Biomedical subjects

K S Ho

Publications and source records attributed to K S Ho.

At least 19 recordsLinked to original sources

PubMed2006

Prospective randomized trial comparing stapled hemorrhoidopexy versus closed Ferguson hemorrhoidectomy.

BACKGROUND: Ferguson hemorrhoidectomy is believed to result in less postoperative pain because of a closed wound. Stapled hemorrhoidopexy, without a perianal wound, should thus have lesser pain. We conducted a prospective randomized trial to compare stapled hemorrhoidopexy (SH) with Ferguson hemorrhoidectomy (FH). METHODS: Fifty patients with third-degree or early fourthdegree hemorrhoids who required surgery were recruited. Patients were prospectively randomized to receive either FH or SH. Data collected include operative time, hospital stay, fecal incontinence and pain scores, morbidity and complications. RESULTS: SH patients had less pain in the early postoperative period. There were no significant differences in hospital stay or major complications. One patient after SH required emergency reintervention for thrombosed hemorrhoids distal to the staple line. FH patients had more minor problems of bleeding, wound discharge and pruritus. Fecal incontinence was similar in the 2 groups but two of the three patients with daily incontinence to gas after SH claimed that their lifestyle was affected. CONCLUSIONS: SH is safe to perform and results in less postoperative pain as well as less minor morbidity. Early reintervention and incontinence to gas compromising lifestyle occurred only after SH.

Anastomosis, Surgical↗

PubMed2006

Prospective randomized crossover trial comparing fibre with lactulose in the treatment of idiopathic chronic constipation.

BACKGROUND: Fibre is often recommended as the first-choice treatment but its effects can be uneven. The aim of the study was to compare the clinical efficacy and tolerability of fibre versus lactulose in outpatients with chronic constipation. METHODS: In a prospective randomized crossover trial, patients were randomized to receive fibre or lactulose for four weeks. Between treatments, patients had at least one week free of laxatives. RESULTS: 50 patients, of median age 50 years (range, 18-85) were recruited and 39 patients completed the trial. Compared to fibre, lactulose resulted in significantly higher mean bowel frequency (7.3, 95% CI 5.7 to 8.9 vs. 5.5, 95% CI 4.4 to 6.5; p=0.001) and stool consistency score (3.4, 95% CI 3.1 to 3.7 vs. 2.9, 95% CI 2.5 to 3.3; p=0.018). Scores for ease of evacuation were similar. The frequencies of adverse effects were not significantly different, but greater in the lactulose group. Mean patients' recorded improvement score was significantly higher after taking lactulose than fibre (6.2, 95% CI 5.5 to 7.0 vs. 4.8, 95% CI 4.0 to 5.9; p=0.017). Of the 39 patients who completed the trial, 24 (61.5%) preferred lactulose and 14 (35.9%) preferred fibre. CONCLUSIONS: Lactulose had better efficacy than fibre for chronic constipation in ambulant patients, although both treatments were equally well tolerated in terms of adverse effects.

Adolescent↗

PubMed2006

PPH03 stapled hemorrhoidopexy: our experience.

BACKGROUND: Stapled hemorrhoidopexy is an established treatment for hemorrhoidal disease. We evaluated our experience with stapled hemorrhoidopexy using the new Procedure for Prolapse and Hemorrhoids (PPH03) Proximate HCS hemorrhoidal circular stapler (Ethicon Endo-Surgery). METHODS: We retrospectively reviewed clinical data for 238 patients who had undergone stapled hemorrhoidopexy in our department over a 2-month period. Patients were followed-up for a median of 3.5 weeks (range, 1-11 weeks) and were analyzed for complications and resolution of symptoms. RESULTS: The hemorrhoids treated were third- and fourth-degree, as well as second degree (after failure of other therapies). Mean duration of surgery was 12.7 minutes (range, 5-20 minutes) and the majority of patients was treated with an ambulatory procedure. Most patients were discharged within 6 hours after surgery. On follow-up, 3.7% of patients had minor complaints after surgery. Technically, the new PPH03 stapler device has a quickclose knob, which allows rapid opening and closing. The closed staple height of 0.75 mm increases staple line compression on tissue and key blood vessels, hence minimizing bleeding. Prior to this, stapled hemorrhoidopexy was done using the PPH01 device. CONCLUSIONS: Stapled hemorrhoidopexy using the new PPH03 stapler is a safe, short and effective procedure in the management of hemorrhoids. It can be done in the ambulatory setting and patients have few postoperative complications.

