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Biomedical subjects

T L Hwang

Publications and source records attributed to T L Hwang.

At least 73 records · Page 4Linked to original sources
PubMed1994

Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by floating tumor debris in common bile duct is rare. Taiwan has a high incidence of HCC and cirrhosis. The authors report their clinical experiences and evaluate the results of different treatment modalities for this disease. METHODS: A retrospective study was undertaken to review 20 patients with obstructive jaundice secondary to ruptured HCC into common bile duct during the 12 years period. RESULTS: All patients on initial examination had recurrent episodic jaundice or cholangitis. Jaundice was relieved by nonsurgical, percutaneous transhepatic biliary stenting in 4 patients and surgical intubation with T-tube drainage in 16. Types of treatment for those who were treated nonsurgically were percutaneous transhepatic biliary stenting in two patients, followed by transcatheter hepatic arterial embolization in another two patients. For the 16 patients who were treated surgically, the types of treatment were T-tube or Y-tube drainage in 11, T-tube drainage followed by hepatic resection in 2, T-tube drainage and hepatic arterial ligation in 1, and T-tube drainage followed by transcatheter hepatic arterial embolization in the other 2. Liver cirrhosis was the associated disease in 12 (75%). Four patients (20%) died in the hospital. The mean survival time for 12 patients with only surgical or nonsurgical biliary stenting was 3.9 months. For the three patients with percutaneous hepatic arterial embolization, the mean survival time was 8.0 months. Two patients who had undergone hepatic resection had a better postoperative survival time, with one surviving for more than 5 years. CONCLUSION: Clinical features, types of management, operative findings, and survival in 20 patients with HCC obstructing the common bile duct by tumor thrombi were reviewed. Not all patients with this disease were terminally ill. With proper management, good palliation and occasional cure are possible.

Adult↗
PubMed1994

Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years.

OBJECTIVES: To report the results of our investigation of the postoperative intrahepatic recurrent rates and the patterns of recurrence and to determine the factors that influenced these patterns of recurrence. DESIGN: Case series. SETTING: Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. PATIENTS: Between 1977 and 1991, 162 men and 43 women with hepatocellular carcinoma underwent hepatic resection. RESULTS: The surgical mortality rate was 4.4%. Of the 196 patients who were discharged from the hospital, 114 have since died and 20 were not available for follow-up. The overall cumulative recurrent rates for the last 5 years (1987 through 1991) were 59.7%, 65.0%, 76.5%, 77.0%, and 79.7%, respectively. Eighty patients experienced intrahepatic recurrence. Of these, 21 (26.2%) had recurrence near the resected stump, 43 (53.8%) had a single nodular recurrence in the remnant liver, and 16 (20%) had wide-spread multinodular recurrence. The patients with resected margins of less than 1 cm in diameter had relatively higher recurrence rates than those with resected margins of greater than 1 cm in diameter. All recurrences were noted within 3 years of the resection. The preoperative serum alpha-fetoprotein levels were directly related to the length of time to recurrence (ie, the higher the serum alpha-fetoprotein level, the sooner the recurrence). CONCLUSIONS: The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum alpha-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate.

Carcinoma, Hepatocellular↗
PubMed1994

Upper gastrointestinal tract ablation for patients with extensive injury after ingestion of strong acid.

OBJECTIVE: Extensive corrosive injury involving the structures beyond the pylorus caused by ingestion of strong acid has a poor prognosis. We reviewed six cases of patients who underwent total upper gastrointestinal tract ablation to see the effect of this extensive procedure for such an injury. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Six patients who ingested more than 250 mL of 20N hydrochloric acid were treated in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China, from 1986 to 1992. RESULTS: Three patients with preoperative metabolic acidosis and renal failure died of multiple organ failure within the first postoperative month. The other three patients survived the acute stage. While being readied for a late reconstructive procedure, sepsis developed in one patient due to cholecystostomy leakage about 1 year postoperatively. Another patient died of respiratory failure after development of aspiration pneumonia due to poor drainage of a spit fistula, after surviving for 6 months. Only one patient had a good recovery following a full reconstruction procedure and restoration of the continuity of the gastrointestinal tract. CONCLUSIONS: Three of six patients died in the hospital. The risk factors were preoperative metabolic acidosis, renal failure, and an upper jejunal resection greater than 100 cm in length. Early and aggressive approaches to resect all the necrotic tissue certainly provide good chances to survive the acute stage and later reconstruction.

Adult↗
PubMed1994

Renal malacoplakia with secondary hepato-duodenal involvement.

