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Lam CM, Yong JL, Chan AO, Ng KK, Poon RT, Liu CL, Lo CM, Fan ST. Better survival in female patients with hepatocellular carcinoma: oral contraceptive pills related? J Clin Gastroenterol 2005; 39:533-9. [PMID: 15942442 DOI: 10.1097/01.mcg.0000165670.25272.46] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) has an indisputable male predominance. "Gender" as an independent prognostic factor for survival is, however, controversial. GOALS Determine the influence of gender on survival in HCC patients, and identify factors that may account for the difference. METHODS A retrospective analysis on a prospectively collected database in a 15-year period, from 1989 to 2003. RESULTS A total of 3,171 HCC patients were managed in our institution (946 with curative treatment, 1,388 with palliative treatment, and 837 with supportive treatment) and studied. Female patients (n = 520) were 4.3 years older (P = 0.000), had a lower proportion of smokers and drinkers (P = 0.000), and were less likely to be hepatitis B carriers (P = 0.000). There was no difference in Child-Pugh status, tumor size, and the use of different treatments between genders. The overall median survival was 25.7 months longer in females after curative treatment (73.6 vs. 47.9 months; P = 0.012). The survival benefit in female patients was observed in early-stage diseases and persisted when only hepatitis B surface antigen-positive patients were analyzed (96.4 vs. 47.9 months; P = 0.044). With multivariate analysis, gender, indocyanine green test value at 15 minutes, number of tumor nodules, size of tumor, major vascular invasion, invasion of adjacent organs, and tumor rupture were the independent variables for survival. More importantly, in female patients, history of using oral contraceptive was an independent factor with survival benefit (P = 0.004). CONCLUSION Gender is an independent variable for survival after curative treatment of HCC. A survival benefit was observed in females. History of using oral contraceptive is associated with a better long-term survival in female patients.
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Ng KK, Fan ST. General surgery review. M. A. Makary (ed.). 209 × 278 mm. Pp. 386. 2004. Ladner-Drysdale: Washington, DC. $74.95. Br J Surg 2005. [DOI: 10.1002/bjs.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chan SY, Poon RT, Ng KK, Liu CL, Chan RT, Fan ST. Long-term survival after intraluminal brachytherapy for inoperable hilar cholangiocarcinoma: A case report. World J Gastroenterol 2005; 11:3161-4. [PMID: 15918211 PMCID: PMC4305861 DOI: 10.3748/wjg.v11.i20.3161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Surgical resection with a tumor-free margin is the only curative treatment for hilar cholangiocarcinoma (Klatskin tumor). However, over half of the patients present late with unresectable tumors. Radiotherapy using external beam irradiation or intraluminal brachytherapy (ILBT) has been used to treat unresectable hilar cholangiocarcinoma with satisfactory outcome. We reported a patient with unresectable hilar cholangiocarcinoma surviving more than 6 years after combined external beam irradiation and ILBT.
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Ng KK, Lam CM, Poon RT, Shek TW, To JY, Wo YH, Ho DW, Fan ST. Comparison of systemic responses of radiofrequency ablation, cryotherapy, and surgical resection in a porcine liver model. Ann Surg Oncol 2005; 11:650-7. [PMID: 15231521 DOI: 10.1245/aso.2004.10.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The degree of systemic response after hepatic radiofrequency ablation (RFA) has not been well investigated. METHODS An in vivo study was conducted on 23 domestic swine. Different hepatic procedures (RFA, cryotherapy, hepatic pedicle ligation, and hepatectomy) were performed on the medial lobe of the liver (30% of the liver volume). Systemic responses in terms of systemic inflammatory marker changes and end-organ functions were determined. RESULTS During the early postoperative period, the systemic inflammatory marker concentrations (tumor necrosis factor-alpha and interleukin-1beta) in the RFA group were significantly lower than in the cryotherapy group but significantly higher than in the control group. The corresponding concentrations in the hepatectomy group remained similar to those in the control group. The pattern of changes of serum inflammatory marker concentrations in the pedicle ligation group followed the pattern in the RFA group. The serum intracellular content concentrations (lactate dehydrogenase and urate) of the cryotherapy group peaked at 6 hours after operation, which was significantly later than in the other groups. Liver function, renal function, and coagulation profiles remained normal in the RFA group. However, the renal function deteriorated in the cryotherapy group on day 1. Both platelet count and activated clotting time showed significant derangement in the cryotherapy group compared with the control group. There was more severe interstitial pneumonitic change of the porcine lung after cryotherapy than after RFA. CONCLUSIONS The systemic responses of RFA were significantly less severe than those of cryotherapy in this porcine model. However, the increase in serum inflammatory markers and pneumonitis after RFA was substantial when compared with hepatectomy.
