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Biomedical subjects

K H Lam

Publications and source records attributed to K H Lam.

At least 109 records · Page 6Linked to original sources
PubMed1980

Surgical treatment of cervical lymph nodes in carcinoma of the tongue.

A series of 56 cases of carcinoma of the anterior two-thirds of the tongue treated surgically was reviewed. Lymph node metastasis occurred in 50% of cases. There was 22% false-negative clinical assessments of lymph node status for the ipsilateral side of the neck. Because of these and the difficulty in ensuring early treatment of subsequent node metastasis, concurrent ipsilateral radical neck dissection is recommended. When the ipsilateral side of the neck was involved the contralateral side has 22% false-negative assessments. Elective radical neck dissection for the contralateral side is recommended in this situation. The overall five-year survival was 50.6%, and was greatly affected by the status of the neck lymph nodes.

Carcinoma, Squamous Cell↗
PubMed1980

Surgical treatment of carcinoma of the hypopharynx and cervical oesophagus.

From 1964 to 1979 a total of 1,702 patients with carcinoma of the oesophagus were admitted into the University Department of Surgery, Queen Mary Hospital, Hong Kong. Among these the tumour was situated at the hypopharynx in 112 cases and at the cervical oesophagus in 36 cases. The treatment of choice for resectable tumours of these sites was pharyngo-laryngo-oesophagectomy (81 cases). Reconstruction with pharyngo-gastric anastomosis was preferred (76 cases). Other methods of reconstruction were indicated only when the stomach had been resected previously. Although the hospital mortality after pharyngo-laryngo-oesophagectomy was 31% this was the only means by which a long term survival could be achieved. Occasionally even when the trachea was infiltrated by tumour, salvage could be attempted by including the posterior wall of the trachea in the resection and repairing with an in-turned delto-pectoral flap. Although the actuarial survival of patients after pharyngo-laryngo-oesophagectomy was only 9%, all the patients who survived the operation were relieved of their distressing symptom of dysphagia.

Adult↗
PubMed1979

Chylothorax following resection of the oesophagus.

Chylothorax complicating operations on the oesophagus has been reported infrequently; it carries a mortality rate of about 50 per cent. A search of the literature has yielded only 10 cases. This paper reports 4 further cases which occurred among 685 resections of the oesophagus, giving an incidence of 0.6 per cent. The diagnosis should be confirmed with lymphangiography. Treatment should be early exploration and ligation in patients in whom the thoracic duct has been divided at operation. If the duct has been injured during blind dissection a period of conservative treatment is advisable. Parenteral nutrition is a useful adjunctive treatment.

Chylothorax↗
PubMed1979

Acute pancreatitis in Hong Kong.

A series of 311 Chinese patients with acute pancreatitis admitted to Queen Mary Hospital, Hong Kong, over a 10-year period is reviewed. Biliary tract disease was associated with pancreatitis in 52.4 per cent of patients and 77.9 per cent of them had stones, mud or parasites in the common bile duct. Fever and jaundice were present in 55 per cent and 41.2 per cent of patients respectively. Because of the prevalence of recurrent pyogenic cholangitis among the indigenous population, emergency operation, with the aim of common duct decompression, was conducted in 54.3 per cent of patients during the acute episode, with a mortality rate of 14.8 per cent. Five of 142 patients (3.5 per cent) died whilst on conservative treatment and all 5 had haemorrhagic pancreatitis. The overall mortality rate was 9.6 per cent. Exploration of the common bile duct, which was carried out in 57.4 per cent of patients in the acute phase, was not associated with a higher mortality than when laparotomy alone was performed, and 19 patients had sphincteroplasty without any death. Subtotal pancreatectomy was performed in 2 patients with haemorrhagic pancreatitis with 1 death.

Acute Disease↗
PubMed1979

Salvage operations for malignant obstruction of the oesophagus.

Two patients with locally advanced carcinoma of the oesophagus, who did not obtain palliation with radiotherapy, underwent salvage operations to restore their ability to swallow. One patient was subjected to pharyngolaryngo-oesophagectomy together with excision of the involved posterior tracheal wall. Reconstruction was by pharyngoglossogastrostomy, with a deltopectoral flap used to replace the tracheal defect. The second patient, who had cervical metastases and severe pulmonary complications, underwent a jejunal loop bypass operation. Both patients were able to eat normally before dying many months later from metastatic disease. Salvage operation should be considered for patients with primary tumours which appear to be slow-growing, even though locally advanced and free of widespread disease. Worthwhile palliation is obtained when the operation, either resection or bypass, has been successful.

