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Biomedical subjects

W Y Lui

Publications and source records attributed to W Y Lui.

At least 127 records · Page 7Linked to original sources
PubMed1995

Lipiodol uptake and retention by human hepatoma cells.

Lipodol has important diagnostic and therapeutic uses in hepatoma. However, the mechanisms of its selective, prolonged retention in hepatoma cells is not well understood. Therefore, using oil-red O, light and electron microscopy and neutron activation analysis we have determined that HepG2 cells are characterized by lipiodol deposition and emulsification on the cell surface, action uptake of lipodol by endocytosis, and prolonged intracellular retention. These findings may have major clinical significance in the development of a new treatment for hepatoma patients.

Carcinoma, Hepatocellular↗
PubMed1995

Elective interval laparoscopic management for periappendiceal abscess.

BACKGROUND: In Far Eastern countries, the right-sided colonic diverticular diseases are more prevalent than the left-sided ones. Accurate differential diagnosis between appendiceal abscess and right-sided diverticulitis with abscess formation is difficult to make preoperatively. Conservative treatment followed by elective interval surgery remains the mainstay of management for patients with periappendiceal abscess. Laparoscopic diagnosis and treatment have been advocated in managing patients with abdominal pain of uncertain diagnosis. The purpose of this study was to evaluate the beneficial effect of interval barium enema and mini-invasive procedures for patients with periappendiceal abscess. METHODS: Patients with periappendiceal abscess (n = 8) were enrolled in this study. Conservative treatment was instituted by administration of antibiotics, and interval barium enema and laparoscopic intervention were scheduled later. Clinical manifestations, results of barium enema, outcomes of laparoscopic intervention and pathological diagnoses were reviewed. RESULTS: The frequency of periappendiceal abscess was 18/263 (6.8%). There were no operative complications. The correlation between barium enema, laparoscopic findings, and pathological diagnosis was quite good. Patients gained the advantages of laparoscopic surgery. CONCLUSIONS: Interval barium enema study and laparoscopic diagnosis and treatment are worthy of trying for patients with periappendiceal abscess, especially in those areas with high prevalence of right-sided diverticular diseases.

Abscess↗
PubMed1995

Piperacillin/tazobactam in comparison with clindamycin plus gentamicin in the treatment of intra-abdominal infections.

BACKGROUND: Concerned about the inactivation of piperacillin by beta-lactamase and the risk of aminoglycoside-induced nephrotoxicity and clindamycin-induced enterocolitis, we conducted the following phase III clinical trial. METHODS: Between November 1991 and March 1993, 77 surgical patients with intraabdominal infections were enrolled and randomly assigned in a 3:2 ratio to receive either piperacillin/tazobactam or clindamycin plus gentamicin to compare safety, tolerance and efficacy between both two treatment groups. RESULTS: There were 76 clinically and 50 bacteriologically evaluable patients with 80 isolated pathogens. The demographic data were comparable in both groups. There was no statistically significant difference of clinical response at any time-point of treatment, with 97.8% favorable clinical response rate in piperacillin tazobactam group and 96.6% in clindamycin plus gentamicin group at endpoint. The bacteriological eradication rates were similar, with 97.7% in piperacillin/tazobactam group and 94.4% in clindamycin plus gentamicin group at pathogen level, and 96.7% in piperacillin/tazobactam group and 95.0% in clindamycin plus gentamicin group at patient level. By susceptibility tests, only 3 (4%) isolated pathogens were resistant to piperacillin/tazobactam, which was much superior to the use of piperacillin, clindamycin or gentamicin alone in antimicrobial activity. The piperacillin tazobactam-related adverse experiences included 1 (2.1%) urticaria and 2 (4.3%) diarrhea. However, there were no significant differences in the adverse experiences between these two groups. CONCLUSIONS: This study has demonstrated that piperacillin/tazobactam is comparable with clindamycin plus gentamicin in efficacy, safety and tolerance in the treatment of surgical patients with intra-abdominal infections. The combination of piperacillin/tazobactam could potentially be the treatment of choice in adjunt to surgical management in intra-abdominal infection.

Abdomen↗
PubMed1995

Morbidity and mortality after radical gastrectomy for patients with carcinoma of the stomach.

