Unusual presentation of mesenteric vasculitis as isolated dissection of the superior mesenteric artery.
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Aortic Dissection↗
Biomedical subjects
I-Rue Lai
Publications and source records attributed to I-Rue Lai.
Transient limb ischemia induces remote preconditioning in liver among rats: the protective role of heme oxygenase-1.
BACKGROUND: We have reported the protective role of heme oxygenase-1 (HO-1) in the mechanism of hypoxic preconditioning. We wish to investigate the role of HO-1 in remote preconditioning (RP) against hepatic ischemia/reperfusion (I/R) injury in rats. METHODS: The remote preconditioning was produced by four cycles of 10-min ischemia-reperfusion of the hind limb of rats. Partial hepatic ischemia was produced in the left lobes for 45 min followed by 240 min of reperfusion. Zinc-protoporphyrin IX (ZnPP), a specific inhibitor of HO enzymatic activity, was intra-peritoneally injected 1 hr before the ischemia-reperfusion injury in separate groups of RP rats. Serum alanine transaminase (ALT) levels, expression of hepatic HO-1 protein and mRNA, immunohistochemical staining and HO enzymatic activity were measured. RESULTS: HO-1 was induced in the livers of rats 4 hr after the RP stimuli, and the overexpression persisted for 24 hr. Immunohistochemical staining demonstrated induction of HO-1 in the hepatocytes. The peripheral lymphocytes did not express HO-1 after RP. RP diminished the elevation of serum ALT levels 4 hr after I/R injury (283.7+/-167.4 U L) when compared with controls (1297.7+/-729.3 U L) and RP+ ZnPP pretreated groups (1429.9+/-750.9 U L). The heme oxygenase activity in treated rats also correlated these results (286.8+/-34.3 pmol mg protein hr for the RP group, 156.3+/-27.5 pmol mg protein hr for the RP+ ZnPP pretreated group, and 170.6+/-19.4 pmol mg protein hr for the control group, 144.8+/-7.8 pmol mg protein hr for the control+ ZnPP pretreated group). CONCLUSION: Our results indicated that the induction of HO-1 in remote preconditioning played a protective role against hepatic I/R injury.
Alanine Transaminase↗
Prospective, randomized, and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease.
AIM: To assess the efficacy and safety of a compound containing alginic acid plus antacid (Topaal) compared to equal-strength antacid (Nacid) in patients with endoscopy-negative reflux disease (ENRD). METHODS: A total of 121 patients with ENRD were randomized to receive Topaal (65 patients) or Nacid (56 patients) for 6 weeks, with a consultation every 3 weeks. The primary end-point assessment was the change in the severity of heartburn as evaluated using a visual analog scale (VAS) at 6 weeks. The secondary end-point assessments were the VAS at 3 weeks, the change of frequency of the reflux symptom, the change of quality of life and the adverse effects. RESULTS: Demographics of randomized subjects in each treatment group were comparable except that the Topaal group included more males. The baseline characteristics between the groups were similar. After 6 weeks of treatment, the reduction of VAS of heartburn was more prominent in the Topaal group (-6.29 cm vs -4.11 cm). At the 3rd week, Topaal group showed greater reduction of VAS for heartburn (P=0.0016), regurgitation (P=0.0006), vomiting (P=0.0373), and belching (P<0.0001). The patients of the Topaal group had lower frequency of heartburn (P=0.0015) and pain (P=0.0163) at the end of the 6-week treatment period. From the doctor's point of view, the Topaal group also showed significant reduction in the severity of heartburn (P=0.0020), regurgitation (P=0.0081), vomiting (P=0.0182), and belching (P=0.0018) at the end of the treatment. The improvement of the quality of life was more remarkable in the Topaal group at the end of the 6-week treatment period (P<0.0001). For the adverse effect, there was no difference in both the groups. CONCLUSION: Topaal is more effective than Nacid for the treatment of symptoms presented by patients with ENRD.
Adult↗
Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results.