Deglutition Disorders↗
PubMed1979

Acute suppurative cholecystitis: a retrospective study of 173 cases.

Over a 14-year period we treated 2,290 cases of non-malignant biliary tract conditions, and among them were 173 cases of acute suppurative cholecystitis, an incidence of 7.6%. A correct preoperative diagnosis of acute suppurative cholecystitis was made in only about half the cases because features of recurrent pyogenic cholangitis dominated the clinical picture on many occasions. The diagnosis was confirmed in all cases at operation. Cholecystectomy (88%) was performed whenever this was found to be safe, and cholecystostomy (12%) was carried out only in poor-risk patients or when operative difficulties were encountered. The overall mortality of operation was 5.8%. Old age, preoperative shock, delay of operation and the presence of free perforation affected the prognosis adversely.

Acute Disease↗
PubMed1979

The effects of experimental division of the vascular pedicle of a transposed subcutaneous ileal loop.

The effects of immediate division of the neurovascular pedicles of ileal loops implanted in the subcutaneous tissues for four weeks were studied in eight mongrel dogs. The structural and functional changes were studied by examining sections under light and electron microscopy and by comparing D-xylose absorption and motility patterns. Arteriograms were done to show the new subcutaneous collaterals supplying the loops. Of the eight dogs, four had loops showing normal histological appearances and D-xylose absorptive functions after division of the pedicles. In the remaining four dogs, the loops showed evidence of pseudomembranous changes in some areas, resulting in patching necrosis possibly due to inadequate collaterals. The absorption of D-xylose was impaired in these dogs. Perhaps a longer period of transposition and a gradual division of the vascular pedicle would improve the results. The motility pattern did not change after division of the pedicle, though the response to intravenous carbachol was significantly delayed.

Animals↗
PubMed1979

Primary sarcomas of the jaw.

Nine cases of primary sarcoma of the jaw seen over a period of 14 years are presented. They consisted of four osteosarcomas, three fibrosarcomas, one myxosarcoma and one Ewing's sarcoma. The treatment of choice for osteosarcomas of the mandible is hemimandibulectomy with disarticulation at the temporomandibular joint. Bone graft reconstruction from the iliac crest should be done at a second stage. Palliative maxillectomy for extensive fibrosarcoma of the maxilla served to relieve one patient of local symptoms for more than a year. Myxosarcoma, a variant of fibrosarcoma, and Ewing's sarcoma of the jaw, are very rare conditions, and since these lesions are usually very extensive radiotherapy is the treatment of choice.

Adolescent↗
PubMed1979

Gastric histology and function in patients with intrathoracic stomach replacement after esophagectomy.

The histological changes and gastric function alterations in 19 patients who had intrathoracic stomach replacement following esophagectomy were studied. Atrophic gastritis was noted in 13 of the 19 patients. The mechanical response of the stomach to distention by food was largely retained. The basal and maximal acid output was reduced markedly, and the serum gastrin was elevated. An association between the degree of gastritis, the percentage of gastric motility at rest, and acid secretion is demonstrated. These changes are consistent with patients with duodenal ulcer following vagotomy and dyloroplasty. Postprandial elevation in serum gastrin was noted in patients with or without vagotomy. The lack of significant difference in integrated gastrin response suggests that the vagus may not be important in the control of postprandial gastrin release.

Adult↗
PubMed1978

Changes in metabolism of major food components in patients with intrathoracic replacement of the oesophagus with the stomach.

In 19 patients in whom the stomach had been used as an intrathoracic replacement after osephagectomy the absorption of fat, carbohydrate and protein was studied. There is no single pattern of disturbance of such absorption. Protein digestion and absorption occur earlier and more rapidly than in normal subjects, probably as a result of accelerated gastric emptying.

Adult↗
PubMed1978

Unresectable malignant obstruction of the bile ducts.

Over a 13-year period we encountered 135 patients with malignant obstruction of the bile ducts, and in 81 of these patients only palliative surgery was possible. The type of operation was largely determined by the site and nature of the obstruction and the condition of the patient. The operative mortality of palliative operation was 37%. Relief of jaundice or pruritus was obtained in 68%, and this figure included a number of patients who died in the first 30 days. The majority of survivors lived for between three and four months after operation, although occasional patients have lived for more than one year.

Adenocarcinoma↗
PubMed1978

Factors influencing morbidity and mortality in esophageal carcinoma.

