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Biomedical subjects

T H Ong

Publications and source records attributed to T H Ong.

At least 37 records · Page 2Linked to original sources
PubMed1994

The management and long-term results of Japanese pediatric liver transplant recipients.

We investigated the long-term results and ongoing management issues of 39 Japanese children who underwent liver transplantation in Brisbane, Australia. Whole liver grafts were used in 15 patients (Wh group) and reduced-size grafts were used in 24 patients (Re group). The 1-year and 3-year survival rates were 74% and 60%, respectively, and all cases of late mortality which occurred after 6 months were due to infection. Statistical analysis showed no differences between the Wh and Re groups with regard to late mortality or liver function tests, although 4 of 24 (16.7%) patients from the Re group developed a recurrence of esophageal varices. Three patients treated with cyclosporine developed lymphoproliferative disorders following transplantation, but none of the patients developed severe nephrotoxicity or hypertension. Although a "catch-up" gain in weight was observed, poor growth in height was displayed, and there were no differences between the Wh and Re groups in this regard. Thus, we conclude that late complications of liver transplantation in children are common and further studies are necessary to evaluate the ongoing growth problems.

Australia↗
PubMed1994

Indwelling mesenteric venous catheterization for early detection of portal vein thrombosis: possible application to pediatric liver transplantation.

Portal vein thrombosis (PVT) is a well-recognized complication after liver transplantation, particularly in children. When it occurs early in the postoperative period, it has serious consequences, and rapid detection is essential. The purposes of this study were (1) to ascertain whether continuous monitoring of mesenteric venous pressure (MVP), via an indwelling mesenteric venous catheter, could assist in early detection of PVT and (2) to investigate the role of portography, via the catheter, in confirming this complication. An animal model of PVT was developed in pigs. At laparotomy, a heparin-coated catheter was inserted into a jejunal mesenteric vein, delivered percutaneously and connected to a pressure transducer. Conditions of PVT were simulated by progressive occlusion of the portal vein (PV) using a silastic tourniquet, and the degree of PV stenosis was assessed by Doppler ultrasound flow-velocity measurement. MVP was recorded 1 and 3 minutes after PV occlusion, and portography was performed via the indwelling catheter. There were significant increases in MVPs with all degrees of PV stenosis (P < .01, Student's t test). No significant changes in MVP were noted between 1 and 3 minutes postocclusion. Portography clearly demonstrated PV stenosis. There were no instances of PVT, despite repeated and prolonged occlusion of the PV. Progressive degrees of PV stenosis have been clearly detected by an indwelling mesenteric venous catheter in an animal model. This method may be useful for the diagnosis and treatment of PVT after pediatric liver transplantation.

Animals↗
PubMed1994

Posttransplant gastrointestinal perforation in pediatric liver transplantation.

The results of 119 consecutive orthotopic liver transplants in 105 pediatric recipients were reviewed to determine the incidence and management of posttransplant gastrointestinal perforation (PTGIP). Transplantation of 22 children (21%) having had no previous surgery resulted in no PTGIP. However, 15 patients (14%) had PTGIP, and this group had had a greater number of previous laparotomies than did 68 children without PTGIP (2.3 +/- 0.9 v 1.5 +/- 0.8; P < .01). Up to 31% of children with two or more previous operations developed PTGIP. The incidence of PTGIP in patients with a preexisting stoma (26%, n = 23) was not significantly different from that in children whose previous portoenterostomy consisted of a simple Roux loop (15%, n = 60). A total of 32 laparotomies were performed for 35 PTGIP. The operative procedures included an oversewing of the perforated site (n = 22), segmental bowel resection/primary anastomosis (n = 5), creation of enterostomy (n = 7), and drainage (n = 1). After these laparotomies, reperforation occurred in 31% of patients, varying from none after defunctioning enterostomy for colonic perforations to 63% after simple oversew of perforated small bowel. Bolus methylprednisolone therapy or cytomegalovirus infection did not show any link with PTGIP. Children having undergone multiple laparotomies before liver transplantation are more susceptible to PTGIP. There was no death directly caused by PTGIP, but morbidity was considerable.

Humans↗
PubMed1994

The safety of elective liver resection in a special unit.

