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Hui-Ping Liu

Publications and source records attributed to Hui-Ping Liu.

At least 19 recordsLinked to original sources
PubMed2006

Complex mutation patterns of epidermal growth factor receptor gene associated with variable responses to gefitinib treatment in patients with non-small cell lung cancer.

Mutational analysis was performed in the kinase domain (exons 18-21) of the EGFR gene on tumor tissues of 65 non-small cell lung cancer (NSCLC) patients who had received gefitinib monotherapy. The association between EGFR gene mutation, gefitinib treatment response, and the overall survival were evaluated. In total, EGFR mutations with complex patterns were identified in 32 tumors. The overall mutation rate was 49.2% (32/65). Twenty of the 32 patients were responders, 10 non-responders, and 2 not assessable. The most common mutation in non-responders was L858R. Gefitinib responsiveness was only significantly associated with EGFR mutation and adenocarcinoma. The median survival for responder (15.5 months) was much longer than non-responder (9.23 months), though the difference only had marginal significance (p=0.056). The difference of overall survival between patients with and without EGFR mutation was non-significant (p=0.7819), mainly due to the short survival of the non-responders with EGFR mutations (median survival=6.2 months). Our study revealed that the response to gefitinib treatment in NSCLC patients with EGFR mutations could be quite variable even for the same EGFR mutation type. An analysis of the various EGFR mutations and the response patterns was also performed and compared with recently published reports on EGFR mutation and gefitinib responsiveness.

Adenocarcinoma↗
PubMed2006

Montgomery T-tube insertion using a rigid bronchoscope under direct observation.

The Montgomery T-tube (T-tube) is an effective device for relieving tracheal stenosis when lesions are inappropriate for surgical reconstruction. Several techniques have been developed for the insertion of the T-tube in difficult conditions. The aim of this study was to present our experience using a rigid bronchoscope for T-tube insertion. A retrospective chart review of patients with tracheal stenosis who underwent T-tube insertion between April 2002 and July 2005 was conducted. Thirty-seven patients underwent 53 T-tube placements. Successful stent placement was achieved in all 37 patients. The T-tube was not tolerated in six patients because of granulation obstruction of the upper limb or sputum impaction. Thirty-one patients had good long-term results and enjoy adequate airway with the T-tube. There was no procedure-related mortality and there were no complications. Rigid bronchoscopic insertion of the T-tube for tracheal stenosis is a safe and an effective procedure. It ensures the correct placement of the T-tube when the technique described by Montgomery fails.

Bronchoscopes↗
PubMed2005

Invasive pulmonary aspergillosis and pulmonary cryptococcosis really coexist in immunocompromised host.

Fungal infections develop slowly in immunocompetent patients and rarely a severe disease, however, they progress rapidly and usually prove fatal in immunocompromised patients. Early diagnosis and treatment of fungal infections is essential to survival of immunocompromised patients. We report a 33-year-old woman with systemic lupus erythematosus undergoing immunotherapy infected with combined invasive pulmonary aspergillosis and pulmonary cryptococcosis diagnosed by video-assisted thoracic surgery lung biopsy and she was successfully treated as a result of early diagnosis and treatment.

Adult↗
PubMed2005

Treatment of esophageal perforation in a referral center in taiwan.

PURPOSE: The high mortality associated with esophageal perforation can be reduced by aggressive surgery and good critical care. We report our experience of treating esophageal perforation in a clinic in Taiwan. METHODS: The subjects were 28 patients who underwent surgery for a benign esophageal perforation. RESULTS: The esophageal perforation was iatrogenic in 11 patients, spontaneous in 8, and caused by foreign body injury in 9. Most (22/28) of the patients were seen longer than 24 h after perforation, and 77% had empyema preoperatively. The perforation was located in the cervical area in 5 patients and in the thoracic esophagus in 23. We performed primary repair in 24 patients, esophagectomy in 3, and drainage in 1. Leakage occurred after primary repair in ten (41%) patients, resulting in one death, and two patients died of other diseases. Postoperative leakage prolonged the hospital stay but had no impact on mortality. Overall survival was 90%. Univariate analysis revealed that age, timing of treatment, and cause and location of the perforation influenced outcome, but multivariate analysis failed to identify a predictor of mortality. CONCLUSIONS: Early diagnosis and intervention are crucial to prevent morbidity and mortality in patients with esophageal perforation. Primary repair is feasible even if the diagnosis is delayed.

Adult↗
PubMed2005

Silicone airway stent for treating benign tracheoesophageal fistula.

