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Li MK, Diaz O, Katz JE. Holmium laser enucleation of the prostate for a case of transition zone prostate cancer. Can J Urol 2024; 31:11861-11863. [PMID: 38642466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
Standard treatment approaches for localized prostate cancer remain limited to active surveillance, radiotherapy, and radical prostatectomy. We present a case of transition zone prostate cancer that was treated with holmium laser enucleation of the prostate, a procedure that is normally reserved for the management of benign prostatic hyperplasia.
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Affiliation(s)
- Michelle K Li
- Department of Urology, University of California, San Diego, La Jolla, California, USA
| | - Orlando Diaz
- Department of Urology, University of California, San Diego, La Jolla, California, USA
| | - Jonathan E Katz
- Department of Urology, University of California, San Diego, La Jolla, California, USA
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2
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Li MK, Shahinyan G, Sigalos JT, Mills JN, Eleswarapu SV. Penile and foreskin stretching practices through time and culture. Urology 2023:S0090-4295(23)00183-8. [PMID: 36868413 DOI: 10.1016/j.urology.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Michelle K Li
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - John T Sigalos
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jesse N Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sriram V Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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3
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Li MK, Sigalos JT, Yoffe DA, Modiri N, Hu MY, Gaither TW, Santamaria A, Walker DT, Regets KV, Mills JN, Eleswarapu SV. Multiple courses of intralesional collagenase injections for Peyronie disease: a retrospective analysis. J Sex Med 2023; 20:200-204. [PMID: 36763912 DOI: 10.1093/jsxmed/qdac030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the original clinical trials evaluating intralesional collagenase Clostridium histolyticum for Peyronie disease (PD), treatment protocols were limited to 8 injections. AIM We sought to describe our single-center experience with the use of multiple rounds (>8 injections) of intralesional collagenase in patients with PD. METHODS We conducted a retrospective analysis of all patients with PD receiving intralesional collagenase injections at our institution from October 2015 through December 2020. Some patients who completed 1 round of treatment elected to undergo additional rounds (16 or 24 injections) based on persistent curvature and presence of penile plaque. Clinical improvement was defined as a 20% reduction in penile curvature from the start of a given round of treatment to the end of that round of treatment. We measured erect penile curvature before and after each round and collected demographics, medical and surgical history, curvature outcomes, and treatment-related adverse events. OUTCOME The primary outcome was the reduction in penile curvature after multiple rounds of treatment with intralesional collagenase injections in patients with PD. RESULTS A total of 330 patients underwent intralesional collagenase injections for PD, of whom 229 completed at least 8 injections and underwent pre- and posttreatment erect penile goniometry. An overall 42.8% (98/229), 38.6% (22/57), and 12.5% (1/8) of patients achieved clinical improvement after 1 round of therapy (8 injections), 2 rounds (16 injections), and 3 rounds (24 injections), respectively. Mean degree and mean percentage improvement of penile curvature for the start and end of each round of treatment were 8.3° and 16.4% (after 1 round), 7.2° and 16.8% (after 2 rounds), and 3.3° and 8.1% (after 3 rounds). Bruising was the most common complication, with an incidence of at least 50% in each round. CLINICAL IMPLICATIONS Knowledge of patient responses to multiple rounds of intralesional collagenase injections may help guide physicians in management and counseling of patients regarding PD treatment options. STRENGTHS AND LIMITATIONS This is the first study to evaluate multiple rounds (>8 injections) of intralesional collagenase for PD. Limitations include retrospective analysis and smaller sample size among patients undergoing 3 rounds (24 injections). CONCLUSION For patients who did not achieve clinical improvement after 1 round of treatment, an additional round may be beneficial. However, no real improvement was observed for patients undergoing a third round.
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Affiliation(s)
- Michelle K Li
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - John T Sigalos
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Dar A Yoffe
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Neilufar Modiri
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Ming-Yeah Hu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Thomas W Gaither
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Alvaro Santamaria
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Dyvon T Walker
- School of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Keith V Regets
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Jesse N Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Sriram V Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
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Hu MYY, Sigalos JT, Walker DT, Li MK, Yoffe DA, Modiri N, Gaither TW, Santamaria AJ, Regets KV, Eleswarapu SV, Mills JN. Intralesional collagenase Clostridium histolyticum for acute phase Peyronie’s disease: a single-center, retrospective cohort study. Transl Androl Urol 2022; 11:1074-1082. [PMID: 36092841 PMCID: PMC9459553 DOI: 10.21037/tau-22-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/26/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ming-Yeah Y. Hu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John T. Sigalos
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dyvon T. Walker
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle K. Li
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dar A. Yoffe
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Neilufar Modiri
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas W. Gaither
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alvaro J. Santamaria
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith V. Regets
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sriram V. Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse N. Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Jiao WY, Hu R, Han SH, Luo YF, Yuan HM, Li MK, Liu HJ. Surprisingly good thermoelectric performance of monolayer C 3N. Nanotechnology 2021; 33:045401. [PMID: 34653997 DOI: 10.1088/1361-6528/ac302c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
The rapid emergence of graphene has attracted numerous efforts to explore other two-dimensional materials. Here, we combine first-principles calculations and Boltzmann theory to investigate the structural, electronic, and thermoelectric transport properties of monolayer C3N, which exhibits a honeycomb structure very similar to graphene. It is found that the system is both dynamically and thermally stable even at high temperature. Unlike graphene, the monolayer has an indirect band gap of 0.38 eV and much lower lattice thermal conductivity. Moreover, the system exhibits obviously larger electrical conductivity and Seebeck coefficients for the hole carriers. Consequently, theZTvalue ofp-type C3N can reach 1.4 at 1200 K when a constant relaxation time is predicted by the simple deformation potential theory. However, such a largerZTis reduced to 0.6 if we fully consider the electron-phonon coupling. Even so, the thermoelectric performance of monolayer C3N is still significantly enhanced compared with that of graphene, and is surprisingly good for low-dimensional thermoelectric materials consisting of very light elements.
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Affiliation(s)
- W Y Jiao
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - R Hu
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - S H Han
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - Y F Luo
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - H M Yuan
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - M K Li
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - H J Liu
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
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Pantelidou C, Sonzogni O, Taveira MDO, Mehta AK, Wang D, Kothari A, Li MK, Visal TH, Guerriero JL, Wulf GM, Shapiro GI. Abstract 4490: PARP inhibitor efficacy depends on CD8+ T-cell recruitment via the STING pathway in BRCA-deficient models of triple-negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Combinatorial clinical trials of PARP inhibitors with immunotherapies are ongoing, yet the immunomodulatory effects of PARP inhibition have been incompletely studied. Here, we sought to dissect the mechanisms underlying PARP inhibitor-induced changes in the tumor microenvironment of BRCA1-deficient triple-negative breast cancer (TNBC). We demonstrate that the PARP inhibitor olaparib induces CD8+ T cell infiltration and activation in vivo, and that depletion of CD8+ T cells severely compromises anti-tumor efficacy. Olaparib-induced T cell recruitment is mediated through activation of the STING/TBK1/IRF3 pathway in tumor and dendritic cells and is more pronounced in HR-deficient compared to HR-proficient TNBC cells. CRISPR-knockout of STING in cancer cells prevents type I IFN production and is sufficient to abolish PARP inhibitor-induced T cell infiltration in vivo. These findings elucidate a novel mechanism of action of PARP inhibitors and provide mechanistic rationale for combining PARP inhibition with immunotherapies for the treatment of TNBC.
