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Biomedical subjects

T L Hwang

Publications and source records attributed to T L Hwang.

At least 109 records · Page 6Linked to original sources
PubMed1985

Central nervous system toxicity with high-dose Ara-C.

We evaluated the CNS complications in 118 adults with acute leukemia who received IV high-dose Ara-C therapy. Fourteen (12%) had cerebellar signs, encephalopathy, seizures, or leukoencephalopathy. Symptoms usually occurred within 24 hours after the last treatment. Patients receiving a cumulative dose in excess of 24 g/m2 had more severe or irreversible symptoms. After lower cumulative doses, symptoms often resolved even though treatment was continued. The incidence of CNS complications of high-dose Ara-C is acceptable and is potentially reversible if appropriate precautions are taken.

Adolescent↗
PubMed1984

Cerebral radiation necrosis following treatment of extracranial malignancies.

Nine patients with cerebral radiation necrosis following radiation therapy for extracranial neoplasms were seen at MD Anderson Hospital between 1956 and 1982. The diagnosis was confirmed at autopsy in one case, by surgical intervention in six cases, and strongly suspected based upon CT scan findings and radiation records in two cases. The world literature is reviewed, and diagnostic criteria using the CT scan and radiation doses presented.

Aged↗
PubMed1983

Takayasu's arteritis: diagnostic considerations and surgical treatment.

A 20-year-old white woman with Takayasu's arteritis had headaches, neck soreness, and a right carotid bruit. Corticosteroid treatment only temporarily relieved symptoms and caused Cushing's syndrome because of high dosage requirements. Progressive narrowing of the right common carotid artery occurred despite treatment. The diseased portion of the artery was successfully resected and replaced by a Dacron graft. Corticosteroid treatment was then tapered and discontinued, and the patient has remained well for 3 years. Carotid Doppler and real-time ultrasound studies performed more than 2 years after surgery showed a patent graft and no new disease process. This technique may be of value in selected cases for both prevention of cerebral ischemia and the elimination of local symptoms of the inflammatory process.

Journal Article↗
PubMedDate not supplied

Intraoperative fiberoptic choledochoscopy for malignant biliary tract obstruction.

A prospective study to determine the safety and effectiveness of intraoperative fiberoptic choledochoscopy in the management of malignant obstruction of the biliary tree was conducted in 44 patients. There were 12 patients with cancer of the pancreatic head, 9 with adenocarcinoma of the distal common bile duct, 4 with adenocarcinoma of the ampulla of Vater, 8 with cholangiocarcinoma of the common hepatic duct, 9 with intrahepatic bile duct carcinoma, and 2 with hepatocellular carcinoma. Five patients with intrahepatic bile duct carcinoma and two with hepatocellular carcinoma were found during a search for intrahepatic duct stones in patients with recurrent cholangitis. In nine patients with bile duct carcinoma (seven extrahepatic and two intrahepatic), histopathological diagnosis was made at operative endoscopy. Treatment strategy was altered in seven patients based on findings at operative choledochoscopy. Complications were few with no mortality. Intraoperative fiberoptic choledochoscopy was safe and useful in the management of malignant obstruction of the biliary tree.

Adenocarcinoma↗
PubMedDate not supplied

Maintenance of small bowel mucosa with glutamine-enriched parenteral nutrition.

Glutamine is an important fuel utilized by the intestinal mucosa that is not present in standard amino acid nutrition solutions. In order to determine the effects of glutamine on the intestine, glutamine enriched nutrition was administered intravenously to male Wistar rats. A standard amino acid solution was enriched with 1 and 2 g/100 ml of glutamine or glycine and used as part of a parenteral nutrition regime for 7 days. Intestinal samples were taken for measurements of jejunal weight, DNA, protein, mucosal thickness and villus height. Animals receiving 2 g glutamine/100 ml in the nutrition solution had increased intestinal weight, DNA, and villus height when compared to animals receiving 2 g/100 ml of glycine. No increase in the intestinal parameters was noted when 1 g/100 ml of glutamine was used. To investigate the dose-response effects of glutamine, further studies were performed using isonitrogenous and isocaloric solutions containing 0, 2, and 3 g of glutamine/100 ml. Animals receiving glutamine had a significant increase in mucosal weight, DNA, protein and villus height when compared to animals receiving no glutamine in the parenteral solutions. There was a dose-response relationship between the increase in jejunal DNA and the increased intake of glutamine (r = 0.93, p less than 0.01) but no correlation with the nitrogen content of the solutions (r = 0.18, p = 0.8). Total body nitrogen retention was greater in animals receiving 2 g/100 ml of glutamine (166 +/- 12 mg, days 6/7) when compared to those receiving 0 and 3 g of glutamine/100 ml (126 +/- 14 mg and 138 +/- 16 mg, respectively, p less than 0.05). These studies demonstrate that glutamine enriched nutrition protects against atrophy of the intestinal mucosa and when given at 2 g/100 ml improves nitrogen retention during intravenous feeding.

