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Biomedical subjects

W Y Lui

Publications and source records attributed to W Y Lui.

At least 145 records · Page 8Linked to original sources
PubMed1994

Adenocarcinoma of midstomach. Clinical and pathoanatomic relation to lymph node metastases.

A detailed clinical and anatomic-pathological study of lymph node (LN) metastases from adenocarcinoma of the midstomach is lacking. To such an end, we prospectively evaluated 100 patients who underwent radical gastrectomy. A total of 3,394 LNs were removed with an average of 34 per specimen (range, 10-105). Forty-seven patients (47%) had involved LNs. The most frequent LNs involved were those along the lesser curvature (38%), greater curvature (23%), left gastric artery (19%), infrapyloric (16%), above the common hepatic artery (13%), suprapyloric (11%), and right paracardia (9%). When tumors involved the upper stomach, the frequency of LN metastases along the splenic artery and in the splenic hilum was 11.8%. Tumors along the lesser curvature or on the anterior or posterior walls had splenic hilar LN metastases in 10%, whereas of tumors involving the whole circumference, 16.7% showed with metastases. Four of 33 patients (12.1%) with early cancer had LN metastasis confined to the perigastric, left gastric artery, and above the common hepatic artery. The LN metastases were closely related to the depth of cancer invasion, location, size, gross appearance, and histology of the tumor.

Adenocarcinoma↗
PubMed1994

Thyroid cancer in children and adolescents.

BACKGROUND: Thyroid cancer in children and adolescents has rarely been reported in Taiwan. The purpose of this study is to realize the characteristics of thyroid cancer of children and adolescents. METHODS: From 1971 to 1992, a total of 726 patients with cancer of thyroid were treated at Veterans General Hospital-Taipei. Of these, 37 were below the age of 21, and were followed 1 to 21 years with an average of 7.4 years. RESULTS: Only one patient with thyroid cancer had the history of previous radiation therapy for head and neck tumor. Neck mass was the most common mode of presentation and 36% had associated cervical adenopathy. Histologically, papillary cancer was found in 29 patients, follicular cancer in 7 and medullary cancer in 1. There was no undifferentiated cancer. Twenty-three patients had lymph node metastases. Eight patients developed distant metastases, especially to the lung, and most of them were male. Recurrence after initial surgical treatment was found in 12 patients, without significant association with the surgical procedure. The major operative complication was hypoparathyroidism. Disease-related mortality occurred in only one case (2.8%). CONCLUSIONS: Well-differentiated carcinomas of the thyroid in children and young adults are rare in Taiwan and are mostly papillary carcinomas not related to previous neck irradiation. Before the age of puberty, boys were predominant in this series. The rate of distant metastasis was higher in males. The prognosis after surgical treatment is excellent.

Adolescent↗
PubMed1994

DNA flow cytometric analysis of primary breast cancer in Chinese women: the relationship of DNA aneuploidy to clinical characteristics.

One-hundred-and-forty fresh frozen breast tissue samples from Chinese patients collected from May 1991 to October 1992 were evaluated for DNA content by flow cytometric analysis. None of the 12 benign tumors displayed aneuploidy. One-hundred-and-twenty-eight of the 140 specimens were histologically proven to be malignant. Ploidy was compared to the clinical characteristics which included age, tumor size, lymph node involvement, menopausal status, steroid receptor status, histological grading and pathological staging. After univariate and multivariate analyses, aneuploidy was more frequently identified in progesterone receptor negative and high grade tumors. This study suggests that an aneuploid DNA content in a breast cancer specimen may indicate more aggressive cancer.

Asian People↗
PubMed1994

Gastric cancer invading the lamina muscularis propria.

BACKGROUND: Gastric cancer invading the lamina muscularis propria is considered to be an intermediate stage between early and far advanced gastric cancer. This study evaluated the clinicopathological pictures of muscularis propria gastric cancer. METHODS: In the past 5 years, 407 patients with adenocarcinoma of stomach underwent radical gastrectomy in Department of Surgery, Veterans General Hospital-Taipei. Of them, 46 patients (11.3%) with gastric cancer invading the muscularis propria were studied. Their clinicopathologic features were further analyzed with special reference to the gross appearance of the tumor. RESULTS: Most muscularis propria gastric cancers occurred at lower stomach. Nodal spread accounted for 32.6% and was largely confined to n2 with limited involvement of n3. Borrmann type cancer comprised 63% (29/46) of cases and early-like type cancer comprised 37%. Early-like type cancer was smaller in size than Borrmann type cancer (p < 0.001). Nodal spread was more extent in Borrmann type cancer than in early-like type cancer. Other clinicopathologic features and survival were identical in both types of muscularis propria gastric cancer. CONCLUSIONS: Most muscularis propria gastric cancers were Borrmann type cancer grossly. Compared with the early-like type, the Borrmann type cancer was larger and had more extensive nodal spread.

