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Biomedical subjects

T L Hwang

Publications and source records attributed to T L Hwang.

At least 91 records · Page 5Linked to original sources
PubMed1992

Calcium transport by rat liver plasma membranes during sepsis.

The effects of sepsis on the ATP-dependent Ca2+ transport in rat liver plasma membranes were investigated. Sepsis was induced by cecal ligation and puncture (CLP). Control rats were sham-operated. The results show that the ATP-dependent Ca2+ transport by liver plasma membranes was not affected during early sepsis (9 hr after CLP) but was decreased by 30-50% (P < 0.05) during late sepsis (18 hr after CLP). Kinetic analysis of the data indicates that during late sepsis, the Vmax values for ATP and for Ca2+ were decreased by 38.5% (P < 0.05) and 41.8% (P < 0.05), respectively, while the Km values for ATP and Ca2+ remained unchanged. Mg2+ stimulated ATP-dependent Ca2+ transport. The Mg(2+)-stimulated activity was unaffected during early sepsis but was decreased by 34-63% (P < 0.05) during late sepsis. These data demonstrate that ATP-dependent Ca2+ transport in rat liver plasma membranes was impaired during late sepsis and that the impairment is associated with a mechanism not affecting the affinity of the Ca2+ transporter for ATP and Ca2+. Since plasma membrane ATP-dependent Ca2+ transport plays an important role in the regulation of intracellular Ca2+ homeostasis in hepatocytes, an impairment in the ATP-dependent Ca2+ transport by liver plasma membranes during late sepsis may have a pathophysiological significance in contributing to the development of altered hepatic metabolism during septic shock.

Adenosine Triphosphate↗
PubMed1991

Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography.

Regeneration of the remnant liver after major hepatectomy in humans was studied by computed axial tomography (CT) in 12 noncirrhotic and five cirrhotic patients. Liver volumes were measured by abdominal CT 3 days, 10 days, 3 months, 6 months, 1 year, and 1.5 years after resection. Of the 17 patients, liver remnant volume was increased in 21.2% +/- 6.7% and 30.6% +/- 12.7% at 3 months and 6 months after resection, respectively. Noncirrhotic livers were 28.4% +/- 9.5% and 48.4% +/- 17.8% larger at 3 and 6 months. For cirrhotic livers, the increase was 8.5% +/- 3.6% and 12.9% +/- 4.5%. In five patients with right hepatectomy (65% resection), the liver remnant volumes were increased 38.4% +/- 11.7%, 48.0% +/- 16.2% and 95.1% +/- 4.5% at 3 months, 6 months, and 1 year after resection, respectively. In seven patients with right partial hepatectomy (30% to 35% resection), the percentages were 7.4% +/- 3.2%, 21.8% +/- 8.4%, and 63.9% +/- 18.3% and in five patients with left lateral segmentectomy (15% resection), they were 15.6% +/- 8.2%, 27.8% +/- 12.2%, and 33.0% +/- 14.5% 3 months, 6 months, and 1 year after resections, respectively. Noncirrhotic livers showed better regeneration than cirrhotic livers. Complete regeneration took about 1 year. The noncirrhotic liver that underwent right lobectomy also needed 1 year to double its postresection volume.

Adult↗
PubMed1991

Early nasoduodenal feeding for the post-biliary surgical patient.

The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery. The patients were randomly divided into two groups with 12 in each group. Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day. The hospital blenderized tube feeding diet provided the enteric nutrition (17% protein, 33% fat and 50% carbohydrate). The nutritional status of the 2 groups was compared over a one week period. The changes in nitrogen balance were measured daily for 8 days. The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later. (-1.91 +/- 1.05 g/day vs -5.84 +/- 0.48 g/day). There was no difference in serum albumin and transferrin levels, but serum prealbumin levels in the group fed early were more desirable than those of the control group (from 15.8 +/- 2.5 mg/dl to 28.9 +/- 3.8 mg/dl vs from 18.0 +/- 2.0 mg/dl to 25.9 +/- 3.9 mg/dl). Total lymphocyte count was also better in the group fed early than in the controls (from 1,325 +/- 204 cells/mm3 to 2,655 +/- 584 cells/mm3 vs from 1,277 +/- 188 cells/mm3 to 1,877 +/- 440 cells/mm3). All the patients in group I felt better than those in group II during the study course. These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance, and a faster increase in short half life visceral protein and total lymphocyte count.

Duodenum↗
PubMed1991

Protection of liver ischemia due to inflow occlusion using prior perfusion with hepatic protective solution in dogs.

