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Biomedical subjects

J F Fang

Publications and source records attributed to J F Fang.

33 records · Page 2Linked to original sources
PubMed1998

Periaortic hematoma on helical CT of the chest: a criterion for predicting blunt traumatic aortic rupture.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of helical CT of the chest for predicting blunt traumatic aortic ruptures when periaortic hematoma is used as a positive criterion. CONCLUSION: We recommend the use of periaortic hematoma as a criterion for predicting traumatic aortic ruptures on CT because this criterion is sensitive and can reduce the false-positive rate of CT interpretations.

Adult↗
PubMed1998

Malakoplakia of the mesocolon with gastric serosa invasion: a case report and review of the literature.

Malakoplakia is a rare, granulomatous, inflammatory disease. The clinical presentation and radiological appearance of the malakoplakia mimics a malignant tumor. In this article we describe a case of the malakoplakia of the mesocolon with invasion into the serosa of the stomach. The frozen section report considered the lesion to be a malignancy. The definitive diagnosis depended on microscopic detection of Michaelis-Gutmann bodies by electronic microscope. We review the current literature about the malakoplakia of gastrointestinal tract, and focus on the pathogenesis, clinical manifestation, diagnosis and treatment.

Adult↗
PubMed1998

Traumatic thoracic aortic injury caused by a sharp edge of left fractured rib on body position change: case report.

Aortic injury caused by penetration of a fractured rib is very rare. We present a patient with aortic injury demonstrated using serial imaging studies. A 66-year-old woman fell from a ladder and sustained multiple left-side rib fractures. There was a small left hemothorax and widened mediastinum on the initial chest roentgenogram in the emergency department. Chest computed tomography (CT) revealed a posterior segmental fracture of the sixth rib on the left side with a sharp edge penetrating into the posterior aspect of the thoracic aorta. It was initially missed. More than 1000 cc of fresh blood suddenly gushed out of the chest tube 7 hours after the traumatic event. After resuscitation, an aortogram was performed which showed blood extravasation from the thoracic aorta at the rib fracture site. Unfortunately, surgical intervention was delayed and she died. Early detection and early surgical intervention are necessary in patients with a widened mediastinum and positive results on imaging studies.

Aged↗
PubMed1997

Isolated common iliac artery occlusion secondary to atherosclerotic plaque rupture from blunt abdominal trauma: case report and review of the literature.

Traumatic isolated common iliac artery occlusion is unusual. Only rare cases of common iliac arterial injuries resulting from blunt abdominal trauma have been reported, and most of them were attributed to the seat-belt syndrome and associated with visceral organ perforation or pelvic fracture. We reported an unusual isolated common iliac artery occlusion secondary to atherosclerotic plaque rupture from blunt abdominal compressive trauma without other visceral injury. This case presented with acute limb ischemia and paralysis that was successfully treated by thromboendarterectomy. The symptoms and signs, surgical modalities, and associated injuries were reported and the literature was also reviewed.

Arterial Occlusive Diseases↗
PubMed1996

Spontaneous rupture of left external iliac vein: case report and review of the literature.

Iliac vein rupture is rare and primarily results from major trauma or occurs during pelvic surgery. Spontaneous nontraumatic rupture is even more unusual, with only 14 cases reported in the literature. We report an additional case, summarize all of the cases, and discuss the possible causes and treatment of iliac vein rupture and the role of anticoagulants in postoperative management.

Aged↗
PubMed1995

Surgical management of juxtahepatic venous injuries in blunt hepatic trauma.

The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.

Adolescent↗
PubMed1995

[Diagnosis of intraperitoneal injuries in patients with pelvic fractures].

It is difficult to diagnose blunt abdominal trauma in unstable patients with pelvic fractures. In the United States the standard diagnostic procedures for these patients were the physical examinations and diagnostic peritoneal lavages. However, abdominal echograms were prevalent in Europe and Japan. We reviewed 60 patients suspected blunt abdominal trauma in 804 pelvic fractures in the past four years. Eighteen DPLs and twenty-five abdominal echograms were done separately. Sensitivity, specificity, and accuracy were 100%, 40%, 66% for DPL and 94.7%, 50%, 84% for abdominal echograms respectively. Besides the better correlation with the results for echogram, it provides easy availability, noninvasiveness, and imaging function. Thus we recommend that the echogram be the first-line screening test DPL acts as a complementary test, especially in the cases of bowel perforation.