Renal parenchymal malacoplakia is uncommon, and coexistence of extensive invasion into the liver and duodenum is extremely rare. Typically, there is an associated long-term urinary tract infection. We report on a 53-year-old woman with a history of diabetes and recurring pyelonephritis, who presented with a renal tumor and upper gastrointestinal bleeding. Surgical intervention included radical nephrectomy, lymphadenectomy, segmental hepatectomy, cholecystostomy, duodenorrhaphy, jejunostomy and appendectomy. There was no surgical morbidity. A pathologist confirmed the diagnosis of malacoplakia. All of the diagnostic criteria, including hematoxylin and eosin stain, iron stain, calcium stain and electron microscopy of Michaelis-Gutmann bodies, were classic. The literature is reviewed.

Duodenal Diseases↗
PubMed1994

Erythrocyte Ca2+ pump is defective during sepsis.

Saturated Ca2+ extrusion rate through the Ca2+ pump of erythrocytes was determined by the cobalt-exposure method in normal subjects and septic patients. From 48 normal subjects, the value of Vmax of erythrocyte Ca2+ pump was 14.83 +/- 0.49 mmol/L cells/hr; from 29 sepsis patients, it was 9.49 +/- 0.59 mmol/L cels/hr, significantly (P < 0.001) lower than that from the erythrocytes of normal subjects. When the severity of sepsis was evaluated by the septic severity score (SSS), a significant correlation (P < 0.0001) was observed between the Vmax of Ca2+ pump and the patient's SSS, indicating that the inhibition of Ca2+ pump depended on the degree of the pathological development of sepsis. Since the ATP-dependent Ca2+ transport in rat liver plasma membrane is also reduced during the late stage of sepsis [Lau et al., Circ Shock 38:238-244, 1992], impairment of the activity of Ca2+ pump appears to have a general pathophysiological significance in the development of severe sepsis.

Adenosine Triphosphate↗
PubMed1994

Rupture of the diaphragm after blunt trauma.

OBJECTIVE: To analyse our cases of acute rupture of the diaphragm after blunt trauma to find out how to diagnose it earlier and manage it more promptly in future. DESIGN: Retrospective study of casenotes. SETTING: Division of general surgery, district hospital, Taiwan. PATIENTS: 50 Patients who presented with acute rupture of the diaphragm after blunt trauma during the 10 year period 1982-91. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The left hemidiaphragm was injured in 43 cases (86%), and the right in 7 (14%). The most common cause was road traffic accidents. 48 Patients had associated injuries, mainly to the chest and abdomen, and pelvic fractures. 44 Ruptured diaphragms were diagnosed before operation by chest radiography or upper gastrointestinal contrast examination. The transabdominal approach was the most appropriate, because 23 patients had intra-abdominal visceral injuries as well. 20 Patients (40%) had complications, and the rate was 33% among those treated within 24 hours and 70% among those whose treatment was delayed longer than 24 hours (p = 0.067). There were 3 deaths (6%); one patient died of empyema of the right chest as a result of simultaneous perforation of a hollow viscus. 6 Patients were permanently disabled by head and spinal injuries, and pelvic fractures. CONCLUSION: The prognosis of repairing diaphragmatic hernias is good as the disability rate is low. The diagnosis should be kept in mind in all patients with chest injuries, pelvic fractures, or abdominal injuries with hypoxaemia, as this will result in earlier treatment and improve prognosis. The transabdominal approach is the most appropriate because it makes simultaneous abdominal injuries easier to treat. Correct operative management at an early stage will keep mortality to a minimum.

Adolescent↗
PubMed1994

Resectional therapy for a giant cavernous hemangioma of the liver.

Twelve patients with cavernous hemangiomas of the liver were treated by surgical resection from 1982 to 1991. There were three male and nine female patients. Their ages ranged from 31 to 62 with a mean of 49. All except one with gall bladder polyp had abdominal pain. Preoperatively, dynamic computerized tomographic scans performed on three patients produced accurate diagnoses, while angiography was correct in only 2 out of 7 patients. The indications for operation were suspected hepatoma in five, symptomatic pain in three, intraperitoneal hemorrhage resulting from biopsy in one, intrahepatic stone with suspicion of cholangioma in one, abdominal mass mimicking a gastric leiomyosarcoma in one and incidental laparotomy in a final patient. Surgical treatment resulted in no operative mortalities apart from one delayed death from cirrhotic decompensation occurring four months postoperatively. Morbidity included one patient with a postoperative hemorrhage and one with bile leakage, however, both of them were discharged uneventfully. During the follow up period from 6 to 72 months, no more abdominal pain attacked in those three patients with preoperative symptomatic pain. Three patients developed multiple recurrent hemangiomas. No identifiable causes were readily apparent. We conclude that the preoperative differentiation between hemangioma and hepatoma in a hepatic lesion is very important. When necessary, such as a giant symptomatic hemangioma of the liver can be safely resected without significant complications.