Temporary occlusion of hepatic inflow is a useful maneuver to reduce hemorrhage from liver trauma and difficult hepatic resections. The liver can be protected with a hepatic protective solution before inflow occlusion, just as the stopped heart is protected by a cardioplegic solution during open heart surgery. Twenty dogs were divided into two groups. The portal inflow of group A was infused via the mesenteric venous branch with a hepatic protective solution composed of 250 mg of hydrocortisone, 15 mEq of KC1, 6 mL of 0.1 N HC1, 5 mL of 10% magnesium sulfate and 250 mg of dextrose in one liter of cold lactated Ringer's solution. Group B was infused with cold lactated Ringer's solution as a control. The hepatic artery and portal vein were isolated and then clamped for 30 minutes. The elevation of serum GOT and GPT after release of the clamps was significantly greater in group B, especially during the first 48 hours. The levels of alkaline phosphatase and total bilirubin were also higher in group B until the 7th day. The results liver biopsies 3 hours after release of the clamps revealed marked congestion and destruction of hepatocytes in group B. We conclude that liver perfusion with a hepatic protective solution before inflow occlusion results in less damage to liver tissue and less impairment of liver function. Such protection is important in liver surgery.

Animals↗
PubMed1991

Influence of age on results of resection of hepatocellular carcinoma.

One hundred and fifty-eight elective hepatectomies carried out between 1976 and 1989 for hepatocellular carcinoma were classified into three groups according to age: group I (n = 20) under 30 years of age; group II (n = 102) 30 to 60; and group III (n = 36) over 60. The number of operations carried out on patients in group III has increased since 1983, and the types of hepatic resection in the three different age groups were slightly but not significantly different. The incidence of small tumours (diameter less than 5 cm) and associated cirrhosis were relatively low in the younger patients. Postoperative complications developed in 4 patients (20%) in group I, 18 (18%) in group II and 8 (22%) in group III, the main ones being hepatic failure and intraabdominal sepsis. Operative mortality was 4%; one patient (5%) died in group I, 4 (4%) in group II, and 2 (6%) in group III, and the principal causes were hepatic failure and massive haemorrhage. Hepatic resection for hepatocellular carcinoma in most patients over 60 years old was associated with slightly higher operative morbidity and mortality, but the risks were such that we recommend that operation should not be denied to selected patients in this age group.

Adult↗
PubMed1991

Flow cytometric DNA analysis of hepatocellular carcinoma: preliminary report.

Flow cytometric DNA analysis was performed in 50 paraffin-embedded specimens of clinical hepatocellular carcinoma (HCC) after hepatic resections. The DNA distribution pattern was classified in two types, diploid and aneuploid, according to the degree of dispersion on the DNA histogram. The major DNA pattern of HCC in this report proved to be aneuploid (78%), although 22% of tumors revealed a diploid pattern. The serum alpha-fetoprotein level exceeded 40 ng/ml in 86.1% of the aneuploid tumors and in 13.9% of the diploid tumors (p less than 0.05). We found no correlation between DNA distribution and hepatitis B surface antigen positivity, the presence of liver cirrhosis or tumor size. Additionally we noted no significant correlation between the DNA pattern and survival rates in patients with HCC who underwent hepatic resection.

Adolescent↗
PubMed1990

Effects of intravenous fat emulsion on respiratory failure.

The effects of intravenous fat emulsion on ventilated normal, diseased or distressed lungs were studied. Forty-eight patients with different types of respiratory failure were divided into four groups. Group A was composed of the patients with a normal lung condition; group B, patients with infectious pulmonary condition and respiratory failure; group C, patients with COPD and respiratory failure; and, group D was composed of the patients with ARDS due to various causes. Five hundred milliliters of 10 percent fat emulsion was infused within 4 h as partial parenteral nutritional support. We concluded that intravenous fat infusion decreased PaO2/FIO2 and increased P(A-a)O2 and intrapulmonary shunt in the patients with ARDS, while it had little effect on the patients with infectious pulmonary disease or COPD. The infusion of fat emulsion had positive effects on the patients with normal lung condition with increased PaO2/FIO2 and decreased P(A-a)O2 and shunt.

Bicarbonates↗
PubMed1989

Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma.

During the 10-year period from 1978 to 1987, hepatic resections were performed on 20 patients with peripheral cholangiocarcinoma (PCC). Nine of these patients were men and 11 were women (mean age, 48.5 years). Among them, 80% had intrahepatic stones with recurrent cholangitis. The 20 patients were subdivided into the following three groups: Group I (12 patients with surgery for PCC); Group II (4 patients with surgery for chronic cholangitis [but the final pathologic diagnosis confirmed PCC]); and Group III (4 patients with surgery for space-occupying liver lesions). No early postoperative mortality was noticed. The few complications that occurred were related to surgery for hepatolithiasis. Postoperative wound infection was the most common complication. The overall mean survival time was 20.5 months. Four patients survived for more than 3 years; one was even alive for more than 5 years after surgery.

