King-teh Lee - Academia.edu (original) (raw)

Papers by King-teh Lee

PubMed, Aug 1, 2004

Background and purpose: Surgical site infection (SSI) after cholecystectomy is a common problem. ... more Background and purpose: Surgical site infection (SSI) after cholecystectomy is a common problem. The aim of this study was to identify the possible risk factors for the development of SSI. Methods: 545 consecutive patients who received open (125) or laparoscopic (420) cholecystectomy due to gallbladder disease during the years 1998 to 2000 were included in the study. Potential risk factors including clinical features, biochemical data, and operative types were analyzed by univariate and multivariate analysis. Results: The overall incidence of SSI was 4.4% (24/545). The wound complication rate was significantly lower in the laparoscopic group than in the open group (1.4% vs 14.4%, respectively). Factors associated with SSI found by univariate analysis (p < 0.05) included age, gender, acute cholecystitis, white blood cell count, serum albumin, blood glucose and bilirubin level, type of surgery, operative time and positive bile culture. Stepwise logistic regression analysis showed that abnormal blood glucose [odds ratio (OR), 4.7; 95% confidence interval (CI), 1.6 to 13.5], positive bile culture (OR, 3.5; 95% CI, 1.2 to 10.4), and open cholecystectomy (OR, 4.3; 95% CI, 1.3 to 13.6) were the most significant predictors of SSI. Conclusion: Poor control of diabetes mellitus before surgery, positive bile culture and open cholecystectomy significantly increased the rate of SSI. These findings indicate that better control of diabetes mellitus, and appropriate selection of surgical procedure and antibiotic regimen in the management of high-risk patients may reduce the incidence of postoperative SSI.

BBA Clinical, 2015

Hepatocellular carcinoma (HCC), the major type of liver cancer, is among the most lethal cancers ... more Hepatocellular carcinoma (HCC), the major type of liver cancer, is among the most lethal cancers owing to its aggressive nature and frequently late detection. Therefore, the possibility to identify early diagnostic markers could be of significant benefit. Urine has especially become one of the most attractive body fluids in biomarker discovery as it can be obtained non-invasively in large quantities and is stable as compared with other body fluids. To identify potential protein biomarker for early diagnosis of HCC, we explored protein expression profiles in urine from HCC patients and normal controls (n = 44) by shotgun proteomics using nano-liquid chromatography coupled tandem mass spectrometry (nanoLC-MS/MS) and stable isotope dimethyl labeling. We have systematically mapped 91 proteins with differential expressions (p b 0.05), which included 8 down-regulated microtubule proteins and 83 up-regulated proteins involved in signal and inflammation response. Further integrated proteogenomic approach composed of proteomic, genomic and transcriptomic analysis identified that S100A9 and GRN were co-amplified (p b 0.001) and co-expressed (p b 0.01) in HCC tumors and urine samples. In addition, the amplifications of S100A9 or GRN were found to be associated with poor survival in HCC patients, and their co-amplification was also prognosed worse overall survival than individual ones. Our results suggest that urinary S100A9 and GRN as potential combinatorial biomarkers can be applied to early diagnosis of hepatocellular carcinoma and highlight the utility of onco-proteogenomics for identifying protein markers that can be applied to disease-oriented translational medicine.

The Kaohsiung Journal of Medical Sciences, 2012

High-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary... more High-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia (HHT). Here we report a 43-year-old woman who presented at 29 weeks gestation of her second pregnancy with complications of right-sided heart failure and preterm labor. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous malformations through non-invasive imaging. Subsequently, a family history of vascular malformations and epistaxis was elucidated and a diagnosis of HHT was made. This case is presented, along with a review of the literature and discussion of hepatic involvement in HHT with particular focus on the pregnant patient.

The Kaohsiung Journal of Medical Sciences, 2013

Through a review of the literature, a splenic artery aneurysm (SAA) with associated spontaneous s... more Through a review of the literature, a splenic artery aneurysm (SAA) with associated spontaneous splenorenal shunt (SSRS) was only reported in patients with liver cirrhosis and portal hypertension. However, a natural course of a SAA with associated SSRS was found in a non-cirrhotic male patient during an 8-year observational follow-up, and thus reported. Initially, splenomegaly and thrombocytopenia were noted; SSRS was observed later with a tortuous dilated splenic artery, and a SAA was then progressively formed and found. The patient received splenectomy with aneurysm resection and SSRS was preserved. Post-operative follow-up revealed that the size of the SSRS was reduced. Through the course, no abnormalities of liver enzymes, portal hypertension, or esophageal-gastric varicose were found in the patient. No positive association was demonstrated between the formation of SSRS and the severity of liver cirrhosis in patients, implying some other factors, e.g., vascular endothelial growth factor (VEGF) mentioned in the literature, might be involved.