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Chok KS, Ng KC, Lam CM, Ng KK, Poon RT, Fan ST. Selective portal vein clamping for radiofrequency ablation of hepatocellular carcinoma with portal vein invasion. J Gastrointest Surg 2005; 9:489-93. [PMID: 15797228 DOI: 10.1016/j.gassur.2004.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Surgical resection provides potential cure for patients with hepatocellular carcinoma. Unfortunately, resection is suitable in only about 10-37% of patients because of the limited hepatic functional reserve from the underlying chronic liver disease in the majority of patients. Survival of patients with unresectable diseases, especially those with portal vein tumor invasion, remains very poor. Radiofrequency ablation (RFA) is a form of locoregional therapy that allows a selected group of previously inoperable patients to be treated. However, problems with RFA leading to induced portal vein thrombosis have been reported in the literature. Nevertheless, patients with portal vein tumor invasion may be considered for radiofrequency tumor ablation to improve survival. We report the case of a patient with hepatocellular carcinoma with left portal vein invasion. Complete tumor ablation was achieved after RFA with left portal vein clamping. He remained disease free both radiologically and biochemically 6 months after the operation.
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Ng KK, Vauthey JN, Pawlik TM, Lauwers GY, Regimbeau JM, Belghiti J, Ikai I, Yamaoka Y, Curley SA, Nagorney DM, Ng IO, Fan ST, Poon RT. Is Hepatic Resection for Large or Multinodular Hepatocellular Carcinoma Justified? Results From a Multi-Institutional Database. Ann Surg Oncol 2005; 12:364-73. [PMID: 15915370 DOI: 10.1245/aso.2005.06.004] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Accepted: 12/20/2004] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large (>5 cm in diameter) or multinodular (more than three nodules) HCC by using a multi-institutional database. METHODS The perioperative and long-term outcomes of 404 patients with small HCC (<5 cm in diameter; group 1) were compared with those of 380 patients with large or multinodular HCC (group 2). The prognostic factors in the latter group were analyzed. RESULTS The postoperative complication rate (27% vs. 23%; P = .16) and hospital mortality rate (2.4% vs. 2.7%; P = .82) were similar between groups. The overall survival rates were significantly higher in group 1 than group 2 (1 year, 88% vs. 74%; 3 years, 76% vs. 50%; 5 years, 58% vs. 39%; P < .001). Among patients in group 2, five independent prognostic factors were identified to be associated with a worse overall survival: namely, symptomatic disease, presence of cirrhosis, multinodular tumor, microvascular tumor invasion, and positive histological margin. CONCLUSIONS Hepatic resection can be safely performed in patients with large or multinodular HCC, with an overall 5-year survival rate of 39%. Symptomatic disease, the presence of cirrhosis, a multinodular tumor, microvascular invasion, and a positive histological margin are independently associated with a less favorable survival outcome.