We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.

Aged↗
PubMed2005

Successful treatment of complicated tracheobronchial rupture using primary surgical repair.

Traumatic tracheobronchial disruption is a life threatening injury in the pediatric population. The clinical presentations are variable depending on whether the peribronchial tissues remain intact. A high index of clinical suggestion and accurate interpretation of radiological findings are necessary to diagnose the injury. Delays in treatment increase the risk of death and complications. We report a 9-year-old boy who presented with subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, and respiratory failure. Bronchoscopy revealed a complex rupture of the airway over the junction of the right main upper lobar and intermediate bronchus. Emergent surgical intervention was performed via a right posterolateral thoracotomy after bilateral chest tube insertion. End-to-end anastomosis of the disrupted bronchus was completed with interrupted absorbable 4-0 vicryl without additional covering of the anastomosis with pleural or muscle flap and intra-operative bronchoscopy showed a normal anastomotic relationship after the procedure was completed. The patient was discharged in good condition 10 days after the operation. At 6 months of follow up, he had good health status and bronchoscopy showed good patency over the anastomotic region.

Accidents, Traffic↗
PubMed2005

Pneumocephalus after thoracoscopic excision of posterior mediastinal tumor.

Pneumocephalus is a very rare complication of video-assisted thoracoscopic surgery (VATS). A 66-year-old man developed pneumocephalus secondary to thoracoscopic excision of a neurogenic tumor in the posterior mediastinum. Pneumocephalus was diagnosed by brain computed tomography. Neurosurgical intervention was performed after conservative therapy had failed. The patient's condition had resolved without any neurologic sequelae 2 years later. When a patient has a relatively large amount of chest tube drainage and neurologic symptoms after VATS, the possibility of pneumocephalus due to cerebrospinal fluid leakage must be considered.

Aged↗
PubMed2004

High frequency of epidermal growth factor receptor mutations with complex patterns in non-small cell lung cancers related to gefitinib responsiveness in Taiwan.

PURPOSE: Epidermal growth factor receptor (EGFR) mutations related to gefitinib responsiveness in non-small cell lung cancer have been found recently. Detection of EGFR mutations has become an important issue for therapeutic decision-making in non-small cell lung cancer. EXPERIMENTAL DESIGN: Mutational analysis of the kinase domain of EGFR coding sequence was done on 101 fresh frozen tumor tissues from patients without prior gefitinib treatment and 16 paraffin-embedded tumor tissues from patients treated with gefitinib. Detection of phosphorylated EGFR by immunoblot was also done on frozen tumor tissues. RESULTS: The 101 non-small cell lung cancer tumor specimens include 69 adenocarcinomas, 24 squamous cell carcinomas, and 8 other types of non-small cell lung cancers. Mutation(s) in the kinase domain (exon 18 to exon 21) of the EGFR gene were identified in 39 patients. All of the mutations occurred in adenocarcinoma, except one that was in an adenosquamous carcinoma. The mutation rate in adenocarcinoma was 55% (38 of 69). For the 16 patients treated with gefitinib, 7 of the 9 responders had EGFR mutations, and only 1 of the 7 nonresponders had mutations, which included a nonsense mutation. The mutations seem to be complex in that altogether 23 different mutations were observed, and 9 tumors carried 2 mutations. CONCLUSIONS: Data from our study would predict a higher gefitinib response rate in lung adenocarcinoma patients in Chinese and, possibly, other East Asian populations. The tight association with adenocarcinoma and the high frequency of mutations raise the possibility that EGFR mutations play an important role in the tumorigenesis of adenocarcinoma of lung, especially in East Asians.

Adenocarcinoma↗
PubMed2004

Pulmonary lymphangioleiomyomatosis: a clinicopathological analysis of ten cases.

BACKGROUND: Lymphangioleiomyomatosis (LAM) of the lung is a very rare disease of unknown etiology which occurs particularly in women of childbearing age. So far, there have been very few reports of LAM in Taiwan. METHODS: Data on all patients with a clinical or pathological diagnosis of LAM in Chang Gung Memorial Hospital from 1990 to 2001 were collected from the pathology files or by consultation with thoracic surgeons, chest physicians, and radiologists of this institution. Cases were confirmed by lung biopsy and high-resolution computed tomographic scanning. Clinical data were obtained from patients' charts. Additional immunostaining for HMB-45 antigen, estrogen receptor, and progesterone receptor was carried out for cases with available paraffin blocks. RESULTS: In total, 10 patients confirmed with a diagnosis of LAM and adequate clinical follow-up information were found from 1991 to 2001. All were females of fertility age. The follow-up periods ranged from 18 to 167 months. Six patients received hormonal therapy. According to the pulmonary function tests and clinical symptoms, 6 patients were in stable condition and 4 showed slow progression of disease by the time of the last follow-up. Two patients died after lung transplantation and abdominal surgery for retroperitoneal LAM, respectively, at another medical center. CONCLUSIONS: The clinicopathological features of our series are similar to those reported from other countries. The clinical course was slowly progressive with no significant response to hormonal therapy. Lung biopsies are important for a diagnosis, but the size and location of the biopsy specimens greatly affect the diagnostic reliability.