Adolescent↗

PubMed2005

Controlled, randomized trial of island flap anoplasty for treatment of trans-sphincteric fistula-in-ano: early results.

Treatment of trans-sphincteric fistula is usually a compromise between recurrence and incontinence. Dermal island flap anoplasty has been found to be useful in the treatment of these fistulas. We performed a randomized trial to compare dermal island flap anoplasty with conventional treatment for trans-sphincteric fistula-in-ano. Seventy nine patients with fistula-in-ano were recruited; twenty patients with trans-sphincteric fistula confirmed by endoanal ultrasound were prospectively randomized to receive either dermal island flap anoplasty (IFA) or conventional treatment (CVN) for trans-sphincteric fistula-inano. Conventional treatment consisted of lay open fistulotomy or seton insertion if deemed unsuitable for fistulotomy. Dermal island flap anoplasty involved a cutaneous advancement flap into the rectum. Pain scores, fecal incontinence scores, operative complications, wound healing and recurrence rates were charted. Two patients in the CVN group required seton insertions, which were still intact at the 9-month follow-up. Two patients with similar high trans-sphincteric fistula in the IFA group avoided having a long-term seton. There were no differences in the postoperative pain score, incontinence score, complications, wound healing and recurrence rates between the two groups. IFA is a safe and useful method for treating transsphincteric fistula. It can be considered when a suprasphincteric extension is suspected, thus avoiding risk of incontinence or the discomfort of a long-term seton.

Adult↗

PubMed2005

Successful resuscitation after carbon dioxide embolism during laparoscopic-assisted abdomino-perineal resection.

We report a 67-year-old woman who underwent laparoscopic-assisted abdomino-perineal resection for rectal carcinoma. She sustained hypotension of 40/20 mmHg associated with bradycardia (heart rate 30 to 45 beats per minute) and an end-tidal carbon dioxide level of zero when she was raised to a head-up position at the end of surgery to facilitate pelvic irrigation. Pulmonary air embolism was confirmed by aspiration of 15 millilitres of foamy blood from her central venous line. Resuscitation was successful and she recovered completely with no neurological deficits.

Aged↗

PubMed2005

Epidemiological study of diabetic retinopathy in a primary care setting in Hong Kong.

OBJECTIVES: To estimate the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients, and to investigate the difference in retinopathy progression in patients with normal fundi or established retinopathy at baseline and the risk factors implicated in the progression. DESIGN: Retrospective community-based study. SETTING: Ten primary care clinics in Hong Kong. PATIENTS: Type 2 diabetic patients; subsidiary analysis included subjects with more than one screening event. MAIN OUTCOME MEASURES: Patient demographics, baseline prevalence, and risk factors of diabetic retinopathy; progression of retinopathy in patients with normal fundi and established retinopathy at baseline, and the associated risk factors. RESULTS: A total of 6165 patients were recruited from January 1998 to May 2004. Primary analysis included 4423 patients with good-quality retinal photographs. The mean age of the patients was 60.36 years (standard deviation, 10.80 years; range, 28-94 years), the mean duration of diabetes was 4.71 years (standard deviation, 4.67 years; range, 0.1-40.6 years), and the mean level of glycated haemoglobin was 7.47% (standard deviation, 1.44%). The prevalence of retinopathy at baseline was 28.4%. Subsidiary analysis showed progression to sight-threatening retinopathy was more common in the group with baseline retinopathy than that without (7.9% vs 0.7%), and occurred at a faster rate (mean, 1.5 [range, 0.5-3.0] vs 2.0 [1.0-4.2] years). Logistic regression revealed that the level of glycated haemoglobin was positively associated with both the onset (P<0.001) and progression of retinopathy (P=0.03). CONCLUSION: Optimal glycaemic control is important for reducing sight-threatening retinopathy. Close observation is required for patients with established retinopathy as progression occurs more rapidly.

Adult↗

PubMed2004

Dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection for rectal tumour.