BACKGROUND: This study sought to analyze the morbidity and mortality rates after radical gastrectomy for carcinoma, since the operation has been criticized as too morbid for the benefits it may provide. STUDY DESIGN: A prospective study of 474 patients who underwent radical gastrectomy was conducted. RESULTS: The overall morbidity and mortality rates were 20.1 and 3.0 percent, respectively. The morbidity and mortality rates fell significantly from 27.0 to 15.7 percent (p = 0.003) and 5.5 to 1.1 percent (p < 0.001), respectively, after the first 200 cases. By logistic regression analysis, it was found that male gender, combined organ(s) resection, extended lymphadenectomy, respiratory system disease, and tumor location were significantly related to postoperative morbidity. In regard to the extent of lymphadenectomy, relative to R2 resection (n = 102), the odds ratio for morbidity after R3 resection (n = 217) was 2.13, and for R4 resection (n = 155) it was 3.12. Age older than 65 years, total gastrectomy, combined organ(s) resection, and respiratory system disease were factors that negatively affected operative mortality. CONCLUSIONS: These observations suggested that radical gastrectomy can be performed with an acceptable risk of morbidity and mortality in a general hospital.

Age Factors↗
PubMed1995

Establishment of in vivo hepatoma models in rat and mouse from rodent hepatoma cell lines.

BACKGROUND: Hepatoma is one of the most common cancers in Southeast Asia and African countries. In Taiwan, it is the leading cause of death in male cancer patients. In order to examine the effect of various factors on the growth of hepatoma, in vivo hepatoma models such as carcinogen-induced hepatoma and subcutaneous implantation of hepatoma in nude mice have been used. However, there are disadvantages in these models. METHODS: Rats and mice were anesthetized by ketamine or ether, respectively. After a midline incision was made, N1S1 rat hepatoma cells were injected intrasplenically to partially hepatectomized or sham-operated rats, while BALB/c mice received intrasplenic injection of ML-2 and ML-3 mouse hepatoma cells. For direct tumor implantation, a 1mm3 N1S1 tumor piece was implanted in liver of Sprague-Dawley (SD) rat using a trocar. Animals were sacrificed at specific times after tumor implantation. Tumor incidence and the number of tumor nodules on the liver surface were recorded. Tumor samples were fixed and embedded for histological examination. RESULTS: After intrasplenic implantation of ML-2 cells, no tumor was observed on the liver in any of the 10 mice 40 days later. In comparison, rapid growth of hepatic ML-3 tumors was observed in all animals. Rat hepatoma cells RH-35, McA-RH7777 and McA-RH8994 cells did not form tumors in SD rats. The tumorigenicity of N1S1 cells in SD rats was dose-dependent on implanted tumor cells. In addition, hepatic N1S1 tumors could be obtained within a few weeks by homograft. CONCLUSIONS: We have successfully established in vivo hepatoma models in both the rat and the mouse. The murine ML-3 cells generated hepatoma in syngeneic BALB/c mice while the tumorigenicity of N1S1 cells in partially hepatectomized SD rats was dose-dependent on implanted tumor cells. These in vivo rodent models will be valuable tools for future studies of hepatoma.

Animals↗
PubMed1995

Anastomotic leakage following pancreaticoduodenectomy.

