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Biomedical subjects

S M Sheen-Chen

Publications and source records attributed to S M Sheen-Chen.

At least 19 recordsLinked to original sources
PubMed1995

Postoperative T-tube cholangiography: is routine antibiotic prophylaxis necessary? A prospective, controlled study.

OBJECTIVE: To determine the value of antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography. DESIGN: A prospective, controlled study. SETTING: A tertiary care center. STUDY PARTICIPANTS: The role of antibiotic prophylaxis during postoperative T-tube cholangiography was prospectively evaluated in 164 patients. INTERVENTION: Sixty-two patients were administered antibiotic prophylaxis treatment (1 g of cephalothin sodium was infused intravenously 30 minutes before the procedure and 500 mg of cephalexin was given orally every 6 hours for 3 days after the procedure). Seventy-one patients were in the control group and did not receive antibiotic therapy. MAIN OUTCOME MEASURES: Complications and adverse reactions following postoperative T-tube cholangiography were recorded and compared between the two groups. RESULTS: There was no significant difference between the groups in regard to age, sex, serum amylase level before T-tube cholangiography, white blood cell count, and liver function. The results of the bacteriologic culture specimens of the bile were also comparable between the groups. One patient who had received antibiotic therapy and one patient in the control group had fever (temperature, > 38 degrees C) and chills after the procedure. Two patients who had received antibiotic therapy and one patient in the control group had mild abdominal pain. These complications were treated conservatively without any event. No significant difference was found in the rates of complications and the success of postoperative T-tube cholangiography between the groups. CONCLUSION: Routine antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography is not necessary under selected conditions.

Bacterial Infections↗
PubMed1995

The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess.

OBJECTIVES: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non-gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. MAIN OUTCOME MEASURES: A chi 2 test for qualitative data and Student's test for quantitative data. RESULTS: Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6 +/- 10 days) (P < .005) and the incidence of septic shock was higher in the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P < .01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (> 5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non-gas-forming group (27.7% vs 14.4%) (P < .01). CONCLUSIONS: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.

Adult↗
PubMed1995

Intraoperative choledochoscopic electrohydraulic lithotripsy for difficulty retrieved impacted common bile duct stones.

BACKGROUND: A difficultly retrieved, impacted distal common bile duct stone is sometimes encountered during supraduodenal common bile duct exploration. Transduodenal sphincteroplasty is usually performed when such stones cannot be retrieved by conventional methods, but not without risk. OBJECTIVES: To achieve clearance of such complicated stones and to avoid the potential risks of transduodenal sphincteroplasty. DESIGN: Prospective clinical trial. SETTING: Medical college-affiliated hospital and tertiary care center. PATIENTS: From July 1991 to April 1993, 10 patients met the following inclusion criteria: (1) an impacted distal common bile duct stone found during supraduodenal common bile duct exploration and (2) failure of conventional methods such as stone forceps, a basket, flushing with normal saline solution, or a Fogarty catheter to retrieve stones via the supraduodenal choledochotomy. Another 10 patients with the same problem, treated with transduodenal sphincteroplasty from February 1989 to May 1991, were used as a comparison group. INTERVENTION: Intraoperative choledochoscopic electrohydraulic lithotripsy was applied with continuous visualization through a choledochoscope. MAIN OUTCOME MEASURES: Effectiveness of stone fragmentation and possible complications. RESULTS: Stones were fragmented and successfully removed by a basket and flushing with normal saline solution. Mild oozing was noted in one patient, but soon stopped spontaneously. The mean operative time of the clinical trial group was significantly shorter (P = .004) than that of the comparison group; the mean postoperative stay was 4 days shorter. The complication rate of the clinical trial group (10%) was lower than that of the comparison group (40%). The 10 successfully treated patients of the clinical trial group remain well, with a mean follow-up of 22 months. CONCLUSION: Intraoperative choledochoscopic electrohydraulic lithotripsy is a safe and effective method for removal of impacted distal common bile duct stones.

