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Biomedical subjects

J W Leung

Publications and source records attributed to J W Leung.

At least 19 recordsLinked to original sources
PubMed1995

Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial.

One hundred consecutive patients with acute suppurative cholangitis were randomized in a prospective, controlled clinical trial to receive either ciprofloxacin (200 mg bd iv) or triple therapy comprising ceftazidime (1 g bd iv), ampicillin (500 mg qds iv) and metronidazole (500 mg tds iv); 46 and 44 patients in the ciprofloxacin and triple therapy groups respectively were suitable for inclusion in the analysis of efficacy. In two-thirds of the patients biliary obstruction was caused by ductal calculi and in one-third by malignant or benign strictures of the biliary tract. Bacteraemia was documented in 38% of patients in the ciprofloxacin group and in 34% of patients in the triple therapy group, while bile cultures were positive in 87% and 92% of patients in the ciprofloxacin and triple therapy groups respectively. Escherichia coli, Klebsiella spp. and Enterococcus spp. were the most common biliary isolates. Eighty-five per cent of evaluable patients in the ciprofloxacin group and 77% of those in the triple therapy group responded to therapy. The mean durations of fever, septicaemic shock and hospitalization were also similar in the two treatment groups. Six (13%) patients in the ciprofloxacin group and seven (16%) in the triple therapy group required urgent endoscopy or surgery for uncontrolled infection. Recurrence of fever after an initial response was documented in one (2%) patient receiving ciprofloxacin and in three (7%) patients receiving triple therapy. The incidences of mortality were 4% in the ciprofloxacin group and 2% in the triple therapy group. The results of this study suggest that ciprofloxacin alone is adequate empirical therapy for patients with cholangitis.

Acute Disease↗
PubMed1994

Palliation of malignant oesophageal obstruction by endoscopic alcohol injection.

Thirty six-patients with inoperable cancers of the oesophagus or gastric tumour in the cardia were treated by endoscopic alcohol injection. After dilatation using Savary dilators, absolute alcohol was injected in 0.5-1 ml aliquots into protuberant parts using a sclerotherapy needle. The mean volume per session was 7.8 ml. The mean dysphagia score improved from 2.7 before treatment to 1.4 after treatment (p < 0.001). Complications included mediastinitis in one patient and tracheo-oesophageal fistulas in two patients. The mean duration of palliation before the development of recurrent dysphagia was 35 days. The mean survival was 82 days. Endoscopic alcohol injection is effective in relieving malignant dysphagia. This inexpensive and easily available technique merits comparative studies with more established forms of therapy, such as laser photocoagulation.

Adenocarcinoma↗
PubMed1992

Randomised controlled trial of short term treatment to eradicate Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE: To determine whether one week's drug treatment is sufficient to eradicate Helicobacter pylori in patients with duodenal ulcer. DESIGN: Single blind, randomised controlled trial. SETTING: Specialised ulcer clinic in a teaching hospital. PATIENTS: 155 patients with H pylori and a duodenal ulcer verified endoscopically which had either bled within the previous 24 hours or was causing dyspepsia. INTERVENTIONS: Patients were allocated randomly to receive either omeprazole for four weeks plus bismuth 120 mg, tetracycline 500 mg, and metronidazole 400 mg (all four times a day) for the first week (n = 78), or omeprazole alone for four weeks (n = 77). Further endoscopy was performed four weeks after cessation of all drugs. MAIN OUTCOME MEASURES: Presence or absence of H pylori (by urease testing, microscopy, and culture of antral biopsy specimens), duodenal ulcer, and side effects. RESULTS: Eradication of H pylori occurred in 70 (95%) patients taking the four drugs (95% confidence interval 86% to 97%) compared with three (4%) patients taking omeprazole alone (1% to 11%). Duodenal ulcers were found in four (5%) patients taking the four drugs (2% to 12%) and in 16 (22%) patients taking omeprazole alone (14% to 32%). Mild dizziness was the only reported side effect (six patients in each group) and did not affect compliance. CONCLUSIONS: A one week regimen of bismuth, tetracycline, and metronidazole is safe and effective in eradicating H pylori and reduces the number of duodenal ulcers four weeks after completing treatment.

Bismuth↗
PubMed1992

Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: a preliminary report.

