-
[show abstract]
[hide abstract]
ABSTRACT: Interphase fluorescence in situ hybridization (FISH) analysis of multiple myeloma (MM) may indiscriminately count signals of nonplasma cells, thus decreasing specificity and sensitivity. We aimed to evaluate the usefulness of an immune-magnetic sorting method for plasma cells in FISH analysis of MM and define optimal sample preparation conditions.
Plasma cells were purified using EasySep(®) CD138 Positive Selection Cocktail and Magnetic Nanoparticles (Invitrogen). We compared FISH results with and without plasma cell purification for three sample preparation methods: direct harvest, 24-h culture, and 96-h culture with interleukin-4 in five newly diagnosed MM patients. Archived fixed bone marrow cells of 17 MM patients were also studied.
The percentage of abnormal cells identified was significantly higher with plasma cell purification than without purification (median, 88.0%; range, 84.0-100.0%vs. 15.0%, 12.5-29.5%, respectively). The three sample preparation methods showed comparable results. Immune-magnetic sorting also significantly increased the percentage of abnormal cells identified in FISH analysis of archived fixed bone marrow cells (P < 0.001). Conclusions: Immune-magnetic CD138-positive cell sorting significantly increased the percentage of abnormal cells identified in FISH analysis of MM samples for all sample preparation methods. This method could also be applied for retrospective FISH analysis of archived fixed bone marrow cells.
International journal of laboratory hematology 06/2012; 34(5):541-6. · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the clinicoradiologic characteristics of patients with branch occlusive disease (BOD)-type intracranial atherosclerotic stroke (ICAS) compared with those of patients with non-BOD-type ICAS or with small artery disease (SAD).
We analyzed 201 consecutive patients with acute infarcts within the middle cerebral artery (MCA) distribution but no demonstrable carotid or cardiac embolism sources. According to the diffusion-weighted imaging (DWI) distribution and the presence of ipsilateral MCA stenosis, of any degree, on magnetic resonance angiography (3-T MRI), we divided patients into 3 groups: 1) BOD: subcortical infarcts with MCA stenosis (n = 46); 2) non-BOD: infarcts beyond the subcortical area with MCA stenosis (n = 52); and 3) SAD (n = 103). We compared risk factors, degree of stenoses and distribution, and radiologic features of microangiopathy (leukoaraiosis and cerebral microbleeds) among the groups.
Risk factor profiles were similar among the groups, except that hypertension and current smoking were more prevalent in the non-BOD than in the BOD group (p = 0.032 and 0.045). The relevant MCA had more severe and focal stenosis in the non-BOD than in the BOD group (stenosis of ≥70%; 76.9% vs 28.3%; p < 0.001), but the degree of nonrelevant stenosis was similar across the groups. Although clinical features, DWI lesion patterns, and microangiopathy findings were similar between the BOD and SAD groups, nonrelevant stenosis was more prevalent in the BOD than in the SAD group (p < 0.01).
BOD is prevalent (47% of ICAS) and shares common characteristics with non-BOD-type ICAS, although its clinicoradiologic features may resemble those of SAD. The morphologic characteristics of stenosis and risk factors may associate with a stroke phenotype in patients with ICAS.
Neurology 03/2012; 78(12):888-96. · 8.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Infants with hypertrophic pyloric stenosis typically present at 2 to 4 weeks of age with nonbilious projectile vomiting. Hypertrophic pyloric stenosis is exceedingly rare in newborn infants and is scarcely reported in literature. Also, the diagnostic criteria for ultrasonographic measurements in newborn infants have yet to be determined. This report is of a newborn infant with hypertrophic pyloric stenosis. The patient presented with high-volume non-bile-stained output from a nasogastric tube and a dilated gastric bubble on abdominal radiograph. Contrast study ruled out intestinal malrotation. Two ultrasound tests showed that the pyloric muscle thickness and pyloric canal length were within normal limits. Subsequent laparotomy showed a thickened pylorus and pyloromyotomy was performed. The patient showed marked improvement in feeding postoperatively. A high index of suspicion is required for newborn infants presenting with gastric outlet obstruction. Ultrasound and contrast studies provide additional information, but definitive diagnosis may only be available intra-operatively.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 06/2011; 17(3):245-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To review the demographic data, imaging features, and outcomes of paediatric haemangiomas.