Abdominal Injuries↗
PubMed1995

Factors that influence the operative mortality after blunt hepatic injuries.

OBJECTIVE: To analyse causes of death and possible factors that influenced the operative mortality in patients with blunt hepatic injuries. DESIGN: Retrospective case study. SETTING: Medical center, Taiwan. PATIENTS: 109 adult patients with blunt hepatic injuries were treated surgically over the four year period from September 1987 to August 1991. MAIN OUTCOME MEASURE: Mortality. RESULTS: 36 patients (33%) had hepatorrhaphy or no repair, complex repairs were done for 73 patients (67%) and the overall mortality was 22% (24/109). Of those deaths, however, 4 were not liver-related, giving us a liver-related mortality of 19% (20/105). Fourteen of the liver-related deaths occurred within 24 hours of injury of hemorrhagic shock or coagulopathy. Six occurred after 24 hours of sepsis and multiple system organ failure. Multivariate analysis showed that higher initial aspartate aminotransferase (AST) and Injury Severity Score as well as increasing operative blood loss resulted in a worsening prognosis. CONCLUSION: The initial AST activity and Injury Severity Score as well as the total operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Prompt, expeditious, and appropriate surgical management to control operative loss is the only way for the surgeon to reduce the mortality of blunt hepatic injuries.

Adolescent↗
PubMed1994

Rupture of the diaphragm after blunt trauma.

OBJECTIVE: To analyse our cases of acute rupture of the diaphragm after blunt trauma to find out how to diagnose it earlier and manage it more promptly in future. DESIGN: Retrospective study of casenotes. SETTING: Division of general surgery, district hospital, Taiwan. PATIENTS: 50 Patients who presented with acute rupture of the diaphragm after blunt trauma during the 10 year period 1982-91. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The left hemidiaphragm was injured in 43 cases (86%), and the right in 7 (14%). The most common cause was road traffic accidents. 48 Patients had associated injuries, mainly to the chest and abdomen, and pelvic fractures. 44 Ruptured diaphragms were diagnosed before operation by chest radiography or upper gastrointestinal contrast examination. The transabdominal approach was the most appropriate, because 23 patients had intra-abdominal visceral injuries as well. 20 Patients (40%) had complications, and the rate was 33% among those treated within 24 hours and 70% among those whose treatment was delayed longer than 24 hours (p = 0.067). There were 3 deaths (6%); one patient died of empyema of the right chest as a result of simultaneous perforation of a hollow viscus. 6 Patients were permanently disabled by head and spinal injuries, and pelvic fractures. CONCLUSION: The prognosis of repairing diaphragmatic hernias is good as the disability rate is low. The diagnosis should be kept in mind in all patients with chest injuries, pelvic fractures, or abdominal injuries with hypoxaemia, as this will result in earlier treatment and improve prognosis. The transabdominal approach is the most appropriate because it makes simultaneous abdominal injuries easier to treat. Correct operative management at an early stage will keep mortality to a minimum.

Adolescent↗
PubMed1994

Perforated intestinal lymphoma in post-renal transplantation--a case report.

This is a case report of a 39-year-old male. Sudden onset of abdominal pain occurred 5 months after a successful cadaveric renal transplant. The immunousuppressants chosen were cyclosporin-A, prednisolone and azathioprine. A small bowel perforation was noted 100cm proximal to ileocecal area during emergent laparotomy. Mesentery lymphadenopathy was also noted. Segmental resection with end-to-end anastomosis was done. The pathology revealed a diffuse mixed small and large cell malignant lymphoma. The postoperative course was smooth and one course of acyclovir therapy was given 2 months after the emergency procedure. From this case and literature review, we know posttransplant lymphoma of the small intestine is very rare, but it should be considered in every posttransplant victim with abdominal symptoms.

Adult↗
PubMed1992

Octreotide in the management of postoperative enterocutaneous fistulas and stress ulcer bleeding.

We report two clinical experiences in the treatment of postoperative enterocutaneous fistula and stress ulcer bleeding with octreotide acetate (Sandostatin). In both patients, upper gastrointestinal bleeding occurred 7 days after operation, and the bleeding proved to be stress ulceration, by panendoscopic examination. Enterocutaneous fistulas also were found in both patients. One was high output (750 ml/day), and the other was low output (50 ml/day). Octreotide 50-100 micrograms was given subcutaneously every 8 h. After three doses of octreotide, a significant reduction in fistula output and control of the stress ulcer bleeding were noted. The fistulas closed promptly after nine doses of octreotide, but the first patient's fistula recurred 2 days later, with fluid losses of about 100-200 ml/day. This fistula closed spontaneously 1 month after discharge. Octreotide appears to be useful as an adjunct to the conventional treatment of enterocutaneous fistulas, especially those complicated by stress ulcer bleeding.

