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1.
Hepatogastroenterology ; 56(91-92): 578-83, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19621658

RESUMO

BACKGROUND/AIMS: To evaluate prospectively the preoperative use of 16-multidetector computed tomography (MDCT) with cholangiography and angiography in determining the resectability of hilar cholangiocarcinoma. METHODOLOGY: From January 2002 to January 2008, 75 consecutive patients with hilar cholangiocarcinoma underwent preoperative MDCT with cholangiography and angiography. 3D images of the portal vein, hepatic artery, and bile ducts were created and viewed simultaneously. The accuracy of MDCT with cholangiography and angiography was determined by comparison with intraoperative and pathologic findings. RESULTS: All patients tolerated the CT imaging well and without serious complication. The sensitivity, specificity, and accuracy rates were 92.9%, 100%, and 96% for portal vein invasion and 83.3%, 100%, and 93.3% for hepatic arterial invasion. The accuracy rate of longitudinal tumor extension, using the modified Bismuth-Corlette classification, was 96%. The sensitivity, specificity, and accuracy of prediction of resectability were 95.7%, 82.1%, and 90.7%, respectively. CONCLUSIONS: Preoperative MDCT with cholangiography and angiography gave a good assessment of the degree of biliary and vascular involvement of hilar cholangiocarcinoma. It also accurately predicted resectability.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Tomografia Computadorizada por Raios X , Angiografia , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Colangiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes
2.
Surgeon ; 4(5): 259-64, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17009543

RESUMO

Surgery in Hong Kong has undergone a significant evolution over the past century. The quality of surgical care, medical education, surgical training and academic research has improved significantly through the joint efforts of the two universities, the government and the surgical colleges over these years. Surgical practice in Hong Kong continues to change also with the development of specialties/subspecialties, the changing pattern of disease and the development of new and effective treatments. Areas of clinical excellence in oesophageal cancer, hepatocellular carcinoma (HCC) and nasopharyngeal cancer (NPC) have gradually developed in these areas in Hong Kong. With the ongoing Westernisation and continued economic development in Hong Kong, some previously uncommon diseases will become more common. The surgical service in Hong Kong will need to continue to change to meet the new challenges in the future


Assuntos
Procedimentos Cirúrgicos Operatórios , Benchmarking , Educação Médica Continuada , Necessidades e Demandas de Serviços de Saúde/tendências , Hong Kong , Humanos , Aprendizagem Baseada em Problemas , Especialidades Cirúrgicas/educação , Especialidades Cirúrgicas/tendências , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/tendências
3.
Atherosclerosis ; 186(2): 360-6, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16112118

RESUMO

This study examines the prevalence of atherosclerosis (using ankle-brachial index (ABI) value <0.9) and associated socioeconomic and lifestyle factors in elderly Chinese, adjusting for presence of cardiovascular diseases and body mass index, in a cross-sectional survey of 1999 men and 1999 women aged 65 years and over living in the community. A questionnaire containing information regarding socioeconomic status, medical history and lifestyle factors was administered. Measurement included height, weight, percentage body fat using dual-energy X-ray absorptiometry and ABI. The Hong Kong population (2000) age adjusted prevalence of ABI <0.9 was 5.3% for men and 11.0% for women. In multivariate analysis, old age, female gender, presence of cardiovascular diseases, cognitive impairment, prolonged 6 m walk, smoking habit and alcohol intake were positively associated with ABI <0.9, while negative associations were observed with Vitamin C intake >100 mg per day, with the lowest OR for the range 141-190 mg (OR 0.4). Physical activity level, and self rated higher social standing in the community, while significant in univariate analysis, were not included as independent significant factors in the multivariate model. Lifestyle factors and the female gender were independent risk factors for atherosclerosis in the elderly Chinese population.