Adult↗
PubMed1994

Comparison of Swan neck catheter with Tenckhoff catheter for CAPD.

To decrease the incidence of exit-site infection, the Swan neck catheter has been used since 1991. Twenty-six patients received Swan neck catheter implants over the past three years. Fifteen patients suffered from exit-site infections and 2 of them developed tunnel infections. The incidence of exit-site or tunnel infections in the Swan neck group revealed no difference from those patients receiving Tenckhoff tube implants (n = 154). Two patients in the Swan neck group and 8 in the Tenckhoff group had tube migrations. There was no difference between the two groups. No patient in the Swan neck group suffered from cuff extrusion or pericatheter leakage, while 9 in the Tenckhoff group suffered from cuff extrusions and 5 had pericatheter leakages. The cumulative catheter survival rates at one, two, and three years in the Swan neck group were 90.9%, 80.2%, and 67.9%, while those in the Tenckhoff group were 84.7%, 67.9%, and 54%. We conclude that the patients receiving Swan neck catheter implantations had a lower incidence of cuff extrusion and pericatheter leakage, and better catheter survival, though the incidence of exit-site/tunnel infection and tube migration was no better than in the Tenckhoff catheter group.

Catheters, Indwelling↗
PubMed1994

The regeneration of cirrhotic liver after partial hepatectomy: a study using the rat carbon tetrachloride-induced cirrhotic model.

There are conflicting data regarding the ability of the liver to regenerate after partial hepatectomy in animals and humans with cirrhosis. The purpose of this study was to document liver regeneration after partial hepatectomy in a carbon tetrachloride rat model of cirrhosis. Liver cirrhosis was produced by weekly intragastric gavage with carbon tetrachloride in 80 adult male rats. Vehicle-gavaged rats (n = 24) served as healthy controls. Liver regeneration was documented 1, 2, 3 and 7 days after partial hepatectomy on the basis of restitution of liver mass and [3H] thymidine incorporation into liver DNA. Restitution of liver mass after partial hepatectomy was significantly decreased in carbon tetrachloride-treated rats at 1 and 7 days compared with the vehicle-treated control rats. In cirrhotic rats, restitution of liver mass at 1, 2, 3 and 7 days did not differ between 33% and 70% hepatectomy. Hepatic DNA synthesis, however, was significantly impaired at 1 and 2 days in cirrhotic rats after 70% hepatectomy and also at 1 day after 33% hepatectomy compared with non-cirrhotic rats. The results of this study indicated that live regeneration did occur after partial hepatectomy in carbon tetrachloride-treated rats but was impaired in comparison with that in vehicle-treated control rats.

Animals↗
PubMed1994

Changes of alpha 1-adrenergic receptors in human liver during intraabdominal sepsis.

We studied changes in alpha 1-adrenergic receptors in human liver plasma membranes during intraabdominal sepsis using [3H]prazosin as a radioligand. Human liver tissues were obtained from nonseptic patients undergoing elective abdominal surgery (control group) and from patients with sepsis requiring laparotomy as a therapeutic measure (septic group). Septic patients were further divided into three subgroups on the basis of septic severity scores: mild sepsis (< 21), moderate sepsis (22 to 32) and severe sepsis (> 33). Plasma membranes were prepared by means of sucrose gradient centrifugation and were purified fivefold on the basis of the enrichment of the activity of the marker enzyme, 5'-nucleotidase. [3H]prazosin-binding studies show that the maximal binding capacity was increased by 49.6% (p < 0.01) in mild sepsis, relatively unchanged in moderate sepsis and decreased by 33.4% (p < 0.05) in severe sepsis (in femtomoles per milligram: 193.7 +/- 5.7 for control [n = 6], 289.8 +/- 23.4 for mild sepsis [n = 4], 192.3 +/- 16.3 for moderate sepsis (n = 4), 129.1 +/- 18.3 for severe sepsis [n = 5]). We found a significant inverse correlation (r = 0.85, p < 0.01) between changes in the densities of alpha 1-adrenergic receptors and septic severity scores. These data indicate that alpha 1-adrenergic receptors in human liver plasma membranes undergo dynamic changes during the development of sepsis--that is, the receptor number increased in mild sepsis, returned to a normal level in moderate sepsis and finally decreased in severe sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

5'-Nucleotidase↗
PubMed1994

The incidence of diarrhea in patients with hypoalbuminemia due to acute or chronic malnutrition during enteral feeding.