Aged↗
PubMed1989

[The treatment of esophagojejunal anastomotic stricture after total gastrectomy].

From December 1983 through December 1988, 200 cases of total gastrectomy were performed in Chang Gung Memorial Hospital. The esophagojejunostomy was performed with EEA staplers in 196 cases, and with hand suture in 4 cases. Twelve cases developed anastomotic stricture after the operation. All of these 12 anastomoses were done with EEA 28 mm staplers. Four of the 12 patients received no further treatment either because the symptoms were mild or because of development of carcinomatosis. Six patients received endoscopic YAG laser treatment, only 2 had good results. Four Patients received balloon dilatation, 2 of them had good results, 4 patients received surgical intervention after failure of the balloon dilatation or YAG laser treatment. Of the 4 patients who underwent surgery, the thoracoabdominal approach was used in 3, and a thoracotomy in 1. Three patients received side to side esophagojejunostomy to bypass the stricture site. In the remaining patient, stricture was excised and a new end to end anastomosis was done with hand sutures. All of these 4 patients had good results after the operation. There are many possible mechanisms of the development of anastomotic stricture. Anastomotic leakage, technical error, lack of mucosa-to-mucosa apposition, size of the EEA stapler and tissue ischemia all have been regarded as the possible causes of anastomotic stricture. Once the esophagojejunal anastomosis stricture occurs, treatment should be done to relieve dysphagia. From the results of our patients, endoscopic YAG laser is not a satisfactory treatment for anastomotic stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Toxicity assessments of chemical substances using primary culture of rat hepatocytes].

A primary hepatocyte culture was used as a model system to assess the toxicity of various chemical substances. Chemical substances tested in this experiment included 14 kinds of organic solvents, arsenic acid and N-nitrosodiumethylamine, most of which are known as hepatotoxic materials. Enzyme (GPT and LDH) leakage and albumin secreted from the hepatocytes to culture medium were measured to evaluate the cell damage after exposure to the chemical substances at various concentrations for 3 d. Cell counts and protein contents before and after exposure to the chemical substances were also measured during the course of these experiments. The extent of LDH leakage from hepatocytes was parallel to that of GPT leakage after exposure to the chemicals. Albumin secreted from the hepatocytes in the culture medium evidently decreased at concentrations of the chemicals which increased the enzyme leakage. Viable cell counts were significantly decreased by chemicals that increased the enzyme leakage, although the cell protein contents were not significantly affected. The minimum concentration of the chemicals at which enzyme leakage from hepatocytes was significantly increased was defined as the lowest toxic concentration (TCL0). Judging from TCL0 values, the degree of toxicity in these chemicals seems to be almost identical to the degree of in vivo hepatotoxicity reported previously. We, furthermore, observed that there is a positive correlation (r = 0.780, p less than 0.01) between PT50 calculated by the LD50 value reported previously and -Log magnitude of TCL0.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine Transaminase↗
PubMedDate not supplied

Preparation and evaluation of a hyaluronate-collagen film for preventing post-surgical adhesion.

Post-surgical adhesion occurs when fibrous strands of scar tissue form, leading to the abnormal joining of anatomical structures. Patients undergoing abdominal surgery are at risk of the complications associated with intraperitoneal adhesions. Hyaluronic acid (HA) is a biocompatible, biodegradable and non-toxic natural polymer, which is gaining popularity as a barrier agent for preventing post-surgical adhesions. As HA is water-soluble and rapidly degraded in vivo, chemical modification is required to produce a non-soluble sheet that might be used to prevent tissue adhesion. We developed a range of biocompatible cross-linked HA-collagen composites and then evaluated them in a rat model of post-surgical adhesion. The results showed that cross-linked HA-collagen was almost totally resistant to hyaluronidase digestion. HA-collagen membranes induced minimal tissue reactions and were bioresorbed within 14 days post-surgery. These results suggest that cross-linked HA-collagen membrane may be a valuable anti-adhesion material to prevent post-surgical intraperitoneal adhesion.

Collagen↗