An anomalous elongated pancreaticobiliary common channel encourages reflux up both the biliary tree and the pancreatic ductal system, resulting in progressive choledochal dilatation, cholangitis with ductal calculi, relapsing pancreatitis and malignant change. Transduodenal sphincteroplasty has been used to improve drainage from the abnormal channel. The use of endoscopic sphincterotomy (ES) to establish drainage and minimize the surgical risks is reported in six symptomatic patients with mild choledochal dilatation (common bile duct diameter less than 15 mm), a common channel less than 15 mm in length and a distal stenosis. This was successful in five patients, who have no further symptoms. ES failed in the only patient with an undilated common channel and this patient went on to have open surgery. We believe ES to be safe and effective in the treatment of selected cases of long common channel.

Bile Ducts↗
PubMed1992

Effect of biliary obstruction on the hepatic excretion of imipenem-cilastatin.

The biliary excretion of imipenem-cilastatin studied by endoscopic cannulation of the common bile duct in patients with complete obstruction and in a group without obstruction showed that despite a 24-h prophylaxis, the bile obtained from patients with obstruction immediately after cannulation contained neither imipenem nor cilastatin, while there were 2 and 5% of peak concentrations in serum for imipenem and cilastatin, respectively, in the bile from patients without obstruction. Biliary excretion of both compounds increased rapidly after decompression, reaching a maximum of 15% of peak levels in serum within 2 h. Twenty-four hours after drainage, the biliary excretion of the drugs further improved. We conclude that since biliary obstruction impairs excretion of antibiotics, drainage is necessary for the control of sepsis in obstructed cholangitis.

Adult↗
PubMed1992

Lugol's iodine dye-enhanced endoscopy in patients with cancer of the oesophagus and head and neck.

Lugol's iodine dye indicates the presence of unsuspected early oesophageal cancers during endoscopy at which such cancers fail to show the characteristic black colour change. We evaluated Lugol's iodine dye-enhanced endoscopy in 17 patients with oesophageal cancer. In a further 37 patients with head and neck cancer we examined the use of Lugol's iodine since these patients have a 29% risk of synchronous oesophageal cancer. The oesophagus was sprayed with Lugol's iodine (1.5%) during endoscopy. Any areas not turning black were biopsied. In 13 patients with oesophageal cancer discrete areas beyond the macroscopically obvious primary tumour showed no change in colour. Biopsy revealed cancer in all cases. Six synchronous cancers were found in the head and neck group, one of which was identified only by the use of Lugol's iodine. Lugol's iodine augmented the information gained about the oesophageal mucosa during endoscopy. It revealed unsuspected cancer which altered the management of patients with primary oesophageal cancer as well as those with head and neck cancer. We recommend the routine use of Lugol's iodine-enhanced endoscopy for surveillance of all 'at risk' oesophageal cases.

Adult↗
PubMed1992

Common bile duct stones: a cause of chronic salmonellosis.

A chronic carrier state of Salmonella spp is present in 0.15% of the population, and is believed to be related to the presence of a diseased gallbladder. We present a patient with common bile duct (CBD) stones, whose bile cultures repeatedly indicated Salmonella typhi, despite an adequate course of antibiotic treatment. The carrier state was abolished after removal of the CBD stones 4 months later. The chronic carrier state may be related to biofilm formation on the surface of the CBD stones. The removal of the biliary stones, which are the most likely reservoir for Salmonella spp, may be a crucial step in eradication of the carrier state.

Aged↗
PubMed1991

Mechanical lithotripsy of large common bile duct stones using a basket.

Experience with the Olympus basket mechanical lithotriptor (BML-1Q) in crushing large common bile duct stones before their endoscopic removal is reported. From January 1988 to January 1990, 68 patients with common duct stones too large to be extracted by Dormia baskets or balloon catheters after sphincterotomy were treated with the BML system. The largest stones in each patient ranged from 1.0 to 4.9 cm in diameter. Fifty-seven patients required one session of lithotripsy, ten patients two sessions and one patient three sessions; 26 patients required further endoscopic extraction of stone fragments after successful lithotripsy. The stones were successfully crushed by the BML system and the ducts cleared in 55 patients (81 per cent). In 13 patients mechanical lithotripsy failed because the stones could not be engaged in the lithotriptor basket. In one patient the stone was crushed with the Soehendra lithotriptor, six patients were successfully managed by electrohydraulic lithotripsy through a 'mother and baby' endoscope, indwelling stents were inserted in four patients and two patients underwent surgery.

Adult↗
PubMed1991

Demonstration of transient bacterobilia by foreign body implantation in feline biliary tract.

