Biomedical subjects

Kuan-Long Hsu

Publications and source records attributed to Kuan-Long Hsu.

4 recordsLinked to original sources

PubMed2005

Laparoscopic fenestration of symptomatic liver cysts.

The purpose of this clinical study was to evaluate the usefulness of laparoscopic fenestration of symptomatic liver cysts. Between September 1996 and September 2001, 6 patients underwent laparoscopic fenestration for symptomatic hepatic cysts. All 6 patients were women. The mean age was 59.5 (range 40-74). Two patients had single and 4 had multiple cysts. The mean diameter of the lesions, measured by preoperative computed tomography (CT), was 16.8 cm (range 10-20). The indications for surgical treatment included abdominal fullness associated with pain or dyspepsia. The surgical procedure involved puncture and aspiration of the cyst and subsequent circular electroresection of the cystic wall. Laparoscopic fenestration was successfully done in all 6 patients. The operating time was 148 minutes (range 110-215). Mean blood loss was 93 mL (range 5-300). Histologic examination of the cyst wall showed 5 simple cysts and 1 papillary serous cystadenoma. There were no intraoperative or postoperative complications. The mean hospital stay after surgery was 4.3 days (range 3-5). Complete relief of symptoms was achieved in 5 patients during the postoperative follow-up (range 2-6 years, mean 4). Follow-up CT (1 month to 4 years) has shown regression of the cysts in all patients (mean 3.8 cm, range 2-8). Laparoscopic fenestration of symptomatic liver cysts is a simple and effective method to relieve symptoms with minimal surgical trauma.

Adult↗

PubMed2003

Spermatogenesis after parathyroidectomy in patients with symptomatic secondary hyperparathyroidism.

BACKGROUND: The changes in spermatogenesis after parathyroidectomy in patients with symptomatic secondary hyperparathyroidism have not been reported before. STUDY DESIGN: Nineteen men with symptomatic secondary hyperparathyrodism were enrolled in our study. Their ages ranged from 29 to 50 years and duration of dialysis from 72 to 168 months. Before operation, serum levels of calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone were checked routinely in association with semen analysis. Those data were checked again 3 months after successful operation. Finally, 15 patients had total parathyroidectomy with subcutaneous autotransplantation of 60 or 90 mg of tissue and complete postoperative data was available for 13 patients. The semen analysis included sperm density, volume of semen, motility index, percentage of active motility, and percentage of normal morphology. RESULTS: Ten patients had normal sperm density (> or =20 x 10(6)/mL), and nine patients had oligospermia (<20 x 10(6)/mL) (n = 4) or azoospermia (n = 5). The ages of patients, duration of dialysis, and weight of removed parathyroid glands were quite similar between the two groups. The serum levels of calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone were not significantly different between the group with normospermia and the group with oligospermia or azoospermia. Three months after total parathyroidectomy with autotransplantation, the serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were markedly decreased; the percentage of active motility and motility index were markedly improved; the serum levels of prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone had no significant changes; and the volume of semen, sperm density, and percentage of normal morphology had no significant improvements. One patient, who had oligospermia with primary infertility, had paternity 6 months after parathyroidectomy, though his oligospermia remained unchanged at that time. CONCLUSION: After parathyroidectomy, the sperm motility index and percentage of active motility can be improved. We speculate that increases in fertilization and paternity in uremic male patients can be expected after surgery.

Adult↗

PubMed2003

Neurorrhaphy of the recurrent laryngeal nerve.

BACKGROUND: It has been controversial to anastomose the severed recurrent laryngeal nerve after transection because when severed recurrent nerves are directly anastomosed, the vocal cords do not regain normal movements and are fixed in the median. The objective of this study was to learn whether direct neurorrhaphy is necessary if the recurrent laryngeal nerve is severed during thyroid or parathyroid surgery. STUDY DESIGN: From 1998 to 2001, 12 patients who had a complete recurrent laryngeal nerve injury during thyroid or parathyroid surgery were enrolled into this study. Eight had primary repair of the nerve; four did not have repair because of cancer invasion. Patients were followed with laryngoscopic or laryngovideostroboscopic examination at 3 months and 6 months postoperatively. Subjective ratings of aspiration and voice quality were based on patient reports. Perceptual voice quality was rated according to grade, roughness, breathiness, asthenia, and strain (GRBAS) scales. If a patient's voice quality, aspiration, and GRBAS scales did not improve at 6 months postoperatively, medialization laryngoplasty was considered. RESULTS: Eight patients with immediate repair showed improved voice quality, aspiration, GRBAS scales, and maximum phonation time at 6 months after surgery. A significant decrease of glottal gap was also noted in patients with neurorrhaphy but not in four patients without neurorrhaphy. Medialization laryngoplasty was performed in all four patients without neurorrhaphy in the followup period. Immobilization of the vocal cord was noted in all of them, but only one in the neurorrhaphy group had an atrophy of the cord; all four patients without neurorrhaphy had atrophy. CONCLUSIONS: Neurorrhaphy of the recurrent laryngeal nerve is a simple and effective procedure to improve voice quality, aspiration, GRBAS scales, glottal gap, and maximum phonation time by preventing atrophy of the vocal cord.

Adult↗

PubMedDate not supplied

Massive hemobilia.

BACKGROUND/AIMS: Massive hemobilia is a relatively rare, but potentially life-threatening cause of upper gastrointestinal hemorrhage. We report our experiences in the treatment of 15 cases of massive hemobilia with different underlying pathologies. METHODOLOGY: Massive hemobilia is defined as a patient with blood discharge from the biliary tree and requiring whole blood transfusion for at least 4 u (1 u = 250 cc). Fifteen such patients were collected during an 8.5-year period (from January 1986 to July 1994), and the clinical courses of these patients were retrospectively reviewed. RESULTS: Among these 15 patients, 11 were males and 4 were females. Age distribution was from 33 to 78 years old. Mean age was 59.7 years. The cause of hemobilia included: percutaneous transhepatic biliary drainage in 7 patients, surgical trauma in 3, choledochoscopic extraction of biliary calculi in 1, pancreatic cancer in 1, radiotherapy for cholangiocarcinoma in 1, after operation for biliary lithiasis in 1, and rupture of the pseudoaneurysm in 1. In 11 patients, hemobilia was first noted by bleeding from percutaneous transhepatic biliary drainage tube (n = 10) or T-tube (n = 1). Three patients had hemobilia during choledocholithotomy. The other one was diagnosed by choledochoscopy. Treatment included pitressin infusion from angiographic catheter in one patient, transarterial embolization in 1, hepatic artery ligation in 1, hepatic artery ligation and transarterial embolization in 1, choledochotomy or choledocholithotomy in 2, and blood transfusion only in 9. Two of the four mortality cases had underlying malignancy. CONCLUSIONS: The most common cause of massive hemobilia was percutaneous transhepatic biliary drainage procedures. Eight cases were successfully treated with blood transfusion only. Transarterial embolization, hepatic artery ligation and open drainage were effective non-surgical and surgical procedures, but the former two procedures might not be successful if sudden and severe hemobilia developed, or when an aberrant hepatic artery existed. Main hepatic artery had better been isolated before removal of the percutaneous transhepatic biliary drainage tube during operation.

Adult↗