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Jeys LM, Thorkildsen J, Kurisunkal V, Puri A, Ruggieri P, Houdek MT, Boyle RA, Ebeid W, Botello E, Morris GV, Laitinen MK, Abudu A, Ae K, Agarwal M, Ajit Singh V, Akiyama T, Albergo JI, Alexander J, Alpan B, Aoude A, Asavamongkolkul A, Aston W, Baad-Hansen T, Balach T, Benevenia J, Bergh P, Bernthal N, Binitie O, Boffano M, Bramer J, Branford White H, Brennan B, Cabrolier J, Calvo Haro JA, Campanacci DA, Cardoso R, Carey Smith R, Casales Fresnga N, Casanova JM, Ceballos O, Chan CM, Chung YG, Clara-Altamirano MA, Cribb G, Dadia S, Dammerer D, de Vaal M, Delgado Obando J, Deo S, Di Bella C, Donati DM, Endo M, Eralp L, Erol B, Evans S, Eward W, Fiorenza F, Freitas J, Funovics PT, Galli Serra M, Ghert M, Ghosh K, Gomez Mier LC, Gomez Vallejo J, Griffin A, Gulia A, Guzman M, Hardes J, Healey J, Hernandez A, Hesla A, Hongsaprabhas C, Hornicek F, Hosking K, Iwata S, Jagiello J, Johnson L, Johnston A, Joo MW, Jutte P, Kapanci B, Khan Z, Kobayashi H, Kollender Y, Koob S, Kotrych D, Le Nail LR, Legosz P, Lehner B, Leithner A, Lewis V, Lin P, Linares F, Lozano Calderon S, Mahendra A, Mahyudin F, Mascard E, Mattei JC, McCullough L, Medellin Rincon MR, Morgan-Jones R, Moriel Garcesco DJ, Mottard S, Nakayama R, Narhari P, O'Toole G, Vania O, Olivier A, Omar M, Ortiz-Cruz E, Ozger H, Ozkan K, Palmerini E, Papagelopoulos P, Parry M, Patton S, Petersen MM, Powell G, Puhaindran M, Raja A, Rajasekaran RB, Repsa L, Ropars M, Sambri A, Schubert T, Shehadeh A, Siegel G, Sommerville S, Spiguel A, Stevenson J, Sys G, Temple T, Traub F, Tsuchiya H, Valencia J, Van de Sande M, Vaz G, Velez Villa R, Vyrva O, Wafa H, Wan Faisham Numan WI, Wang E, Warnock D, Werier J, Wong KC, Norio Y, Zhaoming Y, Zainul Abidin S, Zamora T, Zumarraga JP, Abou-Nouar G, Gebert C, Randall RL. Controversies in orthopaedic oncology. Bone Joint J 2024; 106-B:425-429. [PMID: 38689572 DOI: 10.1302/0301-620x.106b5.bjj-2023-1381] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
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Affiliation(s)
- Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | | | - Ajay Puri
- Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Walid Ebeid
- Orthopedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Keisuke Ae
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Toru Akiyama
- Saitama Medical Center, JIchi Medical University, Saitama, Japan
| | - Jose I Albergo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | - Peter Bergh
- Sahlgren University Hospital, Gothenburg, Sweden
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Michele Boffano
- Orthopaedic Oncology Unit, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Jos Bramer
- Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | | | | | - Rodrigo Cardoso
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
| | | | - Nicolas Casales Fresnga
- National Orthopaedic and Trauma Institute Republic University Montevideo Montevideo, Montevideo, Uruguay
| | - Jose M Casanova
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Chung M Chan
- National University Hospital, Singapore, Singapore
| | - Yang-Guk Chung
- Seoul St. Mary's Hospital/The Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | - Levent Eralp
- Complex Extremity Reconstruction Unit, Acibadem Hospital Group, Istanbul, Turkey
| | - Bulent Erol
- Marmara University Orthopedics and Traumatology, Istanbul, Turkey
| | | | - Will Eward
- Duke University, Durham, North Carolina, USA
| | | | - Joao Freitas
- Centro Hospitalar Universitário de Coimbra, EP, Coimbra, Portugal
| | | | - Marcos Galli Serra
- Hospital Universitario Austral / Orthopedic Oncology Unit Buenos, Aires, Argentina
| | | | | | | | | | | | - Ashish Gulia
- Homi Bhabha Cancer Hospital & Research Centre, Vishakhapatnam, India
| | | | | | - John Healey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Asle Hesla
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Keith Hosking
- Life Orthopaedic Hospital / Groote Schuur, Cape Town, South Africa
| | | | | | - Luke Johnson
- South Australian Bone & Soft Tissue Tumour Unit, Flinders Medical Centre, Adelaine, Australia
| | | | - Min Wook Joo
- The Catholic University of Korea, Seoul, South Korea
| | - Paul Jutte
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Zeeshan Khan
- Rehman Medical Institute and Medical College, Peshawar, Pakistan
| | | | | | | | - Daniel Kotrych
- Pomeranian Medical University of Szczecin, Szczecin, Poland
| | | | | | - Burkhard Lehner
- Orthopedic University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Peng Lin
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | | | | | | | | | | | | | | | | | | | - Sophie Mottard
- Maisonneuve Rosemont Hospital, Université de Montréal, Montreal, Canada
| | | | | | - Gary O'Toole
- St. Vincent's University Hospital Dublin, Dublin, Ireland
| | - Oliveira Vania
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | | | | | | | - Harzem Ozger
- Istanbul University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | - Sam Patton
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michael M Petersen
- Rigshospitalet/University of Copenhagen/Department of Orthopedics, Copenhagen, Denmark
| | | | | | | | | | | | | | - Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | - Ahmad Shehadeh
- Orthopaedic Unit, King Hussein Cancer Center, Amman, Jordan
| | - Geoffrey Siegel
- Michigan Medicine / University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Gwen Sys
- Ghent University Hospital, Ghent, Belgium
| | | | - Frank Traub
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | | | - Oleg Vyrva
- Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Hazem Wafa
- Leuven University Hospitals, Leuven, Belgium
| | | | - Edward Wang
- University of the Philippines Musculoskeletal Tumor Unit, Manila, Phillipines
| | | | | | - Kwok-Chuen Wong
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ye Zhaoming
- The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | | | - Tomas Zamora
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan P Zumarraga
- Hospital Metropolitano / Departamento de Ortopedia y Traumatología, Quito, Ecuador
| | | | | | - R L Randall
- University of California, Sacramento, California, USA
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Jellins T, Hill M, Prager JD, Francom CR, Chan CM, Schneider KW, Sharma A, Herrmann BW. Pediatric head and neck manifestations associated with multiple endocrine neoplasia syndromes. Int J Pediatr Otorhinolaryngol 2023; 173:111703. [PMID: 37604101 DOI: 10.1016/j.ijporl.2023.111703] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Multiple endocrine neoplasia (MEN) syndromes are a group of hereditary cancer syndromes that can predispose children to endocrine neoplasms developing within the head and neck. OBJECTIVE To examine the neoplastic manifestations of MEN type 1 (MEN1) and MEN type 2 (MEN2) in the pediatric head and neck. METHODS Single-institution, retrospective review of pediatric MEN between 2005 and 2022. RESULTS Fifty-three children were genetically confirmed with MEN (15 MEN1, 34 MEN2A, and 4 MEN2B), while three patients received clinical diagnoses of MEN1. The male to female ratio was essentially equal (1.15:1), and a documented family history of cancer was present in 89% (50/56). After multidisciplinary evaluation, a familial MEN diagnosis was confirmed in 91% (51/56). The mean ages of initial presentation and surgical intervention were 8.9 years (SD 5) and 9.8 years (SD 4.8), respectively. Although patients with MEN2 received surgery earlier than patients with MEN1 (8.7 vs 12.7 years), surgical patients with MEN2 in this cohort were older relative to current American Thyroid Association (ATA) guidelines primarily due to late presentation. Thyroid malignancies were identified in 36% (9/25) of thyroidectomy specimens (21 MEN2A, 4 MEN2B), with medullary thyroid carcinoma (MTC) present in five MEN2A patients and three MEN2B patients (89%), and papillary thyroid carcinoma (PTC) present in one MEN2A patient (11%). Nearly 90% (8/9) of thyroid malignancies were occult, with some occurring earlier than predicted by current guidelines (ATA-MOD and ATA-H). Central neck dissections were performed in 24% (2 MEN1, 2 MEN2A, and 4 MEN2B), with two MEN2B (50%) demonstrating cervical lymph node (LN) metastases. Additional histopathologic findings included C-cell hyperplasia in 57% (12/21) of MEN2A thyroidectomy patients. Of the eight MEN1 parathyroidectomy patients, four demonstrated parathyroid hyperplasia and four presented with parathyroid adenoma. CONCLUSION Nearly 60% required head and neck procedures. While MEN1 guidelines were appropriate for our cohort, we identified patients with MEN2 that developed MTC earlier than expected based on current ATA guidelines, including children in categories considered lower risk. In conjunction with a multidisciplinary approach, pediatric head and neck surgeons should be aware of the potential need for earlier surgical intervention in the pediatric MEN2 population.
