Asian Journal of Surgery RSS feed: Current Issue. The Asian Journal of Surgery , founded in 1978, is an indexed, peer-reviewed journal that is published quarterly. Today, the Asian Journal of Surgery is the official publication of seven professional surgical associations in the Asia-Pacific region, including: Asian Association of Endocrine Surgeons Asian Association of Pediatric Surgeons Asian Surgical Association Asian Society for Vascular Surgery Association of University Surgeons of Asia College of Surgeons, Academy of Medicine, Malaysia Endoscopic and Laparoscopic Surgeons of Asia The Asian Journal of Surgery enjoys a growing reputation as an important medium for the dissemination of recent developments in surgery and its related disciplines to the Asia-Pacific region and beyond. The Asian Journal of Surgery invites original contributions as Current Opinions, Original Articles, Case Reports, and Reviews across the entire spectrum of clinical and experimental surgery. The Asian Journal of Surgery is indexed in SCI Expanded, MEDLINE, CAB ABSTRACTS, CAB HEALTH, EMBASE, SCOPUS and SIIC Data Bases. http://www.e-asianjournalsurgery.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. Asian Journal of Surgery1015-9584344October 2011 © 2011 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.e-asianjournalsurgery.com/article/PIIS1015958411000169/abstract?rss=yesSummary: Background: Hyperparathyroid crisis is a rare, critical, and potentially fatal disease. The aim of this study was to classify different clinical courses of this disease, according to their preoperative medical responses and suggest the proper timing for surgery.Methods: Patients who had undergone parathyroidectomies for hyperparathyroid crisis, were enrolled between January 1, 1994 and January 31, 2009. Preoperative medical treatment and responses in terms of predisposing factors, preoperative localization, operative and pathological findings, postoperative outcome, and intervals from medicine to surgery, were retrospectively reviewed.Results: A total of 11 patients, receiving more than 72 hours of medical treatment, were divided into three types by preoperative medical responses. These included: Type I (three patients were resistant to medicine with persistent serum Ca > 14 mg/mL and were eventually treated with emergency surgery; two died of postoperative respiratory and hepatic failure), Type II (six patients with abnormal serum Ca  14 mg/mL after 48 hours of medical treatment. All abnormal parathyroid glands were >1.8 cm in length and easily detectable using preoperative ultrasonography.Conclusion: Because the response to pharmaceutical treatment of hyperparathyroid crisis is unpredictable, relieving the patient’s dehydration is necessary first. Making a definite diagnosis and performing an early parathyroidectomy within 48 hours are then required, especially in patients exhibiting poor medical response.Hyperparathyroid crisis: The timing of surgeryHsin-Hsien Yu, Shih-Yin Lou, Yenn-Hwei Chou, Hon-Man Chan, Hwa-Tzong Chen, Shih-Ming Huang10.1016/j.asjsur.2011.11.004Asian Journal of Surgery 34, 4 (2011)2012-02-27Asian Journal of Surgery2012-02-27344S1015-9584(12)X0002-2Original Articles147152http://www.e-asianjournalsurgery.com/article/PIIS1015958411000388/abstract?rss=yesSummary: Background/Objective: Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite treatment on oxidative stress after partial hepatectomy. In this experimental study, the effects of clinoptilolite treatment after partial hepatectomy on oxidative stress were evaluated.Methods: There were four experimental groups (n=8): Group S, the sham group; Group H, the hepatectomy group; Group HC, the clinoptilolite treatment after partial hepatectomy group; and Group CS, the clinoptilolite-treated sham group. A 70% partial hepatectomy was performed for Group H and HC. Clinoptilolite (5mg/kg) was given to the rats orally (via gavage tube) twice a day for 10 days after hepatectomy. Malondialdehyde (MDA), Cu-Zn super oxide dismutase (SOD), and glutathione (GSH) levels were assessed to evaluate oxidative stress.Results: Plasma and liver tissue MDA levels of Group HC were significantly lower than the H group (p=0.018 and p=0.000, respectively). Liver tissue Cu-Zn SOD activity and GSH levels of Group HC were significantly higher than Group H (p=0.003, p=0.007, respectively).Conclusion: Clinoptilolite administration reduces oxidant activity and supports antioxidant response after partial hepatectomy.Effects of clinoptilolite treatment on oxidative stress after partial hepatectomy in ratsKaya Saribeyoglu, Erman Aytac, Salih Pekmezci, Seha Saygili, Hafize Uzun, Gulsen Ozbay, Seval Aydin, Hakki Oktay