Adult↗
PubMed2004

Experience with early postoperative feeding after abdominal aortic surgery.

BACKGROUND: Abdominal aortic surgery is a form of major vascular surgery, which traditionally involves long hospital stays and significant postoperative morbidity. Experiences with transit ileus are often encountered after the aortic surgery. Thus traditional postoperative care involves delayed oral feeding until the patients regain their normal bowel activities. This report examines the feasibility of early postoperative feeding after abdominal aortic aneurysm (AAA) open-repair. METHODS: From May 2002 through May 2003, 10 consecutive patients with infrarenal AAA who underwent elective surgical open-repair by the same surgeon in our department were reviewed. All of them had been operated upon and cared for according to the early feeding postoperative care protocol, which comprised of adjuvant epidural anesthesia, postoperative patient controlled analgesia, early postoperative feeding and early rehabilitation. The postoperative recovery and length of hospital stay were reviewed and analyzed. RESULTS: All patients were able to sip water within 1 day postoperatively without trouble (Average; 12.4 hours postoperatively). All but one patient was put on regular diet within 3 days postoperatively (Average; 2.2 days postoperatively). The average postoperative length of stay in hospital was 5.8 days. No patient died or had major morbidity. CONCLUSIONS: Early postoperative feeding after open repair of abdominal aorta is safe and feasible. The postoperative recovery could be improved and the length of stay reduced by simply using adjuvant epidural anesthesia during surgery, postoperative epidural patient-controlled analgesia, early feeding, early ambulation, and early rehabilitation. The initial success of our postoperative recovery program of aortic repair was demonstrated.

Aged↗
PubMed2004

Initial experience with the benefits of intraoperative angiography in surgery for peripheral arterial occlusive disease.

BACKGROUND: This preliminary investigation evaluated the procedures for intraoperative angiography-assisted peripheral vascular revascularization in a teaching hospital. METHODS: Between August 2000 and July 2001, intraoperative angiography with or without intervention was applied during surgery for peripheral arterial occlusive disease (PAOD) in 11 patients. Intraoperative angiography was employed to: (1) decide the best possible bypass graft outlet, (2) ensure the quality of the distal anastomosis of the bypass graft, (3) assist in the thrombectomy procedure, and (4) perform concomitant balloon angioplasty of vascular stenoses. Follow-up was conducted based on the clinical status, duplex scans, or angiographic surveillance. RESULTS: The 7 procedures for chronic PAOD included 4 adjuvant intraoperative angioplasties. Amputation was required in 1 patient because the intraoperative angiography confirmed that no suitable distal bypass could be performed. The 4 procedures performed on acute ischemic limbs included 1 adjuvant intraoperative angioplasty and 1 arterial graft bypass. The immediate limb salvage rate was 81.8% (9/11), and the perioperative mortality rate was 8.3% (1/11). Additionally, the overall 1-year primary patency of the vessel/graft was 78% (7/9), immediate limb salvage was 81.8% (9/11), and 2-year survival was 81.8% (9/11). CONCLUSIONS: Preliminary results presented herein confirm the variable usefulness of intraoperative interventional angiography in cases of peripheral arterial occlusive disease. From our results, we concluded that vascular surgeons should apply these endovascular therapeutic skills in their daily practice.

Adult↗
PubMed2004

Brachiobasilic fistula as a secondary access procedure: an alternative to a dialysis prosthetic graft.

