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ABSTRACT: Abstract Background: Acute small bowel obstruction (SBO) is a common cause of emergency hospital admission, often requiring surgical intervention. Herein, we describe the single-incision laparoscopic surgery (SILS) procedure for the management of SBO in the acute care setting. Patients and Methods: Patients with intestinal obstruction who underwent SILS in Chang Gung Memorial Hospital, Linkou, Taiwan, from January 2010 to January 2012 were retrospectively analyzed. Informed consent was obtained from all patients. Demographic information, intraoperative findings, surgery duration, and conversion to multi-incision laparoscopic surgery (MILS) were recorded. Postoperative records included the recovery period after surgery, complications, length of hospital stay, and final prognosis. Results: Ten SILS procedures for the repair of SBO were performed (six women, four men; median age, 52 years [range, 28-89 years]). Only 1 patient (10%) required conversion to MILS. The median operative time was 140 minutes (range, 90-210 minutes), median time to resume oral intake was 3 days (range, 1-7 days), median time to ambulation was 3 days (range, 1-6 days), and median postoperative hospital stay was 7.5 days (range, 3-14 days). There was no mortality in this series. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up. The median follow-up time was 13.5 months (range, 4-26 months). No incisional hernias or adhesions were observed. Conclusions: SILS for SBO is a feasible, safe procedure that can be performed as initial treatment in select patients with bowel obstruction through resection and decompression of the small bowel using intra- or extracorporeal techniques, resulting in a nearly invisible scar.
Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2012; · 1.40 Impact Factor
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ABSTRACT: Abstract Background: Surgery of gastrointestinal stromal tumors (GISTs) has been modified, and laparoscopic resection of GIST has gained improvement and roles. Patients and Methods: We retrospectively reviewed clinical data and oncological outcomes of our GIST patients who underwent laparoscopic surgery and traditional open surgery. In total, 227 pathologically diagnosed GIST cases were retrospectively reviewed in Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, between 2005 and 2010. We excluded those with tumor size >5 cm, biopsy-only, combined other operation, endoscopic mucosal resection, tumor located in the duodenum, colon-rectum, esophagocardiac junction, omentum, pelvic area, or retroperitoneum, or metastasis when operated on and those diagnosed as other disease after immunohistologic examination of GIST. Fifty-eight cases were enrolled, including 16 patients in the laparoscopic surgery group (LSG) and 42 patients in the open surgery group (OSG). The patients' demography, perioperative, pathologic result, and oncology result were recorded and analyzed. Results: Both groups showed no difference in clinical demography, tumor size, and locations. LSG patients showed fewer days to resume diet, shorter postoperative hospital stays, and less use of patient-controlled analgesia. The postoperative morbidity in LSG and OSG was 6.3% and 19%, respectively. The median follow-up time was 32.73 months in LSG and 39.75 months in OSG. Recurrence or metastasis was observed in 3 patients (1 in LSG and 2 in OSG). The recurrence rate between LSG and OSG showed no significant difference. Conclusions: Laparoscopic surgery was technically feasible for GIST of no more than 5 cm located at the stomach and small bowel. In the current study, we demonstrated that LSG patients benefited from fewer days to resume diet (5 versus 5.71 days), shorter postoperative stays (8 versus 9.07 days), and less patient-controlled analgesia use (6.7% versus 90.9%) during the perioperative period with the same short-term oncology result compared with OSG patients.
Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2012; 22(8):758-63. · 1.40 Impact Factor
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ABSTRACT: Tissue microarray (TMA) allows the rapid immunohistochemical analysis of thousands of tissue samples in a parallel fashion. This study was designed to analyze the cortactin status in breast cancer using TMA and to investigate the relationship of cortactin status to breast cancer biology.
Archival tissue specimens from 99 patients with primary invasive breast cancer were selected. The cortactin expression was analyzed by TMA. Age, estrogen receptor status, histological grading and TNM staging data were also collected.
There were 23 patients (23.2%) with low (+) expression of cortactin, 60 patients (60.6%) with intermediate (++) expression and 16(16.2%) with strong (+++) expression. There was no significant relationship between cortactin expression and age, histological grading, primary tumor staging, lymph node status, estrogen receptor and TNM stage. By multivariate analysis, estrogen receptor status and TNM staging were found to be significantly related to the overall five-year survival rate.
Cortactin expression failed to demonstrate a prognostic value for patients with breast cancer.