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Affiliation(s)
- T Jellins
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M Hill
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - J D Prager
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - C R Francom
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - C M Chan
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - K W Schneider
- Department of Pediatrics, Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado School of Medicine, Aurora, CO, USA
| | - A Sharma
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - B W Herrmann
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
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Chan CM, Tse H, Wong SSY, Woo PCY, Lau SKP, Chen L, Zheng BJ, Huang JD, Yuen KY. Corrigendum to "Examination of seroprevalence of coronavirus HKU1 infection with S protein-based ELISA and neutralization assay against viral spike pseudotyped virus" Journal of Clinical Virology 45 (2009) 54-60. J Clin Virol 2022; 157:105295. [PMID: 36307272 PMCID: PMC9597574 DOI: 10.1016/j.jcv.2022.105295] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- C M Chan
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - Herman Tse
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - S S Y Wong
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - P C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - S K P Lau
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - L Chen
- Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - B J Zheng
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China
| | - J D Huang
- Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong
| | - K Y Yuen
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Hong Kong; Research Center of Infection and Immunology, The University of Hong Kong, Hong Kong; Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, PR China.
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Chau HHT, Luk WH, Ma JKF, She HHL, Lam MC, Li YK, Chan CM, Wong WCL. Coronary Computed Tomography Angiography Service in the Accident and Emergency Department: Pilot Study. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- HHT Chau
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - WH Luk
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - JKF Ma
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - HHL She
- Department of Radiology, Adventist Hospital, Hong Kong
| | - MC Lam
- Department of Radiology, Integrated Diagnostic Imaging Centre, Hong Kong
| | - YK Li
- Accident and Emergency Department, Princess Margaret Hospital, Hong Kong
| | - CM Chan
- Accident and Emergency Department, Princess Margaret Hospital, Hong Kong
| | - WCL Wong
- Accident and Emergency Department, Princess Margaret Hospital, Hong Kong
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Chan CM, Lindsay AD, Spiguel ARV, Parker Gibbs C, Scarborough MT. Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma. J Patient Exp 2022; 9:23743735211069818. [PMID: 35005220 PMCID: PMC8733356 DOI: 10.1177/23743735211069818] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rotationplasty is an established technique that is indicated as part of the surgical reconstruction for certain patients with primary bone tumors around the knee who undergo tumor resection. There is considerable variation in the application of rotationplasty by surgeons as well as acceptance of the procedure by patients who may be candidates for this procedure. We qualitatively studied the decision-making process of families of patients who had undergone rotationplasty by interviewing 4 patients and their families using semi-structured interviews. Thematic analysis identified the following themes that were important in the decision-making process: (1) the desire for good information sources, (2) finding value in meeting with other patients who had been faced with a similar decision, (3) prioritizing function over cosmesis, (4) a desire to limit the need for revision surgeries, and (5) accepting that a return to normalcy is not an option with a surgery. Physicians and patients faced with a similar decision can benefit from a better understanding of the process, and by the normalization of anxieties and concerns that they may experience.
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Affiliation(s)
- Chung M Chan
- Division of Musculoskeletal Oncology, Department of Hand and Reconstructive Microsurgery, National University Hospital, National University Health System, Republic of Singapore
| | - Adam D Lindsay
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andre R V Spiguel
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - C Parker Gibbs
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Mark T Scarborough
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
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Chan CM, Rassnick KM, Frimberger AE, Nguyen SM, Moore AS. Phase I dose escalating study of oral cyclophosphamide in tumour-bearing cats. Vet J 2020; 258:105450. [PMID: 32564869 DOI: 10.1016/j.tvjl.2020.105450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/02/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Cyclophosphamide is an alkylating agent used to treat cats with lymphoma, carcinomas and sarcomas. However, no clear consensus exists regarding the maximum tolerated dose (MTD) of oral cyclophosphamide in cats. Toxicities are rarely reported at published oral dosages of cyclophosphamide (200-300 mg/m2). The primary aim of this prospective study was to determine the MTD of oral cyclophosphamide in tumour-bearing cats via a modified phase I trial. A secondary aim was to define any toxicity. Forty-six client-owned tumour-bearing cats were enrolled. The cyclophosphamide dosage was escalated by approximately 10% (300, 330, 360, 400, 440, 460 and 480 mg/m2) in cohorts of at least six cats. The MTD of oral cyclophosphamide in this study was 460 mg/m2 with an inter-treatment interval of two to three weeks. Haematology is recommended 7 and 14 days after first cyclophosphamide treatment, and immediately before each subsequent dosage of cyclophosphamide or any potentially myelosuppressive chemotherapy agent. The dose-limiting toxicity was neutropenia with nadir at 7-21 days. This higher dosage was considered safe in combination with prednisolone and L-asparaginase. However, the higher dose of oral cyclophosphamide has not been evaluated in combination with other chemotherapy agents and thus should not be administered with these agents.
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Affiliation(s)
- C M Chan
- The Pet Oncologist, 1A Norman Street, Fig Tree Pocket, QLD 4069, Australia.
| | - K M Rassnick
- Veterinary Medical Center of Central New York, 5841 Bridge Street, East Syracuse, NY 13057, USA
| | - A E Frimberger
- Veterinary Oncology Consultants, 379 Lake Innes Drive, Wauchope, NSW 2446, Australia
| | - S M Nguyen
- Small Animal Specialist Hospital, 1 Richardson Pl, North Ryde, NSW 2113, Australia
| | - A S Moore
- Veterinary Oncology Consultants, 379 Lake Innes Drive, Wauchope, NSW 2446, Australia
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Moore AS, Frimberger AE, Chan CM. Dosage escalation of intravenous cyclophosphamide in cats with cancer. Vet J 2018; 242:39-43. [PMID: 30503542 DOI: 10.1016/j.tvjl.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/22/2018] [Revised: 09/24/2018] [Accepted: 10/09/2018] [Indexed: 11/15/2022]
Abstract
Cyclophosphamide is an alkylating agent used as chemotherapy for cats with lymphoma, carcinomas and sarcomas. Clinical and pharmacokinetic studies of cyclophosphamide in normal and tumor-bearing cats have shown minimal toxicity and cyclophosphamide at clinically used dosages rarely requires dosage adjustment or treatment delays. Dose intensity appears important for treatment of most cancers; the aim of this study was to perform a modified dose escalation study of cyclophosphamide to establish the maximally tolerated dosage (MTD) for intravenous cyclophosphamide in cats. The dose limiting toxicity appeared to be neutropenia, and 30% of cats experienced grade 3 or grade 4 neutropenia at a cyclophosphamide dosage of 480mg/m2, which was determined as the MTD. Delayed neutropenia was observed commonly at higher dosages. Thrombocytopenia was less common than neutropenia, and always transient. Gastrointestinal toxicities were uncommon even at MTD. The recommended dosage for single agent cyclophosphamide in cats is 460mg/m2 with a post-treatment interval of three weeks, with hematology performed before any subsequent chemotherapy is administered. This dosage appears safe in combination with prednisolone and l-asparaginase; but has not been evaluated in combination with other chemotherapy agents, or with a post-treatment interval shorter than 3 weeks. Such combinations and shorter intervals are found in some protocols, so this recommended cyclophosphamide dose cannot be considered a direct substitute for cyclophosphamide dosages in existing protocols. There is a suggestion that inadequate renal function may exacerbate the myelosuppression of cyclophosphamide which should be further evaluated.
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Affiliation(s)
- A S Moore
- Veterinary Oncology Consultants, 379 Lake Innes Drive, Wauchope, NSW 2446, Australia.
| | - A E Frimberger
- Veterinary Oncology Consultants, 379 Lake Innes Drive, Wauchope, NSW 2446, Australia
| | - C M Chan
- Queensland Veterinary Specialists, 263 Appleby Road, Stafford Heights, QLD 4053, Australia
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Chu KM, Chan CM, Tse KS, Wai AMW, Wong LLS, Fan TW. Intussusception in Children: What Emergency Physicians Need to Know? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800616] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - CM Chan
- Queen Elizabeth Hospital, Accident and Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong
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Chan CM, Wong MY, Chan SL, Wan MY, Mo YF. The Efficacy of Emergency Medicine Ward for the Management of Patients with Mental Disorders. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Patients with mental disorders are one of the target groups selected for management in the Emergency Medicine Ward (EMW) with the enrolment of psychiatric advanced practice nurses. This study aimed to determine whether the EMW can be efficiently used for the management of patients with mental disorders in terms of length of stay (LOS), admission rate, and re-attendance rate when compared with the medical ward. Methods This was a retrospective descriptive study. Patients with mental disorders were defined and recruited from the Princess Margaret Hospital during two selected study periods: pre-opening (pre-EMW) and post-opening (post-EMW) of the EMW. All emergency department records of patients with mental disorders within these two periods were reviewed and data of the selected samples were retrieved from different computer databases. Results The total number of patients with mental disorders was 565 in the pre-EMW period and 404 in the post-EMW period; 214 (37.9%) cases were admitted into the medical ward in the pre-EMW period while only 62 (15.3%) were admitted into the medical ward in the post-EMW period. The mean LOS in the pre-EMW period was 67.7 hours. For the post-EMW period, the mean LOS was 32.3 hours. The reduction in mean LOS was 35.4 hours, and 82% of the study patients treated in the EMW were discharged within 48 hours. Notably, 23.3% of the cases re-attended the emergency department after discharge from the medical ward, whereas only 8.8% of cases re-attended after discharge from the EMW. Conclusion Patients with mental disorders or related problems can be efficaciously managed in the EMW, as evidenced by a decrease in the length of stay, admission rate, and re-attendance rate.
