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Biomedical subjects

W Y Lui

Publications and source records attributed to W Y Lui.

At least 109 records · Page 6Linked to original sources
PubMed1996

Tissue potassium, selenium, and iron levels associated with gastric cancer progression.

The contents of 10 minor and trace elements in histologically confirmed gastric adenocarcinomas and their corresponding normal gastric mucosal tissues obtained from 39 patients at the time of gastric resection were simultaneously determined by instrumental neutron activation analysis. Specimens were irradiated by reactor neutrons and subsequently subject to direct analysis using a high-resolution HPGe gamma-spectrometer. Univariate analysis revealed that gastric cancer tissues had significantly higher concentrations of Fe, K, Mg, Na, Rb, Se, and Zn than normal gastric mucosal tissues. However, multivariate analysis found that Fe, K, and Se were independent elements that associated with gastric cancer. Upon further evaluation of their clinical significance, we found a high tissue K level was related to lymphatic duct metastasis. High Se tissue levels were linked to intestinal type adenocarcinoma. A positive correlation was found between high Fe levels and vascular involvement. These findings suggest that Fe and K are associated with gastric cancer progression. Se is involved in carcinogenesis of stomach in high-risk areas. The mechanisms that underlie the corresponding pathohistological features deserve further study.

Adenocarcinoma↗
PubMed1996

Surgical resection of primary hepatocellular carcinoma extending to adjacent organ(s).

Primary hepatocellular carcinoma (HCC) extending to the adjacent organ(s) is sometimes encountered in patients with large, peripherally located tumours. Over a 4-year period, a total of 151 patients received curative resection of HCC at the Surgical Department of Veterans General Hospital-Taipei, Taiwan. Of these patients, 21 underwent hepatic resection combined with en-bloc resection of the adjacent organ(s) because tumour extension was found during operation. Subsequent histological examination of the resected specimens found evidence of HCC invasion into the resected adjacent organ(s) in only nine patients (group I), and the remaining 12 patients showed no evidence of extrahepatic HCC invasion (group II). Twenty-seven HCC patients with clinico-pathologically matched tumours but without extrahepatic extension were selected as controls (group III). One patient in group I died of hepatic failure after the operation. The morbidity rate was 48% in group I and group II patients, and 30% in group III patients. The difference was not statistically significant. On evaluating the clinico-pathological factors, including DNA ploidy status of the tumours, there were no significant differences between tumours with and without extrahepatic invasion. Patients with locally invasive HCC (group I) had disease-free and overall survival rates comparable with those of the patients without local tumour invasion (group II and III). We conclude that HCC with invasion to the adjacent organ(s) does not seem to be directly related to the 'aggressiveness' of the tumour, and extrahepatic infiltration of the tumour does not preclude a chance of cure. Our results underscore the need for en-bloc resection as treatment of choice for these patients.

Carcinoma, Hepatocellular↗
PubMed1996

Mucin-producing neoplasms of the pancreas. Intraductal papillary and mucinous cystic neoplasms.

OBJECTIVE: The authors compared the clinicopathologic features of the intraductal papillary and mucinous cystic neoplasms of the pancreas and clarified the similarities as well as the differences between these two tumors. In addition, they reviewed 104 cases of the intraductal papillary neoplasm in the English literature to provide a global view of the condition. SUMMARY BACKGROUND DATA: Controversy about the term and clinicopathologic entity still exist regarding intraductal papillary neoplasm of the pancreas. Currently, with only a few cases of this rare tumor in each report, there continues to be inadequate knowledge available regarding the tumor and methods by which to distinguish it from the mucinous cystic neoplasm. METHODS: Multiple demographic and clinicopathologic parameters were compared between intraductal papillary and mucinous cystic neoplasms identified from 1985 to 1994 in the Medical Center, Veterans General Hospital--Taipei. RESULTS: There were four intraductal papillary adenocarcinomas and 10 mucinous cystic neoplasms (8 cystadenocarcinoma and 2 cystadenoma). The sex, age, size, tumor location, and pathologic findings were quite different between these two groups. Clinical presentation of intraductal papillary adenocarcinomas were similar to those of periampullary tumors. The most common presentations of mucinous cystic neoplasm were epigastric pain and abdominal mass. All four intraductal papillary adenocarcinoma showed mucin secretion from a patulous orifice of the ampulla of Vater and filling defects in the dilated main pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP). Accurate preoperative diagnosis was not easy regarding either group. Serum carbohydrate antigen 19-9 (CA 19-9) was more useful for diagnosis in both groups. CONCLUSIONS: The intraductal papillary neoplasm is a unique clinical entity but not a variant of mucinous cystic neoplasm in terms of sex, age, size, tumor location, or pathologic picture. The pathognomonic findings of ERCP should lead to diagnosis. Very aggressive surgical procedures should be attempted for these two mucin-producing neoplasms with low-grade malignancy.