Animals↗
PubMedDate not supplied

The importance of a source of sufficient protein in postoperative hypocaloric partial parenteral nutrition support.

A comparison of postoperative metabolic and nutritional responses to different hypocaloric parenteral nutrition supports was performed in 42 patients with various gastric lesions. Sixteen patients (group A) received 3000 mL of a 5% glucose in water or glucose in saline infusion per day after surgery (approximately 10 kcal/kg per day). Another 14 patients (group B) received 2000 mL of 5% glucose in water or saline plus 1000 mL of 5% amino acid solution per day (approximately 10 kcal/kg per day and 1 g of protein per kilogram per day). The other 12 patients (group C) received 2000 mL of 5% glucose in water or saline plus 500 mL of 5% amino acid solution and 500 mL of 10% fat emulsion (approximately 20 kcal/kg per day and 0.5 g of protein per kilogram per day). After 7 days of study, all three groups were found to have a decrease in body weight, mid-arm circumference, triceps skin-fold, and serum albumin level, and the differences among them were not significant. Groups B and C had significantly less negative mean nitrogen balance than group A (-5.54 +/- 0.63 g/d and -6.07 +/- 0.49 g/d vs -9.20 +/- 0.68 g/d). Group B also had a significantly greater increase of transferrin (from 175.5 +/- 9.9 mg/dL to 185.4 +/- 9.3 mg/dL) than group A and a significantly greater increase in total lymphocyte count (from 956 +/- 113 cells/mm3 to 1196 +/- 176 cells/mm3) than groups A and C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The different manifestation and outcome between pancreatitis and pancreatic malignancy with left-sided portal hypertension.

Left-sided portal hypertension can be induced by isolated splenic venous obstruction due to various etiologies, such as chronic pancreatitis and pancreatic malignancy. The patients may present with bleeding isolated gastric varices and hypersplenism in addition to their pancreatic lesions. In the past 3 years, we have encountered 24 patients with left-sided portal hypertension. They were diagnosed with an abdominal echogram, CT or splenoportography. Twelve patients had histories of acute pancreatitis for a few months to years. Eleven of them were found to have isolated gastric varices. Six of them underwent operation due to hypersplenism or pseudocyst. The postoperative courses were smooth and the gastric varices subsided after splenectomy. The other 12 patients with left-sided portal hypertension were diagnosed as having pancreatic malignancy. Only two of them were found to have isolated gastric varices. Seven of them received operations and only two patients with their tumors located at the pancreatic body and tail could be resected. The other 5 patients were diagnosed with abdominal CT and high serum CA 19-9. We concluded that the patients with left-sided portal hypertension can be suspected by isolated gastric varices without liver cirrhosis. The diagnosis can be confirmed by abdominal CT or splenoportography. The incidence of isolated gastric varices are significantly lower in the patients with pancreatic malignancy than those with chronic pancreatitis. The gastric varices subsided after splenectomy. The prognosis of pancreatic malignancy is poor and most of them are inoperable.

Adenocarcinoma↗
PubMedDate not supplied

Prospective and randomized study of gabexate mesilate for the treatment of severe acute pancreatitis with organ dysfunction.

BACKGROUND/AIMS: Exaggerated production of various proteases may account for the late presence of organ dysfunction in acute pancreatitis. This study examined the effects of early administration of gabexate mesilate on the condition of patients with severe acute pancreatitis and organ dysfunctions. METHODOLOGY: Fifty-two patients with acute pancreatitis and organ dysfunction were enrolled. The treatment group included 26 patients receiving intravenous gabexate mesilate infusion at a dose of 100 mg/hr for 7 days. APACHE-II score, clinical and biochemical parameters were monitored intensively. RESULTS: Coagulopathy ileus, and abdominal pain was significantly improved with gabexate mesilate. Gabexate mesilate reduced the necessity for surgical intervention and peritoneal lavage. The 7-day-mortality and 90-day-mortality rates were also significantly reduced with gabexate mesilate therapy. CONCLUSIONS: There are strong indications from this study that early intravenous gabexate mesilate infusion results in improved survival in acute pancreatitis with organ dysfunctions.

Adult↗
PubMedDate not supplied

Early use of cyclic TPN prevents further deterioration of liver functions for the TPN patients with impaired liver function.