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Affiliation(s)
| | - MY Wong
- Yan Chai Hospital, Accident and Emergency Department, 7–11 Yan Chai Street, Tsuen Wan, N.T., Hong Kong
| | | | | | - YF Mo
- St. John Hospital, Accident and Emergency Department, Cheung Chau Hospital Road, Tung Wan, Cheung Chau, Hong Kong
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Ho KK, Chan CM, Lee KH, Lit CH. How Much do we Know about ST Elevation?: Case Report of a Patient with Acute Coronary Syndrome in the Observation Ward. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The identification of acute coronary syndrome continues to challenge even experienced clinicians. Emergency physicians have the responsibility to identify, treat and admit those patients with true acute coronary syndrome to the appropriate units. This article described a case of acute coronary syndrome that developed in the observation ward, with discussion on some recent reviews of standard electrocardiogram analysis. It is very important to point out that controversy over the measurement of ST elevation exists which may adversely affect patient management.
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Chu KM, Chan CM, Tse KS, Wai AMW, Wong LLS, Fan TW. Intussusception in Children: What Emergency Physicians Need to Know? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800615] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - CM Chan
- Queen Elizabeth Hospital, Accident and Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong
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Yan YY, Hartono S, Hennedige T, Koh TS, Chan CM, Zhou L, Rumpel H, Martarello L, Khoo JB, Koh DM, Chuang KH, Tony Lim KH, Dan YY, Thng CH. Intravoxel incoherent motion and diffusion tensor imaging of early renal fibrosis induced in a murine model of streptozotocin induced diabetes. Magn Reson Imaging 2017; 38:71-76. [PMID: 28038964 DOI: 10.1016/j.mri.2016.12.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/24/2016] [Accepted: 12/25/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To assess if parameters in intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) can be used to evaluate early renal fibrosis in a mouse model of diabetic nephropathy. MATERIALS & METHODS In a population of 38 male CD1 mice (8weeks old, 20-30g), streptozotocin induced diabetes was created in 20 mice via a single intraperitoneal injection of streptozotocin at 150mg/kg, while 18 mice served as control group. IVIM parameters were acquired at 0, 12 and 24weeks after injection of streptozotocin using a range of b values from 0 to 1200s/mm2. DTI parameters were obtained using 12 diffusion directions and lower b values of 0, 100 and 400s/mm2. DTI and IVIM parameters were obtained using region of interests drawn over the renal parenchyma. Histopathological analysis of the right kidney was performed in all mice. Results were analyzed using an unpaired t-test with P<0.05 considered statistically significant. RESULTS Renal cortex fractional anisotropy (FA) was significantly lower in the diabetes group at week 12 as compared with the control group. Renal cortex apparent diffusion coefficient and tissue diffusivity were significantly higher in the diabetes group at week 12 compared with the control group at 12weeks. Blood flow was significantly decreased at the renal medulla at 24weeks. Histopathological analysis confirmed fibrosis in the diabetes group at 24weeks. CONCLUSION FA is significantly reduced in diabetic nephropathy. FA might serve a potential role in the detection and therapy monitoring of early diabetic nephropathy.
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Affiliation(s)
- Y Y Yan
- Department of Oncologic Imaging, National Cancer Centre, Singapore.
| | - S Hartono
- Department of Oncologic Imaging, National Cancer Centre, Singapore
| | - T Hennedige
- Department of Oncologic Imaging, National Cancer Centre, Singapore
| | - T S Koh
- Department of Oncologic Imaging, National Cancer Centre, Singapore
| | - C M Chan
- Department of Renal Medicine, General Hospital, Singapore, Singapore
| | - L Zhou
- Division of Gastroenterology & Hepatology, National University Hospital, Singapore
| | - H Rumpel
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - L Martarello
- Roche-Singapore Hub for Translational Medicine, Singapore
| | - J B Khoo
- Department of Oncologic Imaging, National Cancer Centre, Singapore
| | - D M Koh
- Royal Marsden Hospital, Surrey, UK
| | - K H Chuang
- Singapore Bioimaging Consortium, Singapore
| | - K H Tony Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - Y Y Dan
- Division of Gastroenterology & Hepatology, National University Hospital, Singapore
| | - C H Thng
- Department of Oncologic Imaging, National Cancer Centre, Singapore
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Bonaretti S, Vilayphiou N, Chan CM, Yu A, Nishiyama K, Liu D, Boutroy S, Ghasem-Zadeh A, Boyd SK, Chapurlat R, McKay H, Shane E, Bouxsein ML, Black DM, Majumdar S, Orwoll ES, Lang TF, Khosla S, Burghardt AJ. Operator variability in scan positioning is a major component of HR-pQCT precision error and is reduced by standardized training. Osteoporos Int 2017; 28:245-257. [PMID: 27475931 PMCID: PMC5568957 DOI: 10.1007/s00198-016-3705-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED In this study, we determined that operator positioning precision contributes significant measurement error in high-resolution peripheral quantitative computed tomography (HR-pQCT). Moreover, we developed software to quantify intra- and inter-operator variability and demonstrated that standard positioning training (now available as a web-based application) can significantly reduce inter-operator variability. INTRODUCTION HR-pQCT is increasingly used to assess bone quality, fracture risk, and anti-fracture interventions. The contribution of the operator has not been adequately accounted in measurement precision. Operators acquire a 2D projection ("scout view image") and define the region to be scanned by positioning a "reference line" on a standard anatomical landmark. In this study, we (i) evaluated the contribution of positioning variability to in vivo measurement precision, (ii) measured intra- and inter-operator positioning variability, and (iii) tested if custom training software led to superior reproducibility in new operators compared to experienced operators. METHODS To evaluate the operator in vivo measurement precision, we compared precision errors calculated in 64 co-registered and non-co-registered scan-rescan images. To quantify operator variability, we developed software that simulates the positioning process of the scanner's software. Eight experienced operators positioned reference lines on scout view images designed to test intra- and inter-operator reproducibility. Finally, we developed modules for training and evaluation of reference line positioning. We enrolled six new operators to participate in a common training, followed by the same reproducibility experiments performed by the experienced group. RESULTS In vivo precision errors were up to threefold greater (Tt.BMD and Ct.Th) when variability in scan positioning was included. The inter-operator precision errors were significantly greater than the short-term intra-operator precision (p < 0.001). New trained operators achieved comparable intra-operator reproducibility to experienced operators and lower inter-operator reproducibility (p < 0.001). Precision errors were significantly greater for the radius than for the tibia. CONCLUSION Operator reference line positioning contributes significantly to in vivo measurement precision and is significantly greater for multi-operator datasets. Inter-operator variability can be significantly reduced using a systematic training platform, now available online ( http://webapps.radiology.ucsf.edu/refline/ ).
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Affiliation(s)
- S Bonaretti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | | | - C M Chan
- University of California Berkeley, Berkeley, CA, USA
| | - A Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - D Liu
- University of British Columbia, Vancouver, BC, Canada
| | - S Boutroy
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - A Ghasem-Zadeh
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia
| | - S K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - H McKay
- University of British Columbia, Vancouver, BC, Canada
| | - E Shane
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - M L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - S Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - E S Orwoll
- Division of Endocrinology, Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - T F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - S Khosla
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Affiliation(s)
- C M Chan
- 1 Division of Orthopedic Oncology, Department of Orthopedics and Rehabilitation, University of Florida, USA
| | - B D Stewart
- 2 Division of Bone and Soft Tissue Pathology, Department of Pathology, Immunology and Laboratory Medicine, University of Florida, USA
| | - C P Gibbs
- 1 Division of Orthopedic Oncology, Department of Orthopedics and Rehabilitation, University of Florida, USA
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Chan CM, Chim TMY, Leung KC, Tong CH, Wong TF, Leung GKK. Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease. Hong Kong Med J 2016; 22:62-9. [PMID: 26744123 DOI: 10.12809/hkmj154613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and end-stage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. METHODS A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. RESULTS Currently available clinical evidence shows good outcomes for type 1 diabetes mellitus in terms of patient survival, graft survival, diabetic complications, and quality of life. For type 2 diabetes mellitus, the efficacy and application of the procedure remain controversial but the outcomes are possibly comparable with those in type 1 diabetes mellitus. CONCLUSIONS Simultaneous pancreas and kidney transplantation is a technically demanding procedure that is associated with significant complications, and it should be regarded as a 'last resort' treatment in patients whose diabetic complications have become life-threatening or severely burdensome despite best efforts in maintaining good diabetic control through lifestyle modifications and medications.