AIM: To review the results of dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection (APR) for rectal cancer. PATIENTS AND METHODS: Chart reviews were done on 17 patients who had dynamic graciloplasty following abdominoperineal resection and details of post-operative complications, bowel functions and recurrences were obtained. RESULTS: Seventeen patients (12 males) had dynamic graciloplasty after APR for low rectal tumours. The median age was 58.5 years (range 33-78). Three patients from overseas were lost to follow-up, and three still have not had the defunctioning stoma closed. Only 11 patients were available for evaluation of function. The median time from graciloplasty to continence to solids and liquids is 15.7 months (range 0.4-21.9 months). Six patients had defecatory problems, requiring daily irrigation to evacuate. Nine patients were continent without need for gracilis stimulation. Only two patients needed gracilis stimulation to maintain continence. Fifty percent of rectal carcinoma patients had developed a recurrence. CONCLUSION: Dynamic graciloplasty had a high morbidity and did not always bring about normal defecatory function. Gracilis stimulation was not needed to achieve continence in all cases. Conversely, dynamic graciloplasty may lead to defecatory difficulties in a large number of patients. Graciloplasty should only be considered three years after the initial APR to avoid performing the procedure in a patient who may develop recurrence as well as to select patients who are psychologically prepared for the surgery and its complications.

Adult↗

PubMed2004

Smoking and depressive symptoms in Chinese elderly in Hong Kong.

OBJECTIVE: To examine the association between smoking and depressive symptoms among Chinese elderly in Hong Kong. METHOD: Cross-sectional data on smoking and depressive symptoms from 56,167 Chinese elderly aged 65 or over in Hong Kong were analysed using logistic regression. RESULTS: Current smokers and former smokers were more likely to have depressive symptoms than never smokers. The adjusted odds ratios (OR) and 95% confidence interval (CI) in males and females respectively were 1.62 (1.34-1.96) and 1.43 (1.20-1.70) for current smokers, and were 1.18 (0.99-1.40) and 1.29 (1.12-1.47) for former smokers. Former smokers were less likely to have depressive symptoms than current smokers (OR = 0.80, 95% CI: 0.70-0.92). CONCLUSION: Smoking is positively associated with depressive symptoms in Chinese elderly. Health care workers should be vigilant about the detection of depressive symptoms in elderly smokers.

Aged↗

PubMed2002

Modified Longo's hemorrhoidectomy.

The Longo technique of stapled hemorrhoidectomy is rapidly gaining world-wide acceptance. However, hemorrhoids with large external components are often left with troublesome skin tags after the Longo technique. In this article we present modifications to the Longo technique that make it easier to perform and provide adequate treatment of hemorrhoids that have a significant external component or skin tags.

Digestive System Surgical Procedures↗

PubMed2001

Prospective randomised trial comparing ayurvedic cutting seton and fistulotomy for low fistula-in-ano.

The aim of this study was to evaluate the role of ayurvedic setons in the treatment of low fistula-in-ano. One hundred and eight patients were randomised into either conventional fistulotomy (F) or ayurvedic cutting seton insertion (C). Endpoints investigated included time to wound healing and complications of surgery. Post-operative pain scores were measured daily using a visual analog scale. Anal function was compared using a continence score. Pre- and postoperative manometry and ultrasound were also performed. After exclusions, there were 54 patients in group F and 46 in group C. There were no differences in age, sex or follow-up duration between the two groups. Healing time was similar between the groups. Group C reported more pain following operation and on the first 2-4 postoperative days, but both groups experienced the same amount of pain subsequently. In conclusion, chemical seton was more painful than conventional fistulotomy in the first few days following surgery. However, there was no difference in time to wound healing, complications or functional outcome.

Adolescent↗

PubMed2001

Endoscopic hemoclip treatment of gastrointestinal bleeding.

BACKGROUND: Endoscopic hemostasis of gastrointestinal (GI) bleeding is a widely accepted modality of treatment, and endoscopic hemoclipping has been reported to cause fewer complications. METHODS: Forty patients with gastrointestinal bleeding (active bleeding or non-bleeding visible vessel), 30 men and 10 women with a mean age of 59.1 +/- 14.4 (28-86) years were treated with endoscopic hemoclipping. After panendoscopy or colonoscopy, a local epinephrine injection was routinely given in the initial 20 cases, followed by hemoclipping. For the latter 20 cases, local epinephrine was given only to those with active bleeding. If there was adherent blood clot, irrigation with 3% H2O2, and removal of the blood clot with forceps or basket were done. Six cases with bleeding at technically difficult locations were managed with a new method; a transparent cap (Olympus EMRC) fitted with a 2-channel endoscope for hemoclipping. RESULTS: There were 35 patients with peptic ulcer, 2 with post endoscopic papillotomy bleeding, 1 with duodenal Dieulafoy's lesion, 1 with Mallory Weiss syndrome, and 1 with rectal ulcer. The types of bleeding were spurting in 7, oozing in 12, and non-bleeding visible vessel in 21 cases. The average number of clips used was 3.1 +/- 1.7 (1-9) and the average clip loss was 0.6 +/- 0.9 (0-4) per patient. The success rate for hemostasis using the transparent cap-fitted endoscope was 100% and the overall success rate was 85% with no complications related to the procedure. CONCLUSION: Endoscopic hemoclip treatment for GI bleeding is safe and effective. The transparent cap-fitted endoscope is a new method for hemoclipping in technically difficult lesions.