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Ng KK, Lam CM, Poon RT, Shek TW, Yu WC, To JY, Wo YH, Lau CP, Tang TC, Ho DW, Fan ST. Porcine liver: morphologic characteristics and cell viability at experimental radiofrequency ablation with internally cooled electrodes. Radiology 2005; 235:478-86. [PMID: 15798156 DOI: 10.1148/radiol.2352040425] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate morphologic characteristics and cell viability of radiofrequency ablation zones in porcine liver. MATERIALS AND METHODS Approval of the study protocol was obtained from the Ethics Committee on Use of Live Animals for Teaching and Research at University of Hong Kong. Internally cooled electrodes were used to produce 120 ablated zones ex vivo and 60 ablated zones in vivo with single electrodes (1-, 2-, and 3-cm exposed lengths) or clustered electrodes (1.0-, 2.0-, and 2.5-cm exposed lengths) at 4, 8, 12, and 16 minutes of ablation (ex vivo) and 8 and 12 minutes of ablation (in vivo). Morphologic measurements of each ablated zone were performed. Cell viability in each ablated zone was assessed qualitatively with histochemical staining and quantitatively with measurement of intracellular adenosine 5'-triphosphate (ATP) concentration. RESULTS Exposed length of electrode (coefficient = 0.79, standard error = 0.04, P < .001), duration of ablation (coefficient = 0.14, standard error = 0.01, P < .001), and clustered electrode design (coefficient = 1.21, standard error = 0.05, P < .001) were independent factors that affected minimal transverse diameter and volume of ablated zone in ex vivo study. Similar morphologic characteristics existed among ablated zones in in vivo study. Mean distance of ablation beyond the electrode tip remained constant (ex vivo, 1.0 cm +/- 0.08 [standard deviation]; in vivo, 0.5 cm +/- 0.05) regardless of different ablation conditions. Histochemical staining revealed no viable hepatocytes from center to margins of white zone in each ablated area. Mean intracellular ATP concentration in margins of white zone (9.5 x 10(-12) mol/microg DNA +/- 1.43) was lower than that in red zone (4088 x 10(-12) mol/microg DNA +/- 65.97, P < .001) and in adjacent normal liver (4528 x 10(-12) mol/microg DNA +/- 52.74, P < .001). CONCLUSION Distance of ablation beyond the tip of the electrode remained constant (ex vivo, 1.0 cm; in vivo, 0.5 cm) with different conditions of ablation. Complete and uniform cellular destruction was achieved in the white zone of ablated area.
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Lai AT, Lam CM, Ng KK, Yeung C, Ho WL, Poon LT, Ng IO. Hepatic actinomycosis presenting as a liver tumour: case report and literature review. Asian J Surg 2005; 27:345-7. [PMID: 15564194 DOI: 10.1016/s1015-9584(09)60066-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatic actinomycosis poses a difficult problem in both diagnosis and management. We report the management of a patient with isolated hepatic actinomycosis, and review the clinical features and management of patients with hepatic actinomycosis mimicking liver tumour.
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Chen MY, Ng KK, Ma SY, Wu TI, Chang TC, Lai CH. False-positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography imaging caused by retained gauze in a woman with recurrent ovarian cancer: a case report. EUR J GYNAECOL ONCOL 2005; 26:451-3. [PMID: 16122202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We report a case of a 47-year-old woman with a false-positive [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) result caused by retained gauze during resection of liver metastasis for a Stage IV ovarian cancer at primary cytoreductive surgery. She achieved complete remission and remained free of progression for seven years. Owing to elevation of CA-125, computed tomography and PET studies were performed, and both showed two potentially resectable lesions. One was located ventral to the diaphragmatic surface of the left hepatic lobe and the other was around the gauze at the right hepatorenal fossa. During surgical intervention, the left supraheptic tumor was excised and the gauze with surrounding granulation was removed. However, the former proved to be recurrent ovarian cancer with the latter proven false-positive. This case demonstrates that PET results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesions.
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Abstract
Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare primary liver tumour. We report a carrier of both HBV and HCV presenting with intermittent abdominal pain, fever, chillness and elevated á-fetoprotein (AFP) of 1197 ng/ml. Computed tomography showed an irregular hypodense mass in the left lateral segment of the liver with vague contrast enhancement and multiple regional lymphadenopathy. Hepatic angiogram showed that the mass was hypovascular and the left portal vein was occluded with a tapered end. Percutaneous ultrasound-guided core needle biopsy of the liver yielded HCC-CC. We suggest that HCC-CC should be considered in hypovascular liver tumours with striking elevation of serum AFP and multiple regional lymphadenopathy.
