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Mak MCK, Ho PC. Complications after arthroscopic triangular fibrocartilage complex (TFCC) surgery. J Hand Surg Eur Vol 2024; 49:149-157. [PMID: 38315134 DOI: 10.1177/17531934231218608] [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] [Indexed: 02/07/2024]
Abstract
Wrist arthroscopy is a valuable and widely utilized tool in the treatment of triangular fibrocartilage complex (TFCC) injuries. These procedures include synovectomy alone, peri-capsular or transosseous repair, and arthroscopic-assisted reconstruction, and each are associated with specific complications. This review describes the types of complications and their rates in different types of arthroscopic TFCC surgery reported in the literature and in our centre. Across the spectrum of arthroscopic TFCC surgery, complication rates and the learning curve increase with surgical complexity. Relevant anatomy, prevention and management of complications including nerve injury and irritation, extensor tendon injury and tendinitis, fracture, stiffness, and persistence of symptoms or instability are discussed. Vigilance to anatomical details and careful dissection can help to reduce complications that may result in disturbing pain and functional loss.
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Affiliation(s)
- Michael Chu Kay Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Koo SCJJ, Pang H, Ho PC. Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation. J Wrist Surg 2023; 12:155-160. [PMID: 36923102 PMCID: PMC10010900 DOI: 10.1055/s-0041-1740485] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature. Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured. Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters. Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0-4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0-5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0-3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63-10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction. Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals. Level of evidence This is a Level V study.
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Affiliation(s)
| | - Henry Pang
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong
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Yung WTB, Koo SCJJ, Mak CKM, Yu WPF, Tse WL, Ho PC. Clinical and Radiological Outcome of Osteoscopic-Assisted Treatment of Enchondroma in Hand with Artificial Bone Substitute or Bone Graft: A 7-Year Case Series and Literature Review. J Hand Surg Asian Pac Vol 2023; 28:214-224. [PMID: 37120310 DOI: 10.1142/s2424835523500236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background: This study aims to look at the intermediate-term clinical, functional and radiological outcomes of patients with enchondroma in hand treated with osteoscopic-assisted curettage and artificial bone substitute or bone graft. The addition of osteoscopy allows direct visualisation of the bone cavity during and after curettage of tumour tissue without the need of creating a large opening in the bone cortex. This could lead to better clearance of tumour tissue and lower risk of iatrogenic fracture. Methods: A total of 11 patients who received surgery from December 2013 to November 2020 were retrospectively reviewed. All cases had histological diagnosis of enchondroma. Patients with a follow-up period of less than 3 months were excluded. The mean duration of follow-up was 20.9 months. For the clinical outcome, we measured the total active motion (TAM) and graded with Belsky score grip strength. For the functional outcome, the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score was used. For the radiological outcome, we evaluated the X-ray for bone cavity filling defect, new bone formation according to the system proposed by Tordai. Results: The mean TAM of patients was 257º. A total of 60% patients had Belsky score grading excellent, 40% patients had Belsky score grading good. The mean percentage of grip strength compared with the contralateral side was 86.2%. The mean QuickDASH score was 7.7. For the wound aesthetic rating by patients, 81.8% patients reported as excellent. For the radiological outcome, the postoperative X-ray of all patients showed bone filling defect less than 3 mm. The mean time to complete bone consolidation was 3.8 months. None of the patients showed any radiological signs of recurrence. Conclusions: Our study showed that patients with enchondromas in hand treated with this minimally invasive method demonstrated good functional and radiological outcome. Its application may also be extended into treating other benign bone lesions in hand. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Wai Tat Bernard Yung
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po District, Hong Kong
| | | | - Chu Kay Michael Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin District, Hong Kong
| | - Wai Ping Fiona Yu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin District, Hong Kong
| | - Wing Lim Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin District, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin District, Hong Kong
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Abstract
Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. In this review, world leaders of wrist arthroscopy describe bone graft for scaphoid nonunion, transosseous repair for triangular fibrocartilage fovea avulsion, palmaris longus reconstruction of the triangular fibrocartilage, and arthroscopic reconstruction of the scapholunate and lunotriquetral ligaments.