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Affiliation(s)
- C M Chan
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Thomas M Y Chim
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K C Leung
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - C H Tong
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - T F Wong
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gilberto K K Leung
- Centre of Education and Training, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Chan JPK, Lo SMS, Chan CM, Poon WL, Cheung YL, Shek KW, Tang KW, Wong PH. Transarterial Treatment of Traumatic Carotid Cavernous Sinus Fistula with Carotid Artery Dissection and Ruptured Pseudoaneurysm Using Flow Diverter and Detachable Coils. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1514263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chan CM, Luo R, Matthias RC. Tendon graft ossification: an unusual complication of suspensionplasty for trapeziometacarpal arthritis of the thumb. J Hand Surg Eur Vol 2015; 40:417-9. [PMID: 25142003 DOI: 10.1177/1753193414544089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C M Chan
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - R Luo
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - R C Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Chiang JB, Lo SSM, Ho LC, Chan CM, Poon WL, Tang KW, Cheung YL. Posterior Cranial Fossa Neurenteric Cyst with Malignant Transformation. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Tee LMF, Lui CY, Lau KCH, Fong CY, Chan YCY, Ying M, Chan CM. Ultrasound-guided Percutaneous Radiofrequency-assisted Breast Excision to Remove En-bloc Specimens: Five Years' Experience. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Li TY, Li YK, Chan CM. Who are Prone to Develop Adverse Effects with Oral Tramadol? a Retrospective Cohort Study. HONG KONG J EMERG ME 2014. [DOI: 10.1177/102490791402100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] Open
Abstract
Objective Oral tramadol is a commonly prescribed analgesic in Hong Kong. Significant adverse effects are frequently observed in our locality. Our study aims to describe the rate of significant adverse effect that warrant discontinuation of oral tramadol and identify the risk factors for development of adverse effect. Design Retrospective cohort study. Methods Adult patients aged greater than 18 years old admitted to the emergency medicine ward of a large-scale local hospital in Hong Kong being prescribed with oral tramadol during in-hospital stay were recruited. Significant adverse effects during the hospital stay were observed as the outcome of interest. Results A total of 575 subjects were recruited. 29.9% experienced significant adverse effects likely related to tramadol. Age (p=0.006; odds ratio [OR] = 1.017, 95% confidence interval [CI] = 1.005-1.029) and sex (p=0.006; OR=1.696, 95% CI= 1.166-2.465) were statistically significant predictors of adverse effects after oral tramadol. Conclusion Our study suggests that female and increasing age patients are significant predictors for the development of adverse effect after taking oral tramadol. Possible adverse effects should be explained to the patients careful especially the higher risk groups. (Hong Kong j. emerg.med. 2014;21:3-9)
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Affiliation(s)
| | - YK Li
- Princess Margaret Hospital, Accident and Emergency Department, 2-10 Princess Margaret Hospital Road, Kwai Chung, N.T., Hong Kong
| | - CM Chan
- Princess Margaret Hospital, Accident and Emergency Department, 2-10 Princess Margaret Hospital Road, Kwai Chung, N.T., Hong Kong
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Mak CHK, Cheng KM, Cheung YL, Chan CM. Endovascular treatment of ruptured internal carotid artery pseudoaneurysms after irradiation for nasopharyngeal carcinoma patients. Hong Kong Med J 2013; 19:229-36. [PMID: 23650195 DOI: 10.12809/hkmj133833] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES. To evaluate the efficacy and complications of endovascular treatment for ruptured internal carotid artery pseudoaneurysms following irradiation of nasopharyngeal carcinoma. DESIGN. Retrospective case series. SETTING. Tertiary neurosurgical referral unit of a Hong Kong public hospital. PATIENTS. Patients with ruptured radiation-induced internal carotid artery pseudoaneurysms that were treated endovascularly from October 1999 to October 2011 at Queen Elizabeth Hospital were reviewed. Hospital records, imaging, and angiographic data were studied. RESULTS. During the study period, 15 such nasopharyngeal carcinoma patients were treated by endovascular means at Queen Elizabeth Hospital. Ten presented with epistaxis, three with otorrhagia (bleeding from the ear), and two with both. Therapeutic occlusion of the affected internal carotid artery was performed in four patients, and stenting of the artery (with or without coil obliteration of the pseudoaneurysm) was performed in 11. Immediate haemostasis was achieved in all cases. One (7%) of the 15 patients endured symptomatic recurrence of the pseudoaneurysm, and in another an asymptomatic residual pseudoaneurysm was noted in the follow-up angiogram. Three patients suffered clinically significant procedure-related complications, including cerebral infarction (n=2) and brain abscess (n=1). In the angiograms obtained after a mean post-treatment interval of 13 (range, 0.7-60) months, the stent patency rate was 67%. All three patients with occluded stents were asymptomatic. CONCLUSIONS. Ruptured internal carotid artery pseudoaneurysms following radiotherapy is a rare but life-threatening condition. Endovascular treatment by occlusion or reconstruction of the internal carotid artery with stents provides immediate haemostasis and obliteration of the pseudoaneurysms, with a low recurrence rate. Long-term follow-up is necessary to look out for delayed post-treatment complications.
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Affiliation(s)
- Calvin H K Mak
- Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Chou SQH, Lo SSM, Wong HN, Lau PPL, Chan CM, Tang KW, Cheung YL. Atypical Teratoid / Rhabdoid Tumour in the Sella Turcica of a Female Adult. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1311034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kong JCW, Cheng KM, Cheung YL, Chan CM. Transarterial embolisation with Guglielmi detachable coils in an infant with a vein of Galen aneurysmal malformation. Hong Kong Med J 2012; 18:435-438. [PMID: 23018073] [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: 06/01/2023] Open
Abstract
Vein of Galen aneurysmal malformation is a rare entity in the paediatric population. However, it is being recognised with increasing frequency due to better diagnostic techniques. Neonates usually present with congestive heart failure, while in older infants and children it tends to manifest with seizures, hydrocephalus, intracerebral or subarachnoid haemorrhages. We present a case of ruptured vein of Galen aneurysmal malformation in a 3-month-old baby boy treated by transarterial embolisation using Guglielmi detachable coils.
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Affiliation(s)
- James C W Kong
- Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Woo KT, Lau YK, Chan CM, Zhao Y, Tan HB, Liu FE, Fook-Chong S, Wong KS. ACE gene sequence and nucleotide variants in IgA nephropathy. Singapore Med J 2011; 52:824-834. [PMID: 22173253] [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: 05/31/2023]
Abstract
INTRODUCTION Association studies with single nucleotide polymorphisms (SNPs) have been contradictory. Haplotypes may be more helpful. With gene sequencing, all SNPs can be found for construction of haplotypes. METHODS The ACE gene was sequenced in four healthy Chinese subjects and 20 patients with IgA nephropathy (IgAN) to observe if differences exist among SNPs and haplotypes. 20 patients on angiotensin 1-converting enzyme inhibitor/angiotensin receptor antagonist (ACEI/ATRA) therapy were then compared with another 20 patients not treated with ACEI /ATRA to determine their renal outcome in response to ACEI/ATRA therapy and whether their genetic profile of ACE gene could play a role in determining their outcome to ACEI /ATRA therapy and progression to end-stage renal failure (ESRF). RESULTS IgAN patients had 53 variants, of which 17 were unique, whereas normal subjects had 38 variants, of which two were unique (p less than 0.005). No unique variant was a significant risk factor for IgAN. Significant genotype and allele frequency differences in five variants were observed between IgAN patients with renal impairment and those with ESRF (p less than 0.02). CONCLUSION Our data suggests that at least in the ACE gene, haplotyping SNPs within a single gene seems to have no added advantage over genotyping the individual component SNPs. The D allele and haplotype 3 confer an adverse prognosis, while the I allele and haplotype 5 appear to be renoprotective. The data suggests that genotypes of the ACE gene are linked to certain haplotypes, which could influence IgAN patients' response to ACEI/ATRA therapy.
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Affiliation(s)
- K T Woo
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
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Chan CM, Corso PJ, Sun X, Hill PC, Shorr AF. Evaluating the role for the optical density in the diagnosis of heparin-induced thrombocytopenia following cardiac surgery. Thromb Haemost 2011; 106:934-8. [PMID: 21947303 DOI: 10.1160/th11-04-0273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/22/2011] [Indexed: 11/05/2022]
Abstract
The poor accuracy of the enzyme immune assay (EIA) contributes to the diagnostic challenge of heparin-induced thrombocytopenia (HIT) following cardiac surgery. We sought to determine if adjusting the threshold optical density (OD) defining a positive EIA improves the test's accuracy in subjects with an OD>0.40. We retrospectively analysed the results from both EIA and confirmatory serotonin release assays (SRAs) in cardiac surgery patients with EIA OD of >0.4. Employing the SRA as the standard, we compared the area under the receiver-operating characteristic (AUROC) curves of various OD measurements for identifying HIT. We examined baseline clinical variables associated with a positive SRA in the setting of a positive HIT EIA (OD >0.4). We then used logistic regression to identify baseline clinical variables independently associated with a positive SRA given a positive EIA. The cohort included 99 subjects with positive EIAs and 35% had positive SRAs. An OD>0.40 had moderate utility as a screening test for a positive SRA (AUROC: 0.68; 95% CI: 0.55-0.80). Increasing the OD threshold did not improve the HIT EIA's screening utility. Clinical variables independently associated with a positive SRA if the EIA were positive included female gender, absence of diabetes, and use of cardiopulmonary bypass. A relatively modest elevation in the OD measurement, when it is already known to be greater than 0.4, does not reliably exclude the potential for a positive SRA in this setting.