BACKGROUND/AIMS: Impaired liver function is frequently found in patients who need prolonged total parenteral nutrition. Cyclic total parenteral nutrition can minimize the adverse effects of long-term total parenteral nutrition, such as hepatic complication. The adequate timing to shift to use cyclic total parenteral nutrition for patients with impaired liver function may prevent further hepatic dysfunction. METHODOLOGY: A prospective study of 65 patients who need total parenteral nutrition and have impaired liver functions was performed. Cyclic total parenteral nutrition was used in different groups of patients, when their total bilirubin levels were just over 5 mg%, 10 mg%, or 20 mg% during the course of total parenteral nutrition. The patients of control groups received straight non-cyclic total parenteral nutrition. All the patients had stable vital signs without major stress, such as sepsis or acute bleeding. Ten patients (A2) in Group A were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 5 mg%; the other 10 patients (A1) continued the non-cyclic total parenteral nutrition. Eleven patients (B2) in Group B were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 10 mg%; the other 11 patients (B1) continued the non-cyclic total parenteral nutrition. Ten patients (C2) in Group C were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 20 mg%; the other 13 patients (C1) continued the non-cyclic total parenteral nutrition. The average energy intake among 3 groups had no difference. Their liver functions were examined each week for 2 weeks. RESULTS: The results showed that the patients with non-cyclic total parenteral nutrition had significant increase of direct-total bilirubin and alkaline phosphatase (P < 0.05) in Group A and significant decrease of albumin accompanied with increase of GOT, GPT, direct/total bilirubin (P < 0.05) in Group B. The patients either using cyclic or non-cyclic total parenteral nutrition showed significant decrease of albumin and increase of direct/total bilirubin (P < 0.05) in Group C. CONCLUSIONS: We conclude that the early use of cyclic total parenteral nutrition may prevent deterioration of liver function for the patients with jaundice and need prolonged total parenteral nutrition.

Adolescent↗
PubMedDate not supplied

Surgery for chronic obstructive pancreatitis: comparison of end-to-side pancreaticojejunostomy with pancreaticoduodenectomy.

BACKGROUND/AIMS: Chronic obstructive pancreatitis usually manifests with intractable pain and recurrent episodes of chronic pancreatic inflammation. The side-to-side pancreaticojejunostomy is used for those patients with a large pancreatic duct. But for the patients with small pancreatic duct, the optimal surgical procedure needs to be evaluated. A prospective study was designed to compare the different results between distal pancreatectomy plus end-to-side pancreaticojejunostomy and pancreaticoduodenectomy. METHODOLOGY: The patients were chosen prospectively and randomly to undergo either a distal pancreatectomy plus end-to-side pancreaticojejunostomy or pancreaticoduodenectomy in the last 3 years. Eighteen patients with chronic obstructive pancreatitis were randomly divided into two groups. Ten patients (group A) underwent distal pancreatectomy plus end-to-side and ductal to mucosal pancreaticojejunostomy, and the other 8 patients (group B) underwent pancreaticoduodenectomy were compared. RESULTS: The operative time was significantly shorter and operative blood loss was less in group A. The postoperative follow-up of patients in group A had better outcome with increased body weight and no steatorrhea or diabetes mellitus, and all of them had complete pain relief. CONCLUSIONS: We concluded that distal pancreatectomy with end-to-side pancreaticojejunostomy provided a better surgical treatment for the patients with chronic obstructive pancreatitis and small pancreatic duct.

Adult↗
PubMedDate not supplied

Hepatic resection for 28 patients with small hepatocellular carcinoma.

Twenty-eight patients with hepatocellular carcinoma (HCC) of not larger than 5 cm diameter were surgically treated during the 12 years from 1977 to 1988, twenty-five of them since 1983. Half of the patients were admitted for check up because of elevated serum AFP and were high risk subjects. Serum HBsAg were positive in 24 (85.7%). Serum AFP was less than 10 ng/ml in 2 (7.1%) and greater than or equal to 200 ng/ml in 14 (50%). Coexistent liver cirrhosis was found in 21 (75%). Local resection or partial hepatectomy played a major surgical role in small HCC, especially in the presence of cirrhosis and tumor in right liver. The cumulative survival rates for the 28 patients treated by hepatic resection at 1, 2 and 5 years were 60.6, 42.5 and 42.5 percent. The survival rate of patients with tumor size not larger than 3 cm diameter is not better than those with tumor size between 3 cm and 5 cm. The small HCC patients with AFP less than or equal to 200 ng/ml had better survival than those with AFP greater than 200 ng/ml.

Adolescent↗