BACKGROUND: Since Whipple's successful resection of the head of the pancreas and duodenum in 1935, pancreaticoduodenectomy has become a standard operation for periampullary malignancies. Although the operative mortality has decreased dramatically in the recent years, it continues to be associated with high morbidity; with anastomotic leakage remaining a major problem. METHODS: One hundred and seventy-six pancreaticoduodenectomies performed for periampullary lesions during the past 27 years were reviewed. These included 171 Whipple operations, 4 total pancreatectomies and 1 pylorus-preserving pancreaticoduodenectomy. Among them, 40 cases were complicated with anastomotic leakage following pancreaticoduodenectomy. Their management strategy and outcome were reevaluated. Furthermore, the factors suggested to affect pancreaticojejunostomy leakage were also analyzed. RESULTS: The overall operative mortality was 15.3%, which decreased to 6.7% in recent two years. However, a high complication rate of 50% remained. Among the complications of the whole series (46.6%), anastomotic leakage accounted for 22.7% (40/176). Leakage occurred in 28 pancreaticojejunostomies (16.3%), 9 hepaticojejunostomies (5.1%) and 6 gastrojejunostomies (3.4%). Twelve patients required reoperation for ongoing sepsis or bleeding. This experience disclosed that in most cases hepaticojejunostomy leakage (8/9) could be successfully managed without operation. While three of the six gastrojejunostomy leaks survived after conservative treatment, two of the remaining three patients operated died of sepsis. Among cases with pancreaticojejunostomy leakage, 12 survived after conservative treatment, whereas 6 died of sepsis. Among 10 operated patients, only 3 patients survived. Earlier reexploration for uncontrolled leakage, probably within the first eight postoperative days, seemed to be the only chance for life saving. As far as the risk factors of pancreaticojejunostomy leakage are concerned, there seemed to exert no significant influence in terms of intraoperative blood loss, type and sequence of anastomosis as well as pancreatic stenting. The only clue that may affect the surgical outcome is technical; more experienced (> or = 10 Whipple operations) surgeons tended to render less morbidity and mortality. CONCLUSIONS: The retrospective analysis of our experience in pancreaticoduodenectomy discloses a trend toward decreased mortality rates in the recent years but operative complications remain high. Among the possible complications, anastomotic leakage is still a troublesome concern. Although conservative treatment can benefit most patients, earlier reexploration for uncontrolled sepsis should be considered. If a good result is anticipated, this complicated procedure should only be performed by an experienced surgeon.

Adolescent↗
PubMed1995

Complications of continuous ambulatory peritoneal dialysis: one surgeon's experience with 668 patient-month follow-up.

BACKGROUND: The technique of continuous ambulatory peritoneal dialysis (CAPD) catheterization is critical to patient success. To clarify how important a surgeon's experience to CAPD is, the experience exclusively from a single surgeon was presented and compared with those from a group of surgeons. The roles of intraoperative fluoroscopy and laparoscopy in CAPD catheterization and the rescue of tube migration in the authors' experience would also be introduced. METHODS: Fifty-five patients followed for a total of 668 patient-months between July 1990 and July 1993 were included for analysis. All of the catheterization procedures were done by one surgeon. RESULTS: The overall complication rate was 56%. Twenty-two percent of the patients had peritonitis, with an incidence of 0.56/patient-year, and 25% of the patients had exit-site infection, with an incidence of 0.36/patient-year. Tube migration occurred in two patients (4%). There was no dialysate leakage or incisional hernia. These incidences were much lower than previous reports by groups of surgeons. Laparoscopy successfully rescued a migrated tube. The cumulative 1-year, 2-year and 3-year catheter survival rates were 81%, 75% and 63% respectively. The previous abdominal operation, catheter type and catheterization site were not the prognostic factors of catheter survival. CONCLUSIONS: Based on this favorable outcomes, an experienced CAPD-surgeon may be one of the factors in minimizing the complications and improving the catheter survival in CAPD. Intraoperative fluoroscopy for every catheterization procedure and laparoscopy for the migrated or dysfunctional tube are highly recommended.

Adolescent↗
PubMed1995

Pseudomyxoma peritonei: does a true mucolytic agent exist? In vitro and in vivo studies.

Reproducibility of the so-called "mucolytic effect" of the 2%-10% dextrose-water solution is questioned. To test the mucolytic effect of 5% and 10% dextrose-water solutions and to determine what could be a true mucolytic agent, in vitro and in vivo studies were undertaken in two proven pseudomyxoma peritonei cases. In vitro study: Immediately after the mucin jelly was taken out of the peritoneal cavity, the jelly was immersed in various 40 cc solutions including: 1) 5% dextrose-water; 2) 10% dextrose-water; 3) normal saline; 4) lactated Ringer; 5) distilled water. The mucolytic effects of these solutions were observed once every hour after vigorous mixing. In vivo study: After completion of the operation, the peritoneal cavity was repeatedly irrigated with massive warm 5% dextrose-water and normal saline solutions in an attempt to dissolve the residual mucin cake and jelly. Neither 5% and 10% dextrose-water solution nor control solutions of normal saline, lactated Ringer, and distilled water could dissolve the mucin jelly in test tubes at 0, 1, 2, and 3 hours. The "claimed" mucolytic agent, 5% dextrose-water solution could not facilitate the removal of both mucin jelly and cake in the peritoneal cavity. The 5% dextrose-water solution was not superior to the normal saline solution in terms of mucolytic effect. In the present study, a true mucolytic agent does not exist. Currently, multiple laparotomy for aggressive cytoreduction remains the treatment of choice for pseudomyxoma peritonei.