Journal of the Formosan Medical Association, 2012

Surgical resection for hepatocellular carcinoma (HCC) is regarded as a curable treatment; however... more Surgical resection for hepatocellular carcinoma (HCC) is regarded as a curable treatment; however, the postoperative recurrence still poses a challenge to surgeons. The effect of surgical margin on long-term outcome is still controversial, although it has been considered as the treatment-related risk factor for recurrence. A precise assessment of the effects of surgical margin on clinical outcome is required to clarify the issue. A retrospective study was conducted on 407 patients with microscopically complete resection of HCC; they were divided into three groups with surgical margin negative by 1-5 mm (Group A, n = 156), 6-10 mm (Group B, n = 109), and wider than 10 mm (Group C, n = 142). The groups were compared for clinicopathologic characteristics, perioperative features, postoperative recurrence, and long-term outcome. The median follow-up time for all patients was 72.97 months. Recurrence rates were similar among these groups. There was no significant difference in the overall 1-, 3-, and 5-year actual survival rates for the groups on the log-rank test (p = 0.073). After controlling the independent risks for disease-free survival, there was also no significant difference in the 1-, 3-, and 5-year disease-free survival rates for the groups (p = 0.354). The patients with wider surgical margin had worse perioperative outcomes; more patients in this group needed blood transfusion (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and more patients suffered from postoperative complications (p = 0.020). They also had higher in-hospital mortality rate than that of other groups (1.41% vs. 0.64%). No superiority was seen in patients with wider surgical margin in either perioperative features or long-term outcome.

Journal of the Formosan Medical Association, 2010

Circulating retinol binding protein 4 (RBP4) is associated with a variety of obesity-related dise... more Circulating retinol binding protein 4 (RBP4) is associated with a variety of obesity-related diseases. This study investigated whether there were aberrant concentrations of RBP4 in cholesterol gallstone disease. Serum RBP4 levels of 100 cholesterol gallstone patients and 147 healthy controls were measured by enzyme-linked immunosorbent assay and further correlated with clinical and biochemical characteristics, including insulin resistance and renal function. Gallstone specimens were obtained during laparoscopic cholecystectomy and analyzed for their chemical composition using Fourier transform infrared spectroscopy Significantly lower serum RBP4 levels were found in patients with cholesterol gallstones in comparison with controls (30.57 +/- 13.64 mg/L vs. 41.52 +/- 20.25 mg/L, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Lower serum RBP4 levels were also associated with gallstone occurrence (odds ratio = 0.93; 95% confidence interval = 0.88-0.96; p = 0.004). Serum RBP4 levels of all subjects were positively correlated with total cholesterol, triglyceride, creatinine, insulin resistance and albumin, and inversely correlated with aspartate aminotransferase and alanine aminotransferase. In multivariate analysis, cholesterol gallstone formation was significantly associated with a lower serum RBP4 level (odds ratio = 4.2; 95% confidence interval= 1.40-12.57; p = 0.010). RBP4 levels were significantly decreased regardless of renal function in patients with gallstones, but levels increased proportionate to renal dysfunction in people without gallstones. Circulating RBP4 decreases in cholesterol gallstone disease independent of renal function. Further studies are needed to investigate the relationship between liver function and RBP4 levels in these patients.

Journal of the Formosan Medical Association, 2006

Both cholesterol and triglyceride levels in serum increase progressively during pregnancy. Hypert... more Both cholesterol and triglyceride levels in serum increase progressively during pregnancy. Hypertriglyceridemia is a well-recognized cause of acute pancreatitis, while pancreatitis-associated chylous ascites has rarely been reported. We report a 28-year-old female with coexistence of hypertriglyceridemia, acute pancreatitis, and chylous ascites during pregnancy. After emergency cesarean section, she was treated with nil per os, intravenous hydration, antibiotics, and analgesics as required. Due to the development of positive peritonitis 5 days later, an exploratory laparotomy was performed. Surgical interventions included pancreatic necrosectomy, right hemicolectomy and ileostomy, cholecystostomy, gastrostomy, and feeding jejunostomy. Postoperative treatment included antibiotics, total parenteral nutrition, and then low-fat diet with medium-chain triglyceride supplementation. She was discharged on the 43rd day after surgery and was free of symptoms during 6 months of follow-up. Ileocolostomy was performed 6 months after discharge. Fasting lipid profile should be regularly monitored during pregnancy due to the association of hypertriglyceridemia with development of acute pancreatitis in the mother.