Adult↗

PubMed2001

Hemoclip-assisted endoscopic polypectomy of large superior duodenal angle polyp using a needle knife.

Endoscopic polypectomy of a large polyp can be difficult due to inability to snare the polyp. The difficulty may increase when the polyp is located at turning corner of the bowel. We presented a case of a 3 cm-sized large pedunculated polyp located at the superior duodenal angle that was not amenable to conventional snare polypectomy, but was instead successfully resected by hemoclip-assisted and needle knife method. Such experience has not been reported in the English literature.

Aged↗

PubMed2000

Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia versus general anaesthesia.

BACKGROUND: Application of a topical anaesthetic agent may facilitate infiltration of local anaesthetic at haemorrhoidectomy. METHODS: A randomized clinical trial of 53 consecutive patients requiring elective haemorrhoidectomy was carried out. One group underwent haemorrhoidectomy under general anaesthesia, while the second group had topical anaesthetic cream (containing lignocaine and prilocaine) applied followed by local anaesthetic infiltration for surgical anaesthesia. RESULTS: There were no differences between the two groups in terms of operating time, postoperative pain, nausea or vomiting, pain-free interval after operation, analgesic requirements or patients' satisfaction with the method of anaesthesia. Postoperative oxygen saturation and pulse rate were similar in the two groups. CONCLUSION: Topical anaesthetic and local anaesthesia can be used effectively for haemorrhoidectomy and provide an alternative to general anaesthesia.

Adult↗

PubMed2000

Case reports: the use of intermaxillary screws to achieve intermaxillary fixation in the treatment of mandibular fractures.

INTRODUCTION: Treatment of mandibular fractures commonly involves the use of arch bars in temporary maxillo-mandibular fixation (also called intermaxillary fixation) to aid bone plating, for the postoperative application of light elastic traction to correct minor occlusal discrepancies and intermaxillary fixation for post reduction immobilisation. The purpose of this paper is to describe a quick and simple alternative for intermaxillary fixation. CLINICAL PICTURE: Three cases of mandibular fractures are presented to demonstrate the use of intermaxillary screws instead of conventional arch-bar wiring. TREATMENT: Two cases were treated with closed reduction methods while the other case was treated with open reduction. OUTCOME: Subsequent fracture healing was not compromised using this technique. CONCLUSIONS: With careful case selection, successful treatment outcome may be achieved using this time-saving and technically simple procedure. Some of the advantages and disadvantages of the intermaxillary screws are discussed.

Adult↗

PubMed1999

ERCP in post-Billroth II gastrectomy patients: emphasis on technique.

OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) in post-Billroth II (BII) gastrectomy is more difficult due to anatomical changes. The difficulties include entrance to the afferent loop and selective cannulation. Our aim here is to report the success rate and special manipulations and techniques of this procedure. METHODS: A retrospective review of 56 ERCP procedures in post-BII gastrectomy patients was performed. There were 43 male and 13 female patients with a mean age of 63 yr (range, 32-78 yr). All cases were tried with forward-viewing endoscope first. Of the failed cases, 10 were retried by side-view duodenoscope. The entrance to the afferent loop was attempted by starting from the upper opening at the anastomosis site and, if this failed, then using the lower opening; presence of bile; and air-contrasted afferent loop under fluoroscopy. If failure of afferent loop entrance resulted, hand compression over the mid-abdomen, or polypectomy snare in the working channel of the endoscope, was tried. For failure of common bile duct cannulation with straight catheters, techniques of pushing the catheter against the duodenal wall and bending the tip of the endoscope or guidewire were used. RESULTS: The success rate of afferent loop entrance was 76.7% (43 of 56 cases). The afferent loop was identified in the upper orifice of the anastomosis in 93% (40 of 43) of the cases. Eight cases of afferent loop entrance could be facilitated by hand compression, and three by polypectomy snare in the working channel of the endoscope. The success rate of ERCP cannulation in those successful afferent loop intubation cases was 81.3% (35/43 cases). Most of the selective common bile duct (CBD) cannulation was achieved by straight (new) catheter and an additional six cases were successful using the techniques mentioned. No serious complications were encountered, except three cases of submucosal hemorrhage. CONCLUSION: The overall success rate of BII ERCP was 62.5% (35 of 56 cases). The special manipulations mentioned in BII ERCP can be helpful in certain cases.