The biliary tract of cats is known to be free of autochthonous bacteria above the sphincter of Oddi. In this experiment we investigated whether transient bacterobilia occurs in the biliary system under normal conditions. Polyethylene tubes and human cholesterol stones were implanted surgically into the gallbladder of cats. Sham cholecystostomy was performed as control operation. These cats were euthanized at two, six, and 12 weeks, and the implants were removed, cultured, and studied by scanning electron microscopy (SEM). Cultures and SEM also were undertaken for material scraped from the mucosal surface of the biliary tract from these animals. Colonization of bacteria on the polyethylene tubes and the gallstones was found six and 12 weeks after implantation. Adherent bacterial biofilms were demonstrated on the surfaces of these implants. This experiment showed that transient bacterobilia exists in the feline biliary tract. The foreign body implants have facilitated the adhesion of planktonic bacteria in the bile onto their surfaces and have initiated the formation of adherent biofilms within which these bacteria persisted until the system was sampled.

Acinetobacter↗
PubMed1991

Injection or heat probe for bleeding ulcer.

A prospective randomized trial was performed to compare the efficacy of endoscopic epinephrine injection and heat probe treatment in actively bleeding peptic ulcers. Emergency endoscopy in 1758 patients over an 18-month period identified 132 patients with active ulcer bleeding. They were randomized to receive either endoscopic epinephrine injection or heat probe treatment. After endoscopy, the patients were transferred to the surgical gastroenterology ward and were managed by surgeons unaware of the treatment option. Bleeding was initially controlled in 96% by epinephrine injection and in 83% by heat probe (P less than 0.05). There was no significant difference in outcome as measured by transfusion requirement (4.5 units vs. 3.8 units), emergency surgery (20% vs. 22%), hospital stay (8 days vs. 7 days), and mortality (2 vs. 4) between the injection group and the heat probe group. Two patients in the heat probe group experienced perforation. We conclude that both endoscopic epinephrine injection and heat probe treatment are effective in stopping bleeding from actively bleeding ulcers. Epinephrine injection is technically easier to perform and has a higher initial success rate.

Adolescent↗
PubMed1991

Bacterial invasion of the biliary system by way of the portal-venous system.

It has been suggested that bacteria in the intestine gain access into the biliary tract by entering the portal-venous blood. We have tested the hypothesis of hematogenous infection of the biliary system in cats. The animals were treated in three different groups: group A (no biliary obstruction), group B (acute biliary obstruction) and group C (chronic biliary obstruction). A mutant strain of Escherichia coli was infused into the splenic vein of cats at three different dosages (10(7), 10(5) and 10(3) with sham controls. In the unobstructed biliary system, the mutant E. coli was isolated from the bile 30 min and 90 min after the infusion of 10(7) and 10(5) E. coli, respectively. No bacteria were found in the bile with the infusion of 10(3) E. coli and in the control animals. Bile flow was significantly reduced with the infusion of bacteria. The biliary excretion of E. coli in group B was similar to that in group A. In group C, the bile output in the first hour was very high but declined rapidly. E. coli was excreted into the bile at all three dosages of infusion after 30 min. Histological sections of the liver showed that the infused bacteria entered the sinusoidal blood and that some were phagocytosed by Kupffer cells. The portal-venous blood was considered an important route of bacterial invasion into the biliary system, and the penetration of bacteria was facilitated in biliary obstruction.

Acute Disease↗
PubMed1991

Endoscopic nasobiliary catheter drainage in biliary and pancreatic disease.

Nasobiliary catheter drainage was first introduced a decade ago. It provides drainage of the biliary system and facilitates interventional procedures of the biliary and pancreatic system, both for therapy and research purposes. The present review addresses the designs of nasobiliary catheters, the technique of insertion, and indications for drainage, with special emphasis on the management of bile duct stones and associated complications. Its potential application in biliary research is discussed further. Certain caveats in the performance of nasobiliary drainage are also included. All of these emphasize the need for this technique to be included in therapeutic endoscopy training.

Biliary Tract Diseases↗
PubMed1990

Bile duct size after cholecystectomy: an endoscopic retrograde cholangiopancreatographic study.

Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 43 patients before and 4-14 months after cholecystectomy. All patients had a normal common bile duct and were asymptomatic after the operation. Preoperative and postoperative films of adequate quality were available for scrutiny in 35 patients. The largest mean(s.d.) diameter of the common duct, after correcting for magnification, was 0.96(0.27) cm before cholecystectomy and 1.16(0.29) cm after surgery (P less than 0.0001). Thirty-one of the 35 patients showed increased duct size after cholecystectomy, and the difference was 1 mm or more in 26 patients. There was a positive correlation between the increase in bile duct size and the time interval after cholecystectomy. After cholecystectomy a small but significant increase in bile duct diameter is demonstrable on ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