Journal of Surgical Oncology, 2006

Hepatolithiasis is etiologically related to cholangiocarcinoma. We underwent this study with an a... more Hepatolithiasis is etiologically related to cholangiocarcinoma. We underwent this study with an attempt to examine the expression of DPC4/Smad4 gene in stone-containing intrahepatic bile ducts (IHD) and intrahepatic cholangiocarcinoma (ICC). The immunohistochemical method and RT-PCR analysis were used to study the expression of DPC4/Smad4 gene in normal IHD, stone-containing IHD, and ICC. All the specimens were from hepatic resection. The immunohistochemical study showed that all specimens from 24 normal IHD had marked expression of DPC4/Smad4 gene, while there was 4.4% (2/46) and 33.3% (3/9) loss of DPC4/Smad4 expression in stone-containing IHD and ICC, respectively. Among the specimens of stone-containing IHD, all the hyperplastic epithelial cells showed normal expression of DPC4/Smad4 gene while dysplastic epithelial cells showed 20% (2/10) loss expression of DPC4/Smad4. The RT-PCR analysis showed that the normal IHD had the highest content of DPC4/Smad4 mRNA, which was threefold and sixfold higher than that of stone-containing IHD and ICC, respectively. Loss expression of DPC4/Smad4 gene was found both in stone-containing IHD and ICC. Dysplastic epithelium of stone-containing IHD had higher potential for malignant transformation.

Journal of Surgical Oncology, 2009

Hepatocellular carcinoma (HCC) is one of the most malignant cancers in the world. The effect of p... more Hepatocellular carcinoma (HCC) is one of the most malignant cancers in the world. The effect of preoperative transarterial chemoembolization (TACE) for resectable HCC is still controversial and cost-associated treatments are unknown. We retrospectively compared clinical outcomes and resource utilization after liver resection between patients who underwent preoperative TACE (TACE-LR group, n = 114) and those who did not (LR group, n = 236). The overall mortality rate was 27.54% for the LR group versus 39.47% for the TACE-LR group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The overall recurrent rates were 29.36% for the LR group versus 35.90% for the TACE-LR group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Multivariate Cox regression analysis showed that preoperative TACE was a significant risk factor (P = 0.002, HR = 1.995, 95% CI 1.297-3.069) for overall long-term survival for HCC. The TACE-LR group had longer mean lengths of stay and higher hospital charges, both at index hospitalization and at 6 months for follow-up. Preoperative TACE is not only associated with higher medical utilizations, but it is also correlated with higher mortality rates over a 5-year period. The preoperative TACE does not benefit patients with resectable HCC. The golden standard or clinical guidelines should be developed to provide better clinical decisions and decision support for HCC patients.

Journal of Pain and Symptom Management, 2004

The purpose of this study was to demonstrate the existence of a newly recognized midline posterio... more The purpose of this study was to demonstrate the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pain resulting from hepatobiliary or pancreatic cancer. A punctate midline myelotomy (PMM) of T(3) level was performed in 6 patients who experienced severe visceral pain caused by hepatobiliary or pancreatic cancer. Preoperatively, the pain was refractory to strong opioids. Clinical efficacy of PMM was evaluated by comparing patient pain rating on a visual analogue scale. Follow-up periods ranged from 2-18 weeks after operation. All 6 patients had immediate pain relief after operation. Although the pain recurred from 2-12 weeks later in 3 patients, the severity of recurrent cancer pain markedly decreased. No adverse neurological sequelae were observed. Our results of high thoracic PMM offer clinical support for the concept that neurosurgical interruption of midline visceral pain pathway can effectively control severe visceral pain without causing adverse neurological sequelae in patients with hepatobiliary or pancreatic cancer.