Adult↗

PubMed1999

Diagnosing and managing faecal incontinence.

The aim of this review was to consolidate the impact of recent advances in investigation technology on the clinical diagnostic workup for faecal incontinence. A literature search was made with emphasis on the recent 15 years. The advent of imaging techniques, particularly endoanal ultrasound has improved the understanding of anal incontinence. Of particular significance was the much higher incidence of anal sphincter injuries after childbirth, than previously suspected. Also important was the clarification of the entity of primary degeneration of the internal anal sphincter. Although endoanal ultrasound provides clear images of anal sphincter defects to guide surgery, some of these defects may be false positive findings especially for the inexperienced. Thus, anal manometry is still required to correlate imaging with functional impairment. Recent data have questioned the correlation of poor surgical outcome after sphincter repair with pudendal nerve dysfunction. Although poor pudendal function is no longer considered a contraindication for surgery, longer term follow-up studies have shown that the late results are poorer probably due to other factors such as poorer tissue associated with nerve dysfunction. Furthermore, new treatment modalities such as the electrostimulated gracilloplasty, artificial anal sphincter, sacral nerve modulation and autologous fat injection into the anal mucosa will require detailed precise diagnosis of faecal incontinence such that the most suitable technique may be successfully employed.

Anal Canal↗

PubMed1998

Dietary intervention for cholesterol reduction in public clinic patients.

OBJECTIVES: To test the feasibility and effectiveness of a diet intervention (consisting of interactive mailings, computer-generated phone calls, and classes) in hypercholesterolemic low-income public clinic patients. METHODS: Clinic patients with serum cholesterol > 200 mg/dl, referred by their primary care physician were randomized to a 6-month special intervention (SI) or usual care (UC). The intervention included mailings, computer phone calls, and four 1-hour classes. Serum total cholesterol (TC) was measured before and after intervention, and participation was monitored. RESULTS: One hundred sixty-five of the 212 patients referred (77.8%) agreed to participate. A medical records review revealed 123 (74.5%) met eligibility criteria. Eligible subjects had a mean age of 56.7 years, 80.0% were African American, 74.8% were female, 33.6% were married, and 89.4% had a high school or lower education. Subjects were randomized with 80.5% (99) completing follow-up cholesterol measures. SI subjects were encouraged to use all three components, with 84.6% (55 of 65) actively participating in at least one component. Seventy-two percent (47 of 65) returned at least one mailing, 49.1% (28 of 57) of those with touch-tone phones accessed the computer system, and 43.1% (28 of 65) attended classes. The TC in SI decreased from 273.2 mg/dl to 265.0 mg/dl (P = 0.05) and in UC 272.4 mg/dl to 267.6 mg/dl (P = 0.32). The net reduction in SI compared with UC was 3.4 mg/dl (P = 0.58). CONCLUSIONS: (1) Low-income public clinic patients will participate in diet interventions, (2) computer-generated interactive phone calls are feasible in this population, and (3) clinically meaningful decreases in serum cholesterol are difficult to achieve with interventions of practical intensity.

Analysis of Variance↗

PubMed1998

Comparison of marginal sealing ability of new generation bonding systems.

The purpose of this in vitro study was to evaluate the enamel and dentine marginal sealing ability of four new generation composite bonding systems. Two Class V preparations, which were solely in enamel and dentine/cementum, were made on the buccal surfaces of 96 freshly extracted molar teeth. The teeth were randomly divided into four groups of 24 and restored with composite resin (Silux Plus) utilizing the following bonding systems: Scotchbond Multi-purpose (SB), Fuji Bond LC (FB), Prime & Bond 2.0 (PB) and Bisco One-step (BC). The restorations were finished immediately after photo-polymerization and stored in saline at 37 degrees C for 1 week. Half of the specimens in each group were then thermally stressed for 500 cycles. All restorations were then subjected to dye penetration testing, sectioned and scored. Results revealed no statistically significant difference (P < 0.05) in dye penetration scores for the different bonding systems with the exception of leakage at the dentine margins of thermally stressed specimens where FB exhibited significantly better sealing ability compared with the other bonding systems and BC exhibited significantly less leakage than PB. The marginal seal of 'one-step' (PB and BC) and resin-modified glass-ionomer (FB) bonding systems appear to be as effective as 'two step' systems like SB. Thermal stresses had some influence on marginal seal but this was both product and tissue specific.

Bisphenol A-Glycidyl Methacrylate↗