The benefit of hepatic surgery for benign or malignant conditions is a balance between peri-operative morbidity/mortality and long-term potential for cure or palliation. The aim of this retrospective study was to illustrate that the safety of liver resection is a function of the frequently of performance of the procedure. Between 1973 and 1992, 327 elective liver resections were performed. The indication for surgery was malignant tumour in 275 cases of which 170 (62%) and 105 (38%) were for metastatic and primary disease, respectively, and non-malignant conditions in 52 cases. The series included the complete spectrum of hepatectomies. There were nine deaths (2.7%). Mortality was 8% (3/38) before 1985, 3.4% (3/89) between 1985-88 and 1.5% (3/200) between 1989-92. In non-jaundiced/non-cirrhotic patients, mortality was 1.4% (4/270). Morbidity, defined as the incidence of at least one major complication, occurred in 87 patients (26.6%) with a re-operation rate of 6.4%. During the same time periods, the morbidity rate was 42, 35 and 20%, respectively, and the median blood transfusion requirement and postoperative stay progressively decreased to 2 units and 9 days, respectively. In conclusion, as experience was gained, the need for blood transfusion diminished, morbidity and mortality improved and the hospital stay shortened.

Adolescent↗
PubMed1994

Changes in psychological characteristics of drug abusers in a group counselling programme.

One hundred male ex-addicts who were provided with an indigenized group counselling programme in after-care service during their two-year compulsory supervision were administered two psychological tests at the beginning and the end of the programme. The tests were eight rating scales on attitudinal and psychological characteristics and the 16 PF questionnaire. t tests show that the successes have changed their attitude towards drug-taking from "favourable" to "unfavourable", and that they have improved in their psychological state and functioning.

Adult↗
PubMed1993

Combined cystic teratoma and hepatoblastoma of the liver. Probable divergent differentiation of an uncommitted hepatic precursor cell.

BACKGROUND: Hepatic cystic teratoma is an extremely rare tumor and hepatoblastoma a relatively rare tumor of childhood. Their occurrence as a combined tumor has not been previously reported. METHODS: The relevant clinical, radiologic, and pathologic findings are presented. RESULTS: A 17-month-old boy presented with an abdominal mass. Imaging studies suggested an intrahepatic teratoma, but serum alpha-fetoprotein levels were extremely elevated. The resected tumor comprised adjoining benign cystic teratoma and epithelial hepatoblastoma. The child remains alive and well 37 months after complete resection of the tumor. CONCLUSIONS: The tumor was considered most likely to originate from divergent differentiation of a single uncommitted liver precursor cell.

Cell Differentiation↗
PubMed1992

Undifferentiated (embryonal) sarcoma of the liver. Pathologic findings and long-term survival after complete surgical resection.

Undifferentiated (embryonal) sarcoma of liver is a rare tumor with a reputed poor prognosis. Four patients with this tumor are reported, of whom three were alive without recurrence 1.5, 2.5, and 12 years after initial complete surgical resection, and two of whom received no adjuvant therapy. The fourth patient, in whom complete surgical resection of tumor was not achieved, died with recurrent tumor at 13 months. The latter tumor differed histologically and consisted mainly of closely packed smaller undifferentiated cells with a higher mitotic and apoptotic rate. Eosinophilic globules, characteristic of embryonal sarcoma, were found in some cases to contain condensed nuclear chromatin, evidence of origin from tumor cells dying by apoptosis. One tumor mainly contained large cysts lined by biliary-type epithelium; this suggested an origin from a multipotent precursor cell able to differentiate along both stromal and epithelial lines.

Adolescent↗
PubMed1992

Nutritional support in children with end-stage liver disease: a randomized crossover trial of a branched-chain amino acid supplement.

Malnutrition is common in children with end-stage liver disease (ESLD) awaiting orthotopic liver transplantation (OLT), and nutritional support is assuming an important role in preoperative management. To evaluate preoperative nutritional therapy, 19 children (median age 1.25 y) with ESLD awaiting OLT were prospectively studied. Two high-energy, isoenergetic and isonitrogenous nutritional formulations delivered nasogastrically were compared: a branched-chain amino acid (BCAA)-enriched semielemental formulation and a matched standard semielemental formation. Twelve of 19 patients completed a randomized controlled study before OLT and 10 of 19 completed a full crossover study. Improvements in weight and height occurred during the BCAA supplements, with no statistical change on the standard formulation. Significant increases in total body potassium, midupper arm circumference, and subscapular skinfold thickness occurred during the BCAA supplements, whereas no significant changes occurred during the standard formulation period. Significantly fewer albumin infusions were required during the BCAA supplement. These findings suggest that BCAA-enriched formulas have advantages over standard semielemental formulas in improving nutritional status in children with ESLD, and are deserving of wider application and study.