In 1977, 152 patients with carcinoma of the esophagus were admitted under our care. The lesions were located from the hypopharynx to the cardiac portion of the stomach. A prospective study was conducted and the results (mortality and morbidity) were analyzed by computer. Resection was possible in 88 patients and a bypass procedure in 15. On exploration in five patients, the disease was found to be so extensive that no further operative procedures were undertaken. The mortality rate was high, hospital deaths being included in the operative mortality statistics. The best results were obtained by applying the Lewis-Tanner one-stage esophagectomy. When the disease was extensive, a bypass procedure using the Kirschner operation and postoperative irradiation was the method of choice. When the general condition of the patient was poor, the best procedure was a staged esophagectomy, with the reconstruction being undertaken at a later date.

Adult↗
PubMed1975

Observations of pressure waves in stomach, jejunal, and colonic loops used to replace the esophagus.

The motility characteristics of the stomach, upper jejunum, and right colon were studied in 25 patients in whom these organs were used to replace the resected esophagus. The pattern of motility in all three replacement organs generally was similar to that recorded in normal individuals by other workers. But the stomach replacement showed a greater percentage of Type 1 waves, and Type II contractions were weaker. Activity in the jejunal replacements was much reduced. A propagated pressure wave was observed on swallowing water in the jejunal replacements. The nature of this wave needs further elucidation. The functional result was good, except in patients with a weak or without an upper esophageal sphincter. Patients experienced no pain during the test and no side effects were observed.

Colon↗
PubMedDate not supplied

Maxillary swing approach to the orbit.

A new surgical approach to the inferior half of the orbit is described and 2 cases are presented. The approach involves releasing the roof and the anterior wall of the maxillary antrum by osteotomies, keeping their blood supply via the attached masseter muscle, and swinging the osteoplastic flap away from the orbit. With the wide exposure gained, the retrobulbar tumor or large orbital floor tumor is dealt with, and the mobilized bone is replaced and wired into position. There is no postoperative disturbance of cosmetic appearance.

Adult↗
PubMedDate not supplied

New approach to the nasopharynx: the maxillary swing approach.

A new approach to expose the nasopharynx and the paranasopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopharyngeal space can be adequately resected and tubings for afterloading brachytherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment.

Adult↗
PubMedDate not supplied

Occult lymph node metastasis in small oral tongue cancers.

The need to treat the neck in patients with a small primary cancer in the tongue remains controversial. Twenty-eight patients with stage I or II oral tongue squamous carcinomas were retrospectively reviewed. They had not received previous treatment. The tongue primary was excised via the transoral route and the neck was observed closely during follow-up. Thirteen patients developed ipsilateral nodal metastases during follow-up, three of whom also had simultaneous recurrence at the primary site. An additional patient had recurrence at the primary site alone. The incidence of occult neck metastasis was 42% (10 of 24). No tumor-related death occurred in the group without nodal metastasis. The salvage rate after appearance of nodal metastasis was 30%. In oral tongue cancers, elective neck treatment should be considered regardless of a small primary and negative neck examination because of the high incidence of occult nodal metastasis and the poor outcome after salvage treatment.

Adult↗
PubMedDate not supplied

Squamous cell carcinoma of the hypopharynx--analysis of treatment results.

The results of surgical treatment and causes of failure in 109 patients with squamous cell carcinoma of the hypopharynx were analyzed. The 5-year survival was significantly related to the stage of the disease (stage I, 74%; stage II, 63%; stage III, 32%; and stage IV, 14%) and the preoperative nodal staging (N0, 57%; N1, 28%; N2, 6%; and N3, 0%), but not related to the extent of tumor resection. The local control rate was 86% and the majority of the local recurrences occurred at the upper resection margin. There was no significant difference in the local recurrence rate between those patients who had pharyngolaryngoesophagectomy and those who had pharyngolaryngectomy. However, the resection-associated complications (bleeding, cardiac arrhythmia, pulmonary complications) were more frequent when total esophagectomy was performed. Reconstruction-associated complications such as wound infection and anastomotic leakage occurred less often after gastric pull-up reconstruction as compared with the use of myocutaneous flap, but was associated with more serious outcome after pharyngo-gastric anastomosis. Thirty-seven patients (34%) had neck node recurrences and these were significantly related to the preoperative nodal staging (N0, 20%; N1, 37%; N2, 48%; and N3, 83%). Additional primary cancers occurred in 17% of the patients and was a significant cause of death in those patients who survived more than 2 years.

Adult↗