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Tam TKW, Cheng LPK, Lau DMW, Lai TC, Lai WY, Ng KK, Ng MY, Kong CW, Tsang LCY. The prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting: cross-sectional study. Hong Kong Med J 2004; 10:307-11. [PMID: 15479958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria. DESIGN Cross-sectional community-based study. SETTING Four primary care clinics, Hong Kong. PATIENTS All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003. MAIN OUTCOME MEASURES Patients' demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis). RESULTS The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found. CONCLUSION Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.
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Abstract
BACKGROUND Declining fertility of couples from the fourth decade of life is largely attributable to the drop in female fertility. However, increasing numbers of men, whose fertility theoretically lasts until death, are seeking fertility treatment at older ages, yet there is little information on sperm production and function past the age of 50 years. The few studies of such older men have examined men attending fertility clinics, and therefore willing to provide semen samples, but the participation bias of such recruitment hinders extrapolation to the unselected general male population. METHODS We have taken the opportunity to study a convenience sample of 55 healthy, non-infertile men ranging in age from 52 to 79 years old who provided semen samples as part of a prostate cancer screening project. They were compared with a control group (n = 409) of younger (< 52 years) men from among 567 volunteers screened as potential sperm donors for an artificial insemination program. RESULTS Older men had lower semen volume (mean semen volume 1.8 versus 3.2 ml; P < 0.0001) and total sperm output (median 74 versus 206 million sperm per ejaculate; P < 0.0001), whereas sperm density (median 64 versus 73 million sperm/ml; P = 0.12) was non-significantly decreased. Older men had more abnormal sperm morphology with decreasing numbers of normal forms (mean 14% versus 25%; P < 0.0001) and reduced vitality (mean 51% versus 80%; P < 0.0001), as well as increased numbers of cytoplasmic droplets (median 1 versus 0; P < 0.0001) and sperm tail abnormalities (30% versus 17%; P < 0.0001). Sperm head or neck abnormalities were no different between the groups. CONCLUSIONS While neither study group may be representative of the general male population, these findings suggest that sperm production, reflected in sperm output but not sperm density, as well as sperm morphology and viability are diminished in this population of healthy, non-infertile older men.
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Wan YL, Ko SF, Ng KK, Cheung YC, Lui KW, Wong HF. Role of CT-guided core needle biopsy in the diagnosis of a gossypiboma: case report. ACTA ACUST UNITED AC 2004; 29:713-5. [PMID: 15185035 DOI: 10.1007/s00261-004-0172-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Accepted: 01/07/2004] [Indexed: 10/26/2022]
Abstract
A 66-year-old woman with previous hysterectomy had dysuria and vaginal spotting for 1 month. Computed tomography showed a heterogeneous presacral mass with eccentric calcification. Biopsies of the bladder and vagina and transrectal biopsy of the pelvic mass yielded only inflammation. T2-weighted magnetic resonance images revealed a heterogeneous mass with wavy hypointensities. Computed tomographically guided biopsy targeting at the calcified area disclosed thread-like materials, thus confirming the diagnosis of gossypiboma.
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Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST, Wong J. Learning curve for radiofrequency ablation of liver tumors: prospective analysis of initial 100 patients in a tertiary institution. Ann Surg 2004; 239:441-9. [PMID: 15024304 PMCID: PMC1356248 DOI: 10.1097/01.sla.0000118565.21298.0a] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aims to evaluate the effect of operator experience on the treatment outcomes of radiofrequency ablation (RFA) for malignant liver tumors. SUMMARY BACKGROUND DATA RFA is gaining popularity as the ablative therapy of choice for liver tumors. It is generally considered a simple and safe technique, and little attention has been paid to the importance of operator experience in this treatment. A learning curve in this treatment modality has not been documented before. PATIENTS AND METHODS The clinical data and treatment outcomes of the initial 100 patients undergoing RFA for liver tumors (hepatocellular carcinoma, n = 84; metastasis, n = 15; cholangiocarcinoma n = 1) were collected prospectively. All patients were managed by a single team of surgeons and interventional radiologists. The data of the first 50 patients (group I) and the second 50 patients (group II) were compared. RESULTS RFA was performed by percutaneous (group I, n = 22; group II, n = 19), open (group I, n = 26; group II, n = 30) or laparoscopic (group I, n = 2; group II, n = 1) approach. In group I, 30 patients (60%) had a solitary tumor and 20 (40%) had multiple tumors; in group II, 35 patients (70%) had a solitary tumor and 15 (30%) had multiple tumors (P = 0.295). The size of the largest tumor was comparable between groups I and II (median, 2.8 cm in both groups; P = 0.508). Group II had significantly shorter hospital stay (median, 4.0 versus 5.5 days; P = 0.048), lower morbidity rate (4% versus 16%; P = 0.046) and higher complete ablation rate (100% versus 85.7%; P = 0.006) than group I. There was 1 hospital death (2%) in group I and 0 in group II. By multivariate analysis, treatment period (group I versus group II) was an independent significant factor affecting the morbidity rate and complete ablation rate. CONCLUSIONS A low complication rate and a high complete ablation rate could be achieved with the accumulated experience from the first 50 cases of RFA for liver tumors by a specialized team. This study demonstrates that there is a significant learning curve in RFA for liver tumors.