Assuntos
Tornozelo , Aterosclerose/epidemiologia , Aterosclerose/fisiopatologia , Artéria Braquial/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Aterosclerose/diagnóstico , Aterosclerose/economia , Determinação da Pressão Arterial , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores Socioeconômicos
4.
Pharmacoeconomics ; 19(9): 947-53, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11700781

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) is endemic in parts of Asia and Africa and most patients are not suitable for treatment with a curative approach. Little is known about the cost of palliative care for HCC. OBJECTIVE: To determine: (i) patient-specific costs of palliative care of HCC; and (ii) individual factors that drive patient-specific costs and to develop a model of cost per case under alternative circumstances. METHODS: 204 patients with inoperable HCC were prospectively tracked from first hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal services incurred by payers, caregivers and patients. Observational data from a large Hong Kong cancer care programme were used. A regression analysis was performed using formal costs only, with the cost per observed day as the dependent variable. RESULTS: The median survival was 95 days and the mean observation period was 153 days. The mean value per person for formal healthcare cost was 30 983 Hong Kong dollars [$HK] ($US3872, 1998 values). The distribution of cost values were positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed day, and the Child-Pugh grading of severity of liver cirrhosis was positively related to cost per observed day. A sensitivity analysis based on the regression equation indicated that nonsurvivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to the cost, and chemotherapy increases cost 2-fold. CONCLUSIONS: The relatively modest average cost per patient with HCC in Hong Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy.


Assuntos
Carcinoma Hepatocelular/economia , Neoplasias Hepáticas/economia , Cuidados Paliativos/economia , Idoso , Carcinoma Hepatocelular/classificação , Carcinoma Hepatocelular/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Hong Kong/epidemiologia , Humanos , Neoplasias Hepáticas/classificação , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Índice de Gravidade de Doença
5.
Hepatology ; 34(3): 557-65, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11526542

RESUMO

Recovery of liver cell mass following hepatectomy requires a metabolic compromise between differentiated function and organ regrowth. Clinical experience has shown that hepatic failure after resection is more common when the organ is diseased. We have evaluated intracellular hepatic biochemistry in patients with normal and cirrhotic livers undergoing partial hepatectomy, using 31-phosphorus magnetic resonance spectroscopy ((31)P MRS). Eighteen patients were studied, half with normal liver architecture (normal group, n = 9) and half with cirrhotic parenchyma (cirrhosis group, n = 9). Magnetic resonance examinations were performed preoperatively and on postoperative days 2, 4, 6, 14, and 28. Hepatic volume (estimated by magnetic resonance imaging [MRI]) and blood chemistries were measured at the same intervals. Following a comparable reduction in parenchymal volume, the cirrhotic group demonstrated a more sustained fall in adenosine triphosphate (ATP) energy state. Disturbance of membrane phospholipid metabolism and duration of acute-phase reaction were more marked when the liver was diseased. The pattern of derangement of hepatic function, however, was similar in the two groups. Overall, the recovery process was less efficient in the cirrhotic organ, and culminated in a diminished rate and extent of the regenerative response. These outcomes indicate that liver regeneration after partial hepatectomy involves modulation of hepatic energy economy in response to changing work demands. The efficiency of this process is influenced by the histopathologic state of the organ, and in turn governs the physiologic reserve. These findings may explain the mechanism of posthepatectomy liver failure, and offer a rational basis for the assessment of novel hepatic support strategies.


Assuntos
Metabolismo Energético , Cirrose Hepática/fisiopatologia , Regeneração Hepática , Fígado/metabolismo , Trifosfato de Adenosina/metabolismo , Adulto , Idoso , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Fígado/fisiopatologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Cirrose Hepática/metabolismo , Cirrose Hepática/cirurgia , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fosfolipídeos/metabolismo , Valores de Referência
7.
Clin Ther ; 11(5): 604-13, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2509069