Citation Format: Constantia Pantelidou, Olmo Sonzogni, Mateus De Oliveira Taveira, Anita K. Mehta, Dan Wang, Aditi Kothari, Michelle K. Li, Tanvi H. Visal, Jennifer L. Guerriero, Gerburg M. Wulf, Geoffrey I. Shapiro. PARP inhibitor efficacy depends on CD8+ T-cell recruitment via the STING pathway in BRCA-deficient models of triple-negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4490.
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Affiliation(s)
| | | | | | | | - Dan Wang
- 2Beth Israel Deaconess Medical Center, Boston, MA
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Pantelidou C, Sonzogni O, De Oliveria Taveira M, Mehta AK, Kothari A, Wang D, Visal T, Li MK, Pinto J, Castrillon JA, Cheney EM, Bouwman P, Jonkers J, Rottenberg S, Guerriero JL, Wulf GM, Shapiro GI. PARP Inhibitor Efficacy Depends on CD8 + T-cell Recruitment via Intratumoral STING Pathway Activation in BRCA-Deficient Models of Triple-Negative Breast Cancer. Cancer Discov 2019; 9:722-737. [PMID: 31015319 DOI: 10.1158/2159-8290.cd-18-1218] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 01/21/2023]
Abstract
Combinatorial clinical trials of PARP inhibitors with immunotherapies are ongoing, yet the immunomodulatory effects of PARP inhibition have been incompletely studied. Here, we sought to dissect the mechanisms underlying PARP inhibitor-induced changes in the tumor microenvironment of BRCA1-deficient triple-negative breast cancer (TNBC). We demonstrate that the PARP inhibitor olaparib induces CD8+ T-cell infiltration and activation in vivo, and that CD8+ T-cell depletion severely compromises antitumor efficacy. Olaparib-induced T-cell recruitment is mediated through activation of the cGAS/STING pathway in tumor cells with paracrine activation of dendritic cells and is more pronounced in HR-deficient compared with HR-proficient TNBC cells and in vivo models. CRISPR-mediated knockout of STING in cancer cells prevents proinflammatory signaling and is sufficient to abolish olaparib-induced T-cell infiltration in vivo. These findings elucidate an additional mechanism of action of PARP inhibitors and provide a rationale for combining PARP inhibition with immunotherapies for the treatment of TNBC. SIGNIFICANCE: This work demonstrates cross-talk between PARP inhibition and the tumor microenvironment related to STING/TBK1/IRF3 pathway activation in cancer cells that governs CD8+ T-cell recruitment and antitumor efficacy. The data provide insight into the mechanism of action of PARP inhibitors in BRCA-associated breast cancer.This article is highlighted in the In This Issue feature, p. 681.
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Affiliation(s)
- Constantia Pantelidou
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Olmo Sonzogni
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Mateus De Oliveria Taveira
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Department of Imaging, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Anita K Mehta
- Breast Tumor Immunology Laboratory, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aditi Kothari
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dan Wang
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tanvi Visal
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michelle K Li
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jocelin Pinto
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jessica A Castrillon
- Breast Tumor Immunology Laboratory, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Emily M Cheney
- Breast Tumor Immunology Laboratory, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter Bouwman
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sven Rottenberg
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Switzerland
| | - Jennifer L Guerriero
- Breast Tumor Immunology Laboratory, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gerburg M Wulf
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts. .,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Yao C, Chen LL, Li YP, Peng CZ, Li MK, Yao J. [Multi-variated analysis of differential diagnosis in ultrasonography of idiopathic granulomatous mastitis and invasive ductal carcinoma]. Zhonghua Zhong Liu Za Zhi 2018; 40:222-226. [PMID: 29575844 DOI: 10.3760/cma.j.issn.0253-3766.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ(2) test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion: Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.
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Affiliation(s)
- C Yao
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - L L Chen
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - Y P Li
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - C Z Peng
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
| | - M K Li
- Department of Ultrasound, Zhejiang Xiaoshan Hospital, Hangzhou 311202, China
| | - J Yao
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
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Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, Maktabi M, Lee J, Kwo J, Pino R, Sabouri AS, McGovern F, Staehr-Rye AK, Eikermann M. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth 2015; 115:743-51. [PMID: 25935840 DOI: 10.1093/bja/aev104] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. METHODS Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance. RESULTS Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02). CONCLUSIONS After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov:NCT01479764.
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Affiliation(s)
- B Brueckmann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - N Sasaki
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - P Grobara
- Biostatistics and Research Decision Sciences, MSD, Oss, The Netherlands
| | - M K Li
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - T Woo
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - J de Bie
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - M Maktabi
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lee
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Kwo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - R Pino
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - A S Sabouri
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - F McGovern
- Harvard Medical School, Boston, MA, USA Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - A K Staehr-Rye
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA Essen-Duisburg University, Essen, Germany
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10
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Freedman BS, Brooks CR, Lam AQ, Fu H, Morizane R, Agrawal V, Saad AF, Li MK, Hughes MR, Werff RV, Peters DT, Lu J, Baccei A, Siedlecki AM, Valerius MT, Musunuru K, McNagny KM, Steinman TI, Zhou J, Lerou PH, Bonventre JV. Modelling kidney disease with CRISPR-mutant kidney organoids derived from human pluripotent epiblast spheroids. Nat Commun 2015; 6:8715. [PMID: 26493500 PMCID: PMC4620584 DOI: 10.1038/ncomms9715] [Citation(s) in RCA: 479] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/24/2015] [Indexed: 12/22/2022] Open
Abstract
Human-pluripotent-stem-cell-derived kidney cells (hPSC-KCs) have important potential for disease modelling and regeneration. Whether the hPSC-KCs can reconstitute tissue-specific phenotypes is currently unknown. Here we show that hPSC-KCs self-organize into kidney organoids that functionally recapitulate tissue-specific epithelial physiology, including disease phenotypes after genome editing. In three-dimensional cultures, epiblast-stage hPSCs form spheroids surrounding hollow, amniotic-like cavities. GSK3β inhibition differentiates spheroids into segmented, nephron-like kidney organoids containing cell populations with characteristics of proximal tubules, podocytes and endothelium. Tubules accumulate dextran and methotrexate transport cargoes, and express kidney injury molecule-1 after nephrotoxic chemical injury. CRISPR/Cas9 knockout of podocalyxin causes junctional organization defects in podocyte-like cells. Knockout of the polycystic kidney disease genes PKD1 or PKD2 induces cyst formation from kidney tubules. All of these functional phenotypes are distinct from effects in epiblast spheroids, indicating that they are tissue specific. Our findings establish a reproducible, versatile three-dimensional framework for human epithelial disease modelling and regenerative medicine applications. Generating organized kidney tissues from human pluripotent stem cell is a major challenge. Here, Freedman et al. describe a differentiation system forming spheroids and tubular structures, characteristic of these kidney structures, and using CRISPR/Cas9, delete PKD1/2, to model polycystic kidney disease.