Laparoscopic wedge resection of the stomach (LWS) has become the treatment of choice for patients with benign gastric tumors. The technical consideration and long-term follow-up data of LWS for gastrointestinal stromal tumors (GISTs) of the stomach are limited. We present our experience of 28 LWSs for gastric GISTs with a mean follow-up of 43 months. From October 1995 to December 2002, we successfully performed 28 LWSs for 29 patients with GISTs of the stomach, and one patient needed conversion to laparotomy because of suspected bowel injury when establishing pneumoperitoneum. Patient demographics, perioperative parameters, and outcomes of the 28 patients were assessed retrospectively. The tumors were located in the upper third of the stomach in 13 patients, in the middle third, in eight patients, and in the lower third, in seven patients. The mean size of tumors was 3.4 +/- 1.6 cm in diameter. The duration of operation ranged from 95 to 390 minutes: 189.6 +/- 79.5 minutes with the stapler method and 194.3 +/- 50.5 minutes with the hand-sewn method (P = 0.8870). No blood transfusion was given in the perioperative period in all cases. Cholecystectomy in three patients and repair of hiatal hernia in one patient were performed during the same operation. The oral intake was restored at the third to fourth postoperative days. The hospital stay ranged from 3 to 11 days (mean, 6.7 +/- 1.8 days). The follow-up period ranged from 12 to 95 months (mean, 43.3 +/- 23.5 months, median 42 months). There has been no evidence of tumor recurrence, including one patient with microscopic invasion of section margin. LWS can be performed safely with a satisfactory remission rate for patients with gastric stromal cell tumors.
Adult↗
Laparoscopic versus open appendectomy for perforated appendicitis.
The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean +/- SD = 96.1 +/- 43.1 vs. 67.8 +/- 32.2 minutes, P < 0.01). Return of oral intake was faster in the LA group (3.2 +/- 2.4 vs. 5.0 +/- 7.0 days, P < 0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4 +/- 2.8 vs. 6.3 +/- 7.1 days, P < 0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P < 0.01). Hospital stay days were shorter for the LA group (6.3 +/- 2.9 vs. 9.3 +/- 8.6 days, P < 0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.
Adult↗
Initial experience with ABO-incompatible live donor renal transplantation.
The serious shortage of cadaveric organs has prompted the development of ABO-incompatible live donor renal transplantation. We report our experience of the initial two live donor ABO incompatible renal transplants at our hospital. The first patient was a 55-year-old type A female who received a kidney from her AB type husband. The second patient was a 27-year-old type O male who received renal transplantation from his type A father. Preconditioning immunosuppressive therapy in the two patients with tacrolimus, mycophenolate mofetil and methylprednisolone was started 7 days before transplantation. During the period of preconditioning, double filtration plasmapheresis (DFPP) was employed to remove anti-A and -B antibodies. Laparoscopic splenectomy and renal transplantation were performed after the anti-donor ABO antibodies were reduced to a titer of 1:4. Rituximab, a humanized monoclonal anti-CD20 antibody, was administered to the second patient due to a rebound in the anti-A antibody titer during the preconditioning period. Under a tacrolimus-based immunosuppressive regimen, both patients recovered very well without any evidence of rejection. Serum creatinine levels were 1.0 and 1.4 mg/dL at 6 and 3 months after transplantation, respectively. These cases illustrate that with new immunosuppressive agents, DFPP and splenectomy, ABO-incompatible renal transplantation can be successfully conducted in end-stage renal disease patients whose only available live donors are blood group incompatible.
ABO Blood-Group System↗
Diagnosing porcelain gallbladder.
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Abdominal Pain↗
The protective role of heme oxygenase-1 on the liver after hypoxic preconditioning in rats.
BACKGROUND: Hypoxic preconditioning (HP) confers cytoprotection against ischemia/reperfusion (I/R) injury. This effect is in part attributable to the induction of heme oxygenase (HO)-1. This experiment evaluates liver cell damage after I/R injury in HP rats. METHODS: HP rats were prepared by exposure (15 hr/day) to an altitude chamber (5500 m) for 2 weeks. Partial hepatic ischemia was produced in the left lobes for 45 min followed by 180 min of reperfusion. Zinc (Zn) protoporphyrin (PP), a specific inhibitor of HO enzymatic activity, was subcutaneously injected 1 hr before the I/R injury into separate groups of sea-level (SL) control and HP rats. Serum alanine aminotransferase (ALT) levels, liver HO-1 mRNA and protein, and HO enzymatic activity were measured. RESULTS: HO-1 was induced in the livers of rats exposed to HP. The levels of HO-1 mRNA and protein were obviously overexpressed after 2 weeks of HP. HP diminished the elevation of serum ALT levels after I/R injury (83.7+/- 4.9 U/L) when compared with SL controls (280.8+/-19.4 U/L) and HP+ZnPP-pretreated groups (151.3+/-4.4 U/L). The HO activity in treated rats also was correlated with these results (237.9+/-19.8 pmol/mg of protein per hour for the HP group, 164.3+/-12.7 pmol/mg of protein per hour for the HP+ZnPP group, and 182.6+/-8 pmol/mg of protein per hour for the SL controls). CONCLUSIONS: The authors' results indicated that the induction of HO-1 in hypoxic preconditioning played a protective role against hepatic I/R injury.