Anticancer research 01/2011; 31(1):293-7. · 1.73 Impact Factor
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ABSTRACT: Imatinib mesylate (IM) demonstrates substantial efficacy in most patients with metastatic gastrointestinal stromal tumors (GISTs). However, progression of GIST eventually develops and emerges as a challenge. To assess the role of surgery in the multidisciplinary management of GISTs, we studied the surgical outcomes in GIST patients receiving IM.
Between 2001 and May 2009, 161 metastatic GIST patients received IM. Among them, 35 patients undergoing 38 surgeries were investigated. Patients were categorized based on extent of disease before surgery (responsive or stable disease (PR, SD), local progression (LP), and generalized progression (GP)). Each tumor was investigated for genetic alteration before and after surgery.
Disease status before surgery was significantly associated with surgical result. Gross tumor clearance was achieved in 42.9% of patients with responsive disease, but only 4.8% of those with focal resistance and 0% of those with disease progression (P = 0.022). GIST patients with PR, SD, and LP had significant better 2-year progression-free survival and overall survival than those with GP. Secondary mutations tended to be found more frequently in GIST patients with LP after surgery than those with response (10/21 (47.6%) vs. 2/14 (14.3%); P = 0.07), indicating that surgery may prevent potential development of secondary mutation in GIST patients with response. Secondary kit mutations were also found more frequently with primary exon 11 mutation than those with exon 9 mutation (38.7% vs. 16.7%; P = 0.394).
Surgery may benefit selected GIST patients with PR, SD, and LP, especially for patients with LP because patients with LP had comparable survival to that of patients with responsive lesion. Surgery may prevent potential development of secondary mutations in selected patients with response after IM treatment. Secondary kit mutation was found more frequently in GIST patients with a primary kit exon 11 mutation than those with a primary kit exon 9 mutation.
Journal of Surgical Oncology 11/2010; 102(6):599-603. · 2.10 Impact Factor
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ABSTRACT: The clinical impact of positive surgical margin on the overall survival and recurrence pattern for gastric cancer (GC) patients undergoing intension curative resection has not yet been well investigated.
The clinical features of 1,565 patients with histologically proven GC who underwent intension curative resection from 1994 to 2004 were retrospectively reviewed. Among them, 129 (8.2%) had positive microscopic resection margin. The clinicopathological features and the outcome of 1,436 GC patients undergoing gastrectomy with negative resection margin were used for comparison.
GC patients who underwent gastrectomy with higher T, N stage, and tumor size larger than 5 cm tended to have positive resection margin when compared with those with negative margin. Median follow-up duration for the 1,565 GC patients who underwent intension curative resection was 28.6 months. The overall survival (OS) rate significantly decreased when the patients had positive resection margin, irrespective of different stages. When GC patients underwent gastrectomy with positive resection margin, positive nodal metastasis determined the worst OS. Distant metastasis was the most common site of recurrence, followed by peritoneal and locoregional recurrence.
Aggressive tumor biology might be the main factor contributing to positive microscopic resection margin after gastrectomy. Positive resection margin had a definite unfavorable impact on the OS of gastric cancer patients undergoing gastrectomy. When GC patients underwent gastrectomy with positive resection margin, positive nodal metastasis determined the worst OS, and distant metastasis was the most common site of recurrence.
Annals of Surgical Oncology 08/2009; 16(10):2738-43. · 4.17 Impact Factor
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ABSTRACT: To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery.
From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups.
There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay.
Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients.
World Journal of Gastroenterology 06/2009; 15(19):2376-80. · 2.47 Impact Factor
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ABSTRACT: Cardiovascular disease (CVD) and gallstones are reported to be strongly associated because both diseases are frequently part of a metabolic syndrome. Laparoscopic cholecystectomy (LC) has become the standard treatment for gallbladder disease around the world. Cardiovascular disease is considered as an absolute or relative contraindication for LC; however, clinical information regarding the applicability of LC for treating gallbladder disease in CVD patients is lacking. This study aims to assess the suitability of LC for the treatment of gallbladder disease in CVD patients.
The medical records of 66 patients with severe CVD (including valvular heart disease, ischemic heart disease, and heart failure) and gallbladder disease (CVD-group) who underwent LC between 1966 and 2005 were retrospectively reviewed. Furthermore, these data were compared with the clinical features and outcomes of 8,834 patients with gallbladder disease who underwent LC but did not have severe CVD (NCVD-group).