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Affiliation(s)
- Benjamin S Freedman
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Division of Nephrology, Department of Medicine, University of Washington School of Medicine, 850 Republican Street, Room S565, Seattle, Washington 98109, USA.,Kidney Research Institute, Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359606, Seattle, Washington 98104, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington 98109, USA
| | - Craig R Brooks
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - Albert Q Lam
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Harvard Stem Cell Institute, Harvard University, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA
| | - Hongxia Fu
- Department of Biological Chemistry and Pharmacology, Boston Children's Hospital, Center for Life Sciences, Harvard Medical School, Room 3103, 3 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - Ryuji Morizane
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - Vishesh Agrawal
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 823, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Abdelaziz F Saad
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - Michelle K Li
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Sherman Fairchild Biochemistry Building 160, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA
| | - Michael R Hughes
- The Biomedical Research Centre, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z3
| | - Ryan Vander Werff
- The Biomedical Research Centre, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z3
| | - Derek T Peters
- Department of Stem Cell and Regenerative Biology, Harvard University, Sherman Fairchild Biochemistry Building 160, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Junjie Lu
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 823, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Anna Baccei
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 823, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Andrew M Siedlecki
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - M Todd Valerius
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Harvard Stem Cell Institute, Harvard University, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA
| | - Kiran Musunuru
- Department of Stem Cell and Regenerative Biology, Harvard University, Sherman Fairchild Biochemistry Building 160, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Kelly M McNagny
- The Biomedical Research Centre, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z3
| | - Theodore I Steinman
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue DA517, Boston, Massachusetts 02115, USA
| | - Jing Zhou
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Harvard Stem Cell Institute, Harvard University, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA
| | - Paul H Lerou
- Harvard Stem Cell Institute, Harvard University, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 823, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Joseph V Bonventre
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Institutes of Medicine Suite 550, 4 Blackfan Circle, Boston, Massachusetts 02115, USA.,Harvard Stem Cell Institute, Harvard University, 7 Divinity Avenue, Cambridge, Massachusetts 02138, USA
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11
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Goh YSB, Cheong PSC, Lata R, Goh A, Vathsala A, Li MK, Tiong HY. A necessary step toward kidney donor safety: the transition from locking polymer clips to transfixion techniques in laparoscopic donor nephrectomy. Transplant Proc 2014; 46:310-3. [PMID: 24655950 DOI: 10.1016/j.transproceed.2013.11.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 12/17/2022]
Abstract
Donor safety is of paramount importance in addressing end-stage renal failure through living kidney transplantation. The United States Food and Drug Administration (FDA) issued a Class II recall on the use of Hem-o-lok (Teleflex, Limerick, Pennsylvania, United States) polymer clips on the renal artery in laparoscopic donor nephrectomy (LDN) in June 2006 following 3 reported cases of donor deaths secondary to slipped ligature. The National University Hospital of Singapore made the transition regarding hilar control in minimally invasive donor nephrectomy, from using polymer and titanium clips to transfixion techniques (pure or hand-assisted laparoscopic) via laparoscopic staples or intracorporeal suturing, respectively. This study assessed safety during the transition in arterial transfixion techniques in minimally invasive donor nephrectomy for both donors and recipients. Forty-five consecutive kidney donors underwent donor nephrectomy over a 2-year period starting from June 2010. A total of 37 donors who underwent LDN (pure laparoscopic or hand-assisted laparoscopic) were included in the analysis. Of the 37 patients, 23 kidney donors had renal arterial control using Hem-o-lok while 14 patients from November 2011 onward underwent transfixion of the renal artery. The 2 groups of donor who underwent renal arterial control by either clips ligature or transfixion technique were comparable. The outcomes for the recipients in each group were similar with no statistical difference between postoperative creatinine level, incidence of delayed graft function, or graft survival at 1 year. We conclude that the transition in renal arterial control technique to transfixion techniques in LDN in line with FDA recommendation is feasible and affords equivalent donor and recipient outcomes.
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Affiliation(s)
- Y S B Goh
- Department of Urology, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore
| | - P S C Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R Lata
- Department of Urology, National University Health System, Singapore
| | - A Goh
- Division of Nephrology, Department of Medicine, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore
| | - A Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore
| | - M K Li
- Department of Urology, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore
| | - H Y Tiong
- Department of Urology, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore
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12
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Li MK, Lee TFD, Suen KPL. Complementary effects of auricular acupressure in relieving constipation symptoms and promoting disease-specific health-related quality of life: A randomized placebo-controlled trial. Complement Ther Med 2014; 22:266-77. [PMID: 24731898 DOI: 10.1016/j.ctim.2014.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 10/23/2013] [Accepted: 01/30/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Constipation has been identified as a worldwide health problem among elderly people. Currently, it is not effectively relieved by the use of laxatives and lifestyle modification. Previous studies reported promising results in managing constipation with auricular acupressure (AA), although its effectiveness was not affirmed. This study is to evaluate the complementary effects of AA in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly residential care home (RCH) residents in Hong Kong. DESIGN Randomized placebo-controlled trial. SETTING Elderly RCH. INTERVENTION Ninety-nine participants were randomly assigned to either experimental group (AA using auricular plasters with magnetic pellets), placebo-controlled group (AA using auricular plasters with Semen Vaccariae), or usual care group (AA using auricular plasters only). AA was applied onto seven auricular acupoints for 10 days. MAIN OUTCOME MEASURES Constipation symptoms and disease-specific HRQOL were measured before AA, at the completion of AA (D10), and at the 10th-day follow-up time (D20). RESULTS Significant group×time interaction effect was found in the change of satisfaction subscale between the experimental group and placebo-controlled group at D10 (p=0.016) and D20 (p=0.016) relative to the baselines. For both constipation symptoms and disease-specific HRQOL, the experimental group demonstrated the greatest improvement after receiving AA at both D10 and D20 compared with the other two groups. CONCLUSION The current findings indicated positive clinical value of AA with magnetic pellets in managing constipation in elderly RCH residents. AA was also found to be a safe and acceptable intervention.
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Affiliation(s)
- M K Li
- Division of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong.
| | - T F Diana Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - K P Lorna Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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13
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Li MK, Lee TFD, Suen KPL. Auriculotherapy in relieving symptoms of constipation and improving quality of life for the elderly: a pilot project. Hong Kong Med J 2012; 18 Suppl 6:30-33. [PMID: 23249851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- M K Li
- School of Science and Technology, The Open University of Hong Kong, Hong Kong SAR, China.
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14
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Abstract
AIM This paper details the experience of establishing an integrated skills training centre for use in undergraduate nursing education in The Open University of Hong Kong. BACKGROUND Skills training is an essential element in undergraduate nursing education. Owing to the increasing complexity of the health-care system and patient health needs, undergraduate nursing students should be well prepared for integrated skills competency, critical thinking and rapid decision-making. To achieve this goal, the use of simulation as a skills training tool is being recommended. CONCLUSION The Clinical Nursing Education Centre is established. It adopts simulation as a teaching and learning tool. It has four specific education units, namely: (1) clinical simulation education unit, (2) virtual reality education unit, (3) nursing skills education unit, and (4) Chinese medicinal education unit. These units are specifically designed for the teaching and learning of nursing skills related to general, mental and Chinese medicinal nursing from elementary to advanced level. Experiences pertaining to the conceptualization, exploration and actualization phases of the establishment are presented. Details of the structure and specific functions of the centre are also illustrated. Finally, there is discussion on the challenges encountered during the establishment process and how they were overcome.
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Affiliation(s)
- L Y K Lee
- The Open University of Hong Kong, Kowloon, Hong Kong, China.