Aged↗
PubMed1995

Is pancreatoduodenectomy justified for periampullary cancers with regional lymph node involvement?

Justification of pancreatoduodenectomy for highly malignant periampullary cancers with regional lymph node involvement is questioned. Attempting to clarify the therapeutic dilemma, we compared the prognoses of resectable periampullary cancers with and without lymph node involvement, as well as unresectable cancers with lymph node involvement. The medical records of surgical patients with periampullary adenocarcinoma were reviewed. We compared the survival times of resectable cancers with (resectable TanyN1M0) and without (resectable TanyN0M0) regional lymph node involvement, and the survival times of resectable cancers with lymph node involvement (resectable TanyN1M0) and unresectable cancers with lymph node involvement (unresectable TanyN1M0). There were 138 resectable and 115 unresectable periampullary cancers including 117 cancers of the pancreatic head, 117 cancers of ampulla of Vater, 7 cancers of duodenum, and 12 cancers of distal common bile duct. The prognosis was very poor in cancer of the pancreatic head. Neither resectability nor status of lymph node involvement could influence the survival time of the cancer of pancreatic head. In resectable non-pancreatic periampullary cancers, the prognosis was significantly better in the group without lymph node involvement. However, once the lymph node was involved, the outcomes were the same in the resectable and unresectable groups. Although pancreatoduodenectomy does not seem to be justified for periampullary cancers with regional lymph node involvement, this procedure should be considered for periampullary cancers without nodal involvement.

Adenocarcinoma↗
PubMed1995

A 24-patient experience in hyperalimentation for acute renal insufficiency: emphasis on amino acid determination.

BACKGROUND: Since current quantitative and qualitative determination of amino acids in patients receiving hyperalimentation for acute renal insufficiency is not sufficient in covering many possible clinical situations encountered, a mathematic method was thus devised, using biochemical data, to address various clinical conditions. METHODS: From July 1991, all patients at the Veterans General Hospital-Taipei with BUN > 50 mg/dL and creatinine > 2.5 mg/dL received hyperalimentation according to the following principles: (1) the quantity of amino acid depended upon the amount of urea nitrogen appearance and urine urea nitrogen; (2) enriched branched-chain amino acids (at 60-70% essential amino acids; 30-40% non-essential amino acids) plus a glucose-base energy balance nutrient were used, according to the patients' metabolic state; (3) all parameters were checked once weekly and the data were compared by paired t-test just before and after one-week treatment. RESULTS: Over a 15-month period, a total of 24 patients were treated and evaluated. Significant reduction was found after treatment in nitrogen negative balance, blood urea nitrogen, urea nitrogen appearance or daily amino acid requirement. Serum creatinine, urine urea excretion power and hospital survival were slight but non-significantly improved. CONCLUSIONS: This quantitative and qualitative determination of amino acid can be cheap, easy and safe with some beneficial results. It may provide one more choice of treatment in renal hyperalimentation.

Acute Kidney Injury↗
PubMed1994

Lymph node metastasis from carcinoma of the distal one-third of the stomach.

BACKGROUND: A detailed and thorough pathoanatomic study of lymph node (LN) metastases of adenocarcinoma of the distal one-third of the stomach is lacking. METHODS: From December 1987 to March 1992, 190 patients who underwent radical gastrectomy was analyzed. All LN were dissected and labeled according to the Japanese General Rules for the Gastric Cancer Study. RESULTS: A total of 7052 LN with an average of 37.1 per specimen were removed. LN metastases were encountered in 121 patients (63.7%). The most frequent LN metastases were perigastric, above common hepatic artery, along left gastric artery, and hepatoduodenal ligament. The incidence of LN metastasis varied and was highest when tumor was located close to either curvature and extended to duodenum or midbody. The high incidence of LN metastases in the hepatoduodenal ligament was a unique pathologic feature of adenocarcinoma of the distal one-third of the stomach (P = 0.0012). Univariate and multivariate analysis revealed that depth of cancer invasion was the only factor related to LN metastases. CONCLUSIONS: Cancer in the distal one-third of the stomach had a high incidence of LN metastasis to hepatoduodenal ligament nodes. The LN metastasis is correlated with depth of cancer invasion.