Adenocarcinoma, Papillary↗
PubMed1996

Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma.

UNLABELLED: OBJECTIVE; Morbidity and mortality involved in the resection of hilar cholangiocarcinoma were reviewed retrospectively. The clinicopathologic and laboratory parameters that might influence the patient's survival also were re-evaluated. SUMMARY BACKGROUND DATA: Although much progress has been made in the diagnosis and management of hilar cholangiocarcinoma, long-term outlook for most patients remains poor. Surgical resection is usually prohibited because of its local invasiveness, and most patients can only be managed by palliative drainage. Recently, many surgeons have adopted a more aggressive resection with varying degrees of success. Several prognostic factors in bile duct carcinoma have been proposed; however, no reports have specifically focused on resected hilar cholangiocarcinoma and its prognostic survival factors using multivariate analysis. METHODS: The clinical records and pathologic slides of 49 cases with resected hilar cholangiocarcinoma were reviewed retrospectively. Twenty clinical and laboratory parameters were evaluated for their correlation with postoperative morbidity and mortality, whereas 31 variables were evaluated for their significance with postoperative survival. Variables showing statistical significance in the first univariate analysis were included in the following multivariate analysis using stepwise logistic regression test for factors affecting morbidity and mortality and Cox stepwise proportional hazard model for factors influencing survival. RESULTS: There were 5 in-hospital deaths, and the cumulative 5-year survival rate in 44 patients who survived was 14.9%, with a median survival of 14.0 months. Multivariate analysis disclosed that co-existent hepatolithiasis and lower serum asparate aminotransferase levels (<90 U/L) had a significant low incidence of postoperative morbidity, whereas a serum albumin of less than 3 g/dL was the only significant factor affecting mortality. Regarding survival, univariate analysis identified eight significant factors: 1) total bilirubin > or = 10 mg/dL, 2) curative resection, 3) histologic type, 4) perineural invasion, 5) liver invasion, 6) depth of cancer invasion, 7) positive proximal resected margin, and 8) positive surgical margin. However, multivariate analysis disclosed total bilirubin > or = 10 mg/dL, curative resection, and histologic type as the three most significant independent variables. CONCLUSIONS: Surgical resection provides the best survival for hilar cholangiocarcinoma. An adequate nutritional support to increase serum albumin over 3 g/dL is the most important factor to decrease postoperative mortality. Moreover, preoperative biliary drainage to decrease jaundice and a curative resection with adequate surgical margin are recommended if longer survival is anticipated. Patients with well-differentiated adenocarcinoma seem to survive longer compared to those with moderately or poorly differentiated tumors.

Adult↗
PubMed1996

Clinicopathological significance of intestinal and diffuse types of gastric carcinoma in Taiwan Chinese.