Albumins↗
PubMed1992

The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation.

To evaluate malnutrition in chronic liver disease, and its relationship to nutrient deficiencies and hepatic dysfunction, 27 children with end-stage liver disease were studied. Mean protein-energy intakes were 70% of recommended daily intakes. The patients were underweight and stunted with reduced mean triceps and subscapular skinfold thicknesses and midupper arm circumference. Mean total body potassium was only 63 +/- 18% of that expected for age and sex. Deficiency of essential fatty acids (32%), and low concentrations of fat-soluble vitamins (A, 92%; E, 32%), iron (32%), zinc (42%), and selenium (13%) were common. Serum ammonia concentrations were raised in all patients, and increased methionine, tyrosine, and glutamic acid, and reduced glutamine concentrations were noted. There was no correlation between the degree of malnutrition and the degree of liver synthetic function, the degree of cholestasis, or the degree of liver injury. We suggest that potentially correctable factors in addition to liver failure (eg, inadequate absorbed intake) were important determinants of malnutrition in these patients.

Amino Acids↗
PubMed1991

Survival, growth and quality of life in children after orthotopic liver transplantation: a 5 year experience.

The aims of this study were to investigate outcome and to evaluate areas of potential ongoing concern after orthotopic liver transplantation (OLT) in children. Actuarial survival in relation to age and degree of undernutrition at the time of OLT was evaluated in 53 children (age 0.58-14.2 years) undergoing OLT for endstage liver disease. Follow-up studies of growth and quality of life were undertaken in those with a minimum follow-up period of 12 months (n = 26). The overall 3 year actuarial survival was 70%. Survival rates did not differ between age groups (actuarial 2 year survival for ages less than 1, 1-5 and greater than 5 years were 70, 70 and 69% respectively) but did differ according to nutritional status at OLT (actuarial 2 year survival for children with Z scores for weight less than -1 was 57%, greater than -1 was 95%; P = 0.004). Significant catch-up weight gain was observed by 18 months post-transplant, while height improved less rapidly. Quality of life (assessed by Vineland Adaptive Behaviour Scales incorporating socialization, daily living skills, communication and motor skills) was good (mean composite score 91 +/- 19). All school-aged children except one were attending normal school. Two children had mild to moderate intellectual handicap related to post-operative intracerebral complications. Satisfactory long-term survival can be achieved after OLT in children regardless of age but the importance of pre-operative nutrition is emphasized. Survivors have an excellent chance of a good quality of life and of satisfactory catch-up weight gain and growth.

Activities of Daily Living↗
PubMed1991

Malnutrition in children with chronic liver disease accepted for liver transplantation: clinical profile and effect on outcome.

The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 +/- 0.2) and stunted (mean s.d. height = -2.2 +/- 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium--mean % expected for age = 58 +/- 5%, n = 15). Mean ad libitum nutrient intake was 63 +/- 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight greater than -1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight less than -1.0) was 38% (P less than 0.003). Declining nutritional status during the waiting period also adversely affected outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Religious values and beliefs and place of residence as predictors of alcohol use among Chinese college students in Singapore.

Data drawn from a detailed study of alcohol use among Chinese undergraduate college students in Singapore (N = 767) show identification with religious values and beliefs not to be a significant factor in terms of students' alcohol use. Students' place of residence (i.e., on campus in a hostel or off campus) was found to predict alcohol use but in a way opposite to the pattern commonly predicted - that is, students on campus tend to drink less than their off-campus counterparts. When religious values and beliefs identification as well as place of residence were examined together, it appears that these two factors have no influence on students' alcohol use.

Adult↗
PubMed1989

Peers as perceived by drug abusers in their drug-seeking behaviour.

This paper is part of a major study in drug abuse. It attempts to investigate from the social learning perspective the importance of peers in the interpersonal relationship and in drug-seeking behaviour among a group of drug abusers including adolescents and adults. The subjects included 100 drug abusers randomly selected from those registered with voluntary organizations for treatment and rehabilitation, and 100 non-abusers individually matched for sex, approximate age, ethnic group, educational stream, and neighbourhood. A questionnaire was constructed to collect biosocial and drug-use data and 11 items of them common to those on the official record were used to check the veridicality of the responses of drug abusers. Exact agreement ranged from 83% to 100%. It is found that peers were identified significantly more by the drug abusers than by the non-abusers to be the person they most associated with, and that peer group influence is a strong motivator in the trigger mechanism of drug-taking.

Adolescent↗