BACKGROUND: In order to extend the availability of each extremity as an access site for long-term dialysis, we created a brachiobasilic fistula by superficialization of the basilic vein, which had previously been arterialized. In this work, we present the preliminary results of this procedure. METHODS: Patients with prior forearm arteriovenous fistula dysfunction without an adequate superficial vein were enrolled in this study. The basilic vein was superficialized to create a brachiobasilic fistula. The basilic veins were transposed in 16 patients and elevated in 4 patients. At the same time, another 50 upper arm bridge prosthetic grafts were created. Finally, surgery-related complications and patency rates were analyzed and compared with upper arm prosthetic grafts. RESULTS: Twenty brachiobasilic fistulas and 50 upper arm bridge prosthetic grafts were created in 70 patients in our hospital from September 2001 to January 2004. No surgery-related deaths occurred. Cannulation of the brachiobasilic fistulas began at an average of 33 (range, 21 to 84) days after surgery. All fistulas were successfully used for dialysis. The mean follow-up was 15 (range, 2 to 26) months. Moreover, the primary patency rates for the brachiobasilic fistulas and upper arm prosthetic grafts were 80% and 70%, respectively. Notably, all brachiobasilic fistulas remained patent at the last follow-up. Furthermore, surgery-related complications were 25% for brachiobasilic fistulas and 60% for upper arm prosthetic grafts. Common complications of brachiobasilic fistulas were graft thrombosis, arm swelling, hematoma formation, and steal syndrome. CONCLUSIONS: Brachiobasilic fistulas are technically feasible and show excellent patency. Fewer surgery-related complications were seen compared to upper arm prosthetic grafts, and most of them were treated without loss of the fistula. We suggest that this procedure should be considered before placement of a prosthetic graft whenever feasible. These observations merely represent our preliminary experience regarding this procedure, and further investigation involving larger cases numbers is needed in the future.

Adult↗
PubMed2003

Thoracoscopic ipsilateral approach to contralateral bullous lesion in patients with bilateral spontaneous pneumothorax.

BACKGROUND: Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgical practice. This study describes a novel ipsilateral approach to a contralateral bullous lesion using VATS to achieve simultaneous bilateral bleb excision and pleurodesis. METHODS: From 2001 to 2003, 6 patients underwent our ipsilateral approach with VATS for bilateral pneumothorax. The clinical features, surgical indications, and patient outcomes were reviewed. RESULTS: All the patients were men between 18 and 35 years old (mean age, 25.8 years). The ipsilateral-approach VATS procedure for bilateral pneumothorax was performed successfully in 4 patients. Two patients were switched to a one-stage sequential bilateral VATS procedure. The bullous lesions were at the apex or confined to the upper lobe in 5 patients; multiple lobes were involved in 1 patient. The bullae were resected with an Endo-GIA stapler or ligated with a homemade endoloop. The mean duration of operation was 54.8 minutes. The mean time of chest tube removal was 4.7 days after insertion, and the mean postoperative stay was 5.7 days. There was no recurrence of pneumothorax during the follow-up period. CONCLUSIONS: The thoracoscopic ipsilateral approach is technically feasible for treating patients with bilateral pneumothorax.

Female↗
PubMed2003

The role of surgery in hemoptysis caused by thoracic actinomycosis; a forgotten disease.

OBJECTIVE: Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. Rarely, it may be complicated by an unusual but significant hemoptysis manifestation. We describe our experiences of surgical treatment for hemoptysis in patients with pulmonary actinomycosis. METHODS: From 1984 to 2002, 14 patients with thoracic actinomycosis and hemoptysis were diagnosed after thoracotomy. There were 11 male and three female patients with a mean age of 53.6 years. They all had non-specific symptoms and radiographic findings, and no case was an accurate diagnosis made at the time of hospital admission, including echo-guide aspiration, serial bronchoscopic biopsy and computed tomography biopsy. The indications of surgical intervention in our patients were for treating complications such as hemoptysis, chronic sinus discharge, or empyema, also limited to diagnostic purposes. Preoperative embolization was performed in seven cases; however, none was successful. RESULTS: Among the 14 patients, all the lesions were unilateral. The disease was confined to the lung in all patients; and chest wall involvement in one patient. The surgical procedures included were as follows: pneumonectomy (n=1), bilobectomy (n=1), lobectomy (n=10), wedge resection (n=2), and lung lesion with concomitant chest wall resection and chest wall reconstruction (n=1). Mean intraoperative and postoperative blood loss within the first 24 h was 192.3 ml, and five patients required blood transfusion. All of the specimens from the lesion site showed histological evidence of Actinomyces infection. All patients regularly took 12 million units per day of intravenous crystalline penicillin G during their hospitalization, and oral procaine penicillin for up to 2 months. During the follow-up, all patients had an uneventful postoperative course. CONCLUSIONS: A high index of suspicion for this disease is advised for the surgeon engaged in the treatment of hemoptysis. Surgical resection of pulmonary actinomycosis is effective in preventing recurrence of hemoptysis. After diagnosis, it is treated using penicillin chemotherapy for at least 2 months.

