Biomedical subjects

Tai-Wai Chin

Publications and source records attributed to Tai-Wai Chin.

8 recordsLinked to original sources

PubMed2006

Renal cell carcinoma in children and young adults.

Renal cell carcinoma (RCC) is a relatively uncommon tumor in childhood. Its biologic behavior and prognostic factors have rarely been documented. We report treatment and survival of 4 children (aged 8, 9, 11, and 14 years) who had RCC, along with a review of the literature to analyze the frequency of major symptoms, clinical stage, and prognostic factors based on 130 published cases of RCC in individuals younger than 20 years of age. Two of our cases had renal tumors detected by ultrasound screening, and all 4 cases were followed for a considerable length of time and were alive and free of disease after treatment. An analysis of these 130 published cases of pediatric RCC showed tumor staging and cell type to be the factors that affected patient survival. Tumors composed of granular cells or mixed cells, or at advanced stages, had a poor prognosis. Age, sex, tumor size, symptom duration, and cellular pattern were not related to patient prognosis. Children older than 10 years of age, who have an abdominal mass, flank pain, and/or hematuria should alert clinicians to consider the possibility of RCC. The importance of early diagnosis of renal tumors, using ultrasound as a tool of screening, is emphasized, since surgical treatment leads to a favorable prognosis only in the early stage of RCC.

Adolescent↗

PubMed2006

Esophageal atresia with tracheoesophageal fistula: ten years of experience in an institute.

BACKGROUND: Esophageal atresia (EA), tracheoesophageal fistula (TEF), or both is a complicated problem. The purpose of this study was to evaluate the outcomes and postoperative complications in patients with EA/TEF who were admitted to our hospital. METHODS: In total, 15 patients were enrolled from 1994 to 2003, including 8 males and 7 females. Patient demographics, associated anomalies, and outcomes were analyzed. RESULTS: The most common variant was EA with a distal TEF (type C), which occurred in 12 patients (80%). The latter had associated congenital anomalies, and cardiac anomalies were the most frequent, occurring in 8 patients (53.3%). Of the 6 cases who had life-threatening anomalies, 4 (66.7%) died, and of the 9 cases who had no life-threatening-anomalies, 2 (22.2%) died. Tracheomalacia and/or stenosis were diagnosed in 8 patients (66.7%) postoperatively. Though 3 of the 4 cases who suffered from dying spell received intratracheal stent implantation, 2 cases still died. CONCLUSION: The survival rate of the patients with EA/TEF is influenced mainly by associated life-threatening anomalies. TMS combined with a history of dying spell may be the major fatal complication.

Esophageal Atresia↗

PubMed2005

Surgical treatment of chylothorax caused by cardiothoracic surgery in children.

Four pediatric cases of chylothorax after cardiothoracic surgery, which were managed surgically, are reviewed retrospectively. All patients underwent right thoracotomy and mass ligation of the right thoracic duct without detecting the true site of leakage. Although 1 patient died from heart failure the day after operation, the other 3 recovered quickly without sequelae. Based on our limited experience, we suggest that right thoracotomy with mass ligation of the right thoracic duct can successfully cure chylothorax on either side, particularly if identification of the site of leakage is considered too risky because of severe adhesion from previous cardiothoracic surgery.

Cardiac Surgical Procedures↗

PubMed2004

Xanthogranulomatous pyelonephritis treated by partial nephrectomy.

Xanthogranulomatous pyelonephritis is an uncommon disease in children. We report of a 2-month-old girl with urinary tract infection and with a renal mass detected by ultrasound scan. The preoperative differential diagnoses were Wilms tumor, multicystic dysplastic kidney, renal abscess, and mesoplastic nephroma. The subsequent histopathological findings allowed the diagnosis of xanthogranulomatous pyelonephritis (XGP). Although XGP is rare at this age, it must be considered in the differential diagnosis of a child presenting with renal mass, either with or without associated urolithiasis, anemia, and elevated inflammatory markers. The long-standing mainstay of therapy for diffuse XGP has been nephrectomy. However, we report the successful preservation of renal mass with partial nephrectomy for diffuse XGP. The affected kidney grew normally and preserved residual function after the operation. Hence we strongly suggest parenchymal saving in pediatric cases of XGP to preserve renal function.

Antihypertensive Agents↗

PubMed2004

Pediatric lung abscess: a retrospective review of 23 cases.

Pulmonary abscess is a rare but critical problem in childhood. We did a retrospective review of 23 children with documented lung abscess who had been admitted and treated at the Taipei Veterans General Hospital over a 20-year period from April 1982 to April 2002. Among the 23 children, 11 cases were primary lung abscess, and 12 were secondary lung abscess. The pathogens were isolated in 16 patients (69.6%), and blood cultures yielded in only 3 patients (13.0%). The most common microorganism isolated in this series was Streptococcus pneumoniae. The 2 patients (8.7%) that died in our series had secondary lung abscess. We herein report the presenting symptoms, bacteriology, clinical management, and outcome of these 23 cases.

