Biomedical subjects

Li-Heng Yang

Publications and source records attributed to Li-Heng Yang.

7 recordsLinked to original sources

PubMed2005

Synchronous parathyroid and papillary thyroid carcinoma.

Concomitant thyroid disease is not unusual among patients with primary hyperparathyroidism. However, the simultaneous occurrence of parathyroid and thyroid carcinoma is extremely rare. We report a 38-year-old man with primary hyperparathyroidism who presented with osteitis fibrosa cystica complicated with pathologic femoral neck fracture. Preoperative investigation for exclusion of multiple endocrine neoplasia did not find evidence of medullary thyroid carcinoma or pheochromocytoma, but imaging studies revealed the presence of nodules in the right lobe and a parathyroid lesion over the left inferior pole of the thyroid gland. Total thyroidectomy, left parathyroidectomy, and bipolar hemiarthroplasty of the left hip were then performed simultaneously. The resected specimens were pathologically identified as papillary thyroid carcinoma and parathyroid carcinoma, respectively. After the operation, 131I ablation therapy was administered at a dose of 120 mCi. Additional doses of 30 mCi were given yearly as serum thyroglobulin level became elevated. Serum calcium level remained normal during yearly follow-up. Although parathyroid carcinoma is an uncommon cause of parathyroid hormone-dependent hypercalcemia, it should nonetheless be given due consideration because its surgical approach differs from that of parathyroid adenoma. As the coexistence of parathyroid and non-medullary thyroid carcinoma has previously been reported, the possibility of both malignancies must also be considered in the setting of primary hyperparathyroidism with thyroid nodules. If confirmed with preoperative parathyroid scintigraphic and other laboratory studies, an optimal outcome may be achieved with complete resection of both tumors at the time of initial operation, followed by adjunctive therapy.

Adult↗

PubMedDate not supplied

Transparenchymal retraction maneuver: a simple technique in laparoscopic hepatectomy.

The performance of laparoscopic hepatectomy still presents technical problems. One of the main difficulties is the impossibility of directly grasping the liver during resection. To overcome this problem, we have begun using transparenchymal suture traction in laparoscopic hepatectomy. From January 2000 through August 2001, eight laparoscopic hepatectomies were performed using suture traction during parenchymal resection. The advantages of this technique include no leakage of pneumoperitoneum, no increased trocar hole, ability to repeat application to the liver from various directions, and better exposure of the transected line.

Hepatectomy↗

PubMedDate not supplied

Extrahepatic division of the right hepatic vein in right hepatectomy for blunt liver trauma.

During a 5-year period, 10 patients with right-side blunt liver injury received an anatomic liver resection, using the technique of extrahepatic right hepatic vein division before hepatectomy. Five patients required a right posterior sectionectomy and 5 patients needed a right hemihepatectomy. The mean operation time was 146 minutes and median perioperative blood transfusion was 21.5 units (range, 4-94 units, packed red blood cell (PRBC) or whole blood). There was one hospital mortality; the patient died from multiple organs failure on postoperative day 5. Postoperative complications occurred in 4 of 9 surviving patients. Liver-related morbidity occurred in 2 patients who required reoperation for evacuation of subphrenic hematoma. The median hospital stay was 17 days (range, 6-84 days). Application of extrahepatic division of the right hepatic vein during a right hepatectomy for blunt liver trauma has several advantages: compression of a traumatic liver during mobilization; shortening of the ischemia duration; complete mobilization of the liver before parenchymal resection; and prevention of oozing with easier approximation of the raw surface.

Adolescent↗

PubMedDate not supplied

An easier technique for minimally invasive video-assisted thyroidectomy.

Because of the efforts of many pioneer surgeons, the minimally invasive video-assisted thyroidectomy (MIVAT) has been recognized as a safe procedure, offering advantages such as better cosmetic outcome and less analgesic need. The MIVAT technique was described in 51 selected patients in 2001. The technique was not therefore widely used because of the excess operating time compared with traditional thyroidectomy, and most importantly, this method needed a steep learning period. This study reports a modified MIVAT procedure, which can make this operation easier and shorten the time of learning. We compared the outcomes of the originally described methods with our modified method. The selection criteria for performing MIVAT were as follows: thyroid nodules in one lobe and less than 50 mm on their largest diameter, benign lesion proved by fine-needle biopsy, patient without history of thyroiditis, and no previous neck surgery or irradiation. All patients received lobectomy. Sixty patients were eligible for MIVAT during a period of 27 months. The patients were divided into two groups. Group A consisted of the 17 patients who underwent MIVAT using the original technique that was described previously. Group B consisted of the 43 patients who underwent MIVAT using a self-designed Army retractor with a mosaic ring. The mean operation time of Group A was 120 minutes and that of Group B was 59.2 minutes. The size of the incisions was no difference in either group. There were no postoperative complications except in one patient with transient recurrent laryngeal nerve palsy in Group A. There was one conversion to open thyroidectomy in Group A and none in Group B. The cosmetic results were no different between the two groups. In conclusion, the use of a modified Army retractor with a mosaic ring made the MIVAT procedure easier and offered similar advantages.

Adolescent↗

PubMedDate not supplied

Pseudomyxoma peritonei, origin from appendix: report of cases with images.

This report demonstrates the cases of a 47-year-old housewife, a 54-year-old female, and an 80-year-old woman in whom pseudomyxoma peritonei was found accidentally during surgery. Pseudomyxoma peritonei is a rare disease. No effective treatment is known. Modern treatments include radical surgical excision with appendicectomy and oophorectomy in women and adjuvant hyperthermic intraperitoneal and systemic chemotherapy. Major causes of morbidity and mortality are bowel obstruction and biliary obstruction. Five-year survival rate, depending on whether the disease is benign or malignant, is about 53-75%. Median survival is about 2 years under surgical management.

Aged↗

PubMedDate not supplied

A 10-year experience of unsuspected gallbladder cancer after laparoscopic cholecystectomy.

Unsuspected gallbladder cancer after laparoscopic cholecystectomy (LC) is a cancer that was previously manipulated by laparoscopic technique. The reported incidence was 0.3-1% and became an emerging problem as the popularity of LC increased. Lack of reliable data could address the outcome of reresection or nonreresection patients and the standard management. This study reviewed a single center experience in managing unsuspected gallbladder cancer patients after LC between July 1, 1992 and July 1, 2000 who had at least 2 years of follow-up. There were 11 patients (0.6%) postoperatively diagnosed with gallbladder cancer after 1825 LCs. Group A included three patients (28%) with nontransmural invasion, group B included four patients (36%) who had transmural invasion without secondary surgical intervention, and group C included four patients (36%) with reresection. The perioperation parameters and strategies were collected and compared. A review of the literature was performed simultaneously, and we concluded that unsuspected gallbladder cancer with nontransmural invasion needs no further treatment; however, aggressive reresection is beneficial to transmural invasion cancer, and prevention of bile spillage during LC should be the goal of every surgeon.

Adult↗

PubMedDate not supplied

Anatomic resection for severe blunt liver trauma.

Despite recent advances in management of severe blunt liver trauma, the operative mortality rate in patients with complicated blunt liver trauma (grades IV and V) is still high. The purpose of this study was to assess the results of anatomic liver resection for severe liver trauma in the institution in which liver transplant surgeons are responsible for the management of liver injuries.

Adolescent↗