RESUMO

Patients with serious systemic infections admitted to eight medical centers in six Asian countries were treated with 300 mg of netilmicin given once daily (group A: 92 patients) or 100 mg of netilmicin given three times daily (group B: 93 patients). Netilmicin was administered by intramuscular injection or slow intravenous infusion until clinical, laboratory, and bacteriologic measures were normalized and for not more than two additional days. A clinical cure was achieved in 88% of the patients from group A and in 68% from group B. The causative micro-organisms were eliminated or infection site healed in 90% of group A and in 88% of group B. The mean treatment duration was 6.9 days in group A and 8.8 days in group B. Two patients in each group developed symptoms of nephrotoxicity; the pretreatment serum creatinine levels in all four patients were in the high borderline range. No other serious side effects were found. It is concluded that netilmicin administered once daily is safe and more effective than netilmicin administered three times daily.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Netilmicina/uso terapêutico , Adolescente , Adulto , Idoso , Ásia , Análise Custo-Benefício , Feminino , Humanos , Nefropatias/induzido quimicamente , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Netilmicina/administração & dosagem , Netilmicina/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Gastroenterol Hepatol ; 4 Suppl 2: 35-43, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2491360

RESUMO

To investigate the efficacy of standard and low dosage of omeprazole in the healing of duodenal ulcer, 270 patients with endoscopically active duodenal ulcer were randomized to receive omeprazole, 10 mg or 20 mg every morning, or ranitidine, 150 mg twice daily, using the double-dummy technique. Forty-six potential prognostic factors for healing including clinical, acid-secretory, and endoscopic characteristics were prospectively obtained and healing was assessed by endoscopy at weekly intervals for up to 4 weeks. The cumulative healing rates in the 4 weeks were 43%, 77%, 94% and 95% for omeprazole, 10 mg (n = 83); 49%, 86%, 93%, and 96% for omeprazole, 20 mg (n = 87); and 29%, 63%, 83% and 93% for ranitidine (n = 84), respectively. Life-table analysis showed P less than 0.03 for omeprazole, 10 mg versus ranitidine and P less than 0.002 for omeprazole, 20 mg versus ranitidine. Life-table analysis also showed that in the omeprazole groups, healing rates were lower in smokers than in non-smokers (P less than 0.001), in late- than in early-onset patients (symptoms starting after or before the age of 30 years, respectively, P less than 0.02), in those with less than 5 months than in those with more than 5 months of remission (P less than 0.05), and in those with increased maximal acid output than in those with normal output (P less than 0.05). Patients with healed ulcer were interviewed at 2-month intervals and endoscoped at 4-month intervals or whenever symptoms recurred. The cumulative ulcer relapse rates in 1 year were not significantly different between omeprazole and ranitidine groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Úlcera Duodenal/tratamento farmacológico , Omeprazol/uso terapêutico , Ranitidina/uso terapêutico , Adulto , Método Duplo-Cego , Duodenoscopia , Feminino , Humanos , Masculino , Recidiva
9.
Am J Surg ; 148(3): 375-8, 1984 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6476229

RESUMO

A prospective study was conducted on 107 patients with negative findings at appendectomy. The operation was unnecessary in 94 of the patients. A cause for the symptoms could be found in 43 patients, 32 during operation and 11 later by investigation or by a second operation. Diagnosis remained unclear in 64 patients. There are many diseases that mimic acute appendicitis, and based on the disease entities encountered in this series, the surgeon must examine the abdominal organs carefully if the appendix is normal. The financial loss of negative appendectomy was substantial in our study, and the total early and late complication rate was 14 percent. Patients with negative appendectomy should be regularly followed up to 1 year, since 9.3 percent of patients had a diagnosis made later by investigation, and 12.1 percent had moderate to severe pain on follow-up. Possible means to cut down the negative appendectomy rate without increasing the perforation rate have been suggested herein for further evaluation.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Abdome Agudo/diagnóstico , Adolescente , Adulto , Idoso , Apendicectomia/economia , Criança , Custos e Análise de Custo , Erros de Diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos
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