Seymen10.1016/j.asjsur.2011.11.007Asian Journal of Surgery 34, 4 (2011)2012-02-16Asian Journal of Surgery2012-02-16344S1015-9584(12)X0002-2Original Articles153157http://www.e-asianjournalsurgery.com/article/PIIS1015958411000170/abstract?rss=yesSummary: Objective: Based on a large series of histopathologically confirmed hepatic angiomyolipomas, we retrospectively studied the typical diagnostic features of hepatic angiomyolipoma and proposed a treatment strategy for this disease.Materials and methods: From December 1997 to December 2007, 74 consecutive patients who received definitive treatment for hepatic angiomyolipoma, at a single tertiary center, were studied.Results: There was a marked female predominance (54 females vs. 20 males) and the mean age was 42 years. Forty patients had no symptoms and the tumors were detected incidentally during a medical check-up. From this study, we proposed the typical diagnostic features of hepatic angiomyolipoma to be the absence of risk factors for malignancy, normal tumor marker levels, and typical imaging features on ultrasound (USG), abdominal contrast computed tomography (CT), or magnetic resonance imaging (MRI). Only 23% of patients could have been diagnosed before surgery using these features. One patient (1.4%) had a malignant angiomyolipoma, and died with distant metastases 14 months after surgery. After a median follow-up of 64 months, there was no recurrence in the other 73 patients.Conclusion: Patients with typical diagnostic features suggestive of hepatic angiomyolipoma could be observed with regular surveillance. Definitive treatment should be performed when the tumor has symptoms/complications, when the tumor is enlarging, or when a malignant lesion cannot be ruled out.Diagnostic difficulties and treatment strategy of hepatic angiomyolipomaWei-Gao Hu, Eric C.H. Lai, Hui Liu, Ai-Jun Li, Wei-Ping Zhou, Si-Yuan Fu, Ze-Ya Pan, Gang Huang, Yin Lei, Wan Yee Lau, Meng-Chao Wu10.1016/j.asjsur.2011.11.005Asian Journal of Surgery 34, 4 (2011)2012-02-16Asian Journal of Surgery2012-02-16344S1015-9584(12)X0002-2Original Articles158162http://www.e-asianjournalsurgery.com/article/PIIS1015958412000024/abstract?rss=yesSummary: Purpose: Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed recently. The purpose of this study is to evaluate the relationship between waist circumferences and prostatic hyperplasia in Taiwan.Methods: There were 539 men enrolled in the study who had health examinations at the Healthcare Center of Chang Gung Memorial Hospital; 53 were excluded because of history of conditions affecting prostatic volume. Their anthropometry was measured and serum prostate-specific antigen (PSA) levels as well as lipid profiles were analyzed. Prostate volume was measured by transrectal ultrasonography performed by experienced urologists.Results: The mean prostate volume was 26.43mL, whereas mean body mass index (BMI) was 25.27kg/m2 and mean waist circumference (WC) was 90.81cm. By age-adjusted logistic regression, PSA > 4ng/mL, WC ≥ 90cm, and BMI > 24kg/m2 are associated with increased risk of developing prostatic hyperplasia; only WC ≥ 90cm can be validated by multiple logistic regression. Further analysis of obesity patterns showed that abdominal overweight/obesity places patients at increased risk independently rather than high WC or high BMI alone.Conclusions: Study results showed that waist circumference ≥ 90cm is an independent risk factor of prostatic hyperplasia in Taiwan. Men with abdominal overweight/obesity (WC ≥ 90cm and BMI > 24kg/m2) have a twofold risk of developing prostatic hyperplasia.Waist circumference is an independent risk factor for prostatic hyperplasia in Taiwanese malesHsu-Han Wang, Chi-Jeng Hsieh, Kuo-Jen Lin, Sheng-Hsien Chu, Cheng-Keng Chuang, Hsiao-Wen Chen, Min-Li Hsieh, Ta-Min Wang, Yu Chen, Kuan-Lin Liu, Hsin-Chien Huang, Yu-Chao Hsu, Yang-Jen Chiang10.1016/j.asjsur.2012.02.001Asian Journal of Surgery 34, 4 (2011)2012-03-14Asian Journal of Surgery2012-03-14344S1015-9584(12)X0002-2Original Articles163167http://www.e-asianjournalsurgery.com/article/PIIS1015958411000182/abstract?rss=yesSummary: Background/Objective: About 20% of biliary atresia (BA) survivors have attacks of esophageal variceal bleeding. We propose a method to evaluate the risk of esophageal variceal bleeding (EVB) using noninvasive indices by multislice computed tomography (CT).Methods: We reviewed 31 potential living-related liver recipients aged 99–5314 days (mean, 1474 days) who underwent CT examinations using a 64-slice multislice CT scanner. Of the 31 patients, 19 patients (Group A) with fecal occult blood had EVB on esophagogastroduodenoscopy; the rest belonged to Group B. Splenic diameters (mm) were