Adult↗
PubMed1995

Prognostic factors of resectable intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma is a rare disease. The prognostic factors of resectable cholangiocarcinoma have not been previously reported. Nineteen patients (10M, 9F) with resectable cholangiocarcinoma were investigated to find factors that might influence prognosis. The cumulative survival rate was measured using the Kaplan-Meier method. The log-rank test was used to compare two survivals. Age, sex, tumor size, and positive tissue carcinoembryonic antigen were factors that had no influence on prognosis. Patients with a positive HLA-DR, a well-differentiated carcinoma, and a clear resective margin had better prognoses but were statistically undifferentiatable from the other patients. Patients with positive hilar lymph nodes had poor prognoses (P < 0.01), whereas patients with positive mucobilia had good prognoses (P < 0.05). Positive staining for HLA-DR on tumor cells was observed in nine of 19 cases of intrahepatic cholangiocarcinoma. The positive HLA-DR staining correlated with a better prognosis, but no significant difference was noted between the positive and negative HLA-DR staining group. A positive hilar lymph node was a grave sign, as almost all patients of positive lymph node died within 9 months after operation. Positive mucobilia was a good prognostic sign that correlated with the long-term survival.

Bile Duct Neoplasms↗
PubMed1995

Tuberculosis presenting as a solitary splenic tumour.

A 48-year-old male had suffered from body weight loss and general malaise for 2 months. Abdominal computed tomography showed a dilated intrahepatic duct with stones and a hypodense nodular mass in the spleen. A splenectomy and distal pancreatectomy were performed under the preoperative impression of a malignancy. Histological examination of the specimens revealed tuberculosis.

Diagnosis, Differential↗
PubMed1995

Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism.

BACKGROUND: Primary hyperparathyroidism today is diagnosed in the asymptomatic phase because of the inclusion of serum calcium in sequential multichannel analysis. The purpose of present study was to test for neuromuscular abnormalities in asymptomatic patients and to test the improvement of neuromuscular performance after parathyroidectomy. METHODS: Nine patients with primary hyperparathyroidism and nine patients with nodular goiter were enrolled in this study. Neuromuscular recovery including muscle power, sensation, and fine motor movement was studied before operation and 1 week and 4 weeks after operation. The muscle power was measured as grip power, palm pinch, lateral pinch, and three-chuck pinch. The sensation was measured as touch sensation and two-point discrimination. The fine motor movement was measured with the Purdue Pegboard Test and the Minnesota Manual Dexterity Test. RESULTS: Four weeks after the operation the patients with hyperparathyroidism had increased their muscle strength and had improved fine motor movement but no change was noted in two-point and touch sensation. When the postoperative muscle recovery was compared, there was a reversible correlation (r = -0.62; p < 0.05) with the preoperative muscle strength and no correlation with the preoperative serum calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone levels. No such improvement was detectable among the control subjects. CONCLUSIONS: Surgery can improve muscle strength and fine motor movement but does not affect sensation in asymptomatic patients.

Adult↗
PubMed1995

Ductal dilatation and stenting make routine hepatectomy unnecessary for left hepatolithiasis with intrahepatic biliary stricture.

BACKGROUND: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture. METHODS: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledochoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered. RESULTS: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months. CONCLUSIONS: Postoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.

Adult↗
PubMed1995

Rupture of pyogenic liver abscess.

OBJECTIVE: Our objective was to study the clinical manifestations, course, treatment, and results obtained in 23 patients with ruptured pyogenic liver abscess and compare these findings with those of nonruptured cases. METHODS: Four hundred twenty-four patients with clinical diagnoses of pyogenic liver abscess were enrolled in the study. Among these, 23 patients had ruptured pyogenic liver abscess. The clinical manifestations, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, etiology of abscess, and results of the treatment were recorded. Qualitative data were analyzed by chi 2 test, and quantitative data were analyzed by Student's t test. RESULTS: Except for abdominal pain and septic shock, other symptoms, such as fever, chills, and jaundice, were similar in ruptured and nonruptured groups. Laboratory findings indicated that the group with ruptured liver abscess had higher levels of bilirubin, blood glucose, and aspartate aminotransferase than the non-ruptured group. Of the patients with ruptured abscess, 14 (60.9%) had diabetes mellitus and 15 (65.2%) were cryptogenic. Klebsiella pneumoniae was the bacteria most often isolated in both blood cultures and liver aspirates. Surgical intervention--draining the abscess and cleaning the abdominal cavity--was the only means of saving the patients' lives. The overall mortality rate was higher in this group (43.5%) than in the nonruptured group (15.5%). CONCLUSIONS: Ruptured pyogenic liver abscess should be suspected if septic shock and diffuse abdominal pain are found in a patient with pyogenic liver abscess, concurrent with high levels of bilirubin, aspartate aminotransferase, and blood glucose. Surgery is the only treatment for this condition.