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15
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Tiong HY, Tibung MJB, Macalalag M, Li MK, Consigliere D. Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia. Urol Int 2009; 83:44-8. [PMID: 19641358 DOI: 10.1159/000224867] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/17/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy of Alfuzosin XL 10 mg once daily for the acute management of acute urinary retention (AUR) with placebo in patients with benign prostatic hyperplasia (BPH) and to determine the predictors that impact this. METHODS 67 patients presenting with an initial episode of spontaneous AUR secondary to BPH were catheterized and were then prospectively randomized to receiving placebo or 10 mg Alfuzosin XL once daily for 2 days. The allocation and administration of treatment were double-blinded. The primary outcome measure was the rate of successful trial off catheter (TWOC) after 2 days. Clinical characteristics including intravesical prostatic protrusion (IPP) by transabdominal ultrasound were also assessed using uni- and multivariate analysis for their impact on successful TWOC. RESULTS Three patients withdrew from the study, 2 due to adverse effects of the trial medication. Analysis on an intention-to-treat basis showed a significantly greater proportion of patients in the Alfuzosin XL group (21 of 35 or 60%) had a successful TWOC compared with patients in the placebo group (11 of 32 or 34%) (p = 0.036). Patients with grade 3 IPP (>10 mm) had a significantly lower chance of successful TWOC (p = 0.04) compared to grade 1 (<or=5 mm) and 2 (6-10 mm). It remained a significant independent predictor for failed TWOC after AUR (p = 0.034) on multivariate analysis. CONCLUSION The administration of Alfuzosin XL prior to TWOC following AUR secondary to BPH increases the chance of successful catheter removal. Patients with IPP >10 mm are more likely to fail TWOC on Alfuzosin XL.
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Affiliation(s)
- H Y Tiong
- Department of Urology, National University Hospital of Singapore, Singapore.
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16
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Abstract
Gastric outlet obstruction initiated by acute gastric volvulus is rare but potentially fatal. An unusual case of intrathoracic acute gastric volvulus complicated by distal stomach and transverse colon herniation into retrocardial space is reported. Prompt clinical diagnosis was followed by emergency laparoscopic de-rotation and gastropexy.
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Affiliation(s)
- K K Yau
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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17
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Abstract
BACKGROUND AND STUDY AIM Although magnetic endoscope imaging (MEI) has been reported to improve the performance of colonoscopy, so far only a few randomized controlled studies have been published supporting its adjunctive role. This randomized study was designed to evaluate the role of MEI on the overall performance of colonoscopy. PATIENTS AND METHODS Patients admitted for elective colonoscopy were recruited. They were randomly allocated into two groups, either with an MEI view (study group) or without (control group). Examinations were performed by one of the two designated, trained endoscopists. The primary end point was intubation time. Other outcome measures included completion rate, pain score graded by patients, and ease of procedure as reflected by the number of attempts at straightening the scope, the number of times of hand pressure was applied abdominally, and the need to change the patient's position. Endoscopists were also asked to score the ease of procedure. Finally, in the MEI group, endoscopists were asked to comment on whether MEI helped to locate colonic lesions during endoscopy. RESULTS In a 12-month period, 120 patients were recruited, with 60 patients in each group. The two groups were matched for age, gender distribution, and indications for colonoscopy. No complication occurred in either group. No significant difference was observed in the intubation time and colonoscopy completion rate. Other measures of ease of procedure and pain score were also similar. However, MEI was reported by endoscopists to be helpful in locating colonic lesions in 32 % of examinations with positive findings. CONCLUSION For trained endoscopists, the device confers no benefit in terms of performance improvement. The only identified benefit is in locating lesions. Thus, while the routine use of MEI cannot be recommended, the device could be selectively offered to patients for follow-up examination after local treatment, or to patients with small colorectal tumors in whom laparoscopic surgery is planned.
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Affiliation(s)
- H Y Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China.
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18
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Affiliation(s)
- W T Siu
- Combined Endoscopy Unit, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China.
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19
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Chiong E, Yip SKH, Cheng WS, Vathsala A, Li MK. Hand-assisted laparoscopic living donor nephrectomy. Ann Acad Med Singap 2004; 33:294-7. [PMID: 15175766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. MATERIALS AND METHODS From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon 's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. RESULTS The mean operating time was 163.5 +/- 32 minutes and the mean warm ischaemic time was 2.16 +/- 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 +/- 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 +/- 0.9 days and were discharged 4 +/- 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 +/- 4.6 days. CONCLUSIONS Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.
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Affiliation(s)
- E Chiong
- Department of Urology, National University Hospital, Singapore.
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20
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Affiliation(s)
- L C H Liew
- Department of Urology, National University Hospital, National University of Sinagapore, Sinapore.
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21
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Ng KK, Lim HCP, Ng FC, Li MK, Consigliere D, Chia SJ, Moorthy P, Munisamy M. The use of sildenafil in patients with erectile dysfunction in relation to diabetes mellitus--a study of 1,511 patients. Singapore Med J 2002; 43:387-90. [PMID: 12507022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Erectile dysfunction (ED) seriously impairs the quality of life. Patients with diabetes mellitus (DM) are prone to ED due to various factors, including vasculopathy, neuropathy and sex hormone abnormalities. This is a retrospective study involving 1,511 patients taking sildenafil. Patients with DM have significantly more comorbidities like hypertension and ischaemic heart disease. They are also more likely to be on medications which may affect erectile function, including various antihypertensive drugs. 77.9% of patients with DM reported success with sildenafil, as compared to 86.5% of patients without DM. A significant number of patients with DM require a higher dose of sildenafil as compared to those without DM.
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Affiliation(s)
- K K Ng
- Department of Urology, Changi General Hospital, Singapore 529889.
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22
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Tan JK, Png DJC, Liew LCH, Li MK, Wong ML. Prevalence of prostatitis-like symptoms in Singapore: a population-based study. Singapore Med J 2002; 43:189-93. [PMID: 12188063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To study the prevalence of prostatitis-like symptoms in a generally healthy population. SUBJECTS AND METHODS A population-based cross-sectional survey was conducted in Singapore to evaluate "prostatitis-like symptoms" (PS), lower urinary tract symptoms (LUTS),erectile dysfunction (ED), and quality of life (QoL). Respondents with pain or discomfort in the perineum, testicles, tip of penis or bladder/suprapubic region were identified as having prostatitis-like symptoms. RESULTS Altogether, 1087 males aged 21 to 70 were evaluated. While at least 20% of them had some degree of LUTS, only 2.67% (29 out of 1087) had pain or discomfort suggestive of prostatitis. Six men had pain in the bladder or suprapubic region, two in the perineum, six at the tip of penis and 26 had pain during micturition (11 subjects had more than one location of pain). Only two men had severe pain while seven had moderate and the rest had mild pain. The mean age of subjects with PS was 43.14. In terms of racial distribution, 2.23% (18) of Chinese, 3.15% (4) of Malay, 4.49% (4) of Indians and 12.12% (3) of other ethnic origin had PS. Those who had PS had worse erectile function (International Index of Erectile Function (IIEF) 11.92 vs. 17.16, p < 0.003) and a worse QoL score (2.96 vs. 1.38, p < 0.001) than those without PS. Those with PS were more bothered and worried about their symptoms. CONCLUSION The prevalence of prostatitis-like symptoms in a largely Chinese population is 2.67%. Prostatitis-like symptoms have a negative impact on the quality of life and erectile function.
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Affiliation(s)
- J K Tan
- Department of Surgery, National University of Singapore.