divided by body heights (m) and platelet counts (1000/mm3) to produce standardized ratios of transverse splenic length/body height/platelet count (SLHPR). The transverse diameters of paraesophageal veins (PVs) and perigastric veins (PGVs) were measured adjacent to the lower thoracic esophagus and within the lesser sac, respectively.Results: According to a receiver operating characteristic curve analysis, the SLHPRs (r=0.833), transverse PV (r=0.957), and PGV (r=0.987) diameters were better predictors of EVB than demographic and laboratory variables. However, the transverse diameters of PGVs and PVs were the most accurate predictors of the EVB.Conclusion: For candidates awaiting liver transplantation, screening by noninvasive SLHPR and the transverse diameters of PGVs and PVs by CT may help to identify BA patients with a high risk of EVB.Computed tomography indices and criteria for the prediction of esophageal variceal bleeding in survivors of biliary atresia awaiting liver transplantationCheng-Ta Yang, Huey-Ling Chen, Ming Chih Ho, Steven Shinn-Forng Peng10.1016/j.asjsur.2011.11.006Asian Journal of Surgery 34, 4 (2011)2012-02-20Asian Journal of Surgery2012-02-20344S1015-9584(12)X0002-2Original Articles168174http://www.e-asianjournalsurgery.com/article/PIIS1015958411000145/abstract?rss=yesSummary: Objective: The aims of the study were to assess factors responsible for the reduction of preoperative anxiety in patients undergoing breast and abdominal surgeries. In particular, we investigated whether question prompt lists (QPL), patients’ knowledge, or the communication skills of surgeons had effects on anxiety reduction.Methods: Patients were randomly assigned to QPL and control groups. Anxiety was assessed on the State Trait Anxiety Inventory.Results: Both groups showed significant reduction in anxiety between initial consultation and one day prior to surgery, with QPL patients showing a trend towards a greater reduction of anxiety after surgery and a significant reduction at the first outpatient follow-up. Satisfaction with consultation and the doctor’s ability to answer questions concerning diagnosis, and treatment were significantly associated with anxiety reduction.Conclusion: Effective anxiety reduction hinged on doctors’ communication abilities and patients’ satisfaction with the consultation.Doctor–patient communication, knowledge, and question prompt lists in reducing preoperative anxiety – A randomized control studyLeslie Lim, Pierce Chow, Chow-Yin Wong, Alexander Chung, Yiong-Huak Chan, Wai-Keong Wong, Khee-Chee Soo10.1016/j.asjsur.2011.11.002Asian Journal of Surgery 34, 4 (2011)2012-02-16Asian Journal of Surgery2012-02-16344S1015-9584(12)X0002-2Original Articles175180http://www.e-asianjournalsurgery.com/article/PIIS1015958411000133/abstract?rss=yesSummary: We report a 26-year-old man with 6 years, history of duodenal gastrointestinal stromal tumor (GIST) with liver, peritoneum and lung metastases. He presented with left eye ptosis, diplopia, left facial numbness and a left temporal fossa mass that was confirmed to be GIST with left skull and left orbit metastases. Craniectomy with cranioplasty, tumor excision and decompression were performed. There was an improvement of his visual symptoms and facial numbness. To our knowledge, this is one of the few reports of surgical management of GIST, metastasized to skull and orbit, with good symptomatic relief.Duodenal GIST metastasized to skull and orbit managed by surgery – A case reportLai-Fung Li, Yat-Hang Tse, Siu-Lun Ho, Kin-Wing Yan, Wai-Man Lui10.1016/j.asjsur.2011.11.001Asian Journal of Surgery 34, 4 (2011)2012-02-17Asian Journal of Surgery2012-02-17344S1015-9584(12)X0002-2Case Reports181184http://www.e-asianjournalsurgery.com/article/PIIS1015958411000157/abstract?rss=yesSummary: Colonic volvulus is a rare disease in children. Delayed diagnosis of the condition can often be fatal, especially in pediatric patients with mental retardation. We herein present the case of a female pediatric patient with colonic volvulus, prune belly syndrome, and mental retardation. Preoperative CT scans showed the characteristic signs of this disease. The volvulus occurred in the proximal colon of the colostomy. The release of the colonic volvulus and reconstruction of the colostomy were performed without the resection of the ischemic colon. The postoperative clinical course was uneventful.Colonic volvulus detected by CT scan in a case with mental retardation and prune belly syndromeYoichiro Oka, Kouji Masumoto, Masatoshi Nakamura, Akinori Iwasaki10.1016/j.asjsur.2011.11.003Asian Journal of Surgery 34, 4 (2011)2012-02-20Asian Journal of Surgery2012-02-20344S1015-9584(12)X0002-2Case Reports185188