Journal of Hepato-Biliary-Pancreatic Surgery, 2009

Background/Purpose The outcome analysis of obese patients undergoing laparoscopic cholecystectomy... more Background/Purpose The outcome analysis of obese patients undergoing laparoscopic cholecystectomy (LC) in Asia-Pacific countries is rarely reported. This study examined associations between body mass index (BMI) and clinical outcomes of elective LC in Taiwan. Methods A total of 627 patients with gallbladder disease due to gallstones undergoing LC were divided into three groups based on BMI: \25.0 kg/m 2 (normal, NO; n = 310), 25.0-29.9 kg/m 2 (overweight, OW; n = 252), and [30 kg/m 2 (obese, OB; n = 65). Results Both overweight and obesity were not associated with conversion and complication rates. The conversion rates of the three groups were 5.5 (NO), 6.0 (OW), and 4.6% (OB), and the complication rates were 3.2 (NO), 2.4% (OW), and 4.6% (OB), respectively. However, overweight and obesity were related to a trend toward longer operating time (NO 67.4 ± 31.8; OW 77.8 ± 35.6; OB 79.0 ± 37.9 min) (P trend \0.001). One death (BMI 40.6 kg/m 2 ) was due to septic complications. In the multivariable logistic analysis, only acute cholecystitis, but not BMI, was a predictor for conversion and complications. Conclusions Based on these results, it appears that BMI was not associated with clinical outcomes and that LC is a safe procedure in obese patients with uncomplicated gallstone disease in Taiwan.

Journal of Gastrointestinal Surgery, 2009

Purpose This study analyzed patient demographics and preoperative functional status for associati... more Purpose This study analyzed patient demographics and preoperative functional status for associations with postcholecystectomy quality of life (QOL). Methods This prospective study analyzed 159 cholecystectomy patients at two tertiary academic hospitals. All patients completed the SF-36 and the gastrointestinal quality of life index (GIQLI) at baseline and at 3 and 6 months postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation (GEE) before and after cholecystectomy. Results The examined population significantly (p<0.05) improved in both SF-36 subscales and GIQLI subscales. After adjusting for time effects (time, and time 2 ) and baseline predictors, GEE approaches revealed the following explanatory variables for QOL: time, time 2 , age, gender, preoperative GIQLI score, body mass index, and number of comorbidities. Conclusion The data revealed dramatically improved post-cholecystectomy QOL. However, QOL change was simultaneously associated with preoperative functional status and demographic characteristics.

Journal of Gastrointestinal Surgery, 2008

Introduction To compare responsiveness and minimal clinically important differences (MCID) betwee... more Introduction To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals. Patients and Methods All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates.

Journal of Clinical Laboratory Analysis, 2000

Deregulation of insulin-like growth factor-1 (IGF-1) has been implicated in the pathogenesis of s... more Deregulation of insulin-like growth factor-1 (IGF-1) has been implicated in the pathogenesis of several malignancies. This study aimed to investigate the association of changes in circulating IGF-1 with hepatocellular carcinoma (HCC). The radioimmunoassay was used to analyze serum IGF-1 levels of 65 HCC patients and 165 healthy subjects. Serum IGF-1 levels were significantly decreased in the HCC patients as compared with the healthy subjects (158.46+/-105.07 vs. 247.63+/-149.96 ng/mL, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Furthermore, insulin resistance was significantly higher in the HCC patients than the healthy subjects (P=0.027). In addition, the significant correlations of serum IGF-1 levels with age and insulin resistance in the healthy subjects were not noted in the HCC patients. Intriguingly, individuals with hepatitis C virus (HCV), not hepatitis B virus, had remarkably decreased IGF-1 levels in both groups of the HCC patients and healthy subjects. Moreover, in the HCV subgroup, serum IGF-1 levels were significantly reduced in the HCC patients than the healthy subjects (113.14+/-71.28 vs. 172.42+/-74.02 ng/mL, P=0.003). In conclusion, decreased serum IGF-1 levels were associated with HCC and the decrease was remarkably noted in those patients concomitant with chronic hepatitis C.

European Journal of Radiology Extra, 2007

There have been limited reports about the choledocholithiasis formed around nonabsorbable suture ... more There have been limited reports about the choledocholithiasis formed around nonabsorbable suture material in patients who underwent biliary surgery. We report an unusual case of choledocholithiasis in the common hepatic duct formed around the nidus of suture material, which mimics a pedunculated round tumor on MR cholangiopancreatography (MRCP) images. The diagnosis has been confirmed by surgery.

Digestive Surgery, 1998

Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and the... more Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of severe co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy's signs and distended gallbladders were candidates for ultrasound-guided PC. Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.