Animals↗
Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.
BACKGROUND: Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. Long-term follow-up data of LS for ITP are scarce. METHODS: From May 1997 to December 2002, we performed 67 LS for patients with ITP. Data were assessed retrospectively. RESULTS: LS was successfully attempted in all 67 patients. There was no surgical mortality. Three postoperative complications (5%) were encountered. The mean operative time decreased significantly from 176.2 minutes in the first 41 cases to 125.2 minutes in the last 26 cases. The mean postoperative hospital stay was 3.2 days. Accessory spleens were found in 3 patients (5%) during the LS. The mean follow-up interval was 23.3 months. The initial response to LS was 83%, and overall remission of ITP was 74%. The preoperative effect of steroid therapy had no significant influence on postoperative remission rate. More significant indicators of LS effectiveness were either an immediate postoperative platelet count surge or an immediate postoperative platelet count >or=100000/microL. CONCLUSIONS: LS can be performed safely with a satisfactory remission rate for patients with ITP who do not respond to medical treatment. Our results indicated that an immediate postoperative platelet count surge and/or an immediate postoperative platelet count >or=100000/microL were positive predictors of long-term remission after LS for ITP.
Adult↗
Hand-assisted versus total laparoscopic live donor nephrectomy.
BACKGROUND AND PURPOSE: The optimal minimally invasive procedure to procure live donor kidneys for renal transplantation has not been established. This study compared the donor outcome of hand-assisted laparoscopic live donor nephrectomy (H-LLDN) with total laparoscopic live donor nephrectomy (T-LLDN). METHODS: The outcomes of 12 donors undergoing H-LLDN were compared to that of a subsequent series of 12 donors undergoing T-LLDN. Body mass index, operation time, warm ischemia time, hospital stay, surgical complications, and short-term graft function were compared between the 2 groups. RESULTS: LLDN was successfully performed in all 24 donors. Both approaches resulted in excellent early graft function. The mean operation time in T-LLDN (215 minutes) was slightly shorter than that in H-LLDN (258 minutes), suggesting that the skills developed as surgeons learned the H-LLDN procedure had transferred to their performance of T-LLDN. The mean warm ischemia time of the T-LLDN group (4.5 minutes) was longer than that of the H-LLDN group (3.8 minutes), although this difference was not significant. One minor tear of the lumbar vein occurred in the H-LLDN group and the resultant bleeding necessitated blood transfusion. One mechanical failure occurred when the renal vein was divided by endoscopic gastrointestinal anastomosis in the T-LLDN group. The length of hospital stay, resumption of diet, and the use of narcotic analgesics were not different between the 2 groups. CONCLUSIONS: Both H-LLDN and T-LLDN are safe and effective approaches for the procurement of live donor kidneys. The benefits of the H-LLDN technique include direct manual control of the operative field and increased safety margin. The development of a hospital LLDN program by starting with a hand-assisted approach may reduce the potential bleeding complications and facilitate the safe transition to the cosmetically preferable total laparoscopic approach.
Adult↗
The effect of an intestinal ischemia-reperfusion injury on renal nerve activity among rats.
An intestinal ischemia-reperfusion injury (IIR) may induce renal tubular dysfunction and a reduction in renal blood flow that may be related to the alteration of renal-nerve activity. A rat model of IIR injury was established. The superior mesenteric artery was clamped for 120 min, constituting the ischemic period, and was then released for 60 min, thus constituting the reperfusion period. Renal-nerve activity, renal function, and hemodynamic changes were recorded during the different periods. The levels of calcitonin gene-related peptide (CGRP) in portal-vein blood and intestinal tissue were investigated here. In the reperfusion period, the efferent renal-nerve activity (ERNA) was markedly elevated (94.3% +/- 21.6% higher than the baseline value), such an elevation being only partially reversed by fluid expansion (29.3% +/- 5.2% higher than the baseline value). The elevation of ERNA contributed to the renal blood-flow reduction from 6.8 +/- 0.3 mL/min/g to 2.0 +/- 0.4 mL/min/g, and decreased diuretic and natriuretic responses. The afferent renal nerve activity (ARNA) was markedly depressed (45.7% +/- 8.1% lower than the baseline value) during the reperfusion period. This depression was not reversed by fluid expansion, suggesting that the baroreflex was not responsible for this effect. The blunted ARNA also contributed to the elevation of ERNA by way of a renorenal reflex. The potent vasodilator neuropeptide in the gut, CGRP, revealed an increased level in the portal-vein blood (92.2 +/- 4.4 pg/mL vs. 57.8 +/- 0.6 pg/mL) and also in intestinal tissue (655.8 +/- 115.9 pg/mL vs. 60.5 +/- 9.4 pg/mL) with a time-matched related pattern with the change to renal-nerve activity, suggesting CGRP's role regarding changes in renal-nerve activity. This study indicates that the elevated ERNA level associated with IIR injury is related to a systemic hypotension-induced baroreflex, the contra-lateral inhibition of ARNA, and possibly also gut-released CGRP. In regards to an IIR injury, the depressed ARNA reflects the involvement of a renal sensory- impairment mechanism.