Actinomycosis↗
PubMed2003

Preliminary experience with bronchotherapeutic procedures in central airway obstruction.

BACKGROUND: Central airway obstruction is still challenging to physicians. We herein report on our experiences with bronchotherapeutic procedures over a recent 8-month period. METHODS: From January 2002 to August 2002, 21 patients received 26 procedures (4 core outs, 6 dilations, 13 stent placements, 2 biopsies, and 1 foreign body removal). All patients were treated with or assisted using a rigid bronchoscope technique, except in 1 case in which a fiber bronchoscope was used. The etiologies included 4 cases of lung cancer, 3 cases of malignancy-related tracheoesophageal fistula, 6 cases of airway intubation, 2 cases of laryngotracheal tuberculosis, 1 case of post-anastomotic stenosis, 1 case of laryngotracheal trauma, 1 case of subglottic web, 1 case of foreign body, and 2 cases of unknown origin. RESULTS: Seventeen patients receiving bronchotherapeutic procedures benefited from the procedures, with 2 complications occurring in our series. One patient who was 87 years old with esophageal cancer and tracheoesophageal fistula died 5 days after the operation. Stent-related complications occurred in 2 patients (1 collapse by compression and 1 mucous obstruction). No airway laceration occurred while performing the procedure. Two instances of intraoperative bleeding were encountered, which were successfully controlled by compression of the lesion using the side of the rigid bronchoscope. CONCLUSIONS: In malignant airway obstructions, we resected the endobronchial tumor with the tip of the rigid bronchoscope. Stents were reserved for patients with residual obstruction or severe extrinsic compression. In benign airway obstructions, dilation with a rigid bronchoscope was routinely used. Silicon stents were preferred for managing benign airway obstruction.

Adolescent↗
PubMed2003

Successful treatment of tracheal mucoepidermoid carcinoma using rigid bronchoscopy combined with conventional surgical resection.

Mucoepidermoid carcinoma of the trachea is a rare tumor. This investigation reports on a case of a 67-year-old male with mucoepidermoid carcinoma in the lower 1/3 of the trachea. The patient presented with intermittent coughing and hemoptysis lasting for 1 month. The preoperative investigation revealed an intraluminal polypoid mass in the posterolateral trachea with 75% stenosis of the tracheal lumen. A rigid bronchoscope was used to evaluate the airway before surgery, and the tumor was mechanically resected using the tip of the rigid bronchoscope just before intubation. Finally, the tumor was completely removed, and the airway was successfully reconstructed. At 6 months after surgery with no adjuvant chemoradiotherapy, the patient was free of disease.

Aged↗
PubMed2002

Justifying video-assisted thoracic surgery for spontaneous hemopneumothorax.

STUDY OBJECTIVES: Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgery practice. This study discusses the clinical aspects and utility of VATS in spontaneous hemopneumothorax (SHP). PATIENTS: Of 363 spontaneous pneumothorax (SP) cases, 24 patients presented with SHP (6.6%). The clinical features, surgical indications, emergency VATS technique, and patient outcomes are discussed. RESULTS: All 24 patients were male (mean age, 25.3 years). Eleven patients were in hypovolemic shock, and their hemoglobin levels ranged from 6.7 to 12.7 g/dL; therefore, they received fluid resuscitation and blood transfusion. The amount of blood drained through the chest tube varied from 200 to 3,500 mL. Emergency VATS revealed that 5 cases were simple hemothoraces and 19 cases were associated with pneumothorax. The cause of bleeding was identified by thoracoscopy, as from an aberrant vessel (n = 11), torn parietal pleura (n = 4), ruptured vascularized bullae (n = 2), and lung parenchyma (n = 1). Six patients had no evidence of an obvious bleeding site. Bullous lesions were at the apex of the upper lobe in 14 patients, and multiple lobar involvement was seen in 2 patients. All the bullae were resected with endoscopic stapler in eight patients and ligated with a homemade endoloop in eight patients. The mean operation time was 42 min. The mean chest tube removal time was 3.5 days after insertion, and mean postoperative stay was 4.5 days. There is no recurrence of SHP or SP during the follow-up period. CONCLUSION: SHP complicated by severe bleeding presents a potentially grave emergency. VATS may be considered as feasible treatment for patients with SHP.

Adolescent↗