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Fong YK, Ho SH, Peh OH, Ng FC, Lim PHC, Quek PLC, Ng KK. Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proximal ureteric calculi--a comparative assessment of efficacy and safety. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2004; 33:80-3. [PMID: 15008569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Extracorporeal shockwave lithotripsy (ESWL) is the treatment modality of choice of many urologists for proximal ureteric calculi. In this study, we compared the efficacy and safety of ESWL versus ureteroscopy with holmium laser lithotripsy for the treatment of this group of stones. MATERIALS AND METHODS Between May 1999 and October 2000, 50 patients had ESWL and another 51 patients underwent ureteroscopy with holmium laser lithotripsy for proximal ureteric calculi. The two groups were similar in age, sex ratio and stone size. ESWL was performed with the Dornier Compact lithotriptor whereas holmium laser lithotripsy was performed via retrograde ureteric access with a Wolf 7.5 Fr semirigid ureteroscope. RESULTS Ureteroscopy with holmium laser lithotripsy was significantly better in terms of the mean procedure time (56 min in ESWL; 25 min in ureteroscopy; P < 0.001) and the 1-month stone free rate (50% in ESWL; 80% in ureteroscopy; P = 0.001). The 3-month stone free rate was also higher for ureteroscopy (78% in ESWL; 90% in ureteroscopy) but this difference was not statistically significant (P = 0.09). Minor complications of steinstrasse (6%) occurred in ESWL and proximal stone migration (8%) occurred during ureteroscopy. CONCLUSION Ureteroscopy with holmium laser lithotripsy is a viable and safe alternative to ESWL for the management of proximal ureteric calculi.
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Chok KS, Lam CM, Li FK, Ng KK, Poon RT, Lo CM, Fan ST. Management of hepatocellular carcinoma in renal transplant recipients. J Surg Oncol 2004; 87:139-42. [PMID: 15334642 DOI: 10.1002/jso.20098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE In Hong Kong where hepatitis B virus (HBV) infection is endemic, hepatocellular carcinoma (HCC) accounts for 20% of all malignant transformations in renal transplant recipients. The aim of the present study was to review the management and outcome of HCC in renal transplant recipients at a specialized surgical center. METHOD A retrospective analysis on the data collected prospectively in a tertiary referral center. RESULTS From January 1991 to December 2002, five renal transplant recipients were diagnosed to have primary HCC and received treatment in our center. There were four men and one woman with a median age of 47 (range, 38-68) years. Four of them had cadaveric renal transplantation whereas one had live donor transplantation. All of them were HBV carriers. The median tumor size was 3.5 cm (range, 1.8-8 cm). All tumors, except one, were diagnosed in sub-clinical stage by surveillance serum alpha-fetoprotein assay and percutaneous ultrasonography. Four patients were treated with surgical resection and one received transarterial oily chemoembolization (TOCE) as their primary treatments. There was one peri-operative death and the remaining three surgically treated patients were alive 4, 62, and 64 months after the resection. One patient developed recurrence 18 months after curative resection and was treated with TOCE. The patient with unresectable disease was alive for 50 months after the initial diagnosis. The surgical resection and overall survival rates of these patients were better than the published results. CONCLUSION Early detection with regular serum alpha-fetoprotein assay and ultrasonographic study, vigilant care in the peri-operative period, long-term follow-up for detection and treatment of recurrence, as well as close collaboration between renal physicians and liver surgeons may improve the outcome of treatment of HCC in renal transplant recipients.