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Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Pak Cheong Ho
- Department of Orthopaedic & Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy
| | - Fernando Corella
- Hand Surgery Unit, Orthopadic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
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Chow ECS, Chan YLC, Ko CW, Ho PC. Treatment of Dangling-Type Thumb Polydactyly: Suture Ligation vs. Surgical Excision. J Hand Surg Asian Pac Vol 2021; 26:351-358. [PMID: 34380401 DOI: 10.1142/s2424835521500314] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: To review the cases of dangling-type thumb polydactyly treated with suture ligation vs surgical excision. Methods: Cases of dangling-type thumb polydactyly treated in 2 different hospitals from 1994 to 2014 were recruited. Group 1 includes cases treated with suture ligation in hospital 1; Group 2 includes cases treated with surgical excision in hospital 2. The demographics data, early clinical outcomes and early complications were retrieved from clinical notes. All cases were contacted for a final assessment. Results: There were 23 cases recruited in group 1 and 26 cases recruited in group 2. The mean age at the time of procedure was 15.9 days (group 1) vs. 14 months (group 2). The infection rate was comparable in both groups (4.35% vs. 3.85%). 12 cases in group 1 and 14 cases in group 2 completed a final assessment. Residual tissue is common in group 1 (58.5%) and 4 cases (33.3%) required revision surgery. No case in group 2 had residual tissue and none require revision surgery. There was no painful neuroma in both groups and all patients achieved normal thumb and hand functions. The parental satisfaction score was 7.8 (group 1) and 8.8 (group 2) with no statistical difference (p = 0.061). Conclusions: Suture ligation and surgical excision are safe and effective treatment options for dangling-type thumb polydactyly. Both methods received comparable parental satisfaction. However, residual tissue is common after suture ligation while this problem is not observed after surgical excision.
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Ng AWH, Griffith JF, Tsoi C, Fong RCW, Mak MCK, Tse WL, Ho PC. Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome. Korean J Radiol 2021; 22:1132-1141. [PMID: 33987990 PMCID: PMC8236373 DOI: 10.3348/kjr.2020.1039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 08/28/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.
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Affiliation(s)
- Alex Wing Hung Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carita Tsoi
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Raymond Chun Wing Fong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michael Chu Kay Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Lim Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Koo SCJJ, Leung KYA, Chau WW, Ho PC. Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment. J Wrist Surg 2021; 10:102-110. [PMID: 33815944 PMCID: PMC8012086 DOI: 10.1055/s-0040-1719039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.
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Affiliation(s)
| | - Kam Yiu Adrian Leung
- Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Wai Wang Chau
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
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Abstract
Background Volar wrist ganglion is the second most common wrist mass and accounts for 20% of all cases. Surgery is the gold standard for persistent and symptomatic ganglia. Arthroscopic resection has gained popularity in the past two decades. Application of this technique to ganglia in less accessible locations, such as the scaphotrapeziotrapezoidal (STT) joint, however, remains controversial. Case Description To date, no literature has described using the STT -ulnar (STT-u) and STT -radial (STT-r) joint portals for ganglionic resection. Literature Review In this report, two cases of arthroscopic ganglionic resection utilizing the STT-u and STT-r joint portals at our institution were described. Clinical Relevance Arthroscopic resection of STT joint ganglion under portal site local anesthesia is a technically feasible, safe, and effective approach. There was no recurrence observed for both cases at 50 months of follow-up.
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Affiliation(s)
- Ho Lam Chai
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Cabello Álvaro Pérez
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Wai Ping Fiona Yu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
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Kakar S, Burnier M, Atzei A, Ho PC, Herzberg G, Del Piñal F. Dry Wrist Arthroscopy for Radial-Sided Wrist Disorders. J Hand Surg Am 2020; 45:341-353. [PMID: 32122689 DOI: 10.1016/j.jhsa.2020.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
The development of wrist arthroscopy has been useful in diagnosis, prognosis, and treatment of both ligament and osseous injuries. As the treatment indications and techniques become more refined, this article explores the role of dry arthroscopy to treat radial-sided disorders of the wrist.
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Affiliation(s)
- Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
| | - Marion Burnier
- Service Chirurgie Orthopédique Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
| | - Andrea Atzei
- Hand Surgery Unit, Policlinico G.B. Rossi, Verona, Italy
| | - P C Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Guillaume Herzberg
- Service Chirurgie Orthopédique Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
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Ng AWH, Griffith JF, Tong CSL, Law EKC, Tse WL, Wong CWY, Ho PC. MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Skeletal Radiol 2020; 49:397-405. [PMID: 31396669 DOI: 10.1007/s00256-019-03291-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study MRI criteria for diagnosing and predicting severity of carpal tunnel syndrome (CTS). METHODS Sixty-nine wrists in 41 symptomatic CTS patients and 32 wrists in 28 asymptomatic subjects were evaluated by MRI. Circumferential surface area (CSA), flattening ratio, relative median nerve signal intensity, and retinacular bowing were measured. CTS severity was classified as mild, moderate, or severe. Parameters for patients with and without CTS and for the three severity groups were compared. ROC curves were plotted to assess accuracy for CTS diagnosis and severity prediction. RESULTS Significant differences were found between CTS and control wrists for median nerve CSA, flattening ratio at inlet, relative median nerve signal intensity, and retinacular bowing. ROC curve analysis revealed a sensitivity, specificity, and accuracy of median nerve CSA > 15 mm2 proximal to the tunnel (CSAp) of 85.5, 100, and 90.1%. Using either CSAp or CSAd > 15 mm2 as a diagnostic criterion, MRI could achieve a sensitivity of 100% and specificity of 94% for diagnosis of CTS while overall accuracy was 98%. Significant differences were found among the three severity groups. Sensitivity, specificity, and accuracy of prediction of severe CTS using for CSAp > 19 mm2 were 75.0, 65.9, and 69.6%, respectively. CONCLUSIONS MRI is highly accurate at diagnosing CTS and moderately accurate at determining CTS severity. We recommend using CSA > 15 mm2 either proximal to or distal to the tunnel as a diagnostic criterion for CTS and CSA > 19 mm2 proximal to the tunnel as a marker for severe CTS.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong.