Adenoma, Bile Duct↗
PubMed1989

[The treatment of esophagojejunal anastomotic stricture after total gastrectomy].

From December 1983 through December 1988, 200 cases of total gastrectomy were performed in Chang Gung Memorial Hospital. The esophagojejunostomy was performed with EEA staplers in 196 cases, and with hand suture in 4 cases. Twelve cases developed anastomotic stricture after the operation. All of these 12 anastomoses were done with EEA 28 mm staplers. Four of the 12 patients received no further treatment either because the symptoms were mild or because of development of carcinomatosis. Six patients received endoscopic YAG laser treatment, only 2 had good results. Four Patients received balloon dilatation, 2 of them had good results, 4 patients received surgical intervention after failure of the balloon dilatation or YAG laser treatment. Of the 4 patients who underwent surgery, the thoracoabdominal approach was used in 3, and a thoracotomy in 1. Three patients received side to side esophagojejunostomy to bypass the stricture site. In the remaining patient, stricture was excised and a new end to end anastomosis was done with hand sutures. All of these 4 patients had good results after the operation. There are many possible mechanisms of the development of anastomotic stricture. Anastomotic leakage, technical error, lack of mucosa-to-mucosa apposition, size of the EEA stapler and tissue ischemia all have been regarded as the possible causes of anastomotic stricture. Once the esophagojejunal anastomosis stricture occurs, treatment should be done to relieve dysphagia. From the results of our patients, endoscopic YAG laser is not a satisfactory treatment for anastomotic stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Altered expression and distribution of heparan sulfate proteoglycans in human gliomas.

The expression of heparan sulfate proteoglycans (HSPGs) by human glioma cells was examined by biochemical and immunological methods in vitro and in vivo. Chondroitin sulfate was shown to represent the major [3H]glucosamine-labeled glycosaminoglycan synthesized by cultured normal brain cells. However, high-grade glioma-derived cells were shown to express significantly increased quantities of hyaluronic acid and heparan sulfate and approximately equal amounts of chondroitin sulfate compared with normal glial cells. To investigate further the differential expression of HSPGs, proteoglycans were isolated from glioma cells and were used as an immunogen to generate monoclonal antibodies (MAbs). One of these MAbs, 39H (an IgM), was shown to bind more to high-grade glioma-derived cells then to low-grade glioma or normal brain cells in vitro. MAb 39H was also observed to bind to isolated HSPGs but not to heparan sulfate glycosaminoglycan chains or trypsin-treated cells. Immunofluorescence staining of the cultured high-grade glioma cells revealed an intense diffuse cell surface staining pattern over the entire cell and also isolated footpads. In contrast, the low-grade tumor or normal glial cells showed a distinctive punctated staining. A similar differential staining of MAb 39H was most prominent between tissue sections of glioblastoma multiforme and anaplastic astrocytomas versus low-grade astrocytomas and normal brain. The low grade gliomas exhibited a weak punctated staining, whereas the high-grade gliomas showed significantly more intense staining, particularly along the apical regions of the cells. These results suggest that altered expression of HSPGs may be related to the malignant transformation or growth potential of glial-derived cells.

Antibodies, Monoclonal↗
PubMed1989

Hepatic resection in 120 patients with hepatocellular carcinoma.

During the 11-year period from 1977 through 1987, hepatic resections were carried out in 120 patients with hepatocellular carcinoma (HCC). Twenty-five had HCCs smaller than 5 cm in diameter. There were 97 male and 23 female patients, with an average age of 51.5 years. Among them, 45.8% had liver cirrhosis and 80.8% were positive for hepatitis B surface antigen. Fourteen with ruptured HCCs underwent hepatic resection to control the intra-abdominal hemorrhage. Operative mortality within one month after surgery was 4.1%. The postoperative course was complicated by pleural effusion in 5.8%, subphrenic abscess in 2.5%, postoperative bleeding in 1.6%, hepatic failure in 1.6%, and bile leakage in 0.8% of the patients. The overall five-year survival rate in this series was 25.9%, while survival for the last five years was better (42.3% vs 11.9% for patients treated between 1977 and 1982). The cumulative survival rate had no relation to tumor rupture or liver cirrhosis. The group of patients with smaller tumors (diameter, less than 5 cm) or without vascular invasion by tumor had better survival.