The present study sought to evaluate the clinicopathological features of our gastric cancer patients in terms of a modified Lauren's histological classification and compared the results with those from studies from Japan and Western countries. A total of 536 consecutive patients with gastric cancer were treated surgically between December 1987 and December 1993. A clinicopathological analysis was only performed for intestinal types (IT) and diffuse types (DT) of gastric cancer because patients falling into the 'other' category were too small to produce meaningful data. Of 536 cases of gastric cancer, 268 (50%) were IT, 231 (43.1%) were DT and 37 (6.9%) were of the other type. The overall IT:DT ratio was 1.2. Gastric cancer patients with IT (in contrast to DT) were characterized by older age, male dominance, smaller tumours, the tumour often being located in the lower and upper third of the stomach and less peritoneal metastasis. In both sexes, the peak incidence of gastric cancer patients was in the age group 65-74 years. Men had higher proportions of IT carcinoma than women. The IT:DT ratio for men and women was 1.4 and 0.4, respectively. Although the increased ratio of IT:DT paralleled the advance of age in both sexes, the transitional age (the age at which the IT:DT ratio exceeds 1.0) in male patients (age group 51-64 years) was earlier than for female patients (age group 65-74 years). Patients with IT gastric cancer had a significantly better survival rate than those with DT. However, the type of carcinoma (IT or DT) was not an independent predictor of survival. These data indicate that gastric cancer in Taiwan Chinese has different biological behaviour in terms of IT and DT. The clinicopathological features in IT and DT carcinoma are similar to studies from Japan and from Western countries.

Adenocarcinoma↗
PubMed1996

Relationship between age and clinical characteristics of patients with gastric cancer.

The relationship between the prognosis and age of patients with gastric cancer is controversial. To evaluate whether there is a biological characteristic specific to the age of patients, we examined the clinical characteristics of patients with gastric cancer with special reference to their age. Based on a prospective database, a retrospective study of 419 patients who underwent radical gastrectomy for cure in the past 6 years was conducted. Clinical characteristics including gender, gross appearance of the tumour (Borrmann's classification, tumour location), histopathology (depth of tumour invasion, lymph node status, Lauren's classification and degree of tumour cell differentiation) and TNM tumour stage were analysed in six different age groups (< 39, 40-49, 50-59, 60-69, 70-79, > 80 years). The mean age of the 419 patients was 64.6 years (range from 26-91) and the peak age incidence of gastric cancer (46.3%) was in the 60-69 year old age group. The male: female ratio was 4.6:1 on the whole and male gender predominated at ages > 60. The proportion of diffuse type tumours (68.4%) by Lauren's criteria in the young age group (< 39 yrs) decreased with age (25% in the > 80 years group; P < 0.001). Similarly, the proportion of poorly-differentiated tumours (89.5%) in the young age group (< 39 yrs) decreased with advancing age (P < 0.001). These findings suggest that both diffuse type and poorly-differentiated tumours predominate in younger patients and, without considering the factor of delay in diagnosis, may explain the poorer prognosis demonstrated in younger patients.

Adult↗
PubMed1996

Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma.

BACKGROUND: No nodal grouping category of gastric cancer has been universally accepted for the grading of the effectiveness of therapeutic regimens. AIMS: To establish an appropriate nodal grouping as a forecaster of distant disease and test its validity as a determinant in survival. PATIENTS: Five hundred and ten patients who underwent curative resections for gastric cancer were studied. METHODS: Retrospectively analyse the prognostic significance of the number of metastatic lymph nodes. RESULTS: A total of 17 176 lymph nodes with an average of 34 per specimen were removed, of which 2811 (16%) showed metastases. Among the 510 patients, 287 (56%) had lymph node metastases, with an average of 9.8 per metastatic case. The survival of all patients was related to their nodal status, an abrupt decrease in survival was seen between 0 and 1 and 4 compared with 5 or more modes while little difference in survival existed among 1, 2, 3, and 4, and among 5, 6, 7, and 8 positive nodes. Multivariate analysis showed that the number of positive nodes (1-4, 5-8 versus > or = 9; relative risk 2.2) and depth of cancer invasion (three levels; relative risk 1.9) were independently correlated with survival. The current nodal stage was not a prognostic factor. CONCLUSIONS: Gastric cancer patients with 0, 1 to 4, 5 to 8, and > 9 positive nodes may represent four appropriate prognostic groups and should be adopted for classification of nodal stage in gastric cancer.

Adenocarcinoma↗
PubMed1996

Hepatic artery injection of Yttrium-90-lipiodol: biodistribution in rats with hepatoma.