Adolescent↗

PubMed2004

Hepatoblastoma and hepatocellular carcinoma in children.

BACKGROUND: After nation-wide hepatitis B vaccination in Taiwan, the authors reviewed retrospectively their experience to investigate how the histopathology type of pediatric malignant hepatic tumors changed and whether the survival rate was improved with current surgical technique and adjuvant chemotherapy. METHODS: Cases of hepatoblastoma and hepatocellular carcinoma were retrospectively analyzed and divided into 2 groups by time of diagnosis. Group I was those who received treatments during 1978 to 1990. Group II was those treated during 1991 to 2001. RESULTS: There were 20 cases of hepatoblastoma and 15 cases of hepatocellular carcinoma. Male predominance was noted in both groups (male:female, 12:8 and 9:6, respectively). The patients with hepatoblastoma were younger than those with hepatocellular carcinoma (mean/range, 9/2-36 months and 10/0.7-15 years, respectively). Cases of hepatocellular carcinoma were all hepatitis B carriers. The ratio of hepatoblastoma:hepatocellular carcinoma increased from 11:12 in group I to 9:3 in group II. Three-year survival rate of hepatoblastoma was zero in group I and 55% (5/9) in group II. Three-year survival rate of hepatocellular carcinoma was zero in both groups. Operative mortality was 9% (2/23) in group I and zero in group II. CONCLUSIONS: Since the institution of national program of universal hepatitis B vaccination, the incidence of hepatocellular carcinoma in children have declined in Taiwan. The improved survival of hepatoblastoma resulted from better surgical technique and chemotherapy.

Adolescent↗

PubMed2002

Impalpable cryptorchidism--a review of 170 testes.

BACKGROUND: The diagnosis and treatment of cryptorchidism are continuously straightforward except impalpable testis. Preoperative diagnosis and surgical plans of impalpable testis are controversial. In this study, we evaluated our results of treating patients with impalpable testes. METHODS: One hundred and fifty patients with 170 impalpable testes are retrospectively reviewed. The preoperative diagnostic modalities, preoperative localization, operative findings and methods and operative results are analyzed. The operated testes are evaluated and followed for at least 6 months after operation. RESULTS: Preoperative localization could be achieved in 120 testes (70.6%) by image studies (111 by ultrasound, 6 by computed tomography and 3 by magnetic resonance image) and was completely compatible with operative localization. Operative localization for the other 50 testes was done by exploration with laparoscopic assistance in 25. Vanished testis or testicular remnant was noted in 37 testes (21.8%) and the locations of viable testes were prescrotal in 24 (14.1%), canalicular in 86 (50.6%) and abdominal in 23 (13.5%). Preoperative ultrasound could find 96.3% (106/110) of viable testes located in prescrotal and canalicular area, but only 21.7% (5/23) in abdomen. Laparoscopic assistance is very useful of localizing intraabdominal testes and confirming vanished testes. Orchiopexy was done in 126 viable testes (94.7%) by one-stage in 120 testes and two-stage in 6. Post-operative testicular atrophy was noted in 6 testes. CONCLUSIONS: Most of the impalpable viable testes located in prescrotal and canalicular could be detected by ultrasound. Laparoscopic examination can avoid unnecessary exploration. Excluding vanishing and severe atrophic testes, about 90% of impalpable testes can be saved with orchiopexy, mostly by one-stage operation.

Adolescent↗

PubMed2002

Neonatal Duhamel's pull-through for Hirschsprung's disease.

BACKGROUND: Neonatal Duhamel's pull-through was compared with 2 other approaches to Hirschsprung's disease (HD) diagnosed in the neonatal period. METHODS: Fifty HD patients, undergoing Duhamel's pull-through, were divided into 3 groups. Group I had 14 patients with neonatal pull-through; group II had 9 patients with delayed one-stage pull-through; and group III had 27 patients with two-stage pull-through. Operative bleeding and time, complications, and functional results were analyzed. RESULTS: The operative bleeding and operative time were significantly more and longer in group III (p < 0.001). Post-operative enterocolitis and fecaloma occurred in 9 (18%) and 16 (32%) patients respectively, and neither of the complications were different among 3 groups (p = 0.826 and 0.868). The common wall of the rectal pouch in group I was eliminated by endo-GIA stapler in 11 patients, and clamp placement in 3. Of 4 patients of group I with fecaloma, only I used endo-GIA stapler. The functional results were good in 35 patients, with mild constipation in 15 and were not statistically different among 3 groups (p = 0.184). CONCLUSIONS: HD on neonates can be successfully treated by Duhamel's pull-through in neonatal period using endo-GIA stapler. The functional results are as good as those with the delayed one-stage or two-stage Duhamel's procedure, with the child usually benefitting by not having home enema or stoma.

Digestive System Surgical Procedures↗