Adolescent↗
PubMed1989

Intrahepatic stones associated with cholangiocarcinoma.

Twenty cases of cholangiocarcinoma associated with hepatolithiasis were treated surgically. The incidence of cholangiocarcinoma associated with hepatolithiasis was 2.4%. Surgical procedures included common bile duct exploration after intraoperative choledochofiberoscopy in 20, with hepatic resection in nine. Overall survival was 8 months, with a range of 3-40 months. The hepatectomy group seemed to have a better prognosis. Accurate preoperative diagnosis of intrahepatic bile duct carcinoma associated with intrahepatic stones is difficult. All 20 patients in this series had surgery for recurrent cholangitis due to intrahepatic stones. From a retrospective review, it became apparent that early diagnosis can be obtained from the following: 1) detection of a hyperechoic mass in the liver parenchyma during abdominal ultrasonography, 2) a scintigraphic defect near the hilum, 3) filling defects or obliteration of intrahepatic ducts in ERCP or PTC, 4) gross appearance of the liver during surgery revealed a nodular tumor mass or an atrophic, fibrotic liver, and 5) intraoperative choledochoscopic findings which showed an intraluminal tumor or infiltrative lesion.

Adenoma, Bile Duct↗
PubMed1988

Surgical treatment for spontaneous rupture of hepatocellular carcinoma.

Twenty-seven patients with spontaneous rupture of hepatocellular carcinoma (HCC) underwent surgical treatment during the past ten years. The indications for emergent laparotomy were hemoperitoneum in 14 and unspecified peritonitis in 13. Twelve were found to have noncirrhotic HCC. The incidence of associated cirrhosis was 55.56 per cent. Surgical procedures included hepatic resection in 14, hepatic arterial ligation in six and packing, suture and electrocauterization in seven. Seven died within one month postoperatively, a surgical mortality rate of 28 per cent. Recently, palliative resection has been used more frequently. The group of patients who underwent resection have a better prognosis.

Adolescent↗
PubMed1987

Resection of hepatocellular carcinoma after transcatheter arterial embolization. Reevaluation of the advantages and disadvantages of preoperative embolization.

Hepatocellular carcinomas (HCCs) were resected in eight patients who had preoperative transcatheter arterial embolization (TAE) and in 25 patients without preoperative TAE. Three patients in the former group had ruptured HCCs before operation. Two of the former group and three of the latter group were found to have recurrences after a follow-up of 1 1/2 years. Although preoperative TAE resulted in significantly increased tumor necrosis, it increased the risk of gangrenous change of the gallbladder, induced adhesion of the hepatoduodenal ligament, and was not effective in reducing operative blood loss or operative time if the vessel selected for TAE was inadequate. Pathologic examination revealed tumor emboli still existing in the intrahepatic veins. Daughter nodules and capsular invasion by tumor cells were not affected by TAE. Transcatheter arterial embolization seems to be effective in controlling bleeding from ruptured HCC prior to staged resection of the tumor.

Adult↗
PubMed1987

Nonthoracotomy esophagectomy for corrosive esophagitis with gastric perforation.

Surgical treatment of corrosive esophagitis with gastric perforation is a high risk operation. Nonthoracotomy esophagectomy plus total gastrectomy was performed upon seven patients and compared with cervical esophagostomy plus total gastrectomy performed upon five patients. Two patients in the first group and all of the patients in the second group died. Transpleural esophagectomy for these critically ill patients is usually dangerous with high morbidity rates, while nonthoracotomy esophagectomy is a procedure which has lower risks and more advantages for removing the damaged esophagus of the patient with corrosive esophagitis.

Burns, Chemical↗
PubMed1986

High dose Ara-C related leukoencephalopathy.

Two patients with acute myelomonocytic leukemia in central nervous system relapse developed clinical signs and computerized tomographic evidence of leukoencephalopathy five to seven days after intravenous high dose Ara-C therapy. The first patient had received 30 gm of intravenous Ara-C with cranial irradiation (1680 rad in 2 fractions) and intrathecal Ara-C (100 mg X twice) for an intracerebral chloroma and leptomeningeal leukemia. In this patient the leukoencephatlopathy was probably a result of a synergistic effect of the concomitant triple therapy. The second patient had received intrathecal administration of Ara-C and methotrexate for five and one-half months prior to intravenous Ara-C therapy. He developed altered mental status after 24 gm of intravenous Ara-C infusion. CT scan showed changes in the white matter compatible with leukoencephalopathy. In this patient the intravenous Ara-C probably was the precipitating factor of the development of leukoencephalopathy. The possible mechanism of the Ara-C induced leukoencephalopathy is discussed.

Adult↗