UNLABELLED: In this study, we analyzed the biodistribution of 90Y-lipiodol in rats with liver tumors (hepatoma) following hepatic arterial injection. METHODS: Sixteen male Sprague-Dawley rats with liver tumors were killed at 1, 24, 48 and 72 hr (four rats at each time) after injection of approximately 0.1 mCi 90Y-lipiodol through the hepatic artery, respectively. Samples of tumor, liver, spleen, skeletal muscle, lung, kidney, bone, whole blood and testis were obtained and counted to calculate the tissue concentrations (%ID/g). RESULTS: We found that the radioactivity in the liver tumor was high at 1 and 24 hr and then declined slowly. The biological half-time was 84.1 hr. The radioactivity in normal liver tissue was also high at 1 hr but was significantly lower than that in the tumor. The biological half-time was 38.5 hr. The ratio of tissue concentration between liver tumor and normal liver tissue (T/N ratio) was 3.03 at 1 hr and rose to 6.45 at 72 hr. The radioactivity in the lung was almost as high as in normal liver tissue at 1 hr and declined rapidly with a biological half-time of 25.6 hr. The activity levels of the kidney were moderate at 1 hr and remained at almost the same level throughout the study. A moderate concentration of radioactivity in bone was noted within the first 24 hr. The concentration, however, rose over the ensuing time. The concentration of radioactivity in skeletal muscle, spleen, testis and whole blood was quite low. CONCLUSION: Following hepatic arterial injection of 90Y-lipiodol, tracer uptake in liver tumor was high and tumor retention was lengthy. Consequently, large radiation doses could be delivered to the tumor. We suggest that 90Y-lipiodol is a potential agent in the treatment of liver malignancy.

Animals↗
PubMed1996

Serum interleukin-6 levels reflect disease status of gastric cancer.

OBJECTIVES: Interleukin-6 (IL-6) has been shown to be associated with cancer development. However, its role in gastric cancer patients has never been investigated. Our intent was to investigate this role. METHODS: Using enzyme-linked immunosorbent assay, we determined the IL-6 levels in sera of patients with gastric cancer (n = 218), benign gastric lesions (n = 9), and hepatitis B (n = 9), and in normal subjects (n = 85). C-reactive protein (CRP) levels and Helicobacter pylori antibodies were simultaneously determined in 150 and 133 gastric cancer patients, respectively. Serial serum IL-6 levels were also measured in 14 gastric cancer patients. Six gastric cancer cell lines were examined for IL-6 secretion. For comparison, serum carcinoembryonic antigen levels in all gastric cancer patients were also determined. RESULTS: Mean IL-6 levels were significantly higher in patients with gastric cancer (10.0 +/- 9.5 pg/ml) than in patients with benign gastric lesions (2.6 +/- 0.5 pg/ml), in hepatitis B carriers (2.8 +/- 0.9 pg/ml), and in normal subjects (2.5 +/- 0.3 pg/ml). Gastric cancer patients with IL-6 > 10 pg/ml increased in a stage-related manner (p = 0.0001). Serum IL-6 levels increased when four patients had recurrence, whereas IL-6 levels decreased in 10 patients with a disease-free status after gastric resection. Serum IL-6 levels correlated moderately with serum CRP levels (r = 0.5, p < 0.01), but not with H. pylori antibody titers (p = 0.23). Serum IL-6 levels correlated with survival, but not as an independent prognostic indicator. Conversely, patients with CEA > 5 ng/ml increased in a stage-related manner, but this is not an effective reflection of disease progression. Five of six gastric cancer cell lines secrete IL-6. CONCLUSIONS: Serum IL-6 levels correlate with disease status of gastric cancer and may be used as a new tumor marker for monitoring treatment and response of gastric cancer patients.

Adenocarcinoma↗
PubMed1996

Ruptured hepatocellular carcinoma: treatment strategy and prognostic factor analysis.