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Affiliation(s)
- C M Chan
- Washington Hospital Center, Washington, DC 20010, USA
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Leung HK, Lam Y, Cheng KM, Chan CM, Cheung YL. Intracranial aneurysms in twins: case report and review of the literature. Hong Kong Med J 2011; 17:151-154. [PMID: 21471597] [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: 05/30/2023] Open
Abstract
Intracranial aneurysm in twins is a rare clinical disease entity. Only 15 cases have been described in the literature. We report on a pair of identical twins with intracranial aneurysms. One presented with subarachnoid haemorrhage; digital subtraction angiography showed a left posterior communicating artery aneurysm, which was treated by coiling. The patient's twin sister was called for screening, whereupon digital subtraction angiography revealed a right ophthalmic internal carotid artery aneurysm that was treated conservatively.
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Affiliation(s)
- H K Leung
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Suhail SM, Kee TSY, Woo KT, Tan HK, Yang WS, Chan CM, Foo MWY, Li HH, Siddique MM, Wong KS. Impact of patterns of proteinuria on renal allograft function and survival: a prospective cohort study. Clin Transplant 2011; 25:E297-303. [PMID: 21362048 DOI: 10.1111/j.1399-0012.2011.01415.x] [Citation(s) in RCA: 3] [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: 11/28/2022]
Abstract
BACKGROUND Proteinuria is an important complication in renal transplant recipients. The aim of this prospective study was to evaluate the long-term impact of transplant proteinuria patterns on allograft function and survival. METHODS We analyzed urinary protein of a cohort of 83 renal transplants with proteinuria ≥0.5 g/d by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and radial immunogel diffusion assay. After initial stratification and analysis, the cohort was followed up for 16 yr. The graft outcome and survival were analyzed using Cox regression model to determine their association with different patterns of initial transplant proteinuria. RESULTS Group with predominantly glomerular (middle- and high-molecular-weight with or without low-molecular-weight) proteinuria (61%) had higher serum creatinine (p < 0.001) than the group with predominantly tubular (low-molecular-weight) proteinuria (39%). The incidences of chronic graft dysfunction and graft loss had increased in the glomerular proteinuria group (p < 0.001, hazard ratio 3.6, 95% confidence interval 1.7-7.5 and p < 0.001, hazard ratio 4.9, 95% confidence interval 1.9-12.1, respectively). Patient death did not differ (p = 0.434, hazard ratio 1.5, 95% confidence interval 0.5-4.5). CONCLUSION Proteinuria in renal transplants can be differentiated into glomerular and tubular types based on molecular weight. Glomerular proteinuria is associated with significant increase in graft dysfunction and graft loss.
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Affiliation(s)
- S M Suhail
- Department of Renal Medicine Department of Clinical Research Duke-NUS Graduate Medical School, Singapore.
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Abstract
SUMMARY BACKGROUND Rapid, accurate risk stratification is paramount in managing patients with acute pulmonary embolism (PE). The PE Severity Index (PESI) is a simple tool that risk stratifies patients with acute PE. OBJECTIVES We sought to validate the PESI as a predictor of short- and intermediate-term mortality and to determine the inter-rater variability. PATIENTS/METHODS We retrospectively identified all patients with acute PE between October 2007 and February 2009. Two clinicians reviewed charts and independently scored PESI blinded to each other and to patient outcomes. Thirty- and 90-day mortality served as study endpoints and vital status was assessed via the Social Security Death Index. To facilitate analyses, raw PESI score was converted into risk class groups (I-V) and further dichotomized into low risk (I-II) vs. high risk (III-V) groups. Intraclass correlation and the kappa statistic were used to determine inter-rater variability. RESULTS The cohort included 302 subjects (mean age, 59.7 +/- 17.2 years; 44% male). All-cause 30- and 90-day mortalities were 3.0% and 4.0%, respectively. The mortality rate increased as raw PESI score increased. Risk of death correlated with risk class (P < 0.001). There were no deaths in risk classes I-III, but 30- and 90-day mortality for class V were 9.2% and 10.5%, respectively. Overall, mean PESI scores were similar between observers: 103.3 +/- 39.3 and 96.5 +/- 37.6 (P = NS). The inter-rater variability was good (kappa = 0.69; P < 0.0001). CONCLUSIONS The PESI correlates with 30- and 90-day mortality. It represents a reproducible scoring tool to risk stratify patients with acute PE.
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Affiliation(s)
- C M Chan
- Pulmonary & Critical Care Medicine, Washington Hospital Center, Washington, DC 20010, USA.
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Lai HP, Cheng KM, Yu SCH, Au Yeung KM, Cheung YL, Chan CM, Poon WS, Lui WM. Size, location, and multiplicity of ruptured intracranial aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage. Hong Kong Med J 2009; 15:262-266. [PMID: 19652232] [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: 05/28/2023] Open
Abstract
OBJECTIVE To review the pattern of ruptured intracranial aneurysms in terms of size, location, and the prevalence of multiple aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage. DESIGN Retrospective study. SETTING Three public hospitals in Hong Kong. PATIENTS A total of 267 Chinese patients with subarachnoid haemorrhage from ruptured intracranial aneurysms between July 1998 and June 2002 were reviewed retrospectively. RESULTS The patients had a mean age of 59 (range, 13-96) years, with a female-to-male ratio of 2:1. Concerning the age at presentation, males presented with ruptured intracranial aneurysms at a younger age (P=0.001) than females. Ruptured aneurysms were more commonly located in the anterior than posterior circulation (84% vs 16%). The posterior communicating artery (26%) and anterior communicating artery (22%) were the most common sites of rupture. As a whole, 64% of the aneurysms had a size of 5 mm or less. The anterior communicating artery had a higher proportion with a size of 5 mm or less compared to other locations (P<0.05). In this cohort, the prevalence of multiple aneurysms was 17%. There was no significant difference in the prevalence of multiple aneurysms between men and women (P=0.30). In patients with multiple aneurysms, the sizes of ruptured aneurysms were greater than those of the largest unruptured aneurysms (P<0.001). When compared with the group with single aneurysms, patients with multiple aneurysms had a smaller proportion of small aneurysms, sized 5 mm or less (P<0.05). CONCLUSIONS The pattern of ruptured intracranial aneurysms in the Hong Kong Chinese population was different from western and Japanese populations. Although the distribution of locations for ruptured aneurysms was similar, Hong Kong Chinese had a larger proportion of small aneurysms sized 5 mm or less. The prevalence of multiple aneurysms in Hong Kong is comparable to that in the Japanese population, but lower than that in the western populations.
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Affiliation(s)
- H P Lai
- Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Abstract
An anterior cerebral artery traumatic aneurysm in a 15-month-old infant is described. The diagnosis was confirmed by computed tomographic angiography. The patient recovered fully after successful clipping of the aneurysm. As the signs of traumatic intracranial aneurysm may be subtle especially in young children, a high degree of suspicion is essential in patients presenting with delayed neurological deterioration after head trauma.
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Affiliation(s)
- T C Tan
- Department of Neurosurgery, and Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Tan CHR, Loh PT, Yang WS, Chan CM. Mycophenolate mofetil in the treatment of IgA nephropathy: a systematic review. Singapore Med J 2008; 49:780-785. [PMID: 18946610] [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: 05/27/2023]
Abstract
INTRODUCTION The aim of this study was to determine the effectiveness of mycophenolate mofetil (MMF) in IgA nephropathy (IgAN). METHODS A search through Cochrane Library, EMBASE and PubMed was carried out. Randomised controlled trials (RCTs), which compared MMF with conventional treatments, were identified. Patients' baseline, treatment strategies and study end-points were compared. RESULTS Four RCTs (168 patients) were selected. All patients had histologically-confirmed IgAN and proteinuria greater than 1 g/day. The follow-up duration ranged from 1.5 to 3.0 years. MMF was used at a titrated dose of 1-2 g/day. In the two trials with subjects having moderate to high risk for progressive disease, MMF did not demonstrate any significant difference in retarding the decline in renal function and proteinuria reduction. One trial concluded that there was a trend towards worse outcomes when MMF was used in moderately-advanced disease. Only one trial involving subjects with less advanced disease (reflected by a favourable histological grade) showed a significant decrease in proteinuria in the MMF-treated group. No serious adverse events occurred in all the four trials using MMF. CONCLUSION No benefit was seen in moderately-advanced IgAN treated with MMF. In a selected group of patients with less advanced disease, MMF was effective in proteinuria reduction. Larger randomised studies are needed to confirm or reject these results.