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Tan CF, Ng KK, Ng SH, Cheung YC. Magnetic resonance imaging of hyaline cartilage regeneration in neocartilage graft implantation. Transplant Proc 2003; 35:3105-7. [PMID: 14697990 DOI: 10.1016/j.transproceed.2003.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the regenerative potential of hyaline cartilage in a neocartilage graft implant with the aid of MR cartilage imaging using a rabbit model. METHODS Surgical osteochondral defects were created in the femoral condyles of 30 mature New Zealand rabbits. The findings of neocartilage in autologous cartilage grafts packed into osteochondral defects were compared with control group of no implant to the osteochondral defect. The outcome of the implantations was correlated with histologic and MR cartilage imaging findings over a 3-month interval. RESULTS Neocartilage grafts packed into osteochondral defects showed regeneration of hyaline cartilage at the outer layer of the implant using MR cartilage imaging. Fibrosis of fibrocartilage developed at the outer layer of the autologous cartilage graft together with an inflammatory reaction within the osteochondral defect. CONCLUSION This animal study provides evidence of the regenerative ability of hyaline cartilage in neocartilage transplants to repair articular cartilage.
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Ng KK, Lam CM, Poon RT, Law WL, Seto CL, Fan ST. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma. HEPATO-GASTROENTEROLOGY 2003; 50:1641-3. [PMID: 14571805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Spontaneous rupture of hepatocellular carcinoma is a distinct presentation causing acute abdomen. Different treatment approaches have been advocated including emergency hepatectomy, initial hemostasis by hepatic artery ligation or transarterial embolization and second-stage hepatectomy. Unrecognized ruptured hepatocellular carcinoma during laparotomy is often encountered in countries where the incidence of hepatocellular carcinoma is low. Radiofrequency ablation is a new localized thermal ablative technique for the treatment of unresectable hepatic tumors including hepatocellular carcinoma. We report a case where radiofrequency ablation was used as a salvage procedure for ruptured hepatocellular carcinoma during emergency laparotomy.
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Ng KK, Cheng YF, Lui KW, Wan YL, Wai YY, Tan CF, Cheung YC, Chen YM. Application of GD-enhanced renal allograft MR angiography for evaluation of posttransplantation complications. Transplant Proc 2003; 35:307-8. [PMID: 12591414 DOI: 10.1016/s0041-1345(02)03963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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] [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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Teh HS, Lin MBK, Tsou IYY, Khoo TK, Lim PHC, Ng FC, Chin CM, Peh SOH, Ho SH, Ng KK, Fong YK. Penile colour duplex ultrasonography as a screening tool for venogenic erectile dysfunction. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2002; 31:165-9. [PMID: 11957552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Vasculogenic impotence is one of the major causes of erectile dysfunction. Cavernosometry and cavernosography is traditionally the gold standard for evaluation of venogenic impotence. However, it is invasive and there are potentially significant complications. Penile colour flow Doppler imaging (PCDI) is non-invasive and can be used to assess venous incompetence. MATERIALS AND METHODS One hundred and sixty-eight patients were referred for PCDI assessment from March 1998 to February 2001. Forty-three of these also had cavernosogram and cavernosometry done and were included in the study. RESULTS The sensitivity was 93.9%, the specificity was 90.0%, the accuracy was 93.0% with a negative predictive value of 81.8% and a positive predictive value of 96.9%. Kappa value of 0.81 was obtained, indicating excellent agreement between PCDI and cavernosogram and cavernometry. CONCLUSIONS Penile colour flow Doppler imaging is accurate in the assessment of venogenic erectile dysfunction. It can replace cavernometry and cavernosogram as a screening tool. Cavernometry and cavernosogram should only be done in cases when PCDI suggests venogenic impotence, and when surgery is contemplated.