BACKGROUND: The prognosis of ruptured hepatocellular carcinoma (HCC) is generally poor, but few studies have focused on the analysis of prognostic factors of this catastrophic event. METHODS: Eighty-four consecutive patients with ruptured HCC were included. Twenty-nine clinical and laboratory variables were correlated to prognosis by using uni- and multivariate analyses. RESULTS: Epigastralgia and/or right upper quadrant abdominal pain was the most common initial presentation (70%), followed by shock (42%), abdominal distension (27%) and others (17%). Of these 84 patients, 50 patients were treated by supportive measure, 21 by operation and 13 by transcatheter arterial embolization (TAE). The median survival was 13, 30 and 202 days in each group, respectively, and 24 days overall. TAE showed the lowest hemostatic failure rate (20%). Univariate analysis showed that active treatment (operation or TAE), group I tumor with a solitary nodule or single nodule with proliferation into surrounding area, serum creatinine (< or = 1.2 mg/ml), alkaline phosphatase (< or = 95 U/L), alanine aminotransferase (ALT, < or = 40 U/L), total bilirubin (< or = 1.6 mg/ml), initial systolic blood pressure (> or = 90 mmHg), and absence of main portal vein thrombosis were correlated with a survival longer than 90 days (p < 0.05) in univariate analysis. Active treatment, ALT level and initial systolic blood pressure were still significant in multivariate analysis (p < 0.05). CONCLUSIONS: TAE may help stop the tumor bleeding. Treatment regimen, ALT levels and initial blood pressure are correlated with the prognosis of ruptured HCC.

Adolescent↗
PubMed1996

Results of curative gastrectomy for carcinoma of the distal third of the stomach.

BACKGROUND: Carcinoma of the distal stomach metastasizes to lymph nodes along the bile duct, pancreatic head, and duodenum. We reviewed the results of patients who underwent operation for carcinoma of the stomach, and placed special emphasis on survival related to lymph node metastasis. STUDY DESIGN: We conducted a prospective study of 258 consecutive patients with adenocarcinoma of the distal third of the stomach who underwent curative gastrectomies. RESULTS: Most of the patients (193 [75 percent]) had advanced cancer (extension beyond the submucosa). A subtotal gastrectomy was the procedure most commonly performed (89 percent). Combined organ resection was performed in 100 patients (39 percent). The operative morbidity was 17 percent; the most frequent complications were chylous leakage, anastomotic insufficiency, and intra-abdominal infection. Ninety-four patients (36 percent) had tumor recurrence, with local recurrence occurring in 45 patients. In 40 of the 45 cases, the local recurrence resulted from remnant lymph nodes (LNs), or soft tissues in the gastric bed. Lymph node metastases were observed in 152 patients (59 percent). Excluding five patients (2 percent) who died, the overall five-year cumulative survival rate was 53 percent. The five year survival rate was 98 percent for patients with TNM stage I disease; 68 percent for patients with stage II disease; 40 percent for patients with stage III disease; and 10 percent for patients with stage IV disease. The survival rate for patients with n0, n1, n2, and n3 disease was respectively 92 percent, 45 percent, 30 percent, and 20 percent. For patients with metastatic LNs in the hepatoduodenal ligament, the five-year survival rate was 20 percent. CONCLUSIONS: These data suggest that survival rate relates to the extent of LN metastasis. It appears that systematic lymph node dissection may have a beneficial effect. However, the efficacy of radical lymph node dissection can only be determined by prospective, randomized clinical trials with a proper study design.

Adenocarcinoma↗
PubMed1996

Establishment and characterization of two cell lines derived from a single hepatocellular carcinoma containing multiploid DNA distribution.