Adenocarcinoma↗
PubMed1994

Lymph node metastasis from carcinoma of the distal one-third of the stomach.

BACKGROUND: A detailed and thorough pathoanatomic study of lymph node (LN) metastases of adenocarcinoma of the distal one-third of the stomach is lacking. METHODS: From December 1987 to March 1992, 190 patients who underwent radical gastrectomy was analyzed. All LN were dissected and labeled according to the Japanese General Rules for the Gastric Cancer Study. RESULTS: A total of 7052 LN with average of 37.1 per specimen were removed. LN metastases were encountered in 121 patients (63.7%). The most frequent LN metastases were perigastric, above common hepatic artery, along left gastric artery, and hepatoduodenal ligament. The incidence of LN metastasis varied and was highest when tumor was located close to either curvature and extended to duodenum or midbody. The high incidence of LN metastases in the hepatoduodenal ligament was a unique pathologic feature of lower stomach cancer (P = 0.0012). Univariate and multivariate analysis revealed that depth of cancer invasion was the only factor related to LN metastases. CONCLUSIONS: Cancer in the distal one-third of the stomach had a high incidence of LN metastasis to hepatoduodenal ligament nodes (No. 12). The LN metastasis is correlated with depth of cancer invasion.

Adenocarcinoma↗
PubMed1994

Can the hormonal receptor status of primary breast cancer be altered by neoadjuvant chemotherapy?

In order to know whether neoadjuvant chemotherapy would change the hormonal receptor status of primary breast cancer, 10 patients with locally advanced breast cancer treated with neoadjuvant CEF (endoxan, epirubicin, 5-fluorouracil) were studied. Tissue was obtained by incisional biopsy before chemotherapy and by mastectomy after three courses of treatment. All the specimens were subjected to histology study and the tests of estrogen (ER) and progesterone (PgR) receptors. The results revealed that the only hormonal status of one out of 10 tumors was altered. Among the 10 tumors, 2 out of 10 ER and 3 out of 10 PgR were changed after neoadjuvant CEF. From our results together with other findings, it is concluded that neoadjuvant CEF dose not significantly change the hormonal receptor status of primary breast cancer. The hormonal receptor assay is unnecessary before chemotherapy.

Adult↗
PubMed1994

Steroid hormone receptors in three human gastric cancer cell lines.

Steroid hormone receptors in three human gastric adenocarcinoma cell lines and their transplanted tumors (except nontumorigenic KATO-III) in nude mice were determined by dextran-coated charcoal assay. Progesterone receptors (PgR) were found in all cell lines, transplanted NUGC-3, and AZ 521 tumors. Estrogen receptors (ER) were found in KATO-III cells, transplanted NUGC-3, and AZ 521 tumors, whereas glucocorticoid receptors (GR) were found only in NUGC-3 tumor and no androgen receptor was found in any cell lines or transplanted tumors. Since NUGC-3 cells had ER, PgR, and GR, it was used for the study of the effects of steroid hormones on growth. The results showed the cell cycle phase distributions and growth rate of transplanted tumors were similar in hormone-treated and nontreated groups. The persistent expression of PgR in gastric cancer cell lines and tumors, and the slight increase of tumor volumes in the progesterone-treated group suggests that progesterone and its receptors may be important in the pathogenesis of gastric cancer, but their biological function remains to be elucidated.

Adenocarcinoma↗
PubMed1994

Flowcytometric analysis of the effect of berberine on the expression of glucocorticoid receptors in human hepatoma HepG2 cells.