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Ghani U, Ng KK, Choudhary MI, Ullah N, James MN. Crystal structure of gamma-chymotrypsin in complex with 7-hydroxycoumarin. J Mol Biol 2001; 314:519-25. [PMID: 11846564 DOI: 10.1006/jmbi.2001.5148] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The 1.8 A crystal structure of 7-hydroxycoumarin (7-HC) bound to chymotrypsin reveals that this inhibitor forms a planar cinnamate acyl-enzyme complex. The phenyl ring of the bound inhibitor forms numerous van der Waals contacts in the S1 pocket of the enzyme, with the p-hydroxyl group donating a hydrogen bond to the main-chain oxygen atom of Ser217, and the o-hydroxyl group forming a water-mediated hydrogen bond with the carbonyl oxygen of Val227. The structure of the acyl-enzyme complex suggests that the mechanism of inhibition of 7-HC involves nucleophilic attack by the Ser195 O(gamma) atom on the carbonyl carbon atom of the inhibitor, accompanied by the breaking of the 2-pyrone ring of the inhibitor, and leading to the formation of a cinnamate acyl-enzyme derivative via a tetrahedral transition state. Comparisons with structures of photoreversible cinnamates bound to chymotrypsin reveal that although 7-HC interacts with the enzyme in a similar fashion, the binding of 7-HC to chymotrypsin takes place in a productive conformation in contrast to the photoreversible cinnamates. In summary, the 7-HC-chymotrypsin complex provides basic insight into the inhibition of chymotrypsin by natural coumarins and provides a structural basis for the design of more potent mechanism-based inhibitors against a wide range of biologically important chymotrypsin-like enzymes.
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Tan CF, Yen PS, Wong HF, Ng KK, Wan YL. The value of dynamic enhanced MRI in the early diagnosis of hip pain in patients having received marrow transplantation. Transplant Proc 2001; 33:3670-1. [PMID: 11750561 DOI: 10.1016/s0041-1345(01)02582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sim S, Rosenzweig KE, Schindelheim R, Ng KK, Leibel SA. Induction chemotherapy plus three-dimensional conformal radiation therapy in the definitive treatment of locally advanced non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2001; 51:660-5. [PMID: 11597806 DOI: 10.1016/s0360-3016(01)01666-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate our institution's experience using chemotherapy in conjunction with three-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS From 1991 to 1998, 152 patients with Stage III non-small-cell lung cancer (NSCLC) were treated with 3D-CRT at Memorial Sloan-Kettering Cancer Center. A total of 137 patients (90%) were surgically staged with either thoracotomy or mediastinoscopy. The remainder were staged radiographically. Seventy patients were treated with radiation therapy alone, and 82 patients received induction chemotherapy before radiation. The majority of chemotherapy-treated patients received a platinum-containing regimen. Radiation was delivered with a 3D conformal technique using CT-based treatment planning. The median dose in the radiation alone group was 70.2 Gy, while in the combined modality group, it was 64.8 Gy. RESULTS The median follow-up time was 30.5 months among survivors. Stage IIIB disease was present in 36 patients (51%) in the radiation-alone group and 57 patients (70%) in the combined-modality group. Thirty-nine patients had poor prognostic factors (KPS < 70 or weight loss > 5%), and they were equally distributed between the two groups. The median survival times for the radiation-alone and the combined-modality groups were 11.7 months and 18.1 months, respectively (p = 0.001). The 2-year rates of local control in the radiation-alone and combined-modality groups were 35.4% and 43.1%, respectively (p = 0.1). Grade 3 or worse nonhematologic toxicity occurred in 20% of the patients receiving radiation alone and in 16% of those receiving chemotherapy and radiation. Overall, there were only 4 cases of Grade 3 or worse esophagitis. CONCLUSION Despite more Stage IIIB patients in the combined-modality group, the addition of chemotherapy to 3D-CRT produced a survival advantage over 3D-CRT alone in Stage III NSCLC without a concomitant increase in toxicity. Chemotherapy thus appears to be beneficial, even in patients who are receiving higher doses of radiation therapy than are typically given with conventional techniques. Because locoregional failure remains a major challenge in patients with advanced disease, 3D-CRT in conjunction with chemotherapy may allow safe treatment to the dose levels required to further enhance local control.
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