Digestive Surgery, 2004

The volume-outcome effect has been well documented in both medical treatment and surgery. The rel... more The volume-outcome effect has been well documented in both medical treatment and surgery. The relationship of volume-outcome utilization in laparoscopic cholecystectomy has not been studied. The aims of this study were to examine whether the operational volume of individual surgeons is associated with the clinical and economic outcomes of patients with gallbladder diseases undergoing laparoscopic cholecystectomy. A retrospective study was made of all patients who underwent elective laparoscopic cholecystectomy in the Department of Surgery, Kaohsiung Medical University Hospital between January 1998 and April 2002. In total, 916 patients were operated on by 4 surgeons and the volume for each surgeon was 502, 192, 147, and 75 cases, respectively. Clinical and economic information for each patient was abstracted from medical charts and the financial division. Multiple logistic and linear regression models were used to examine the relationship between three outcome variables, complications, length of stay, total hospital charges, and surgeon volume while controlling for the severity of illness and other selected covariates (morbidity index). Overall, a complication rate of 1.2% was identified. On average, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s stay in hospital was 4.7 days, and the average total hospital charge was TWD 49,581. After adjusting for covariates, three regression models indicated that the surgeon with the highest volume had the lowest complication rate, shortest length of stay, and lowest hospital charges. The operative volume of individual surgeons not only had a positive impact on clinical outcomes, it also had greater effect on conservation of health care resources. The findings validate the theory of practice makes perfect.

Digestive Surgery, 1992

During 11 years, 107 of 586 patients (18.3&amp;amp;amp;amp;amp;percnt;) with intrahepatic... more During 11 years, 107 of 586 patients (18.3&amp;amp;amp;amp;amp;percnt;) with intrahepatic stones underwent hepatic resection to remove intrahepatic stones at Kaohsiung Medical College Hospital. Guided by the location of the intrahepatic stones, 80 (74.8&amp;amp;amp;amp;amp;percnt;) of these patients underwent left lateral segmentectomy, 21 (19.6&amp;amp;amp;amp;amp;percnt;) left lobectomy, and 6 (5.6&amp;amp;amp;amp;amp;percnt;) right posterior segmentectomy. There were no operative mortalities. The postoperative complications were usually

Digestion, 1998

Gallbladder mucus itself has been recognized to play an important role in gallstone development. ... more Gallbladder mucus itself has been recognized to play an important role in gallstone development. Despite the diverse mechanisms of stone induction and the differences in stone composition, there is a quantitative increase in the epithelial mucus production period before stone formation. As brown pigment stones are found frequently in gallstone disease, we conducted a study on gallbladders with brown pigment stones or combination stones with a brown periphery to evaluate the mucin content in the gallbladder epithelium in comparison to gallbladders with cholesterol stones and those without stones. Gallbladder specimens were fixed in 10% formalin immediately after cholecystectomy and then embedded in paraffin. The specimens were sectioned for periodic acid-Schiff-alcian blue (PAS-AB, pH 2.5) double stain to evaluate the intra-epithelial mucin content. The PAS-AB index was calculated as a proportion of the PAS-AB-positive mucin area to the total epithelial area, using a computerized image analyzer. Evaluation of the PAS-AB index on the lining epithelia of gallbladders showed that it was 32.43 +/- 9.96% in gallbladders with brown stones, which is significantly (p < 0.001) higher than in gallbladders with cholesterol stones (15.63 +/- 6. 75%) and gallbladders without stones (9.55 +/- 4.77%). The results show that gallbladders with brown stones contain more abundant mucin than gallbladders with cholesterol stones or those without stones. They also suggest that the gallbladder epithelium per se might play a more important role in stone formation in those with brown stones than in those with cholesterol stones.

Diagnostic Cytopathology, 2007

Schistosomiasis japonica is not an endemic parasite in Taiwan. Previously, there have been no pri... more Schistosomiasis japonica is not an endemic parasite in Taiwan. Previously, there have been no primarily infected cases reported with the exception of Chinese war veterans who had immigrated from Mainland China. We reported a 79-year-old patient who was diagnosed as having non-B, non-C liver cirrhosis complicated with a 1.2 x 1.2 x 1.2 cm liver tumor in the S5 of the liver. For a definitive diagnosis, we performed ultrasonographic-guided fine needle (21 gauge) aspiration biopsy. In the smear of liver aspiration, a calcified fragment of a parasite egg with foreign body reaction adjacent to the crowding cancer cells of hepatocellular carcinoma was found. To our knowledge, parasite eggs are difficult to find within the fibrotic bands using fine needle aspiration biopsy. The etiologic relationship between Schistosomiasis japonica infection and the hepatocellular carcinoma is also discussed in this report.