Retrospective study.
University teaching hospital, Hong Kong.
A total of 58 children diagnosed with haemangioma between 1998 and 2007.
Demographic data, imaging features, type of treatment received, and outcomes.
In all, 19 (33%) of these patients were males and 39 (67%) were females. Most of the lesions (64%) were in the head and neck region. Three (5%) of the patients were complicated by the Kasabach-Merritt syndrome; 21 underwent no imaging, and 37 had ultrasound and/or magnetic resonance imaging. In the majority (85%), ultrasound of the lesions revealed mixed echogenicity and/or phleboliths with variable colour Doppler patterns. On magnetic resonance imaging, most (87%) of the lesions were T1 iso- to hypo-intense and T2 hyperintense with slight heterogeneous signalling and revealed presence of central flow voids (vascular channels) or low-signal areas (fibrous tissue or calcification). In all, 85% appeared homogeneous while 15% showed heterogeneous enhancement. Of 58 patients, 39 (67%) patients received conservative treatment; the lesions resolved spontaneously in 34 (87%) patients, enlarged in 2 (5%), and remained static in 3 (8%). Interventions were directed at the lesions in 19 patients. These entailed surgical excision (n=7), argon laser therapy (n=3), and medical treatment (n=9). Of the latter patients, treatment included: systemic steroids (n=5), interferon (n=1), steroids and interferon (n=1), vincristine (n=1), and sclerotherapy (n=1). Partial or complete resolution of the lesions ensued in 15 (79%) of the patients, while their size remained static in four (21%).
Though ultrasound and magnetic resonance imaging features varied, the diagnosis of most haemangiomas could be confidently made by imaging. About 33% of haemangiomas underwent surgical/medical interventions, for which imaging was useful to monitor post-treatment progress.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 10/2010; 16(5):334-40.
-
[show abstract]
[hide abstract]
ABSTRACT: Imperforate hymen is a relatively rare congenital anomaly. However, it is not an uncommon cause of lower abdominal pain presenting in teenage girls. Without careful history taking and thorough examination, the condition can be missed easily. We report an imperforate hymen presenting as abdominal pain in three teenage girls aged 12, 12 and 13 years, respectively, within a six-month period. The presentation was reviewed and the various types of hymenotomy were discussed.
Singapore medical journal 11/2009; 50(11):e378-9. · 0.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Littre's hernia is a rare complication of Meckel's diverticulum. It was originally defined as 'the presence of a Meckel's diverticulum in any hernia sac' by Rieke in 1841. It is difficult to diagnose before surgery. With the advances in the development of laparoscopic surgery in children, diagnosis of this rare condition, together with subsequent repair of Littre's hernia and Meckel's diverticulectomy can be performed by laparoscopy. We herein report the use of laparoscopy in the management of two boys with Littre's hernia, including one with incarcerated hernia.
Pediatric Surgery International 08/2008; 24(7):855-8. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, is prone to develop complications in the pediatric population. The authors report their 10-year experience with the management of complicated Meckel's diverticulum in children using laparoscopy.
A retrospective review of all complicated Meckel's diverticulum cases involving children from 1998 to 2007 was performed. The efficacy and safety of laparoscopy used to manage complicated Meckel's diverticulum were assessed.