OBJECTIVES: Critically ill patients usually have hypoalbuminemia. The incidence of diarrhea in patients with hypoalbuminemia receiving enteral nutrition was studied. METHODS: One hundred and ninety-eight patients with serum albumin level below 3 g/dl in the Burn Unit and Nutritional Support Service were retrospectively studied. Diarrhea was defined as liquid or loose stool at least three times a day with a daily volume of more than 300 g for at least 2 days. Most patients in the Burn Unit had acute or subacute onset of hypoalbuminemia, and most patients who were referred to the Nutritional Support Service had a chronic onset of hypoalbuminemia. The patients whose diarrhea were due to formula-related factors, administration techniques, or concomitant drug therapy were excluded. RESULTS: The results showed that 27% of the patients with albumin levels less than 2 g/dl had diarrhea, but only 10.5% of patients with albumin levels higher than 2 g/dl had diarrhea; the difference was significant. Diarrhea occurred in 35.1% of the patients with chronic development of hypoalbuminemia, but only 9.9% of the patients with rapid development of hypoalbuminemia had diarrhea; that difference also was significant. CONCLUSIONS: We concluded that the hypoalbuminemia-related diarrhea during tube feeding was significantly higher in patients with albumin levels less than 2 g/dl, and the patients with hypoalbuminemia due to chronic malnutrition had a significantly higher incidence of diarrhea than those with acute malnutrition, such as burned patients.

Acute Disease↗
PubMed1993

A reappraisal of cholangiocarcinoma in patient with hepatolithiasis.

BACKGROUND: Hepatolithiasis associated with cholangiocarcinoma is not often encountered. During the past 3 years, an increased incidence of patients with hepatolithiasis associated with cholangiocarcinoma was noted. Data were needed to reliably determine the incidence of this disease. METHODS: Data concerning the relationship between cholangiocarcinoma and hepatolithiasis are presented. The treatment modalities and factors that influence long-term survival are discussed. RESULTS: The overall incidence of cholangiocarcinoma in association with hepatolithiasis was 5.0% (55 in 1105). Before 1987, 65% of cholangiocarcinoma in association with hepatolithiasis was diagnosed postoperatively. After 1987, the incidence of accurate preoperative diagnosis increased (22.8%), and in most of the other instances (62.8%), the diagnosis was made at laparotomy. Surgical procedures consisted of common bile duct exploration with T-tube drainage (100%) and hepatectomy (38.2%). Mortality for patients who underwent surgery was 5.4%; they died of recurrent cholangitis. The overall median survival time of patients with cholangiocarcinoma in association with hepatolithiasis was 10.4 months; the 1-, 2-, and 4-year cumulative survival rates were 30.0%, 12.7%, and 3.6%, respectively. Patients with hepatectomy or the presence of mucobilia had better survival rates (P < 0.05). CONCLUSIONS: The overall incidence of hepatolithiasis associated with cholangiocarcinoma was 5%. In most patients with cholangiocarcinoma in association with hepatolithiasis, diagnosis can be made preoperatively and at laparotomy. Patients with hepatectomy or presence of mucobilia had better survival rates.

Adenoma, Bile Duct↗
PubMed1993

The use of indirect calorimetry in critically ill patients--the relationship of measured energy expenditure to Injury Severity Score, Septic Severity Score, and APACHE II Score.

The nutritional needs of critically ill septic patients or patients with multiple injuries are often difficult to estimate. Indirect calorimetry can simply and accurately determine individual caloric and nutritional needs, especially in cases of critically ill patients with complicated injuries. This prospective study compared the measured energy expenditures of 30 patients using indirect calorimetry with their predicted basal energy expenditure according to the Harris-Benedict equation, or their calculated energy expenditure derived from basal energy expenditure times, an activity factor, and a stress factor. These numbers were then used to evaluate the relationship between measured energy expenditure, measured energy expenditure per kilogram, and four specific scoring systems--the Septic Severity Score (SSS), the Injury Severity Score (ISS), the Trauma Score (TS), and APACHE II. The results showed the severity of sepsis or trauma correlated with the measured energy expenditure per kilogram of body weight. Among the 15 septic patients, in whom the measured energy expenditure per kilogram was 42.2 +/- 2.6 kcal/kg, the SSS provided a better predictor of energy needs and closer correlation with measured energy expenditure per kilogram (r = 0.69, Y = 1.41 + 0.72 X). Their stress factors could be modified as "0.97 + 0.0125 x SSS" to get a more accurate Harris-Benedict calculation. For the 15 patients with multiple injuries in whom the measured energy expenditure per kilogram was 34.9 +/- 1.6 kcal/kg, the ISS offered the best correlation with measured energy expenditure per kilogram (r = 0.84, Y = -31.47 +/- 1.73 X). Their stress factors could be modified as "1.04 + 0.0077 x ISS" to get a more accurate Harris-Benedict calculation.