Of the 8,900 patients with gallbladder disease undergoing LC, the 66 (0.74%) who comprised the CVD-group clearly exhibited advanced age, male predominance, higher blood urea nitrogen (BUN) levels, and a longer duration of hospitalization as compared with the NCVD-group patients. A longer duration of hospitalization and a higher incidence of acute cholecystitis and chronic cholecystitis were identified as independent factors differentiating the CVD-group patients, who had previously undergone open-heart surgery, from the NCVD-group patients who underwent LC. For the CVD-group patients, adjustment of anticoagulant therapy contributed to the longer duration of hospitalization, but postoperative complications did not. Advanced age and male predominance were identified as independent factors differentiating the patients who developed ischemic heart disease that required intervention from the NCVD-group patients undergoing LC. The operative morbidity and mortality rates of LC are likely to be similar when it is used to treat selected patients with severe CVD and gallbladder disease and when it is used to treat patients with gallbladder disease and no CVD.
Laparoscopic cholecystectomy is a suitable procedure for treating selected patients with severe CVD and gallbladder disease, and its operative morbidity and mortality rates are similar in these patients and in patients with gallbladder disease alone. Nevertheless, appropriate preoperative preparations and established operative techniques in the hands of an experienced surgeon are mandatory.
World Journal of Surgery 06/2009; 33(8):1720-6. · 2.36 Impact Factor
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Journal of the Air & Waste Management Association (1995) 02/2009; 59(2):163-171. · 1.52 Impact Factor
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ABSTRACT: Conventional diesel and palm oil methyl esters were blended in 6 ratios (0, 10, 30, 50, 75 and 100% of biodiesel by volume) and fed into an unmodified 4-stroke engine with a constant output power. The semi-volatile and particulate products in the exhaust were collected separately and their biological toxicities evaluated by both Microtox test and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The Microtox test indicates that the TUVs (toxicity unit per liter exhaust sampled, TU/L-exhaust) in the semi-volatile extracts were 3 to 5 times those of the particulate extracts. Diesel particulates had the highest unit toxicity, TUW (toxicity unit per microg soluble organic fraction of particulate, TU/microg particle SOF) of all of the other biodiesel blends. According to the Microtox tests results, the effect of biodiesel blending in MTT assay demonstrated higher toxicity in the semi-volatile products than the particulates.
Journal of Environmental Science and Health Part A 01/2009; 43(14):1735-43. · 1.19 Impact Factor
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ABSTRACT: We conducted a prospective and case-controlled study to evaluate the impact of supplement of alanyl-glutamine dipeptide (Gln) in parenteral nutrition on perioperative immune and nutritional changes and clinical outcomes for patients undergoing gastrointestinal (GI) operations.
During 2006, 70 patients undergoing GI surgeries were allocated equally into two groups. One group received regular parenteral nutrition and the other received the same formulation and supplemented with the Gln; the two groups were isonitrogenous. The infusion was started from 1 day before operation to the sixth day after operation for 7 days. Blood samples were collected on the morning of the day before the operation and on the morning 6 days after the operation and analyzed for immune and nutrition parameters.
There were no differences between the two groups in terms of clinical characteristics, operative procedures, biochemistry, nutritional status, and immune status preoperatively. After GI surgery, significant reduction in nutritional and immune parameters were observed in both groups, demonstrated by significant difference of albumin, C-reactive protein (CRP), lymphocyte count, T cell, and CD8 cell. The length of hospital stay is slightly longer in the control group patients, but not to statistical significance (16.3 +/- 21.3 versus 12.2 +/- 6.8 days, p = 0.299). In terms of morbidity, there was no difference between the two groups, but two patients in the control group had wound infection; none was noted in the Gln group (p = 1.0). No surgical mortality was noted in this study.
Perioperative parenteral nutrition supplemented with Gln is beneficial for patients undergoing GI surgery. Gln supplementation significantly attenuated postoperative inflammation and ameliorated postoperative immunodepression as well as nutritional depression in GI surgery.
Langenbeck s Archives of Surgery 09/2008; 393(6):849-55. · 1.81 Impact Factor
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ABSTRACT: We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.
World Journal of Gastroenterology 09/2007; 13(31):4278-81. · 2.47 Impact Factor
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ABSTRACT: Most gastrointestinal stromal tumors (GISTs) express constitutively activated mutation of kit or platelet-derived growth factor receptor alpha (PDGFRA), which are therapeutic targets for imatinib. Results of 64 Taiwanese with advanced GIST treated with imatinib were reported.
Between 2001 and May 2006, a prospective, non-randomized, and a single center trial containing 64 Taiwanese patients with advanced GIST treated with imatinib was conducted. Each tumor was investigated for mutations of kit or PDGFRA.