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23
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Chung CC, Ha JP, Tsang WW, Li MK. Laparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer. Surg Endosc 2001; 15:1098-101. [PMID: 11727078 DOI: 10.1007/s00464-001-9000-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total mesorectal excision (TME) and colonic J pouch reconstruction has been widely practiced for mid- or low-rectal cancer. However, the laparoscopic version of TME has never been described. METHODS Five patients suffering from newly diagnosed mid- to low-rectal cancer were seen between March and July 1999. These five patients were selected for laparoscopic TME and colonic J pouch reconstruction because preoperative investigations revealed resectable tumor without extrarectal disease. RESULTS There were three men and two women with a mean age of 61 years. The average body weight was 69 kg (range, 57-80). None of the patients had had previous abdominal operations. In all five patients, the tumor was located within 9 cm from anal verge. The average size of the main incision was 5 cm. All patients had a covering ileostomy at the end of the procedure. The mean operating time was 208 min; average blood loss was 158 ml; and mean hospital stay was 10.6 days. Three patients had Dukes' B disease and two had Dukes' C disease. The resection margins (proximal, circumferential, and distal) were all clear. There were no deaths or major complications. Two patients suffered from transient urinary retention. After ileostomy closure, the median frequency of bowel motion was twice per day at 6-month follow-up. Neither incontinence nor nocturnal soiling was reported. CONCLUSION To the best of our knowledge, this is the first published series of such an operation. With good patient selection, laparoscopic-assisted TME and colonic J pouch-anal anastomosis is safe and feasible.
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Affiliation(s)
- C C Chung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
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24
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Ha JP, Siu WT, Tang CN, Li MK. Images in focus. Self-knotting of feeding tube. Endoscopy 2001; 33:644. [PMID: 11473343 DOI: 10.1055/s-2001-15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J P Ha
- Dept. of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
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25
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Siu WT, Leong HT, Law BK, Onsiong SM, Fung KH, Li AC, Tai YP, Li MK. Outpatient laparoscopic cholecystectomy in Hong Kong: patient acceptance. Surg Laparosc Endosc Percutan Tech 2001; 11:92-6. [PMID: 11330391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors performed a prospective evaluation of 60 Hong Kong Chinese patients with symptomatic gallstones and gallbladder polyps undergoing outpatient laparoscopic cholecystectomy in a regional hospital in Hong Kong from March 1996 to May 1998 to determine the feasibility, satisfaction, and acceptance of this procedure among Chinese patients. Patients with American Society of Anesthesiologists grade I and II gallstones or polyps were selected. Exclusion criteria included 1) history of upper abdominal operations, attacks of acute cholecystitis, cholangitis, or pancreatitis; 2) abnormal liver function; and 3) ultrasonographic evidence of contracted gallbladder, thickened gallbladder wall, dilated common bile duct, or common bile duct stones. Patients discharged at 5:00 PM on the day of cholecystectomy were defined as having undergone outpatient procedure. Patients were asked about procedure acceptance, rated on a scale of 1 to 10 (best), using a standardized questionnaire 4 weeks after operation. The study included 21 men and 39 women with mean age of 40.5 years (range, 27-59). There were no conversions to open procedures in the series. There were 6 (10%) unanticipated postoperative hospital admissions; all patients were discharged on the first postoperative day. Another patient was readmitted 3 days after operation because of a common bile duct stone. Overall patient acceptance of outpatient laparoscopic cholecystectomy was good, with a mean score of 8.6 of 10. Thirteen patients (22%) expressed dissatisfaction with being discharged earlier than they had expected, and 9 (15%) would have preferred inpatient care. Forty-eight patients (80%) resumed full daily activities by the first postoperative day; the remaining 12 did so by the end of the first week. Among the 44 working patients, only 4 (9%) resumed full duty within the first postoperative week; 29 (66%) did so by the second week and the remaining 11 (25%) returned to work after the third week. By selecting appropriate subjects, outpatient laparoscopic cholecystectomy is feasible and highly accepted among Hong Kong Chinese patients. Approximately one quarter of the patients preferred a longer postoperative stay or inpatient care.
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Affiliation(s)
- W T Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
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26
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Wong J, Tang CN, Chau CH, Luk YW, Li MK. Laparoscopic cholecystectomy and exploration of common bile duct in a patient with situs inversus. Surg Endosc 2001; 15:218. [PMID: 12200663 DOI: 10.1007/s004640040037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2000] [Accepted: 06/02/2000] [Indexed: 12/27/2022]
Abstract
Situs inversus is a rare anomaly with a genetic predisposition. We report a patient with situs inversus, cholelithiasis, and choledocholithiasis who was treated successfully with laparoscopic cholecystectomy and laparoscopic exploration of the common bile duct. We believe this to be the first such case reported in the literature.
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Affiliation(s)
- J Wong
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chai Wan, Hong Kong
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27
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Abstract
BACKGROUND Kidney entrapment is generally considered to be a difficult step in retroperitoneoscopic nephrectomy (RN). Normally, a large device is needed to accommodate the specimen, which may measure </=14 x 10 cm. There is just too little space to maneuver either the entrapment device or the specimen. Herein we describe a technique that can overcome this difficulty and even turn the space limitation to advantage. METHODS After the nephrectomy, the specimen is pushed caudally. A 15-mm Endocatch is inserted via the posterior cranial port. It is positioned strategically underneath the specimen so that when the entrapment bag is released, the specimen will have no room to move (because of the limited space) and will simply fall into the bag (because of gravity). RESULTS We have used this technique for our last four cases of retroperitoneoscopic nephrectomy and found that it remarkably shortened the operative time for this step. CONCLUSION One of the criticisms leveled against retroperitoneoscopic surgery concerns the problems posed by the space limitation. This technique turns the space limitation into an advantage and guarantees successful specimen entrapment.
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Affiliation(s)
- S K Li
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
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Li MK, Lim PH, Wong MY, Fok A, Chia SJ, Consigliere D, Adaikan PG, Moorthy P. Transurethral alprostadil for the treatment of erectile dysfunction: results of a multicentre trial. Ann Acad Med Singap 2000; 29:727-31. [PMID: 11269978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION The incidence of erectile dysfunction (ED) has been shown to increase significantly in Singaporean male population. Thus, this prospective study (no controls) assessed the clinical efficacy and safety of a medicated urethral system for erection (MUSE) in Singaporean male patients with a known history of ED. SUBJECTS AND METHOD Eighty-six men with a mean age of 55.7 years with differential causes of ED were administered with MUSE in the clinic with a titration adjustment of 4 possible dose regimes (125, 250, 500 and 1000 mcg) till efficacy is achieved. Subsequently, patients were subjected to home treatment for a duration of 3 months. RESULTS Sixty per cent of inclinic patients exhibited good responses and were given MUSE for home treatment. The efficacy rate for home treatment was 86%. Overall, the patients (n = 86) had a 51.2% success rate in achieving satisfactory sexual intercourse. Diabetic and psychogenic patients were noted to respond well to MUSE. No severe adverse events were found in this study. CONCLUSION MUSE showed to be a safe, less invasive, well-tolerated and efficient alternative treatment for ED in Singaporean men.
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Affiliation(s)
- M K Li
- Division of Urology, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119704.
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Lee BR, Png DJ, Liew L, Fabrizio M, Li MK, Jarrett JW, Kavoussi LR. Laparoscopic telesurgery between the United States and Singapore. Ann Acad Med Singap 2000; 29:665-8. [PMID: 11126706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Telemedicine is the use of electronic digital signals to transfer information from one site to another. With the advent of a telepresence operative system and development of remote robotic arms to hold and manoeuvre the laparoscope, telemedicine is finding its role in surgery, especially laparoscopic surgery. CLINICAL FEATURES AND TREATMENT: We report two successful cases of laparoscopic surgery--radical nephrectomy and varicocelectomy for a 3-cm renal tumour and for bilateral varicoceles causing pain, where a less experienced laparoscopic surgeon in Singapore was telementored by an experienced laparoscopic surgeon located remotely in the United States. Both patients recovered uneventfully and returned home on postoperative day 4 and on the day of surgery, respectively. OUTCOME This study demonstrates that telementored laparoscopic systems are feasible and safe, between countries halfway across the world. CONCLUSIONS As the Internet expands in utility and the cost of higher bandwidth telecommunication lines decreases, even to remote countries, telementoring systems will become more affordable and may potentially pave the way for advanced surgical and laparoscopic applications and training for the future.