Afferent Pathways↗
Successful living-related renal transplantation in a 2-year-old girl weighing less than 10 kilograms.
The success of renal transplantation for infants weighing less than 10 kg is very limited because of graft thrombosis. We report a successful living-related renal transplant in a 2-year-old girl weighing 9.5 kg. Chronic renal failure was diagnosed 1 month before the transplantation. Laparoscopic donor nephrectomy was performed to retrieve the left kidney of her father, a 36-year-old man weighing 70 kg, and the recipient operation was conducted via a right retroperitoneal approach. The right native kidney of the recipient was removed to accommodate the graft kidney during the transplant surgery. The graft renal artery, renal vein, and ureter were anastomosed to the recipient abdominal aorta, inferior vena cava, and bladder, respectively. The abdominal fascial defect was closed with absorbable mesh grafting, and the skin was closed primarily. With intensive fluid therapy and monitoring after reperfusion of the graft kidney, the patient recovered uneventfully and was discharged with an FK506-based immunosuppressive regimen 2 weeks after the operation. Renal function was good, and serum creatinine was 0.5 mg/dL 6 months after the operation.
Body Weight↗
Handport-assisted laparoscopic living-donor nephrectomy; initial experience in Taiwan.
The feasibility of handport-assisted laparoscopic living-donor nephrectomy in Taiwan was assessed by comparison with conventional open nephrectomy. Six serial patients undergoing laparoscopic living-donor nephrectomy (LLDN) were compared with six patients undergoing open donor nephrectomy. Body-mass index (BMI), operating time, hospital stay, and short-term graft function were assessed in both groups of patients. Handport-assisted LLDN was successfully attempted in all six patients. Mean ischemic time was 4.5 min in the laparoscopic group. There was no major complication in either group. Short-term graft function was good in all patients, except for one case of chronic rejection with mild azotemia in the open group. The length of stay was significantly longer in the open group, but the operation time of the laparoscopic group was much longer than that of the open group. There was no difference in the resumption of diet and in the use of narcotic analgesics in addition to patient-controlled analgesia. LLDN is a technically demanding approach. With handport assistance, the surgeons could shorten their learning curve. While initial graft function rates are equal to those of the open method, cosmesis and hospital stay are improved by the laparoscopic approach. Longer follow-up and larger patient numbers are needed to confirm these initial results in Taiwan.
Adult↗
Laparoscopic Heller myotomy with fundoplication for achalasia.
BACKGROUND AND PURPOSE: Laparoscopic Heller cardiomyotomy for the treatment of achalasia can be performed safely. The application of this minimally invasive approach has not been reported in Taiwan. This study assessed the results obtained using this new method in Taiwanese patients. METHODS: From January 1998 to December 2000, we recruited 10 patients (3 men, 7 women; average age 37.3 yr) with achalasia who underwent laparoscopic cardiomyotomy and fundoplication. Before and after surgery, the severity of three symptoms (dysphagia, regurgitation, chest pain) was evaluated by symptom scores (0 = symptom absent; 1 = occasional; 2 = every day; 3 = every meal). Barium swallow study and panendoscopy were performed in all patients. Esophageal manometry was performed before surgery in seven patients. Laparoscopic Heller myotomy and anterior (Dor) fundoplication was performed through five abdominal trocar sites. The myotomy extended 7 cm, 6 cm above and 1 cm below the gastroesophageal junction. RESULTS: Barium swallow study showed that one patient had a normal or mildly dilated esophagus (< 3 cm) and nine patients had moderate esophageal dilatation (3-7 cm). Mean operative time was 162.5 +/- 29.7 minutes. Mean hospital stay was 5.1 +/- 1.6 days (range, 3-9 d). The mean follow-up time was 21.3 +/- 9.4 months, longer than 19 months in eight patients. Dysphagia was alleviated in all but one patient (90%). Regurgitation and chest pain also improved in all patients. No intraoperative complication occurred. Postoperative weight gain (> 4 kg) was noted in all patients. CONCLUSIONS: Laparoscopic Heller myotomy and anterior fundoplication result in significant symptomatic relief for patients with achalasia.