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Affiliation(s)
- C H R Tan
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
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Chan E, Tsui S, Chan CM, Chan CS, Chen YW, Law P, Wong A. Molecular and genetic characterisation of the SARS coronavirus auxiliary protein X1 in Drosophila. Hong Kong Med J 2008; 14 Suppl 4:14-16. [PMID: 18708668] [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: 05/26/2023] Open
Abstract
1. We have generated monoclonal antibodies against the SARS coronavirus (SARS-CoV) X1/3a protein (3a), which are suitable for western blotting, immunocytochemistry, and immunohistochemistry. 2. We have established and characterised an in-vivo 3a transgenic Drosophila model, and demonstrated its usefulness in studying SARS-CoV 3a gene function. 3. We validated our in-vivo findings on 3a gene function in mammalian Vero E6 cells. 4. Our findings raise the possibility of using ion channel blockers as a novel approach to suppress SARS-CoV-induced cell death.
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Affiliation(s)
- E Chan
- Department of Biochemistry, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Lau CH, Chan CM, Chan YW, Lau KM, Lau TW, Lam FC, Law WT, Che CT, Leung PC, Fung KP, Ho YY, Lau CBS. Pharmacological investigations of the anti-diabetic effect of Cortex Moutan and its active component paeonol. Phytomedicine 2007; 14:778-84. [PMID: 17298878 DOI: 10.1016/j.phymed.2007.01.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 12/11/2006] [Indexed: 05/14/2023]
Abstract
Cortex Moutan (CM, root bark of Paeonia suffruticosa Andr.) is one of the common herbs found in anti-diabetic traditional Chinese medicine formulae. To study the potential anti-diabetic mechanisms of CM, four in vitro models (intestinal brush border membrane vesicles (BBMV), rat hepatoma cell line H4IIE, human skin fibroblasts cell line Hs68 and mouse adipocytes 3T3-L1) were used. CM showed significant in vitro anti-diabetic effects by inhibiting glucose uptake of BBMV and enhancing glucose uptake into Hs68 and 3T3-L1 cells. Using bioassay-guided fractionation, paeonol was confirmed to be one of the active constituents for inhibiting BBMV glucose uptake. With neonatal-streptozotocin diabetic rats, paeonol (200 and 400mg/kgbody wt.) was found to improve oral glucose tolerance in vivo. To the best of our knowledge, this is the first report on the anti-diabetic effect of paeonol.
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Affiliation(s)
- C H Lau
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, New territories, Hong Kong, China
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Zhang X, Kong B, Tsui OKC, Yang X, Mi Y, Chan CM, Xu B. Effect of pattern topology on the self-cleaning properties of textured surfaces. J Chem Phys 2007; 127:014703. [PMID: 17627360 DOI: 10.1063/1.2748383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The water contact angle and self-cleaning property of microfabricated surface textures possessing different topologies are compared. In one kind of surface textures, the protruded regions form a connected square network. In the other kind of surface textures, the protruded regions form a regular array of square posts. We find that the water apparent contact angle of the connected textures agrees with the Cassie equation [Discuss. Faraday Soc. 3, 11 (1948)], but that of the disconnected textures is much larger. Nevertheless, the disconnected textures exhibit inferior self-cleaning property, contrary to conventional conception. We discuss the possible reasons for these observations.
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Affiliation(s)
- Xueyun Zhang
- Department of Physics, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China
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Tse THZ, Chan BP, Chan CM, Lam J. Mathematical modeling of guided neurite extension in an engineered conduit with multiple concentration gradients of nerve growth factor (NGF). Ann Biomed Eng 2007; 35:1561-72. [PMID: 17520368 DOI: 10.1007/s10439-007-9328-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 05/09/2007] [Indexed: 12/11/2022]
Abstract
Neurotrophic factors such as nerve growth factor (NGF) provide essential cues to navigate growing axon toward their targets. Concentration and concentration gradient of NGF are key parameters affecting the growth rate and direction of neurites and axons. However, the maximum distance for guided nerve growth under stimulation of a single concentration gradient is limited and is thus unfavorable in nerve regeneration. Since the sensitivity of PC12 cells to NGF signals is restorable even after brief removal of the factors, exposure to multiple concentration gradients of the factor can achieve longer distances and greater rates of guided growth. In this study, a mathematical model simulating nerve growth in a virtually constructed nerve conduit incorporating multiple NGF concentration gradients is established. Using a genetic algorithm, optimized initial profiles of NGF able to achieve 4.5 cm of guided growth with a significantly improved growth rate has been obtained. The model also predicts an inverse relationship between the diffusion coefficient of the factor and the neurite growth rate. This model provides a useful tool for evaluating various conduit designs before fabrication and evaluation.
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Affiliation(s)
- T H Z Tse
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China
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Lui CY, Lam HS, Chan LK, Tam KF, Chan CM, Leung TY, Mak KL. Opportunistic breast cancer screening in Hong Kong; a revisit of the Kwong Wah Hospital experience. Hong Kong Med J 2007; 13:106-13. [PMID: 17406037] [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: 05/14/2023] Open
Abstract
OBJECTIVE To analyse the performance of opportunistic breast screening in local Well Women Clinics during the 5-year period from 1998 to 2002, with reference to international as well as our own earlier experience (1991 to 1993 to 1995). DESIGN Prospective study. SETTING Well Women Clinics in regional Hong Kong hospitals. PARTICIPANTS Women attending the Well Women Clinics of the Tung Wah Group of Hospitals for breast cancer screening. MAIN OUTCOME MEASURES All screening-detected breast cancers. RESULTS After 46 637 screening mammograms and excluding palpable masses detected by the patients themselves, 232 women were detected with cancers, yielding a crude detection rate of 5.0 per 1000. Age range for cancer detection was 35 to 72 (median, 49) years. Clinic staff detected palpable lumps in 83 patients, constituting 36% of the detected cancers, of which 15 (6.5% of all detected cancers) were not identified by mammography. The cancer detection rate was 5.9 per 1000 in the age-group 40-49 years and 3.7 per 1000 in those 50 years or older. The cancer detection rate was 58.5 per 1000 in the high-risk group (aged <40 years with positive family history). The minimal cancer detection rate was 2.2 per 1000, representing 45% of all cancers whose pathology was available to us. Ductal carcinoma in situ comprised 28% of all such cancers. Our recall rates were 4.6% for additional views only, 3.3% for ultrasound only, and 2.3% for both. Positive predictive values for abnormal mammograms and biopsies were 4.9% and 26.0%, respectively. CONCLUSION Mammographic screening has been reported to reduce mortality up to 35% in western countries. However, data concerning Asian Chinese populations are meagre. Our Well Women Clinics pioneered large-scale self-referred breast screening in Hong Kong. Despite the lower incidence of breast cancers than in Occidental populations, our screening programme performed comparably to those in the West, and has improved over time. Our screening service for self-referred women detected breast cancers even at an early stage, which facilitated a better prognosis and more treatment options, whilst appearing to be highly acceptable to our community. Besides, it could provide training and expertise in breast radiology and mammography, which are essential prerequisites for establishing population screening.
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Affiliation(s)
- C Y Lui
- Department of Radiology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong.
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37
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Chan CM, Chan YW, Lau CH, Lau TW, Lau KM, Lam FC, Che CT, Leung PC, Fung KP, Lau CBS, Ho YY. Influence of an anti-diabetic foot ulcer formula and its component herbs on tissue and systemic glucose homeostasis. J Ethnopharmacol 2007; 109:10-20. [PMID: 16891069 DOI: 10.1016/j.jep.2006.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 04/27/2006] [Accepted: 06/07/2006] [Indexed: 05/11/2023]
Abstract
Complications of diabetes impose major public health burdens worldwide. The positive effect of a Radix Astragali-based herbal preparation on healing diabetic foot ulcers in patients has been reported. Formula 1 is also referred as the 'Herbal drink to strengthen muscle and control swelling'. This formula contains six Chinese medical herbs, including Radix Astragali, Radix Rehmanniae, Rhizoma Smilacis Chinensis, Rhizoma Atractylodis Macrocephalae, Radix Polygoni Multiflori Preparata, and Radix Stephania Tetrandrae. Three of these herbs (Radix Astragali, Radix Rehmanniae, Rhizoma Atractylodis Macrocephalae) are commonly used in different anti-diabetic formulae of Chinese medicine. The objective of the current study is to use an interdisciplinary approach to test the hypothesis that Formula 1 and its components influence tissue and systemic glucose homeostasis. In vitro and in vivo models have been established including: (1) glucose absorption into intestinal brush border membrane vesicles (BBMV); (2) gluconeogenesis by H4IIE hepatoma cells; (3) glucose uptake by 3T3-L1 adipocytes and Hs68 skin fibroblasts; (4) normalization of glycaemic control in a diabetic rat model. The results of in vitro studies indicated that all herbal extracts can modify cellular glucose homeostasis. Since Formula 1 and Rhizoma Smilacis Chinensis extracts demonstrated potent effects on modifying glucose homeostasis in multiple tissues in vitro, they were further studied for their anti-diabetic activities in vivo using a streptozotocin (STZ)-induced diabetic rat model. The results showed that Formula 1 and Rhizoma Smilacis Chinensis extracts did not significantly improve oral glucose tolerance or basal glycaemia in diabetic rats. In conclusion, the anti-diabetic foot ulcer Formula 1 contains ingredients active in modifying tissue glucose homeostasis in vitro but these biological activities could not be associated with improved glycaemic control of diabetes in vivo.