Berberine is an alkaloid found in many plants, including the Coptis chinensis and Arcangelisia flava. Berberine has been reported to have cytostatic effect on tumor growth. Previously, we have found that the level of glucocorticoid receptors (GR) was significantly higher in hepatoma than in adjacent liver tissues. Using human HepG2 hepatoma cells, we have found that GR were expressed not only in G0-G1 phases, but also in S and G2+M phases. The objective of the present study was to examine the effect of berberine on the expression of GR and its relation to cell cycle progression of HepG2 cells. Continuous exposure of HepG2 cells to various concentrations (1-50 microM) of berberine resulted in growth inhibition in a dose dependent manner. The viability of berberine-treated HepG2 cells was greater than 90% in all treatment groups. Flowcytometric analysis of berberine-treated HepG2 cells showed that the S phase fraction was significantly reduced. GR levels were higher in berberine-treated HepG2 cells than in vehicle (DMSO)-treated cells. In addition, the secretion of alpha-fetoprotein by HepG2 cells was inhibited by berberine. Finally, the berberine induced cell growth arrest was partially reversible in HepG2 cells.

Analysis of Variance↗
PubMed1994

Comparison of resectable and unresectable periampullary carcinomas.

Two hundred and fifty-eight patients with pathologically proved periampullary carcinomas who underwent surgical treatment between the years 1965 and 1992 were evaluated. Comparison was carried out between the resectable and unresectable groups. Carcinoma of the pancreatic head occurred in less than one-half (47 percent) of the patients, and only 23 percent were resectable. In contrast, carcinoma of the ampulla of Vater had a similar rate of occurrence, but a much higher resectable rate (86 percent). Thus, carcinoma of the pancreatic head was the minor group (19 percent) in the resectable patients we studied. The main clinical presentations and durations of symptoms before diagnosis did not differ in the resectable and unresectable groups, so it was impossible to predict the resectability by symptoms. Incidences of diabetes mellitus and diarrhea increased twofold in the unresectable group. Preoperative biopsy was difficult to perform for those with carcinoma of the pancreatic head. Comparing pancreatoduodenectomy and palliative operation, pancreatoduodenectomy resulted in a higher complication rate (43 versus 13 percent), a higher surgical mortality rate (17 versus 9 percent) and a longer hospitalization period (31 versus 20 days), but there was no statistical difference in the median survival time between the resectable and unresectable carcinomas of the pancreatic head (seven and one-half versus five months). Most of the patients (81 percent in the resectable group and 70 percent in the unresectable group) we studied died of cachexia with tumor recurrence. Although the advantage of pancreatoduodenectomy for resectable carcinoma of the pancreatic head was questioned, we still recommend this procedure for all periampullary carcinomas to avoid depriving the occasional patients with pancreatic carcinomas of long term survival and forfeiting the chance of cure for some misdiagnosed patients with other more favorable periampullary carcinomas.

Age Factors↗
PubMed1994

I-131-lipiodol cytotoxicity in hepatoma cells.

Hepatoma is a common cancer in Taiwan. New effective treatment for hepatoma patients is urgently needed. Encouraging results of I-131-lipiodol treatment for hepatoma with minimal toxicity have been recently reported. The mechanism of lipiodol targeting and retention by hepatoma are not well understood. The cellular interaction of lipiodol and the cytotoxic effects of I-131-lipiodol on hepatoma cells were investigated in this study. HepG2 cells were cultured with lipiodol, and untreated HepG2 cells were used as the control. Changes of cellular morphology were accessed by light and electron microscopy. The uptake and retention of lipiodol by HepG2 cells were studied by phase contrast microscopy and neutron activation analysis. HepG2 cells were cultured with I-131-lipiodol varying from 0.12 microCi to 120 microCi. The cytotoxic effect of I-131-lipiodol was evaluated by the surviving fraction of HepG2 cells. Changes in cellular morphology was examined by light microscopy. Results indicated that HepG2 cells were capable of active uptake of large amounts of lipiodol by endocytosis and prolonged intra-cellular retention associated with the formation of many bulging cytoplasmic extensions. I-131-lipiodol was highly cytotoxic to HepG2 cells. There was a steep dose response relationship, and the effective dose (LD50) was 1.2 microCi (480 rads). The cytotoxic effects of I-131-lipiodol were associated with pleomorphism of HepG2 cells, an increase in cell size and nuclear-cytoplasmic ratio, an increase in the size and number of nuclei, and vacuolation of the cytoplasm around the nuclear regions. Multiple nucleoli, fragmentation and segregation and ring shaped changes of nucleoli were also observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Hepatocellular↗