Adenocarcinoma↗
PubMed1994

Breast cancer and pregnancy.

BACKGROUND: Breast cancer developing during pregnancy or lactation is such an infrequent problem that, when it occurs, physicians are confronted with ethical and therapeutic challenges. Moreover, there are very few references to compare or discuss breast cancer in pregnant women in Taiwan. We hope that data from this review will add to our understanding of such difficult problem as well as help improve the treatment of our patients. METHODS: Between 1979 and 1988 the charts of 21 women, who were pregnant or postpartum within one year of the breast cancer diagnosis, were analyzed retrospectively. All of the patients were followed until Dec. 1990. Patients with pregnancy-associated breast cancer were compared with nonpregnant women (199 cases) of similar age who were treated at the same hospital and during the same period. RESULTS: We found no statistical differences in the overall 5-year survival rate between pregnant (57.1%) and nonpregnant (69.6%) groups. It is noteworthy that the time lag was significantly longer in the pregnant group than in the nonpregnant group. A stage-by-stage comparison showed equivalent survival rates between pregnant and nonpregnant patients. The pregnant patients at stage II had a somewhat lower survival rate; however, there was no statistical significance. CONCLUSIONS: The rule of cancer treatment, "early diagnosis followed by aggressive management," is still a key principle to improve the treatment in pregnant women with breast cancer.

Adult↗
PubMed1994

Comparison of aged and young adult patients with cholelithiasis: a prospective controlled study.

BACKGROUND: Surgical operations for gallstones are associated with increased perioperative mortality in the elderly. The presence of pre-existing cardiovascular disease and acute cholangitis might be the cause as found in the literature. METHODS: From August 1989 to December 1990, twenty-nine patients (Age > or = 70 years) with cholelithiasis undergoing biliary surgery in Veterans General Hospital-Taipei were collected as experimental group. Twenty-nine patients from 62 patients (Age < or = 50 years) with cholelithiasis were selected as control group. The basic data, symptomatology, blood biochemistry, peri-operative complications, mortality and gallstone compositions were analyzed and compared between both groups. RESULTS: There was a higher male to female ratio (4.8:1) in the aged group. Aged patients had higher incidence of common bile duct stone (11/29 versus 3/29, P < 0.025), while young adult patients had higher incidence of intrahepatic stone (1/29 versus 10/29, P < 0.05). The perioperative morbidity and mortality was higher in the aged group (37.9% and 3.4%) as compared with the young age group (3.4% and 0%, P < 0.005). CONCLUSIONS: Aged cholelithiatic patients were associated with male preponderance, more common bile duct stones, higher perioperative morbidity and mortality, as compared with the young adult cholelithiatic patients.

Adult↗
PubMed1993

Bile duct injury and bile leakage in laparoscopic cholecystectomy.

Between January 1991 and July 1992, 350 laparoscopic cholecystectomies were performed. There were six biliary complications (1.7 per cent): common bile duct (CBD) injury (one patient), delayed CBD necrosis (one), immediate postoperative bile leakage (one) and delayed bile leakage (three). All six patients required laparotomy. Primary repair with long-arm T tube splinting for 3 months was performed for the CBD injury. Religation of the cystic duct was carried out after immediate postoperative bile leakage. Laparotomy with T tube choledochostomy only was performed in the three patients with delayed bile leakage, and hepatojejunostomy Roux-en-Y was undertaken for CBD necrosis. The patient with primary repair of the CBD injury required choledochojejunostomy Roux-en-Y 18 months later for stenosis. Episodes of intermittent cholangitis occurred in the patient with CBD necrosis. The outcome for the four patients with bile leakage was good. There were no deaths.

Adult↗
PubMed1993

DNA ploidy as a major prognostic factor in resectable ampulla of Vater cancers.

The archival paraffin-embedded specimens from 63 ampulla of Vater cancers after pancreaticoduodenectomy between 1965 and 1991 were analyzed by flow cytometry. Of the 63 cancers, 31 (49.2%) were diploid DNA cancers and 32 (50.8%) were aneuploid. Patients with diploid DNA cancer had a median survival time of 159.0 months, and patients with aneuploid DNA cancer had 24.0 months. This difference is statistically significant (P = 0.0257). The aneuploid group did have a poorer prognosis than the diploid group. The multivariate analysis demonstrated that DNA ploidy was an independent and very important prognostic factor, even stronger than the stage and lymph node status. There was a tendency toward higher values of S-phase fraction, proliferative index, and total aneuploid DNA fraction in the shorter survival groups, but they were of no statistical significance. These data suggest that DNA ploidy appears to be the most important and the only pre-operative predictor of prognosis in resectable ampulla of Vater cancers since endoscopic biopsy is feasible.