Adolescent↗
Comparison of open and laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease in Taiwanese.
BACKGROUND AND PURPOSE: Laparoscopic antireflux surgery has recently been introduced as an alternative to laparotomy for the treatment of gastroesophageal reflux disease (GERD) at National Taiwan University Hospital. This study compared the results of traditional open and laparoscopic fundoplication for the treatment of GERD. MATERIALS AND METHODS: The surgical records and medical charts of 29 adult patients who were surgically treated for GERD between 1980 and 2001 were retrospectively reviewed. The clinical characteristics, indications for surgery, and surgical findings and procedures were analyzed. RESULTS: Laparotomy and Nissen fundoplication were carried out on 20 of the patients between 1985 and 2000. Laparoscopic Nissen or Toupet fundoplication was performed on nine patients between 1997 and 2001. Patients in the laparoscopic group were younger than those in the laparotomy group (46.7 +/- 15.9 vs 58.3 +/- 18.5 yr). The incidence of associated prominent hiatal hernia was significantly higher in the laparotomy group (60 vs 33%). The mean operation time was 164.5 +/- 25.5 minutes in the laparotomy group and 182.2 +/- 52.2 minutes in the laparoscopy group (p = 0.6129). The mean hospital stay in the laparotomy group was significantly longer than that in the laparoscopy group (8.7 vs 3.4 days). Postoperative complications included three ventral hernias and one ileus in the laparotomy group. Results were good or excellent in 78.9% (15/19) of patients undergoing laparotomy (one patient was lost to follow-up 2 months later), and in 77.7% (7/9) of those undergoing laparoscopy. Symptomatic and endoscopic recurrence was recorded in two patients in the laparotomy group and one in the laparoscopy group. CONCLUSION: Laparoscopic fundoplication is as effective as traditional laparotomy for treating GERD. More GERD patients in Taiwan, even the young and those without associated hiatal hernia, would rather undergo the less invasive and cosmetically better laparoscopic surgery than require medication throughout their lives.
Adult↗
Comparison of serum CA72-4, CEA, TPA, CA19-9 and CA125 levels in gastric cancer patients and correlation with recurrence.
BACKGROUND/AIMS: Serum tumor markers were investigated as prognostic factors for recurrence in patients with gastric cancers. METHODOLOGY: Preoperative serum levels of CEA, CA72-4, CA19-9, TPA and CA125 were sampled in 196 patients with gastric cancers undergoing curative surgery. The results were compared with the clinical recurrence and various clinicopathological factors. RESULTS: CA72-4, CEA, CA19-9, TPA and CA125 had sensitivities of 16.4%, 31.4%, 16.1%, 31.6%, and 6%, respectively. Sensitivity of two combinations was as high as 56.5%. Seventy-seven patients (39.9%) had clinical recurrence in the follow-up periods. For those with preoperatively elevated serum tumor markers, 38% (12/32) had CA72-4, 42% (13/31) had CA19-9, 48% (29/60) and had CEA, 54% (6/11) had CA125, and 62% (37/61) had TPA, and remained disease-free. Univariate analysis showed that TNM staging, Tumor size, Borrmann classification of tumor growth, and preoperative serum CA72-4 level were correlated with recurrence of disease. Multivariate analysis showed that independent prognostic factor of recurrence was TNM staging (P = 0.0007). CONCLUSIONS: Preoperative serum CA72-4 level is correlated with staging of disease, but is not an independent predictor for clinical recurrence of disease in patients with gastric cancers that undergo surgery.
Adult↗
Is imatinib justified as an adjuvant chemotherapy for patients with recurrent gastrointestinal stromal tumors.
Imatinib, an inhibitor of the tyrosine kinase activity of c-kit, was used as an adjuvant chemotherapy in two patients who underwent curative surgery for recurrent gastrointestinal stromal tumors. One patient has maintained tumor-free survival for 12 months, while the other had rapid recurrence and metastasis of tumors 3 months after he discontinued the drug. The indication and effects of imatinib for prevention of recurrence of GIST after ablative surgery were discussed.
Adult↗