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
| | - Eric K C Law
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
| | - W L Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
| | - Clara W Y Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
| | - P C Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T, Hong Kong
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Li HWR, Ko JKY, Lee VCY, Yung SSF, Lau EYL, Yeung WSB, Ho PC, Ng EHY. Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial. Ultrasound Obstet Gynecol 2020; 55:303-309. [PMID: 31325336 DOI: 10.1002/uog.20402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on antral follicle count (AFC) vs serum anti-Müllerian hormone (AMH) level, in women undergoing in-vitro fertilization (IVF) using the gonadotropin-releasing hormone (GnRH) antagonist protocol. METHODS This was a randomized double-blind trial carried out in a university-affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH-antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1 month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC > 5 and those with baseline AFC ≤ 5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian-stimulation cycle was assessed using Cohen's kappa (κ). RESULTS There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups (P = 0.479). The median number of oocytes retrieved was nine vs seven (P = 0.070), and the median follicular output rate was 0.54 vs 0.55 (P = 0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC ≤ 5 and AFC > 5 at the start of ovarian stimulation (P > 0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle (κ = 0.478 and 0.587, respectively). CONCLUSION The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH-antagonist protocol is similar when the gonadotropin-dosing algorithm used is based on AFC or serum AMH level. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H W R Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Shenzhen Key Laboratory on Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, People's Republic of China
| | - J K Y Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - V C Y Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S S F Yung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Shenzhen Key Laboratory on Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, People's Republic of China
| | - E Y L Lau
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W S B Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Shenzhen Key Laboratory on Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, People's Republic of China
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Shenzhen Key Laboratory on Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, People's Republic of China
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Shenzhen Key Laboratory on Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, People's Republic of China
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Li H, He YL, Li R, Wong C, Sy B, Lam CW, Lam K, Peng HM, Mu S, Schooling M, Yeung W, Ho PC, Ng E. Age-specific reference ranges of serum anti-müllerian hormone in healthy women and its application in diagnosis of polycystic ovary syndrome: a population study. BJOG 2020; 127:720-728. [PMID: 32009280 DOI: 10.1111/1471-0528.16147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To establish the age-specific centiles of serum anti-müllerian hormone (AMH) levels in Chinese women, and to explore the use of multiples of median (MoM) AMH levels for the diagnosis of polycystic ovary syndrome (PCOS). DESIGN An observational study. SETTING University-affiliated hospitals and community clinics. POPULATION We included 3137 healthy women aged 20-44 years recruited prospectively or who had archived serum samples from previous research projects. Another validation cohort of 751 women with PCOS as well as ovulatory controls, which was a convenient sample of women attending for infertility or menstrual disorders, was also studied. METHODS The serum samples were assayed for AMH by the automated Access AMH assay. MAIN OUTCOME MEASURES Age-specific reference ranges were constructed on the primary cohort with the Lambda-Mu-Sigma method. The MoM AMH of each subject in the validation cohort was calculated. RESULTS Centile curves of serum AMH level against age were established. MoM AMH was significantly higher in women with PCOS than in controls (P < 0.05). The area under the ROC curve was 0.852 (95% confidence interval [CI] 0.825-0.877) (P < 0.0001) for discriminating women with PCOS from ovulatory controls by MoM AMH. CONCLUSIONS We established a set of year-by-year age-specific reference ranges of serum AMH levels in Chinese women. The MoM AMH derived from this set of reference ranges is a promising tool to replace antral follicle count in the diagnosis of PCOS. TWEETABLE ABSTRACT A set of age-specific reference ranges of AMH levels was established in Chinese women. Multiples of median AMH may be used to diagnose PCOS.