Over a 10-year period, 20 children (17 boys and 3 girls) with a mean age of 5 years (range, 7 months to 13 years) were included in the study. Of the 20 children, 12 presented with gastrointestinal bleeding, 2 had intestinal obstruction, 3 had abdominal pain mimicking acute appendicitis, 2 had inguinal hernia, and 1 had intussusception. Diagnostic laparoscopy was performed for all the patients. Laparoscopically assisted transumbilical Meckel's diverticulectomy was performed successfully for 18 of the children. The operative time ranged from 50 to 190 min (mean, 115 min). All the children had an uneventful recovery except one, who experienced a postoperative wound infection. Ectopic gastric mucosa was found in 14 cases.
Diverse pediatric surgical conditions result from Meckel's diverticulum. Laparoscopy is a safe and effective method for the management of complicated Meckel's diverticulum.
Surgical Endoscopy 07/2008; 22(6):1509-12. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BackgroundMeckel’s diverticulum, the most common congenital anomaly of the gastrointestinal tract, is prone to develop complications
in the pediatric population. The authors report their 10-year experience with the management of complicated Meckel’s diverticulum
in children using laparoscopy.
MethodsA retrospective review of all complicated Meckel’s diverticulum cases involving children from 1998 to 2007 was performed.
The efficacy and safety of laparoscopy used to manage complicated Meckel’s diverticulum were assessed.
ResultsOver a 10-year period, 20 children (17 boys and 3 girls) with a mean age of 5years (range, 7months to 13years) were included
in the study. Of the 20 children, 12 presented with gastrointestinal bleeding, 2 had intestinal obstruction, 3 had abdominal
pain mimicking acute appendicitis, 2 had inguinal hernia, and 1 had intussusception. Diagnostic laparoscopy was performed
for all the patients. Laparoscopically assisted transumbilical Meckel’s diverticulectomy was performed successfully for 18
of the children. The operative time ranged from 50 to 190min (mean, 115min). All the children had an uneventful recovery
except one, who experienced a postoperative wound infection. Ectopic gastric mucosa was found in 14 cases.
ConclusionsDiverse pediatric surgical conditions result from Meckel’s diverticulum. Laparoscopy is a safe and effective method for the
management of complicated Meckel’s diverticulum.
Surgical Endoscopy 05/2008; 22(6):1509-1512. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a case of pheochromocytoma in the urinary bladder of a 14-year-old girl who presented with headache and palpitation after voiding. This is an extremely rare condition in pediatric age group and thus can be missed easily. This case is the seventh case reported in the reviewed literature.
Pediatric Surgery International 05/2008; 24(4):479-80. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors.
A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005.
Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results.
With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.
Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2008; 17(6):817-20. · 1.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report our experience with endoscopic retrograde cholangiopancreatography-(ERCP-)based interventions in children with complicated choledochal cysts that are refractory to conservative management. Between 1999 and 2006, 42 children (12 boys, 30 girls; median age 3 years, range 2-14.5 years) were admitted for surgical treatment of choledochal cysts. Seven of these patients (16.7%; one boy, six girls; median age 3 years, range 2-12 years) showed signs of complicated choledochal cysts, and presented with pancreatitis/cholangitis (n = 4) and obstructive jaundice (n = 3). The anatomical classification of the cysts was type Ic (n = 3), type If (n = 3), and type IV (n = 1). ERCP was successfully performed in 6/7 patients, and therapeutic interventions included removal of debris (n = 3), sphincterotomy (n = 3), and stent placement (n = 4). One patient required blood transfusion for post-sphincterotomy bleeding. The patient in whom the ERCP failed underwent ultrasound-guided percutaneous transhepatic biliary drainage. Definitive surgery was performed after a median interval of 10 days (range 7-68 days) after the ERCP intervention.
Endoscopy 10/2007; 39(9):836-9. · 5.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Inflammatory myofibroblastic tumor of the bladder is an uncommon condition of unknown neoplastic potential. In adults the tumor is seen in association with instrumentation of the lower genitourinary tract, while in children it appears to run an idiopathic course. Its clinical and radiological presentation in children resembles sarcoma. The case of a 10-year-old girl with inflammatory myofibroblastic tumor is presented, outlining the histological and immunhistochemical features to allow differentiation between sarcomas, the most important differential diagnosis. An outcome meta-analysis of the literature identified 35 cases of inflammatory myofibroblastic tumor in the bladder of children. Conservative surgery is the strategy of choice. There is no evidence of recurrence or metastasis at a median follow up of 1.5 years.