Ampulla of Vater↗
PubMed1993

Analysis of glucocorticoid receptors in human hepatocellular carcinoma and HepG2 cells.

Hepatocellular carcinoma is the leading cause of male cancer death in Taiwan. We have found that the level of glucocorticoid receptor in hepatocellular carcinoma is significantly higher than that in the peritumoral tissue. In this study, we used a rat liver glucocorticoid receptor complementary DNA probe to examine the expression of glucocorticoid receptor gene in 15 paired samples of hepatocellular carcinoma and their peritumoral tissues. No differences in genomic DNA patterns of the glucocorticoid receptor gene were found between the tumor and peritumoral tissues. The amount of glucocorticoid receptor was found to be significantly higher in hepatoma samples than in peritumoral liver samples. The levels of glucocorticoid receptor messenger RNAs were increased in most tumors compared with their peritumoral samples. To examine the function of glucocorticoid receptors in hepatoma, we examined the expression of glucocorticoid receptor and its relation to cell-cycle progression in human HepG2 cells. Using specific monoclonal antibodies and flow cytometric study, we found glucocorticoid receptor to be expressed constitutively in all cell-cycle phases. In addition, hydrocortisone treatment of HepG2 cells resulted in increased expression of glucocorticoid receptors and increased secretion of alpha-fetoprotein. RU-486, a glucocorticoid antagonist, blocked the hydrocortisone effect, indicating that glucocorticoid receptors are functional in HepG2 cells. Taken together, our data suggest that glucocorticoids and their receptors play an important role in the growth of hepatoma.

Adult↗
PubMed1993

DNA analysis and persistent hypercalcitoninemia in medullary thyroid carcinoma.

The clinical data of 20 patients with medullary thyroid carcinoma (MTC) treated in Veterans General Hospital (VGH)-Taipei from 1970 to 1991 were reviewed. DNA content of the MTC and postoperative serum calcitonin (CT) were compared to evaluate patients' survival. All three patients with stage IV disease had aneuploid DNA and died within 7 months. The average survival was 4 months. The other 17 patients were all alive at the time of study and the mean follow up was 86 months. Three (3/7) patients had less than total thyroidectomy while only 2 (2/13) of the total thyoidectomized patients needed reoperation because of tumor recurrence. Of the 15 patients with available calcitonin data 11 had persistent post-operative hypercalcitoninemia. Among these 11 patients 5 out of the 6 patients with demonstrable lesions received reoperation; the other five (5/11) without demonstrable lesions were not operated and lived well in spite of persistent hypercalcitoninemia. One in 4 diploid patients and 9 in 12 aneuploid patients had metastatic lesions. No statistical significant correlation was found between the DNA content and survival, metastases or hypercalcitoninemia, although aneuploid MTC tended to be more advanced. We therefore concluded that total thyroidectomy is the treatment of choice for MTC. Persistent postoperative hypercalcitoninemia without clinical demonstrable lesions can be treated conservatively and DNA aneuploidy cannot be used as a reliable indicator of the grade of malignancy for MTC.

Adolescent↗
PubMed1993

Gastrojejunal disconnection in the presence of purulent peritonitis as an alternative approach in gastroduodenal operations.

A two stage operation is presented, for example, a life-saving procedure that halts further leakage and drainage of abscess by a modification of the gastrojejunal disconnection and reconstruction. It may be considered as an alternative approach in gastroduodenal operations in the presence of purulent peritonitis, especially in delayed surgical treatment.

Duodenum↗
PubMed1993

The use of fibrin adhesive for hemostasis after liver resection.

Bleeding, biliary fistula and subphrenic abscess represent the major postoperative complications after liver surgery. Many different adjuvant methods have been developed for control of hemorrhage from the raw surface of liver, but the superiority of any single method remains to be proved. The use of a two-component fibrin adhesive for the control of solid organ bleeding seems to be promising. This study was to evaluate the efficacy of this fibrin adhesive for control of postoperative bleeding in liver surgery. Forty patients were randomized into two groups, similar in all demographic and clinical conditions. Fibrin adhesive was applied to the raw surface of liver resections at the end of operations for 20 patients. Nothing was applied for the control group. Postoperative bleeding was estimated by multiplying the drain amount by the free hemoglobin concentration, every day. Estimated postoperative bleeding was 8.12 +/- 5.65 gm for patients with fibrin adhesive, 15.57 +/- 14.43 gm for control group. Fibrin adhesive has been used in the treatment of injury to the liver and spleen. In this study, it proved to be useful in the control of postoperative bleeding in liver resection, and hopefully decreasing morbidity.