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Affiliation(s)
- C M Chan
- Department of Biochemistry, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
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Lau TW, Chan YW, Lau CP, Chan CM, Lau CBS, Fung KP, Leung PC, Ho YY. Investigation of the effects of Chinese medicine on fibroblast viability: implications in wound healing. Phytother Res 2007; 21:938-47. [PMID: 17583899 DOI: 10.1002/ptr.2191] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
Diabetes mellitus has been a clinical problem for hundreds of years. Over 194 million people suffer from this disease worldwide. Improper control of diabetes may result in diabetic foot ulcer or even amputation. Granulation formation is an important issue essential for ulcer healing. The CRL-7522 fibroblast cell line and primary fibroblasts from a diabetic foot ulcer patient were used to model the wound healing enhancing activities of two clinically efficacious Chinese herbal formulae, Formula 1 (F1) and Formula 2 (F2) and their component herbs. Results showed that the two formulae and four of their component herbs, Radix Astragali, Radix Rehmanniae, Rhizoma Alismatis and Rhizoma Atractylodis Macrocephalae significantly enhanced CRL-7522 cell viability. However, these component herbs showed compromised effects on the viability of primary fibroblasts cultured from the ulcerous tissue of a diabetic patient. Interestingly, F1 and F2 enhanced the viability of primary cultured fibroblasts from the diabetic patient even in the face of insulin resistance. These results further support the previously reported clinical efficacies of the two formulae on healing diabetic foot ulcers.
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Affiliation(s)
- T W Lau
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China
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Chan CM, Wong KH, Chung WK, Chow TS, Wong PK. Photocatalytic degradation of di(2-ethylhexyl)phthalate adsorbed by chitin A. Water Sci Technol 2007; 56:125-134. [PMID: 17951876 DOI: 10.2166/wst.2007.685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Di(2-ethylhexyl)phthalate (DEHP) is a ubiquitous environmental contaminant due to its extensive use as a plasticiser and its persistence. Currently, there is no cost-effective treatment method for its removal from industrial wastewater. In a previous study, DEHP was effectively adsorbed from aqueous solution by biosorption onto chitinous materials. Biosorption can pre-concentrate DEHP from the aqueous phase for further treatment. As biosorption cannot degrade DEHP, in this study the degradation (and detoxification) of DEHP adsorbed onto chitinous material by photocatalytic oxidation (PCO) is attempted. PCO relies on hydroxyl radical (.OH), which is a strong oxidising agent, for the oxidative degradation of pollutants. It is a non-selective process which can degrade DEHP adsorbed onto chitinous material. The first part of this study is the optimisation of the degradation of adsorbed DEHP by PCO. Adsorption was carried out in the physicochemical conditions optimised in the previous study, with 500 mg/L chitin A and 40 mg/L DEHP at initial pH 2, 22+/-2 degrees C and 150 rpm agitation for 5 min. After optimisation of PCO, a 61% removal efficiency of 10 mg/L of DEHP was achieved within 45 min under 0.65 mW/cm2 of UV-A with 100 mg/L TiO2, and 10 mM of H2O2 at initial pH 12. The optimisation study showed that UV-A and TiO(2) are essential for the degradation of DEHP by PCO. The degradation intermediates/products were identified by GC-MS analysis. GC-MS results showed that the di(2-ethylhexyl) side chain was first degraded, producing phthalates with shorter side chains. Further reaction produced phathalic anhydride and aliphatic compounds such as alkanol and ester. The toxicities of parental and degradation intermediates in the solution phase and on chitinous materials were followed by the Microtox test. Results indicated that toxicity can be removed after 4 h treatment by PCO. Thus the decontamination of DEHP by integrating biosorption and PCO is feasible.
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Affiliation(s)
- C M Chan
- Department of Biology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
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Chan HY, Cheng KM, Lo MW, Chan CM, Cheung YL. A treatable case of dementia--intracranial dural arteriovenous fistula. Hong Kong Med J 2006; 12:74-6. [PMID: 16495595] [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: 05/06/2023] Open
Abstract
Dementia is a common medical problem that affects elderly patients. We report on a 77-year-old man with an intracranial dural arteriovenous fistula who presented with dementia that was initially thought to be irreversible and degenerative. Subsequent neuroendovascular intervention resulted in significant functional and cognitive improvement.
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Affiliation(s)
- H Y Chan
- Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Hung WK, Chan CM, Ying M, Chong SF, Mak KL, Yip AWC. Randomized clinical trial comparing blue dye with combined dye and isotope for sentinel lymph node biopsy in breast cancer. Br J Surg 2005; 92:1494-7. [PMID: 16308853 DOI: 10.1002/bjs.5211] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [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: 02/06/2023]
Abstract
Abstract
Background
Use of blue dye alone as a marker for sentinel lymph node (SLN) biopsy is effective, but combining it with isotope marking can improve the success rate. Use of the isotope adds extra cost and there are potential radiation hazards. The two techniques were compared in a randomized trial.
Methods
Women with early breast cancer (less than 3 cm) and no palpable axillary nodes were recruited. Women older than 70 years with multicentric cancers or previous surgery to the breast or axilla were excluded. Patients were randomized to either blue dye alone or combined mapping for SLN biopsy. All women had a level I and II axillary dissection after the SLN biopsy.
Results
A total of 123 patients were recruited, of whom five were excluded from analysis. Blue dye alone was used in 57 women and 61 had combined mapping. Baseline demographic data were similar in the two cohorts. The success rate of SLN biopsy was higher with combined mapping than with blue dye alone (100 versus 86 per cent; P = 0·002). The accuracy and false-negative rate were similar (accuracy 100 per cent for combined mapping versus 98 per cent for blue dye; false-negative rate 0 versus 5 per cent).
Conclusion
Combined mapping was superior to blue dye alone in identification of the SLN, but accuracy and false-negative rates were similar.
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Affiliation(s)
- W K Hung
- The Breast Centre, Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong.
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Chan CM. Hyperlipidaemia in chronic kidney disease. Ann Acad Med Singap 2005; 34:31-5. [PMID: 15726217] [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: 05/01/2023]
Abstract
Cardiovascular disease is a major cause of mortality and morbidity in patients with chronic kidney disease (CKD). The prevalence of hyperlipidaemia or dyslipidaemias is much higher compared to the general population. Total or low-density lipoprotein (LDL) cholesterol is highest in patients with chronic renal impairment. The majority of patients with CKD do not develop renal failure; indeed, most of them die of cardiovascular causes before the development of renal failure. The K/DOQI (Kidney Disease Outcomes Quality Initiative) guidelines on dyslipidaemias in CKD suggest that all patients should therefore be evaluated for dyslipidaemias. They should have a complete fasting lipid profile with total, LDL and high-density lipoprotein cholesterol, and triglycerides measured to identify those at risk and those who require treatment. Generally, the treatment approach parallels that suggested by the National Cholesterol Education Program Adult Treatment Panel III guidelines, in which the main focus of treatment is the level of LDL cholesterol. Patients with CKD should be considered a "very high risk" category and aggressive therapeutic intervention initiated to reduce the risk of cardiovascular events.
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Affiliation(s)
- C M Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore.
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Woo KT, Lau YK, Chan CM, Wong KS. ATRA therapy restores normal renal function and renal reserve and prevents renal failure. Ann Acad Med Singap 2005; 34:52-9. [PMID: 15726220] [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: 05/01/2023]
Abstract
This article presents clinical data which suggest that the current dosage of losartan 50 to 100 mg/day may not be the optimum in many cases, especially if used as monotherapy in the treatment of proteinuria and we may have to increase to 200 mg/day. However, about 30% of patients cannot take angiotensin-converting enzyme inhibitor (ACEI) because of the side effect of cough. To potentiate the anti-proteinuric effect of losartan, especially for patients who do not adhere to a low salt diet, a 12.5-mg dose of hydro-chlorothiazide may further decrease proteinuria. The main message of this article is that we would have to, in many instances, increase the dose of losartan to a minimum of 100 mg/day or 100 mg twice a day for some patients for optimal therapy. The second message is to monitor the creatinine clearance test (CCT) and to start therapy when CCT is reduced and not wait for serum creatinine to rise to abnormal levels (renal impairment) before starting therapy. The first group involves half a dozen patients with hypertension but no proteinuria. Therapy with losartan is shown to improve the renal function. This data suggest that losartan, apart from its use in reduction of proteinuria, can be used in patients with mild renal impairment without proteinuria to reverse the mild renal impairment and preserve renal function. The second group deals with 3 patients with low creatinine clearance. After a followup period of an average of 3 years, they all developed renal impairment. In another 6 patients, the data suggest that we should perhaps treat patients with low CCT as soon as possible and with dose ranging from 100 to 200 mg/day if necessary, to derive maximum beneficial effect. The third group highlights 5 patients with high CCT due to glomerular hyperfiltration. With time, the high CCT decreases and renal impairment sets in. The data suggest that patients with high CCT should be treated early to prevent renal impairment. The fourth group illustrates 6 patients where their proteinuria was markedly reduced with the increase of losartan from 100 mg/day to 200 mg/day, suggesting that losartan 200 mg/day is probably the optimum dose. In conclusion, apart from its traditional usage in reduction of proteinuria to retard progression to renal failure, the data suggest that losartan is also indicated in patients with renal impairment in the absence of proteinuria; patients with low CCT, patients with high CCT and patients who do not respond to a dosage of 100 mg/day should have the dosage increased to 100 mg twice daily to increase efficacy of losartan. It is hoped that with these new and earlier indications as well as increased dosage of losartan starting with 100 mg, whenever possible, and increasing to 200 mg/day, if there is no response, we can prevent more patients from developing renal failure. Based on these observations, further randomised controlled trials should be designed to address these issues.