Pediatric Surgery International 09/2007; 23(8):815-9. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Excision of a choledochal cyst followed by biliary reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice for type I and IV choledochal cysts. We present a rare complication which was identified 8 years after the original reconstructive surgery. Conventional imaging modalities failed to identify the pathology. Only a contrast enhanced CT scan supported by image rendering software allowed for the visualization of the underlying chronic obstruction of part of the mesentery.
Pediatric Surgery International 11/2006; 22(10):841-4. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Helicobacter pylori infection is common in paediatric population. To date, there is still no universally accepted recommendation on the treatment of this infection in children. Ranitidine bismuth citrate-based triple therapy has been shown to be effective in H. pylori eradication in adults but its use has rarely been validated in children.
To investigate the efficacy of ranitidine bismuth citrate-based triple therapy in eradication of H. pylori in children and to determine the shortest duration of treatment required.
We conducted a prospective randomized study comparing ranitidine bismuth citrate plus amoxicillin plus clarithromycin given for 4 days vs. 7 days in H. pylori-infected children diagnosed by (13)C-urea breath test. Eradication was evaluated by repeat (13)C-urea breath test at 6 weeks after treatment.
A total of 206 children were recruited (median age 12 years, 97 boys and 109 girls). Ninety-eight (47.6%) and 108 (52.4%) children were randomized to receive 7-day and 4-day regimen respectively. The eradication rate of 4-day treatment arm was 77.8% (both intention-to-treat and per protocol) compared with 88.8% (intention-to-treat, P = 0.036) and 89.7% (per protocol, P = 0.022) of 7-day regimen. There was no statistical difference in terms of side effects between the two groups.
Seven-day ranitidine bismuth citrate-based triple therapy is an effective and well-tolerated treatment for eradication of H. pylori in children.
Alimentary Pharmacology & Therapeutics 08/2006; 24(1):81-6. · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi-ureteric junction (PUJ) obstruction.
Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25-10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction). The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent.
The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103-235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan.
Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long-term results await further studies.
BJU International 05/2001; 87(6):509-13. · 2.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report our experience of laparoscopic excision of symptomatic prostatic utricles in children.
Prostatic utricles were excised laparoscopically in four boys (mean age 6.3 years, range 1.5-17). Cysto-urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure. Laparoscopy was conducted via a 5-mm port inserted through a supra-umbilical incision. Two more 5 mm working ports were inserted at the right and left mid-abdomen. The prostatic utricle was easily identified with the guidance of cystoscopic transillumination. Dissection was further facilitated by lifting and counter-traction of the prostatic utricle using the indwelling cystoscope. The prostatic utricle was completely mobilized and divided at its confluence with the urethra using an ultrasonic scalpel.
Laparoscopic excision of the prostatic utricle was successful in all four patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in one. One patient also had a nonfunctioning dysplastic kidney associated with an ectopic ureter joining into the prostatic utricle, and underwent nephroureterectomy at the same setting. The mean (range) operative duration was 148 (105-225) min. All four patients recovered uneventfully with no complications.
Laparoscopic excision under cystoscopic guidance is effective for symptomatic prostatic utricles, offering a good surgical view and allowing easy dissection in a deep and narrow pelvic cavity.
BJU International 05/2001; 87(6):505-8. · 2.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Gastrointestinal bleeding (GIB) in children with no identifiable source found after upper endoscopy and colonoscopy or GIB of obscure origin can pose a great management problem for pediatric surgeons. The recent advent of laparoscopy in children has provided a useful solution.
The authors reviewed their experience of using laparoscopy in the management of 17 children (13 boys) with GIB of obscure origin over an 8-year period. The mean age was 9.8 years (range, 3 to 17 years).