Adult↗
PubMed1993

Can determination of the proliferative capacity of the nontumor portion predict the risk of tumor recurrence in the liver remnant after resection of human hepatocellular carcinoma?

To test the hypothesis that increased proliferative capacity of cells in a liver remnant is a risk factor for tumor recurrence in patients who have undergone liver resection for hepatocellular carcinoma, DNA flow-cytometric measurement and cell-cycle analysis of the nontumor parts of resected hepatocellular carcinomas (tumor size < 5 cm) were performed. The disease-free survival rates 1, 2, 3 and 4 yr after surgery were 64%, 58%, 43%, and 36%, respectively. Proliferative capacity (fractions of synthetic, postsynthetic and mitotic phases) of the nontumor parts, irrespective of liver pathology, was higher than that of normal liver and statistically lower than that of tumor parts from resected hepatocellular carcinoma specimens. Livers with chronic active hepatitis (+) and with hepatocyte dysplasia (-) had significantly lower proliferative activity than did those with chronic active hepatitis (-) and with hepatocyte dysplasia (+), respectively [corrected]. We saw no significant difference in proliferative capacity between patients with and without cirrhosis. Disease-free-survival analysis showed that the presence of liver pathology (hepatitis B infection, cirrhosis, chronic active hepatitis and hepatocyte dysplasia) was not the factor linked to tumor recurrence in the liver remnant and that a marked increase in proliferative capacity (> or = 18%), regardless of liver pathology, was the risk factor linked to tumor recurrence after liver resection. We conclude that there is some degree of increased proliferative capacity in the nontumor parts of resected hepatocellular carcinomas and that a marked increase in the proliferative capacity (> or = 18%) of the nontumor part is a significant risk factor in predicting tumor recurrence in the liver remnant after liver resection.

Aged↗
PubMed1992

Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resection.

A total of 238 patients who received curative hepatic resections during the last 10 yr were observed to search for the risk factors linked to early tumor recurrence of human hepatocellular carcinoma after hepatectomy. The results revealed that tumor size, tumor appearance and DNA ploidy were the factors in predicting tumor recurrence after resection for hepatocellular carcinoma. Patients with a tumor size less than or equal to 5 cm or a tumor appearance of the solitary type had better disease-free survival than did those with a tumor size greater than 5 cm or a tumor appearance of multiple/daughter nodule types (p < 0.05). Although patients with pattern III (aneuploid with > or = 2 G0/G1 peaks) hepatoma had fewer statistically significant differences (p = 0.19) than did those with pattern I (diploid) or pattern II (aneuploid with single G0/G1 peak) tumors in predicting tumor recurrence, they did have poorer results in terms of the overall survival rate (p < 0.05). We conclude that patients with hepatocellular carcinoma having the aforementioned risk factors should be observed closely.

Carcinoma, Hepatocellular↗
PubMed1992

Clinicopathologic comparisons between estrogen receptor-positive and -negative gastric cancers.

We report that a modified dextran-coated charcoal (DCC) assay, including the addition of sodium molybdate and 5% DCC stripping of endogenous hormone, detected higher estrogen receptors (ERs) than those by the conventional assay. ERs in 21 gastric adenocarcinoma were determined by the modified DCC assay; 13 patients had ERs of 2.5 to 520.2 fmol/mg protein with a mean dissociation constant of 1.9 x 10(-10) M. The remaining 8 patients had no detectable amount of the receptor. There were no differences between the ER-positive and ER-negative groups in clinico-pathologic characteristics such as age, sex, tumor size, location, gross appearance, invasive depth, invasion of lymph vessel or vein of stomach wall, nodal involvement, peritoneal dissemination, liver metastasis, and curability. Histological analysis, using Japanese, Lauren's, or Ming's classifications, all revealed no differences between the ER-positive and -negative groups. The survival rate was identical for the 2 study groups. These results suggest that the presence or absence of ERs in gastric adenocarcinoma does not correlate to either biologic or clinicopathologic characteristics of this tumor; the role of ERs in human gastric cancer remains to be elucidated.

Adenocarcinoma↗
PubMed1992

Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study.

For many years, it has been said that Taiwan has the highest relative prevalence of hepatolithiasis among the Asian countries. To confirm this, and to reevaluate the chronological changes regarding gallstone disease in Taiwan, a retrospective nationwide cooperative study was conducted in this country. A total of 17,182 patients from 28 medical centers are included in this survey. A gradual increase during the past 20 years in gallstone prevalence with a concomitant decrease of choledocholithiasis and hepatolithiasis are well demonstrated. Both nutritional and environmental factors are involved in these changes. With respect to hepatolithiasis, Taiwan continues to have the highest prevalence among Asian countries, and 20% may be the average figure for the whole country.

Bile Duct Diseases↗