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1.
Hong Kong Med J ; 15(1): 53-6, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19197097

ABSTRACT

Substance abuse is a major health and social problem among Hong Kong youth and ketamine is the drug most commonly abused. Ketamine abuse is associated with a series of side-effects that include hallucination, nausea, vomiting, elevation of blood pressure, and urinary bladder dysfunction. Here we report three cases of ketamine abuse in which the abusers presented with recurrent epigastric pain and dilated common bile ducts that mimicked choledochal cysts on imaging. The dilated biliary tree may occur more frequently than was once assumed.


Subject(s)
Analgesics/adverse effects , Common Bile Duct Diseases/etiology , Ketamine/adverse effects , Substance-Related Disorders/complications , Adult , Choledochal Cyst/diagnosis , Common Bile Duct Diseases/diagnosis , Diagnosis, Differential , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/etiology , Female , Hong Kong , Humans , Male , Treatment Outcome , Young Adult
2.
Am J Surg ; 197(4): e38-40, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19178900

ABSTRACT

Gastroduodenal artery pseudoaneurysm is a rare but life threatening complication of pancreatitis. Diagnosis and management of it remain challenging. Surgical treatment was associated with a high mortality. Percutaneous transarterial embolization of bleeding artery has recently been advocated as a definitive therapy and can be attempted as the initial measure to control bleeding. We herein report a case of chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery which was successfully controlled with transarterial embolisation.


Subject(s)
Aneurysm, False/diagnosis , Aneurysm, False/therapy , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/therapy , Pancreatitis, Chronic/complications , Adult , Aneurysm, False/etiology , Aneurysm, Ruptured/etiology , Embolization, Therapeutic , Humans , Male , Rupture, Spontaneous
3.
Hong Kong Med J ; 13(6): 442-8, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18057432

ABSTRACT

OBJECTIVE: To evaluate the benefits of laparoscopic versus open resection of liver tumours. DESIGN: Case control study. SETTING: Tertiary teaching hospital, Hong Kong. PATIENTS: Data from 25 patients who underwent laparoscopic resections for liver tumours from 2003 to 2006 were compared to a retrospective series of 25 patients who underwent open hepatectomy in a pair-matched design. MAIN OUTCOME MEASURES: Duration of operation, operative morbidity and mortality, blood loss, tumour resection margin, analgesics usage, days to return to an oral diet, duration of postoperative hospital stay, and survival of patients with malignancy. RESULTS: The demographic data and the tumour characteristics were comparable in the two patient groups, as were mortality (0% in both groups) and morbidity rates (4% in both groups). Two (8%) of the patients having laparoscopic resections were converted to open surgery. There was no statistically significant difference between the two groups in terms of operating time or resection margins. However, the laparoscopically treated patients experienced significantly less blood loss (median, 100 vs 250 mL), had shorter hospital stays (median, 4 vs 7 days), were prescribed less analgesia (median morphine dosage, 0.16 vs 0.83 mg per kg body weight), and resumed oral diet earlier (median, 1 vs 2 days). For patients with malignant tumours, there was no significant difference between the two groups in terms of actuarial and disease-free survival. CONCLUSION: Compared to open hepatectomy, in selected patients laparoscopic liver resection delivers the benefits of decreased blood loss, shorter hospital stay, lesser requirement for analgesics, and an earlier return to an oral diet, without evidence of compromised oncological clearance.


Subject(s)
Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Adult , Aged , Case-Control Studies , Female , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged
4.
Hong Kong Med J ; 13(5): 353-8, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17914140

ABSTRACT

OBJECTIVES: To review the reliability of radiological diagnosis and need of regular scans for giant liver haemangioma, in terms of long-term outcome and management options. DESIGN: Retrospective study. SETTING: Division of Hepato-biliary and Pancreatic Surgery, Prince of Wales Hospital, Hong Kong. PATIENTS: Patients with giant liver haemangioma noted on initial imaging from February 1996 to July 2006. MAIN OUTCOME MEASURES: Patient demographics, clinical assessments, management, and outcomes. RESULTS: There were 42 female and 22 male patients with a median age of 49 (range, 27-84) years with a suspected haemangioma. The median maximal diameter of the lesions was 5.5 cm (range, 4.0-20.3 cm). They were first detected by ultrasonography (n=45), contrast-enhanced computed tomographic scan (n=18), or magnetic resonance imaging (n=1). Besides regular follow-up scans, 22 patients were investigated further to confirm the diagnosis/exclude malignancy. Finally, 63 patients had a haemangioma and one had a hepatocellular carcinoma. Regarding the patients with haemangiomas, two were operated on for relief of pain and the rest were managed conservatively. The median duration of follow-up was 34 months. Most (54%) of the patients were asymptomatic, but in 17% the haemangioma enlarged to exceed its original size by more than 20%. There were no haemangioma-associated complications. CONCLUSIONS: Majority of patients having giant liver haemangioma are asymptomatic and do not suffer complications. If the diagnosis is uncertain, selective further investigations may be necessary. Lesions with a confirmed diagnosis tend to remain static in size; performing regular scans for asymptomatic giant liver haemangiomas may not be necessary.


Subject(s)
Carcinoma, Hepatocellular/diagnosis , Hemangioma/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hong Kong , Hospitals , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Ultrasonography
5.
Surg Today ; 37(10): 915-7, 2007.
Article in English | MEDLINE | ID: mdl-17879047

ABSTRACT

As a safer approach to right hepatectomy, Belghiti et al. (J Am Coll Surg 193:109-11, 2001) described a liver-hanging maneuver. However, this procedure is performed blind, with the risks of damaging the small retrohepatic veins and consequential bleeding. To overcome this problem, we modified the procedure so that, instead of performing blind dissection using a long vascular clamp, we use a flexible choledochoscope to dissect the retrohepatic space filled by loose alveolar tissue anterior to the inferior vena cava (IVC). The avascular path is identified by a combination of saline irrigation and gentle movement of the tip of the choledochoscope. Cotton tape can then be passed around the liver parenchyma to elevate the liver away from the anterior surface of the IVC. This modification of Belghiti's liver-hanging maneuver allows direct vision along the plane anterior to the IVC, thus avoiding injury to the retrohepatic veins.


Subject(s)
Endoscopy, Digestive System , Hepatectomy , Hepatic Veins/surgery , Liver/surgery , Dissection , Humans
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