In all patients, upper endoscopy and colonoscopy results did not show a bleeding source. Pertechnetate technetium Tc 99m scan showed positive uptake in 6 patients. Of these, 4 were found on laparoscopy to have a Meckel's diverticulum, 1 had intestinal duplication, and the remaining patient had nodular lymphoid hyperplasia at the terminal ileum. Ten patients had a negative pertechnetate scan. Of these, 3 had a Meckel's diverticulum, 1 had lymphoid hyperplasia, 1 had intestinal duplication, 1 had vascular enteritis, and 4 had normal findings on videolaparoscopy. Pertechnetate scan was not performed in 1 patient and, on laparoscopy, it turned out to be Meckel's diverticulum. Laparoscopic-assisted small bowel resection was performed successfully in all patients with Meckel's diverticulum, intestinal duplication, and nodular hyperplasia. Conversion to open surgery was required in the patient with extensive ileal vascular enteritis secondary to Henoech Scholein purpura. All patients, including the 4 with normal findings on laparoscopy, had made uneventful recovery without further episode of bleeding.
Laparoscopy is a useful diagnostic as well as therapeutic tool in children with GIB of obscure origin.
Journal of Pediatric Surgery 10/2000; 35(9):1291-3. · 1.45 Impact Factor
-
Australian and New Zealand Journal of Surgery 08/2000; 70(7):542-4.
-
[show abstract]
[hide abstract]
ABSTRACT: The present study, conducted in Hong Kong, was designed to evaluate the clinical assessment and interobserver variation between doctors with different levels of training in the assessment of recurrent varicoceles, and to compare their findings with those made by ultrasound. Fifteen patients, previously operated for left varicocele testis, were evaluated clinically by four observers. The mean age was 12.9 years (range 8-15 years) at surgery. The testicular texture, size and flow with and without the Valsalva manoeuvre were determined by colour Doppler sonography. The follow-up time was 6-48 months after surgery. The echotexture of the testes was normal in all patients. The mean volumes of the left and right testes were equal after surgery (left 9.0 ml [range 2.4-15.2 ml and right 8.7 ml [range 3.4-15.6 ml]). There was large variation between observers in the predictability of both positive and negative clinical findings of varicocele testis when compared with ultrasound. Objective assessment in grading varicocele testis and testicular volume using ultrasound is required for both clinical management and scientific research.
Scandinavian Journal of Urology and Nephrology 05/2000; 34(2):119-22. · 0.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors' experience of using laparoscopy in the management of 23 girls (mean age: 8.9 years; range: 3 months-15 years) with various adnexal pathologies over a 3-year period is reviewed.
Of the 23 patients, seven were evaluated for congenital gonadal pathologies, 15 presented with abdominal pain and one patient had an antenatally diagnosed adnexal mass. Detailed laparoscopic examination of the pelvic cavity and laparoscopic gonadectomy were successfully performed in all seven patients with congenital gonadal pathologies: mosaic Turner's syndrome (n = 2), gonadal dysgenesis (n = 3) and testicular feminization syndrome (n = 2). Of 15 patients presenting with abdominal pain, 11 had an adnexal mass, two had acute appendicitis and two had pelvic inflammatory disease.
Laparoscopic excision of the adnexal masses were successfully performed in 10 of 11 patients. Conversion to open surgery was required in one patient with a huge teratoma. Laparoscopic appendicectomy was successfully performed in both patients with acute appendicitis while diagnostic laparoscopy was the only procedure required in the two patients with pelvic inflammatory disease. Laparoscopy in the infant with an antenatally diagnosed adnexal mass confirmed this to be an omental cyst, which was successfully excised. All patients recovered without complications and good cosmetic result was universally achieved.
Laparoscopy is safe and effective in both diagnosis and treatment of adnexal pathologies in children.
Australian and New Zealand Journal of Surgery 04/2000; 70(3):192-5.