Adult↗
PubMed1993

Biphasic intracellular redistribution of alpha 1-adrenergic receptors in rat liver during sepsis.

Changes in the distribution of alpha 1-adrenergic receptors in two subcellular fractions, the plasma membrane and the light vesicle, of rat liver during sepsis were studied using [3H]prazosin binding and photoaffinity labeling with [125I]arylazidoprazosin in combination with sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Sepsis was induced by cecal ligation and puncture (CLP). Septic rats exhibit two metabolically distinct phases: an initial hypermetabolic (hyperglycemic) phase (9 h after CLP; early sepsis) followed by a hypometabolic (hypoglycemic) phase (18 h after CLP; late sepsis). [3H]prazosin binding studies show that during early sepsis, the maximal binding capacity (Bmax) was increased by 35% in plasma membranes but was decreased by 28% in light vesicles; while during late sepsis, the Bmax was decreased by 30% in plasma membranes but was increased by 33% in light vesicles. The photoaffinity labeling studies revealed two major binding peptides with M(r) of 77,000 and 68,000 Da and one minor binding protein with M(r) of 39,000 Da. The total binding for the three labeled peptides during early sepsis was increased by 26% in plasma membranes but was decreased by 33% in light vesicles, while during late sepsis the total binding was decreased by 19% in plasma membranes but was increased by 35% in light vesicles. These data indicate that alpha 1-adrenergic receptors in the rat liver were externalized from light vesicles to plasma membranes during the hyperglycemic phase while they were internalized from surface membranes to intracellular sites during the hypoglycemic phase of sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Calcified brain metastasis.

Two patients with rare cases of calcified brain metastases are reported. The relatively benign clinical course and prolonged survival are stressed. The first patient had an adenocarcinoma of unknown origin with three calcified brain metastases. The patient underwent an incisional brain biopsy without radiotherapy and survived for 2 years and 9 months. The second patient had a squamous cell carcinoma of the lung with a large, solitary brain metastasis. The brain tumor was calcified and remained stable without progression for at least 4 months before surgical resection.

Adenocarcinoma↗
PubMed1993

Angiosarcoma of the small intestine after radiation therapy: report of a case.

A case of angiosarcoma of the small intestine is reported. The patient had a past history of cervical cancer, for which she had received radiotherapy eight years previously. She presented with an acute abdomen, and a distal jejunal perforation was found during emergency surgery. The patient expired due to reperforation of the bowel with peritonitis two months after discharge. The pathology of the resected bowel segment showed evidence of previous radiotherapy and infiltration by angiosarcoma involving all layers of the bowel, which had perforated. Submucosal fibrosis and angioectasia indicative of radiation therapy were also evident. The findings suggest that angiosarcoma of the small intestine may occur at sites of previous radiation therapy and may be causally related.

Female↗
PubMed1993

Augmentation of liver regeneration with glucagon after partial hepatectomy in rats.

The direct stimulating effect of glucagon on partially hepatectomized rats was studied. Following a 70% hepatectomy, male Wister rats were divided into three groups. Group I received glucagon 0.8 mg/kg/day; group II received hydrocortisone 10 mg/kg/day; and group III received normal saline as a control. Their blood sugar levels and food intake were not significantly different. After one week, the regenerated livers in group I were larger (9.69 +/- 0.30 cm3 vs 8.29 +/- 0.34 cm3 in group II and 8.20 +/- 0.10 cm3 in group III), and heavier (9.83 +/- 0.28 g vs 8.52 +/- 0.33 g in group II and 8.75 +/- 0.21 g in group III) than those in the other two groups. The mitotic index in group I was also higher. The results suggest that glucagon has a direct hepatotrophic effect and enhances regeneration of the liver in rats.

Animals↗