Female↗
PubMed1994

Adjuvant chemotherapy for resectable gastric cancer: a preliminary report.

In this prospectively random study, the effect of oral Ftorafur as an adjuvant chemotherapy was compared with that of oral placebo in patients with Stage II and Stage III gastric cancer. Patients had undergone a subtotal gastrectomy with a resection margin that should have been free of tumors. Ftorafur (10 mg/kg) was given daily to 59 Group A patients. Multiple vitamins were given twice a week to 56 Group B patients. We found that there was no statistical significance in Stage II patients with regard to survival. In Stage III patients, those treated with oral Ftorafur had better 3-year and 5-year survival rates than those receiving oral placebo. This preliminary report on this ongoing study seems to indicate that long-term postoperative Ftorafur treatment may be beneficial to Stage III gastric cancer patients.

Adenocarcinoma↗
PubMed1994

The presence of higher levels of thyroglobulin, but not thyroid autoantibodies, in the thyroid vein in Graves' disease.

To investigate the possible major source of thyroid autoantibodies production, blood samples were obtained from thyroid vein, jugular vein and peripheral vein during subtotal thyroidectomy in 12 patients with Graves' disease (11F, 1M; age 16-39 yr). Among them, 7 were treated preoperatively by methimazole, 4 by iopanoic acid and 1 by propranolol. All blood samples were assayed for thyroglobulin (Tg), thyrotropin binding inhibition immunoglobulin (TBII), antithyroglobulin antibody (TgAb) and antimicrosomal antibody (McAb). Tg, a native product of thyroid gland, was markedly elevated in the thyroid veins, over 4 to 6 folds that of jugular veins or peripheral veins. However, the level of thyroid autoantibodies including TBII, TgAb and McAb in the thyroid veins were not significantly different from that in the jugular or peripheral veins. Our preliminary data suggest that it is thyroglobulin, and not thyroid antibodies that is present at higher level in the thyroid vein than the periphery.

Adolescent↗
PubMed1994

Prognostic factors after hepatectomy for hepatocellular carcinoma.

During a seven and a half year period from 1985 through June 1992, hepatic resection was carried out on 84 patients with hepatocellular carcinoma. Their ages ranged from 10 to 79, with an average of 55 years. Hepatitis B surface antigen (HbsAg) was positive in 83%, an alfafetoprotein level of more than 20 ng/dl was found in 71%, and cirrhosis was noted in 64%. Surgical mortality was 3.6% and hospital mortality 1.2%. The 1-, 3- and 5-year actuarial survival rates, excluding in-hospital deaths, were 74%, 56% and 49%, respectively. The large number of patients operated on in the early stage (52%), and Child's class A (61%) might account for the low surgical mortality and high survival rate. The favorable conditions were identified as follows; no cirrhosis, surgery in the early stage, tumor size less than 5 cm, negative HbsAg and freedom from vascular involvement. Multivariate analysis showed that only negative HbsAg had better survival.

Adolescent↗
PubMed1994

Gastric leiomyosarcoma: a clinicopathological review.

