.6%). This review, though retrospective in nature, further supports the more recent trend that radical cyst excision with hepaticojejunostomy is the treatment of choice. This procedure carried no mortality and low morbidity. All 17 patients treated in this manner are well and free from jaundice and recurrent cholangitis. Cyst excision eliminates the reservoir for bile stasis, biliary obstruction, cholangitis, and biliary cirrhosis. It also removes the possibility of malignant change in the cyst and spontaneous rupture.

Bile Ducts↗
PubMed1985

Acute pancreatitis in children.

Twenty-nine children with acute pancreatitis were managed during the period 1971 to 1983. Aetiology included trauma (5), mumps (5), drug therapy (4), biliary disease (1), and cystic fibrosis (1); 13 cases were classified as idiopathic. Diagnosis could be difficult, and unnecessary laparotomies were performed in 7 instances for suspected appendicitis. One patient, however, had a well-justified laparotomy revealing coexisting severe appendicitis and pancreatitis. Morbidity included relapses (7), pseudocysts (3), obstructive duodenal hematoma (1), and miscellaneous problems (4). Improvements in management included endoscopic retrograde cholangio-pancreatography (ERCP) to exclude anatomical anomalies in relapsing cases, ultrasonography for the diagnosis of pseudocysts and for follow-up measurements in two such cases successfully managed conservatively, and increasing use of total parenteral nutrition in cases with protracted disease or serious complications.

Acute Disease↗
PubMed1983

Three successfully treated cases of nonamoebic liver abscess.

Three previously healthy children developed nonamoebic liver abscess. Diagnosis was aided by liver scan, ultrasound assessment, and computed tomography. A variety of surgical procedures were successful in achieving proper drainage, resection of chronic lesions, and resolution of associated cholangitis.

Child↗
PubMed1982

Interposing fascial pedicle flap for the repair of urethral fistulae after hypospadias surgery.

A one-stage technique for the repair of urethral fistulae after urethroplasty for hypospadias is reported. A pedicle flap prepared from the facial layers of the scrotum is interposed between the urethra and the overlying skin. In the nine patients operated on, there was one failure, and it was due to postoperative hematoma formation. This technique is especially recommended for patients with multiple small urethral fistulae.

Child↗