The median follow-up time after imatinib administration was 16.1 months. 12 patients (18.8%) had complete response (CR), 24 (37.5%) had a partial response (PR), 12 stationary disease (18.8%), 16 progressive disease (25.0%). The 64 Taiwanese with advanced GIST had an estimated median survival of 48.0 months and 4-year survival rate for 76.1%. Kit mutation was found in 49 of 54 (90.7%) test patients and five of them had no mutation (9.3%). No PDGFRA mutant was identified. In 40 patients harboring kit exon 11 mutations, the CR and PR rates (ORR) were 57.5% , nine patients with tumors containing kit exon 9 mutation had ORR rates of 22.2%, and five patients with no mutation had ORR rates of 60.0% (not significant; P = 0.149).
Activated mutation of kit constituted 90.7% genetic alteration of Taiwanese with advanced GIST and no PDGFRA mutation was detected. Imatinib induced a sustained objective response in more than half of Taiwan advanced GIST patients. ORR did not differ between patients whose GISTs had no mutation, kit exon 9, and 11 mutations.
Annals of Surgical Oncology 04/2007; 14(3):1123-8. · 4.17 Impact Factor
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ABSTRACT: Primary squamous cell carcinoma (SCC) of the liver is rare. Totally nine such cases have been reported in the literature. Primary SCC of the liver has been reported to be associated with hepatic teratoma, hepatic cyst, or hepatolithiasis. Complete remission of poorly differentiated SCC of the liver could be achieved by systemic chemotherapy followed by surgery or remarkably respond to hepatic arterial injection of low dose chemotherapeutic drugs. Here we report the first case of primary SCC of the liver presenting as a solid tumor and receiving successful hepatic resection with 9-mo disease free survival.
World Journal of Gastroenterology 10/2006; 12(33):5419-21. · 2.47 Impact Factor
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ABSTRACT: This study surveyed emissions from 2- and 4-stroke new and in-use motorcycles. Emission tests were carried out on a dynamometer following the designated test procedure of the Economic Commission for Europe (ECE). Samples were derived during various driving stages, which included idle, acceleration, 30 km/hr cruise, 50 km/hr cruise, and deceleration. All test motorcycles (10 new and 15 in-use) complied with Taiwan Environmental Protection Administration's Phase III Motorcycle Emission Standards. The dominant volatile organic carbon (VOC) species were isopentane (53 and 295 mg/km, 2- and 4-stroke, respectively), 2-methylpentane (75 and 83 mg/km), 3-methylpentane (34 and 66 mg/km), and toluene (30 and 100 mg/km). The VOC emission factors for the 2-/4-stroke motorcycles were 311/344 (new) and 1479/433 (in-use) mg/km, respectively. In addition, the dominant carbonyl species for the new and in-use motorcycles were formaldehyde (0.4 and 0.7 mg/km, respectively), acetaldehyde (0.6 and 1.2 mg/km), and acetone (0.5 and 0.7 mg/km). The carbonyl compound emission factors for the 2- and 4-stroke motorcycles were 3.2/3.1 (new) and 5.3/4.6 (in-use) mg/km, respectively. The ozone formation potentials, based on an ECE test cycle, show that the values from the in-use motorcycles were higher than those from the new motorcycles. The dominant VOC species for the ozone formation potential were propylene (65 and 502 mg-O3/km, respectively), isopentane (98 and 501 mg-O3/km), 2-methylpentane (152 and 167 mg-O3/ km), 3-methylpentane (79 and 253 mg-O3/km), and toluene (127 and 398 mg-O3/km). Further, the dominant carbonyl species were formaldehyde (4.1 and 6.2 mg-O3/ km, new and in-use, respectively) and acetaldehyde (4.8 and 9 mg-O3/km).
Journal of the Air & Waste Management Association (1995) 06/2003; 53(5):516-22. · 1.52 Impact Factor
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ABSTRACT: Cor triatriatum (CT) is a rare cardiac anomaly, characterized by a membrane in the left atrium which separates the atrium into the proximal and distal chambers. Association of CT with atrioventricular septal defects (AVSD) is extremely rare; only three cases with complete AVSD and 10 with partial AVSD have been reported. In this study, we present an 11-month-old female infant with complete AVSD and cor triatriatum. The patient recovered uneventfully after surgery and normal cardiac performance was achieved 2 years later.
Chang Gung medical journal 30(3):270-3.