Previous studies showed that patients with resectable multiploid hepatocellular carcinoma (HCC) had lower overall survival rate and higher recurrent rate than did those with diploid or single aneuploid tumors after hepatic resection. We describe in this study the establishment and characterization of cell lines derived from a single HCC nodule containing multiploid DNA distribution. Two human HCC cell lines, designated HAGS 2.1 and HAGS 2.2, were established by primary culture and single cell cloning methods from a patient with a multiploid HCC tumor. Both cell lines expressed bile canalicular domain-specific antigen of human hepatocyte. The HAGS 2.1 cells were spindle-shaped without prominent intracellular vesicles and had a doubling time of 38 h with DNA ploidy of 4.4 N; cells of HAGS 2.2 were polygonal with many intracellular vesicles and had a doubling time of around 42 h with DNA ploidy of 5.1 N. Hepatitis B surface antigen was detectable in HAGS 2.2 but negative in HAGS 2.1 cells. Both HAGS 2.1 and HAGS 2.2 expressed major histocompatibility complex (MHC) class I antigen, but the former expressed more MHC class II antigen than did the latter. Polymerase chain reaction and subsequent single strain conformation polymorphism analysis disclosed the presence of preS and S regions and the absence of C and X regions of HBV genome in cells of both HAGS 2.1 and HAGS 2.2. We conclude that the establishment of cell lines derived from a single HCC tumor containing multiploid DNA distribution might provide a good in vitro model to study the carcinogenesis and the recurrence mechanism of human hepatocellular carcinoma.

Antigens, Neoplasm↗
PubMed1996

The surgical treatment and prognostic factors of well-differentiated thyroid cancers in Chinese patients: a 20-year experience.

BACKGROUND: Well-differentiated thyroid cancers (WDTC) are usually slow-growing neoplasm with an indolent clinical course. Assessment of treatment modalities for them requires a long-term follow-up in a large population, and is still of much debate. A systematic analysis of the history, prognosis and therapy for this disease in Taiwan is lacking. METHODS: A retrospective analysis of clinical and pathological records was conducted on 488 patients (149 male and 339 female, male: females = 1:2.28) treated for WDTC in the Veterans General Hospital-Taipei from 1971 to 1991 with subsequently follow-up until December 1994 (Mean follow-up: 8.5 years). Factors influencing recurrence, survival and different treatment were analyzed. RESULTS: Papillary thyroid cancer increased obviously as compared to our experience from 1959-1976. Changing tumor behaviors, including increasing female/male ratio, higher percentage of papillary cancer, decreasing primary tumor size and lower distant metastatic rate at the time of initial diagnosis, were noted. Factors influencing survival, as determined by univariate analysis, included age, gender, distant metastasis, extrathyroidal invasion, tumor size, nodal involvement, histological type, extent of surgical therapy and use of postoperative radioactive iodine. Those patients aged more than 45 at initial diagnosis, with primary tumors larger than 4 cm, with extrathyroidal invasion, and with distant metastasis at initial diagnosis were classified as being at high risk. The others were at low risk. Total or near total thyroidectomy (TTx), depending on the judgement of each surgeon, had much higher complication rate than lobectomy with/without isthmusectomy, but offered no benefit effect on disease-free survival or overall survival rates. Postoperative radioactive iodine ablation treatment and thyroxine replacement in suppressive dose after TTX improved survival among high risk patients. Lobectomy with/without isthmusectomy in low risk patients, followed by thyroxine suppression therapy, was adequate to improve the postoperative outcome and with low complication rate. Lymph node resection in patients with clinically palpable nodes improved longterm prognosis. CONCLUSIONS: Changing tumor behavior of WDTC leading to favorable prognosis has been noticed since 1971. Total or near total thyroidectomy is worthwhile in high risk patients with WDTC but does not appear necessary in low-risk patients. Lymph node dissection for metastatic lymph node could improve the survival rate.

Adult↗
PubMed1996

A prospective randomised study of laparoscopic v. open cholecystectomy in aged patients with cholecystolithiasis.

Between August 1992 and July 1993, 27 patients aged 70 years of older with cholelithiasis were prospectively randomised into 2 groups. Fifteen patients underwent laparoscopic cholecystectomy and 12 patients underwent open cholecystectomy. Shorter operation time (93.3 +/- 25.3 minutes v. 176.3 +/- 26.1 minutes, P < 0.00001), fewer postoperative analgesic requirements (0.53 +/- 0.52 days v. 2.00 +/- 0.74 days, P < 0.00001), shorter postoperative hospital stay (3.93 +/- 1.71 days v. 7.92 +/- 0.79 days, P < 0.00001) and better cosmesis were found in the laparoscopic cholecystectomy group. The above data suggest that laparoscopic cholecystectomy is the treatment of choice for cholecystolithiasis in elderly patients.