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Affiliation(s)
- B R Lee
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Hospital, Baltimore, USA
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30
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Yau KK, Tang CN, Chau CH, Siu WT, Fung KH, Li MK. Nonoperative management of biliary stent-induced duodenal perforation. Endoscopy 2000; 32:S47. [PMID: 10935803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K K Yau
- Dept. of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Abstract
Angiomyolipoma (AML) is a benign renal tumour that occasionally requires intervention. We evaluated the surgical management of symptomatic angiomyolipoma, with special attention to the feasibility of nephron-sparing surgery. A retrospective study was conducted enlisting 23 patients (including 3 patients with tuberous sclerosis) who had their AML treated surgically from 1991 to 1998. The study included 7 males and 16 females, with a mean age of 49 years (range 24-75). The mean tumour size was 12.3 cm (range 1.5-30.0) including 7 lesions < or = 4 cm and 16 lesions > 4 cm. The presenting features included abdominal/loin pain (9 patients), spontaneous rupture (5 patients), non-specific symptoms (7 patients) and incidental findings (2 patients). AML was diagnosed by computed tomography in 16 patients and malignancy was suspected in 7 patients. The latter group included 5 patients with lesions smaller than 4 cm, one of them having coexisting AML and renal cell carcinoma. All patients underwent elective surgery, with the exception of one, who required a semi-emergency operation. Nephron-sparing surgery using frozen section in 5 patients (all diagnostic) was carried out on 16 patients, including all 5 patients with previous haemorrhage and 2 patients with suspected lesions from preoperative studies. Total nephrectomy was performed in 7 patients, including the other 5 patients with lesions suspected to be malignant. There was no operative mortality. Two complications were encountered in the entire group. We conclude that elective nephron-sparing surgery is feasible, even for massive angiomyolipoma or after previous rupture, especially when the diagnosis is made by preoperative imaging and/or intraoperative frozen section.
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Affiliation(s)
- S K Yip
- Department of Urology, Singapore General Hospital, Singapore.
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32
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Li AC, Siu WT, Li MK. Endometrioma simulating inguinal hernia: case reports. Can J Surg 1999; 42:387-8. [PMID: 10526526 PMCID: PMC3788907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- A C Li
- Department of Surgery, Pamela Youde Nethersoie Eastern Hospital, Chai Wan, Hong Kong
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33
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Chung CC, Siu WT, Li MK. Ventriculoperitoneal shunt mimicking a colonic polyp. Endoscopy 1999; 31:S60. [PMID: 10533753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- C C Chung
- Dept. of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
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34
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Li MK, Choy DK, Yip SK. Renal cell carcinoma in patients with chronic renal failure. Ann Acad Med Singap 1999; 28:512-5. [PMID: 10561763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
It has been found that patients suffering from chronic renal failure (CRF) are prone to develop acquired cystic kidney disease, which may subsequently lead to the development of renal cell carcinoma (RCC). We reviewed 250 consecutive cases of RCC diagnosed between January 1990 and June 1998 in our department and found 19 had associated CRF (7.6%). Their clinical presentation, mode and duration of dialysis, diagnostic evaluations, pathological stage and surgical outcome were reviewed. Sixteen had CRF with chronic glomerulonephritis and 3 with adult polycystic kidney disease. Three patients were on continuous ambulatory peritoneal dialysis (CAPD), 5 were on haemodialysis (HD) and 3 had renal transplant (2 on HD, 1 on CAPD previously). The remaining 8 patients were not on renal replacement therapy at the time of diagnosis. Ten patients were asymptomatic with incidental radiological findings while 9 had specific urological symptoms, most commonly haematuria. Ultrasonography (USG) and computed tomography (CT) scan were the main modalities of imaging employed. Nine out of the 10 asymptomatic patients had suspicious lesions detected incidentally by USG. All had subsequent preoperative CT scans confirming the presence of these lesions. All patients had single focus RCC except for 1 with multi-focal disease involving both kidneys. Sixteen patients had early stage (T1 or T2) and low grade (G1 or G2) RCC. The remaining 3 patients had advanced stage (T3a or T3b) and high grade (G3) tumours. Since half of the patients were asymptomatic, USG may be a useful tool in the outpatient review of patients with CRF and allow early diagnosis and surgical treatment of early stage, low-grade tumours and therefore may have better survival.
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Affiliation(s)
- M K Li
- Department of Urology, Singapore General Hospital.
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35
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Li MK, Yip SK, Cheng WS. Inferior vena cava thrombectomy for renal cell carcinoma with thrombus. Ann Acad Med Singap 1999; 28:508-11. [PMID: 10561762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Up to 10% of patients with renal cell carcinoma have intracaval neoplastic extension. The results of nephrectomy and caval cavotomy to remove the renal tumour and caval thrombus were reviewed. From September 1991 to October 1997, 16 consecutive patients (13 males, 3 females) with a mean age of 59 years (range 45 to 75 years) underwent radical nephrectomy together with cavotomy and thrombectomy (15) or caval resection (1). The tumour thrombi extended to the infrahepatic vena cava in 9 patients, intrahepatic cava in 5 and suprahepatic cava in 2. The surgical approaches included abdominal (8), right thoraco-abdominal (5) and abdominal with median sternotomy (3), respectively; cardiac bypass was not required. The mean cava clamp time was 15 minutes and the average operative time was 127 minutes (range 70 to 190 minutes). There was no operative mortality but the complication rate was 31%. The mean hospital stay was 12 days (range 7 to 23 days). Ten patients had Robson's stage IIIa disease, 4 had stage IIIc disease and 2 had stage IV disease. During a mean follow up of 20 months (range 1 to 54 months), 6 patients were alive with no recurrence and 10 patients had died of the disease. The survival of stage IIIa patients was significantly better than stage IIIc and IV patients. In summary, caval thrombectomy is associated with acceptable operative morbidity and mortality; however, advanced staged disease dictates a short survival.
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Affiliation(s)
- M K Li
- Department of Surgery, National University Hospital, Singapore
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36
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Toh KL, Yip SK, Li MK, Htoo MM. Case No. 1. Computed tomography (CT) of a 70-year-old male presenting with sepsis and right renal mass. Tech Urol 1999; 5:119, 120. [PMID: 10458670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- K L Toh
- Department of Urology, Singapore General Hospital, Singapore
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37
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Chong KW, Yip SK, Lo RH, Li MK, Foo KT. Clinics in diagnostic imaging (38). Post-ESWL perinephric haematoma. Singapore Med J 1999; 40:430-3. [PMID: 10489515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 57-year-old man presented with urosepsis related to urinary calculi. He underwent multiple sessions of ESWL and developed a perinephric haematoma that was treated conservatively and monitored by serial imaging. However, the haematoma became infected, necessitating percutaneous drainage 2 months after the initial ESWL. The risk factors and sequelae of post-ESWL perinephric haematoma, as well as its diagnosis and imaging, are discussed.
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Affiliation(s)
- K W Chong
- Department of Urology, Singapore General Hospital, Singapore
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38
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Yip SK, Cheng WS, Tan BS, Li MK, Foo KT. Partial nephrectomy for renal tumours: the Singapore General Hospital experience. J R Coll Surg Edinb 1999; 44:156-60. [PMID: 10372483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
From January 1991 to August 1998, 220 radical nephrectomies were performed for renal cell carcinoma (RCC). During the same period, 27 patients underwent partial nephrectomy for their renal tumours. These included 19 male and 8 female (mean age, 54; range, 35-75). Their clinical presentation, diagnostic modalities and surgical outcome were evaluated. The lesions included 18 RCCs, 7 angiomyolipomas (AMLs), 1 oncocytoma and 1 dysoncogenetic renal tumour. Only 8 patients had specific urological symptoms. Computerised tomography (CT) scan was diagnostic in 78% of cases. Tumour size ranged from 15-50 mm for RCC and 30-190 mm for AML, respectively. Operative time averaged 92 minutes (range: 35-145). The hospital stay ranged from 3 to 25 days (mean 11). Complications occurred in four cases (14.8%); there was one death (3.7%). No tumour recurrence was detected during a mean follow up of 20 months. None of the patients developed significant renal impairment. Partial nephrectomy is feasible in small RCC and some large AML, and can be offered in selected patients.
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Affiliation(s)
- S K Yip
- Department of Urology, Singapore General Hospital, Singapore.
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39
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Tan YM, Yip SK, Li MK. Clinics in diagnostic imaging (36). Benign renal oncocytoma. Singapore Med J 1999; 40:314-6. [PMID: 10487092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 50-year-old Indian man presented with non-specific right-sided abdominal pain. Ultrasound of the abdomen demonstrated a small right renal tumour. Computed tomography showed features suggestive of a benign renal oncocytoma. This was confirmed by frozen section during surgical exploration. A partial nephrectomy was carried out. The role and limitations of imaging in the management of solid renal masses is discussed.
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Affiliation(s)
- Y M Tan
- Department of Urology, Singapore General Hospital, Singapore
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40
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Lau KO, Vathsala A, Kong S, Li MK. Preliminary results of heart-beating and non-heart-beating donor kidney transplants--the Singapore experience. Ann Acad Med Singap 1999; 28:222-6. [PMID: 10497671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Renal transplantation is the ideal renal replacement therapy for treatment of end stage kidney failure but its limitation is the constant shortage of cadaveric donors. While the traditional source of cadaveric kidneys is procurement from heart-beating donors, organ procurement from non-heart-beating donors (NHBD) would help in coping with the rising demand for organs. However various important legal, logistic and technical constraints have limited the implementation of such a procurement programme. Nevertheless, prolonged warm ischaemic times in procuring kidneys from NHB donors may affect the viability of these organs and adversely affect overall outcome after transplant. Fifty-three consecutive patients who underwent renal allotransplantation (Tx) between January and December 1994 at the Singapore General Hospital were retrospectively reviewed. Outcomes after renal transplantation among 25 heart-beating donor (HBD) and 28 NHBD were compared. Despite significant differences in donor age (23.7 +/- 11.0 and 34.1 +/- 7.9, P = 0.001), first warm (0 and 22.2 +/- 9.0 minutes) and cold ischaemic times (12.8 +/- 6.7 and 5.2 +/- 5.0 hours, P = 0.001) between the HBD and NHBD groups, the two-year patient and graft survivals were very similar in both groups (100% versus 98% and 98% versus 96%). The incidence of delayed graft function (DF) was also comparable between the HBD (41%) and the NHBD (50%) Tx. These results suggest that NHBD is a viable source for kidney transplants and comparable patient and graft survivals can be achieved if the first warm and cold ischaemic times are kept to the minimum.
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Affiliation(s)
- K O Lau
- Department of Urology, Singapore General Hospital, Singapore
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41
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Abstract
OBJECTIVES To evaluate the long-term results of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) with up to 5 years of follow-up at our institution. METHODS From October 1991 to November 1993, 106 patients were treated for BPH with TUMT using the Prostatron 2.0. Of the 106 patients, 64 were available for evaluation of symptoms (Madsen-Iverson score), uroflow, residual urine, and retreatment rate at a mean follow-up of 50+/-5.4 months (mean+/-SD). RESULTS The mean age of the patients was 65.2+/-9.8 years. Thirty-two patients (50.0%) were treated with one session of TUMT. Additional treatments were required for 32 patients (50.0%). Three patients had two sessions of TUMT, 14 underwent transurethral resection of prostate, and 3 had laser prostatectomy. Twelve patients received medical therapy. The mean symptom score decreased significantly from 12.9+/-2.5 to 5.7+/-3.6 (P = 0.001). The mean peak flow rates and postvoid residual volume showed little difference before and after TUMT. On the basis of the criteria described by Poincelet and Cathaud the overall clinical efficacy rate was 39.1% (15.6% complete response and 23.5% partial response). No obvious clinical parameter was useful to predict favorable outcome after TUMT. CONCLUSIONS The present study showed that the efficacy rate of TUMT with the Prostatron 2.0 at 50 months was 39.1 %. None of the preoperative clinical factors was predictive of a favorable outcome.
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Affiliation(s)
- K O Lau
- Department of Urology, Singapore General Hospital, Singapore
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42
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Abstract
Gastric volvulus is an infrequently encountered clinical entity characterized by abnormal rotation of the stomach around an axis made by its two fixed portions, the cardia and pylorus. Surgical treatment by anterior gastropexy is usually indicated for chronic gastric volvulus to prevent complications and treat the underlying pathology. We report a patient with chronic gastric volvulus who was treated with laparoscopic anterior and diaphragmatic gastropexy. Laparoscopy not only identifies underlying predisposing conditions but also allows effective fixation for gastric volvulus. Laparoscopic approach minimizes the access trauma and is superior for benign upper gastrointestinal lesions.
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Affiliation(s)
- W T Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital No. 3, Lok Man Road, Chai Wan, Hong Kong
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43
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Chan VS, Li MK. Quantitative analysis on the localization of chondroitin sulfate proteoglycan in renal tissues of patients with calcium nephrolithiasis. Urol Res 1998; 26:271-4. [PMID: 9760001 DOI: 10.1007/s002400050056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Previous studies have shown a significant decrease of heparin sulfate proteoglycan (HSPG) in the basement membrane of the glomerulus and the mucosa of the ureter/renal pelvis in patients with calcium nephrolithiasis. In this study, we looked at the localization of another influential proteoglycan, chondroitin sulfate (CSPG), using similar study groups by indirect immunofluorescence staining. Microscopic images were digitized and image analysis was used to quantitate the staining intensity of CSPG present in the basement membrane of the nephron. Our data showed significant loss of CSPG in the Bowman's capsule and the basement membrane of the mucosa of the ureter/renal pelvis using Mann-Whitney U-Wilcoxon Rank Sum W test with P-values of 0.0043 and 0.0041, respectively. However, absence of staining was noted in the basement membrane of the glomerulus and no significant change in the basement membrane of the tubular epithelium was observed. In conclusion, our results showed changes in the localization of CSPG in the basement membrane of the nephron, accompanied with HSPG, which may contribute to the pathological condition of calcium nephrolithiasis.
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Affiliation(s)
- V S Chan
- Department of Clinical Research, Singapore General Hospital, Singapore
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44
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Gan E, Li MK. Repair of complex ureterovaginal and vesicovaginal fistulas with ileal cystoplasty and ureteric reimplantation into an antireflux ileal nipple valve--a case report. Ann Acad Med Singap 1998; 27:707-9. [PMID: 9919345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We report a case of a 59-year-old woman with bilateral ureterovaginal and vesicovaginal fistulas after radical total hysterectomy and bilateral salphingo-oophorectomy who failed transvesical repair of the vesicovaginal fistula. The bladder was extensively scarred, half of which had to be excised. This was replaced with an ileal cystoplasty with an antireflux ileal nipple valve into which the ureters were reimplanted. Continuity of the urinary tract was re-established without a urinary diversion or stoma.
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Affiliation(s)
- E Gan
- Department of Urology, Singapore General Hospital, Singapore
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45
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Koh JS, Wong MY, Li MK, Foo KT. Idiopathic retroperitoneal fibrosis with bilateral lower ureteric obstruction--a case report with literature review. Singapore Med J 1998; 39:416-7. [PMID: 9885722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Whilst prostatic enlargement remains the commonest cause of bilateral hydronephrosis in males greater than 50 years of age, other rarer conditions such as retroperitoneal fibrosis should be borne in mind. We report a case of bilateral hydronephrosis which was eventually diagnosed as idiopathic retroperitoneal fibrosis and treated with open surgical ureterolysis with omental wrapping.
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Affiliation(s)
- J S Koh
- Department of Urology, Singapore General Hospital, Singapore
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46
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Abstract
Glybenclamide, an adenosine triphosphate-dependent potassium (K+(ATP)) channel blocker, lowered portal pressure and attenuated the hyperdynamic splanchnic circulation in rats with partial portal vein ligation (PPVL). The purpose of this report was to confirm these observations and to test the hypothesis that glybenclamide could reduce acidified ethanol-induced gastric mucosal injury in rats with PPVL. Gastric mucosal blood flow (hydrogen gas clearance), systemic blood pressure, and portal pressure were monitored in rats with PPVL or sham operation (SO). Intravenous glybenclamide (20 mg/kg) or vehicle was administered, followed by intragastric acidified ethanol (0.15 N HCl and 15% ethanol). The area of gastric mucosal lesions was assessed by image analysis. In contrast to published findings, there was no significant elevation of portal pressure after glybenclamide administration in rats with PPVL. Glybenclamide did not alter the gastric mucosal hyperemia in these rats. Glybenclamide significantly increased mucosal injury. The data are consistent with the hypothesis that K+(ATP) channels play a role in protecting the gastric mucosa in rats with PPVL.
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Affiliation(s)
- M K Li
- Department of Medicine, Chinese University of Hong Kong, Hong Kong
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47
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Abstract
OBJECTIVE To evaluate the impact of the modified ileal neobladder reconstruction on lifestyle, voiding habits and functional outcome in Asian patients. PATIENTS AND METHODS Twenty-seven Asian patients (25 men and two women, mean age 59 years, range 41-76) underwent modified ileal neobladder reconstruction after radical cystectomy for carcinoma of the bladder. The mean (range) follow-up was 21 (3-75) months. All patients were evaluated retrospectively using case notes, reviews, interviews and voiding charts; 18 patients underwent urodynamic studies. RESULT Twenty-five patients (93%) achieved diurnal and 23 (85%) nocturnal continence within 6 months. Of the 19 patients who were in employment before surgery, 15 continued to be economically active afterward; 26 patients (96%) reported no change in their daily living activities. Of 16 men who reported being potent pre-operatively only four retained some residual erectile function. Twenty-three patients were interviewed about their voiding habits and satisfaction with the outcome of surgery. Fourteen patients had no sensation of reservoir fullness and of the 21 men, 13 had to squat or sit to void effectively. The mean (range) voiding frequency was 5 (4-8) during the day and 2 (0-4) during sleep. Twenty-two patients were satisfied with the overall outcome. CONCLUSIONS The modified ileal bladder provides a high urinary continence rate with minimal changes in daily living activities and occupational status. The functional outcome was very satisfactory and accepted well, despite some changes in reservoir sensation, voiding posture and erectile function. The method is a viable option for reconstruction after cystectomy in Asian patients.
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Affiliation(s)
- K T Lee
- Department of Urology, Sultanah Aminah Hospital, Johore Bahru, Johore, Malaysia
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48
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Li MK. Perceptions of effective clinical teaching behaviours in a hospital-based nurse training programme. J Adv Nurs 1997; 26:1252-61. [PMID: 9429978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Clinical teaching behaviour is a critical determinant for quality clinical learning experiences of student nurses. It is believed that a better understanding of the perceptions of clinical teaching behaviours between student nurses and nurse educators will enhance clinical teaching. This study examined the perceptions of effective clinical teaching behaviours of nurse educators by student nurses (n = 81) and nurse educators (n = 10) in a hospital-based 3-year general nurse training programme in Hong Kong. Knox & Mogan's Nursing Clinical Teacher Effectiveness Inventory (NCTEI) (1985) was adopted. The respondents were asked to rate the importance of each discrete behaviour on a seven-point scale. It was found that there was greater agreement in the 10 most important behaviours than the 10 least important behaviours among the four groups: students, junior students, senior students and nurse educators. No statistically significant difference could be identified in the perceptions between the nurse educators and students as well as between the junior and senior students regarding the five behavioural categories. The nature and the student status of the nursing programme was accountable for most of the discrepancies between the findings of this study and those of past studies.
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Affiliation(s)
- M K Li
- School of General Nursing, Queen Elizabeth Hospital, Kowloon, Hong Kong
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49
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Siu WT, Chan WC, Hou SM, Li MK. Laparoscopic management of ruptured pyogenic liver abscess. Surg Laparosc Endosc Percutan Tech 1997; 7:426-8. [PMID: 9348626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically. The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples. A thorough peritoneal lavage could be also performed. The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.
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Affiliation(s)
- W T Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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50
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Png JC, Tan E, Foo KT, Li MK, Cheng C, Rekhraj IR. A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissues after simultaneous oral ingestion. Br J Urol 1997; 79:781-4. [PMID: 9158519 DOI: 10.1046/j.1464-410x.1997.00146.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the levels of two quinolones, ofloxacin and ciprofloxacin, potent broad-spectrum antibiotics with very good oral bioavailability and low minimum inhibitory concentrations (MICs) for most pathogens, in the prostates of patients who underwent transurethral resection of the prostate (TURP) after oral ingestion for surgical prophylaxis. PATIENTS AND METHODS Twenty-eight patients with BPH requiring a TURP ingested 250 mg of both drugs 2-4 h before operation. The levels of the drugs in the serum and prostate were measured using high-performance liquid chromatography and the levels of both drugs determined at the 6 and 9 o'clock positions in the prostate to examine any local variations in drug concentration. RESULTS Ofloxacin concentrations were significantly higher in the serum and prostatic tissues compared with ciprofloxacin for the same dose, but its penetrance into the prostate was lower. This mainly reflected its higher oral bioavailability. Both drugs were present in concentrations 50% higher at the 6 o'clock than at the 9 o'clock position but both exceeded the MICs for most Gram-negative organisms except Pseudomonas. CONCLUSION Ofloxacin has the advantage against ciprofloxacin of exceeding the MICs for Staphylococcus and Chlamydia. However, ciprofloxacin has the advantage of having prostate-to-serum ratios of unity, but for the same dose the prostatic concentrations of ofloxacin is significantly higher.
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Affiliation(s)
- J C Png
- Department of Urology, Singapore General Hospital, Singapore
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