OBJECTIVE: To report our experience of eight patients with primary gastric leiomyosarcoma. DESIGN: Retrospective study. SETTING: Teaching hospital, Taiwan. SUBJECTS: 8 patients who presented with primary gastric leiomyosarcoma between 1986 and 1990. MAIN OUTCOME MEASURES: Endoscopic, radiological, and histopathological features, DNA ploidy, and outcome. RESULTS: Abdominal pain and gastrointestinal bleeding were the most common presenting symptoms. In 5 of the 7 patients who had endoscopy preoperatively a diagnosis of submucosal tumour was made, but a definite diagnosis of leiomyosarcoma was made in only 3. A provisional diagnosis of leiomyosarcoma was made in 3 of the 4 patients who had computed tomography. All patients underwent some form of gastric resection ranging from palliative resection to total gastrectomy. Patients in whom the tumour had invaded adjacent organs had a poor prognosis. Histopathological grading of tumours correlated well with DNA ploidy. CONCLUSION: Both histopathological grading and DNA ploidy could be helpful objective prognostic criteria in patients with primary gastric leiomyosarcoma.

Aged↗
PubMed1994

Prognostic factors for pyogenic abscess of the liver.

BACKGROUND: Percutaneous drainage and antibiotics for pyogenic abscess are well established therapeutic modalities. However, the mortality rate for hepatic abscess of liver remains high. STUDY DESIGN: Three hundred fifty-two cases of pyogenic hepatic abscesses were studied to evaluate prognostic factors. RESULTS: Using univariate analysis, the following factors were associated with a high mortality rate: patient age, gas-forming abscess, rupture of abscess, bilobe involvement, clinical sepsis, bilirubin (more than 2 mg per dL), blood urea nitrogen (more than 20 mg per dL), serum creatinine (more than 2 mg per dL), aspartate aminotransferase (more than 100 U per L), and albumin (less than 2.5 gm per dL). Using multivariate analysis, the following were independent significant factors in predicting mortality: patient age (more than 60 years), blood urea nitrogen (greater than 20 mg per dL), serum creatinine (greater than 2 mg per dL), total bilirubin (greater than 2 mg per dL), and albumin (less than 2.5 gm per dL). CONCLUSIONS: Systemic effects of hepatic abscess with sepsis and multiple organ failure were significant factors in predicting mortality. Local findings, such as rupture of the abscesses, multiple abscesses, and gas-forming abscesses, were not independent factors. Percutaneous drainage is always considered if the condition of the patient can not be improved with antibiotic therapy. Operative treatment is indicated if the patient is unresponsive to medical treatment and percutaneous drainage or if the patient has complications of biliary tract stone or rupture of the abscess.

Aged↗
PubMed1992

Successful treatment of an impacted common bile duct stone with intraoperative choledochoscopic electrohydraulic lithotripsy.

An impacted distal common bile duct stone which was encountered during supraduodenal common bile duct exploration could not be retrieved using stone forceps, a basket, normal saline flushing or a Fogarty catheter. Using intraoperative choledochoscopic electrohydraulic lithotripsy the stone was fragmented and successfully removed with a basket and normal saline flushing. The patient was well after a follow-up period of 18 months.

Endoscopy, Digestive System↗
PubMed1992

Early gastric cancer in southern Taiwan.

Between January 1986 and November 1990, 231 patients underwent resection for primary gastric adenocarcinoma at Chang Gung Memorial Hospital in southern Taiwan. Thirty-nine (17%) of these patients had early gastric cancer (limited to the mucosa or submucosa regardless of nodal metastases). Epigastric pain was the most frequent symptom (71.8%). The lesions were located in the lower third of the stomach in 84.6% of the patients and in the middle third in 15.4%. A preoperative diagnosis of gastric cancer was achieved in 94% of patients by endoscopic examination with biopsies. All of the patients underwent distal subtotal gastrectomy without mortality. Macroscopically, 84.6% of cases were included in types IIc, III, and IIc-III. One patient died of multiple liver metastases 3.2 years after operation. The cumulative survival rate at 5 years is 92.9%. We comment on these matters and place early gastric cancer in Taiwan into a more global context.

Adenocarcinoma↗
PubMed1992

Primary squamous cell carcinoma of the breast.

We have described three patients with primary squamous cell carcinoma of the breast. All three have remained well after modified radical mastectomy. One patient received postoperative radiotherapy. Estrogen receptor status was determined by monoclonal antibody technology in two cases, and the results were negative.

Adult↗