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Affiliation(s)
- Hwr Li
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.,The Family Planning Association of Hong Kong, Hong Kong, Hong Kong
| | - Y-L He
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - R Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Cyg Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.,The Family Planning Association of Hong Kong, Hong Kong, Hong Kong
| | - B Sy
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - C W Lam
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ksl Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - H-M Peng
- Reproductive Medicine Center, People's Liberation Army General Hospital, Beijing, China
| | - S Mu
- Reproductive Medicine Center, People's Liberation Army General Hospital, Beijing, China
| | - M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wsb Yeung
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - P C Ho
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ehy Ng
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
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Lui MW, Yeung WSB, Ho PC, Ng EHY. In vitro fertilisation in Hong Kong: the situation in 2019. Hong Kong Med J 2019; 25:468-472. [PMID: 31796641 DOI: 10.12809/hkmj198057] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The popularity of in vitro fertilisation has continuously increased throughout the past 40 years owing to an increased incidence of infertility and delayed planning for pregnancy. The aim of this paper is to review the current situation of in vitro fertilisation in Hong Kong. In Hong Kong, in 2018, 7995 women underwent 5055 fresh and 5050 frozen-thawed embryo in vitro fertilisation cycles, resulting in an ongoing pregnancy rate of 33.7% per transfer. However, in vitro fertilisation is associated with several problems, including a high rate of multiple pregnancies and risks associated with cross-border reproductive care. Single embryo transfer is a simple strategy to reduce multiple pregnancies without compromising the cumulative live birth rate.
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Affiliation(s)
- M W Lui
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - W S B Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
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14
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Wong YC, Ho PC. Arthroscopic Thermal Shrinkage: A Novel Method for the Treatment of Chronic Volar Plate Instability at the Metacarpal Phalangeal Joint of the Thumb. J Hand Surg Asian Pac Vol 2019; 24:347-352. [PMID: 31438798 DOI: 10.1142/s2424835519500449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Chronic volar plate instability of the thumb metacarpal phalangeal joint (MCPJ) is a disabling clinical problem. Patients usually present with pain and disability in terms of reduction in pinch and grip power. Numerous surgical techniques have been described for the treatment of this condition. Here we describe a novel method for the treatment of this condition by thermal shrinkage of the volar plate via thumb MCPJ arthroscopy. Methods: A retrospective review of 8 patients with chronic thumb MCPJ volar plate instability treated with the novel technique of thermal shrinkage of the volar plate via thumb MCPJ arthroscopy. The primary outcome is maintenance of saggital plane stability at the thumb MCPJ. Secondary outcomes include pinch and grip power, The Disabilities of the Arm, Shoulder and Hand (DASH) Score and thumb MCPJ range of movement. The duration of follow up and complications were also reviewed. Results: The mean follow up period was 41.4 months (range, 2-134 months). One case had recurrence of instability requiring open volar plate capsulodesis. All other cases had their thumb hyperextensibility resolved and maintained throughout the entire follow up period, up to 134 months for the case with the longest duration of follow up. Conclusions: Preliminary results suggest this novel, minimally invasive technique for the treatment of thumb MCPJ volar plate instability is effective and the long term follow up results are durable.
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Affiliation(s)
- Yu Chung Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Pak Cheong Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
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15
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Ng AWH, Tong CSL, Hung EHY, Griffith JF, Tse WL, Wong CWY, Mak MCK, Ho PC. Top-Ten Tips for Imaging the Triangular Fibrocartilaginous Complex. Semin Musculoskelet Radiol 2019; 23:436-443. [PMID: 31170740 DOI: 10.1055/s-0039-1688715] [Citation(s) in RCA: 3] [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: 10/26/2022]
Abstract
The triangular fibrocartilage complex (TFCC) is a crucial structure for both maintaining the stability of the distal radioulnar joint (DRUJ) and acting as a cushion for axial loading of the ulnocarpal joint. Injury to the TFCC can lead to early degeneration of the DRUJ and ulnocarpal joint, with resultant chronic wrist pain and weakness. The TFCC is a moderately complex structure with several attachments to the adjacent bony and cartilaginous structures. Familiarity with the anatomy of the TFCC is a prerequisite for identification of TFCC tears. Several pitfalls can occur while assessing the TFCC on magnetic resonance imaging (MRI) if one is not familiar with the MRI appearances. This article illustrates key tips for diagnosing TFCC tears on MRI.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Esther H Y Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - W L Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Clara W Y Wong
- Hand, Wrist, Elbow and Microsurgery Clinic, Chinese University of Hong Kong
| | - Michael C K Mak
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - P C Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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16
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Lee RKL, Griffith JF, Ng AWH, Tipoe GL, Chan AWH, