HCC : PE-079 ; Two cases of hepatic carcinoma post-hepatic resection presenting with chylous ascites: a case report

( Billy James Uy ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Chylous ascites is a rare phenomenon characterized by milky turbid ascitic fluid usually caused by ruptured lymphatics associated with a variety of causes. The main causes are usually malignant tumors, hepatic cirrhosis and tuberculosis. This case report aims to present two cases of chylous ascites post-hepatic resection that presented with significantly different outcomes. Presentation: Case No. 1. A 53 year old male alcoholic drinker presented with a right hepatic mass during appendectomy. Segmental (segment VII) hepatic resection revealed hepatic carcinoma with a cirrhotic background. One year after, CT scan revealed left hepatic mass wherein patient underwent left lateral segmentectomy. A year after the 2nd hepatic resection, patient developed globular abdomen where paracentesis revealed the presence of chylous ascites. Patient`s ascites was refractory to diuretics, octreotide and other medical management leading to his eventual demise. Case No. 2. A 48 year male diagnosed with hepatitis B presented with a 19 cm liver tumor involving segment V, VII and VII infiltrating the pleura and right lower lung lobe. CT scan revealed multiple lymphadenopathy on the portal and suprapancreatic area. Right hemihepatectomy with enbloc resection of the diaphragm, left lower lung resection and radical lymph node dissection was done. Patient developed chylous ascites 8 days post-op but eventually subsided with dietary fat restriction and intravenous octretide for 7 days. Patient recovered well. Conclusion: Hepatic resection of hepatocellular carcinoma could lead to the development of chylous ascites. However, the presence of liver cirrhosis could have led to the development of liver failure leading to intractable ascites that was refractory to treatment.

LT, Others : PE-130 ; Laser lithotripsy in a diffucult case of hepatocholedocholithiasis with distal common bile duct stricture done at the national kidney and transplant institute: a case report

( Billy James Uy ),( Kristine Trocio ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Introduction: The presence of intrahepatic lithiasis is an operative dilemma for surgeons. Not all cases are amenable to endoscopic retrograde cholangiography (ERCP) extraction, and intraoperative biliary extraction is fraught with difficulties. A usual option is to insert a t-tube to allow percutaneous choledoscope extraction post-operatively. Hepatic resection is also another option but has a higher morbidity. Recent studies have shown the applicability of laser lithotripsy in the removal of intrahepatic stones. Methods: We report a case of intrahepatic lithiasis not amenable to ERCP and intraoperative biliary extraction that was done in a center specialized in urologic cases. Summary: A 52 year old male presented colicky abdominal pain where ultrasound showed calculous cholecystitis. Patient was initially treated with antibiotics but developed jaundice with acolic stools after a week. Patient was admitted and repeat ultrasound revealed calculous cholecystitis with suspicious obstructing calculus in the proximal CBD, distal CBD stricture was noted. Ductal dilatation and stone extraction failed, hence a F10 stent was inserted and scheduled for surgery. Intraoperative ultrasound revealed multiple stones in the CBD and was extracted through a choledochotomy. A 0.5 cm stone was impacted in the secondary radicles of the right hepatic duct. A nephroscope was inserted and stone basket extraction done but failed. Laser lithotripsy was used to break the stone into smaller fragments, flushed out and extracted more proximally. A roux-en-y hepaticojejunostomy was done to bypass the distal CBD stricture. Patient recovered and was eventually discharged. Conclusion: In intrahepatic stones that have failed ERCP and biliary extraction, the combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy could provide a viable option for stone removal. However, for centers not specialized in hepatobiliary surgery with lack of equipment, this could pose a significant challenge on its applicability.

LT, Others : PE-130 ; Laser lithotripsy in a diffucult case of hepatocholedocholithiasis with distal common bile duct stricture done at the national kidney and transplant institute: a case report

( Billy James Uy ),( Kristine Trocio ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Introduction: The presence of intrahepatic lithiasis is an operative dilemma for surgeons. Not all cases are amenable to endoscopic retrograde cholangiography (ERCP) extraction, and intraoperative biliary extraction is fraught with difficulties. A usual option is to insert a t-tube to allow percutaneous choledoscope extraction post-operatively. Hepatic resection is also another option but has a higher morbidity. Recent studies have shown the applicability of laser lithotripsy in the removal of intrahepatic stones. Methods: We report a case of intrahepatic lithiasis not amenable to ERCP and intraoperative biliary extraction that was done in a center specialized in urologic cases. Summary: A 52 year old male presented colicky abdominal pain where ultrasound showed calculous cholecystitis. Patient was initially treated with antibiotics but developed jaundice with acolic stools after a week. Patient was admitted and repeat ultrasound revealed calculous cholecystitis with suspicious obstructing calculus in the proximal CBD, distal CBD stricture was noted. Ductal dilatation and stone extraction failed, hence a F10 stent was inserted and scheduled for surgery. Intraoperative ultrasound revealed multiple stones in the CBD and was extracted through a choledochotomy. A 0.5 cm stone was impacted in the secondary radicles of the right hepatic duct. A nephroscope was inserted and stone basket extraction done but failed. Laser lithotripsy was used to break the stone into smaller fragments, flushed out and extracted more proximally. A roux-en-y hepaticojejunostomy was done to bypass the distal CBD stricture. Patient recovered and was eventually discharged. Conclusion: In intrahepatic stones that have failed ERCP and biliary extraction, the combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy could provide a viable option for stone removal. However, for centers not specialized in hepatobiliary surgery with lack of equipment, this could pose a significant challenge on its applicability.

HCC : PE-079 ; Two cases of hepatic carcinoma post-hepatic resection presenting with chylous ascites: a case report

( Billy James Uy ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Chylous ascites is a rare phenomenon characterized by milky turbid ascitic fluid usually caused by ruptured lymphatics associated with a variety of causes. The main causes are usually malignant tumors, hepatic cirrhosis and tuberculosis. This case report aims to present two cases of chylous ascites post-hepatic resection that presented with significantly different outcomes. Presentation: Case No. 1. A 53 year old male alcoholic drinker presented with a right hepatic mass during appendectomy. Segmental (segment VII) hepatic resection revealed hepatic carcinoma with a cirrhotic background. One year after, CT scan revealed left hepatic mass wherein patient underwent left lateral segmentectomy. A year after the 2nd hepatic resection, patient developed globular abdomen where paracentesis revealed the presence of chylous ascites. Patient’s ascites was refractory to diuretics, octreotide and other medical management leading to his eventual demise. Case No. 2. A 48 year male diagnosed with hepatitis B presented with a 19 cm liver tumor involving segment V, VII and VII infiltrating the pleura and right lower lung lobe. CT scan revealed multiple lymphadenopathy on the portal and suprapancreatic area. Right hemihepatectomy with enbloc resection of the diaphragm, left lower lung resection and radical lymph node dissection was done. Patient developed chylous ascites 8 days post-op but eventually subsided with dietary fat restriction and intravenous octretide for 7 days. Patient recovered well. Conclusion: Hepatic resection of hepatocellular carcinoma could lead to the development of chylous ascites. However, the presence of liver cirrhosis could have led to the development of liver failure leading to intractable ascites that was refractory to treatment.

Ultrasonography and dual-energy computed tomography: impact for the detection of gouty deposits

Christoph Schwabl,Mihra Taljanovic,Gerlig Widmann,James Teh,Andrea S.Klauser 대한초음파의학회 2021 ULTRASONOGRAPHY Vol.40 No.2

Ultrasonography (US) and dual-energy computed tomography (DECT) are useful and sensitive diagnostic tools to identify monosodium urate deposits in joints and soft tissues. The purpose of this review is to overview the imaging findings obtained by US and DECT in patients with gout, to understand the strengths and weaknesses of each imaging modality, and to evaluate the added value of using both modalities in combination.

Development and Validation of an Attitudinal-Profiling Tool for Patients With Asthma

Aileen David-Wang,David Price,조상헌,James Chung-Man Ho,Chong-Kin Liam,Glenn Neira,Pei-Li Teh,REcognise Asthma and LInk to Symptoms and Experience 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.1

Purpose: To develop a profiling tool which accurately assigns a patient to the appropriate attitudinal cluster for the management of asthma. Methods: Attitudinal data from an online survey of 2,467 patients with asthma from 8 Asian countries/region, aged 18-50 years, having had ≥2 prescriptions in the previous 2 years and access to social media was used in a discriminant function analysis to identify a minimal set of questions for the Profiling Tool. A split-sample procedure based on 100 sets of randomly selected estimation and validation sub-samples from the original sample was used to cross-validate the Tool and assess the robustness of its predictive accuracy. Results: Our Profiling Tool contained 10 attitudinal questions for the patient and 1 GINA-based level of asthma control question for the physician. It achieved a predictive accuracy of 76.2%. The estimation and validation sub-sample accuracies of 76.7% and 75.3%, respectively, were consistent with the tool’s predictive accuracy at 95% confidence level; and their 1.4 percentage-points difference set upper-bound estimate for the degree of over-fitting. Conclusions: The Profiling Tool is highly predictive (>75%) of the attitudinal clusters that best describe patients with asthma in the Asian population. By identifying the attitudinal profile of the patient, the physician can make the appropriate asthma management decisions in practice. The challenge is to integrate its use into the consultation workflow and apply to areas where Internet resources are not available or patients who are not comfortable with the use of such technology.