Aged↗
PubMed1995

Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma.

OBJECTIVES: To evaluate the feasibility and results of segmentectomy for curative resection of hepatocellular carcinoma and to compare the clinicopathological findings of the patients according to the tumor location in the liver. DESIGN: Case series. SETTING: A tertiary care center. PATIENTS: Seventy-five patients with Child's grade A or B liver function who had hepatocellular carcinoma that was confined to one segment and who underwent segmentectomy for curative resection of the tumor. The patients were divided into four groups: group P (posterior segmentectomy, n = 23); group A (anterior segmentectomy, n = 10); group M (medial segmentectomy, n = 16); and group L (lateral segmentectomy, n = 26). MAIN OUTCOME MEASURE: Disease-free survival rate. RESULTS: Seventy-three percent of the patients had cirrhosis of the liver. The surgical mortality and morbidity rates were 5.3% and 36.0%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 61.9%, 39.1%, and 26.3%, respectively, and were not significantly different among the four groups (P = .86). Group L had the least operative blood loss and shortest operative time when compared with the other three groups (P < .05). The postoperative liver function changes were mild and transient in the four groups of patients. With regard to pathological factors, only tumor size differed among the groups (tumors in group L were significantly larger than those in the other three groups, P < .05). Forty-three percent of the recurrent tumors were solitary in the early stage, with 81% involving the segment(s) adjacent to the resected one and 57% being confined solely to the segment adjacent to the resected segment. Patients having recurrent hepatocellular carcinomas had significantly larger tumors at the time of resection than did those without recurrence (P = .03). CONCLUSIONS: Hepatic segmentectomy is an effective therapeutic approach for small hepatocellular carcinomas and can be done safely even in patients with chronic liver disease and impaired liver function.

Carcinoma, Hepatocellular↗
PubMed1995

An analysis of the possible factors contributing to the delayed return of gastric emptying after gastrojejunostomy.

The possible factors contributing to delayed-return gastric emptying (DRGE) after gastrojejunostomy were analyzed through a review of 955 consecutive patients who had undergone gastric surgery for the first time, which revealed 23 patients who had experienced DRGE. Of 7 consecutive patients who had undergone a reoperation for postsurgical gastroparesis syndrome, 3 were found to have experienced persistent DRGE. The chi-squared and/or Student's t-tests showed the significant factors to be (a) an age over 60, and (b) a history or nonresection gastric bypass, Roux-en-Y reconstruction, or reoperation for the preexistence of postoperative gastroparesis, with P values of less than 0.05. There was a higher incidence of DRGE in patients who had received a vagotomy, and there were increasing nutritional indices when patients were recovered from DRGE; however, vagotomy and malnutrition could not be considered independent variables. In conclusion, the incidence of DRGE was significant in patients aged over 60 who had undergone gastrojejunostomy, with nongastric resection, Roux-en-Y reconstruction, or reoperation for gastroparesis. In the event of DRGE, a longer period of supportive treatment is required to avoid unnecessary second surgery as most patients recover spontaneously, whereas a high incidence of persistent DRGE may occur following early reoperation.

Adolescent↗
PubMed1995

Blunt gastrointestinal injury in trauma patients.

The evaluation, management, and final outcome of 34 patients with blunt gastrointestinal injury (BGI) were reviewed. Initial absence of symptoms and signs led to two delayed diagnoses. Sonography provided 80% (12/15) positive-predictive value, and three false-negative patients were subsequently detected by diagnostic peritoneal lavage (DPL). Besides repeated clinical surveillance, screening by sonography complemented with DPL provided early detection of blunt bowel injury in trauma patients. In the outcome analysis, BGI patients with high injury-severity scores, intraoperative hypotension, or accompanying major medical diseases were associated significantly with increased risk of infectious complications (P < .05).

Adolescent↗