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Affiliation(s)
- K T Woo
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Abstract
Social learning theory expects the social worker to hold more favorable beliefs about elderly people and scapegoat theory expects one having higher self-esteem to be so. The role of social work and self-esteem may be factors explaining ageism at the individual level. Because ageism seems to emerge in Hong Kong as well as other industrialized societies, the study surveyed the general public, social workers, students, elderly center members to (1) determine the relative extent of ageism in terms of beliefs about physical, social, and psychological dimensions of elderly people, and (2) test hypotheses deriving from social learning and scapegoat theories. Analysis of data from 902 respondents showed that people younger than 60 years were more favorable regarding the social dimension and less favorable regarding the psychological dimension of beliefs about elderly people. One with higher self-esteem tended to be more favorable in beliefs about social and psychological dimensions of elderly people but less favorable in the belief about the physical dimension. Although the gerontological social worker was more favorable in the belief regarding the social dimension of elderly people than others, this difference might be attributable to his or her higher self-esteem. Hence the role of social work did not necessarily improve one's image of elderly people in Hong Kong.
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Affiliation(s)
- C K Cheung
- Department of Applied Social Studies, City University of Hong Kong, Kowloon.
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Chan CM, Cheng KM, Cheung JYL, Lee FWT, Tang KW, Tse CH, Chan SCH. MR Detection of Dilated Deep Medullary Veins in Intracranial Dural Arteriovenous Fistulas with retrograde Leptomeningeal Venous Drainage. Interv Neuroradiol 2002; 8:265-72. [PMID: 20594484 DOI: 10.1177/159101990200800306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2002] [Accepted: 08/17/2008] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Patients with dural arteriovenous fistula (DAVF) are at higher risk of developing neurological deficits when there is retrograde leptomeningeal venous drainage. Our aim is to demonstrate the presence of dilated deep medullary veins in the brain on magnetic resonance imaging (MR) in this group of patients, and to assess their clinical significance. Nine patients with angiographically proven DAVF associated with leptomeningeal venous drainage who had MR before treatment were studied.MR was performed in at least two orthogonal planes before and after gadolinium administration. The dural fistula was located at the cavernous sinus in five patients, at the transverse-sigmoid sinus in three and at the tentorium in one. Dilated deep medullary veins were noted in six patients. Of these, four showed parenchymal abnormalities which included intracerebral haematoma, venous infarction, brain oedema and T2 hyperintensity in brainstem. Venous varix was present in one patient. No neurological complication or parenchymal change was observed in the three patients without dilated deep medullary veins. Therefore, in patients with intracranial DAVF associated with leptomeningeal venous recruitment, the MR finding of dilated deep medullary veins suggests a more severe degree of venous hypertension and congestion in the brain. This subgroup of patients has a much higher chance of neurological complications and warrants urgent intervention.
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Affiliation(s)
- C M Chan
- Departments of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
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Cheng KM, Chan CM, Cheung YL, Chiu HM, Tang KW, Law CK. Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases. Acta Neurochir (Wien) 2002; 143:351-5; discussion 355-6. [PMID: 11437288 DOI: 10.1007/s007010170089] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [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: 10/27/2022]
Abstract
Haemorrhage from rupture of petrous ICA aneurysm can be life threatening and emergency treatment is required. We report 2 cases of radiation-induced petrous internal carotid artery (ICA) aneurysm presenting with acute haemorrhage (epistaxis and otorrhagia) after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Both patients had a history of RT treatment for NPC. The first patient, a 54-year-old man, presented with sudden severe epistaxis and haemorrhagic shock. The second patient, a 35-year-old man, presented with episodes of severe otorrhagia. The first patient was immediately resuscitated. Obliteration of the aneurysm was performed by endovascular occlusion of the ICA with Guglielmi detachable coils and fibered platinum coils. For the second patient, the aneurysm was treated by deploying a self-expandable stent across the aneurysm neck. In an emergency situation, ruptured petrous ICA aneurysm can be treated with endovascular occlusion of the ICA with microcoils if there is a good collateral blood flow. Alternatively, the aneurysm can be treated by deployment of a stent, which can induce stasis and eventual thrombosis of the aneurysm.
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Affiliation(s)
- K M Cheng
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
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Abstract
We cloned the AFMP1 gene, which encodes the first antigenic cell wall galactomannoprotein in Aspergillus fumigatus. AFMP1 codes for a protein, Afmp1p, of 284 amino acid residues, with a few sequence features that are present in Mp1p, the antigenic cell wall mannoprotein in Penicillium marneffei that we described previously, as well as several other cell wall proteins of Saccharomyces cerevisiae and Candida albicans. It contains a serine- and threonine-rich region for O glycosylation, a signal peptide, and a putative glycosylphosphatidyl inositol attachment signal sequence. Specific anti-Afmp1p antibody was generated with recombinant Afmp1p protein purified from Escherichia coli to allow further characterization of Afmp1p. Afmp1p has a high affinity for Galanthus nivalis agglutinin, a characteristic indicative of a mannoprotein. Furthermore, it was recognized by a rat monoclonal antibody against the galactofuran side chain of galactomannan, indicating that it is a galactomannoprotein. Ultrastructural analysis by immunogold staining indicated that Afmp1p is present in the cell walls of the hyphae and conidia of A. fumigatus. Finally, it was observed that patients with aspergilloma and invasive aspergillosis due to A. fumigatus develop a specific antibody response against Afmp1p. This suggested that the recombinant protein and its antibody may be useful for serodiagnosis in patients with aspergilloma or invasive aspergillosis, and the protein may represent a good cell surface target for host humoral immunity.
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Affiliation(s)
- K Y Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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Abstract
BACKGROUND Non-palpable breast lesions present diagnostic difficulties. Ultrasound-guided fine-needle aspiration cytology (FNAC) is a common method used to obtain a diagnosis, but FNAC is frequently inconclusive or insufficiently accurate. Recently a vacuum-assisted biopsy device (Mammotome, Ethicon, Endo-surgery, USA) has been introduced. The diagnostic accuracy of this biopsy device was assessed for lesions that were visible on ultrasound. METHODS Fifty ultrasound-guided mammotome biopsies were performed. All were small breast lesions primarily detected by ultrasound. All received FNAC as initial assessment. Mammotome biopsy was performed whenever the breast lesion was considered indeterminate or if it was considered benign and there were associated risk factors such as a family history of breast cancer. RESULTS Of 50 mammotome biopsies 45 had benign histology. Three of 45 lesions were excised at the patients' request and were confirmed to be benign. The remaining 42 patients received an ultrasound follow up at 6 months. The lesion size remained static in 39 patients. In three patients the lesion size increased and they were excised and histology was benign. For the four malignancies diagnosed with mammotome biopsy, three patients received definitive treatment and one patient defaulted. There was one failed mammotome biopsy in the present series. CONCLUSIONS Mammotome biopsy is an acceptable diagnostic method for small breast lesions seen on ultrasound. It reduces the need for open biopsy without compromising diagnostic accuracy.
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Affiliation(s)
- W K Hung
- Department of Surgery, Kwong Wah Hospital, Hong Kong Special Administrative Region, China.
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Chan CM, Chew PT, Alsagoff Z, Wong JS, Tan DT. Vascular patterns in pterygium and conjunctival autografting: a pilot study using indocyanine green anterior segment angiography. Br J Ophthalmol 2001; 85:350-3. [PMID: 11222345 PMCID: PMC1723902 DOI: 10.1136/bjo.85.3.350] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To characterise the vasculature of pterygium using indocyanine green (ICG) anterior segment angiography and to demonstrate the pattern of revascularisation following conjunctival autografting. METHODS ICG anterior segment angiography was performed on nine patients with pterygium. Angiography was repeated at 1-2 weeks and 2 months following conjunctival autografting in these patients. RESULTS Angiography showed a single feeder vessel originating from the anterior conjunctival circulation in six cases (66.7%). This vessel branched to form the radial vessels of the pterygium. Following conjunctival autografting, reperfusion of the vessels in the conjunctival autograft was demonstrable as early as 1 week postoperatively from the episcleral bed. At 2 months postoperatively, the graft appeared well perfused with mild leakage demonstrable at the edges of the graft. CONCLUSIONS A single feeder vessel from the anterior conjunctival circulation branches to form the radial vessels in pterygium. Reperfusion of conjunctival autografts occurs as early as 1 week postoperatively from the episcleral bed.
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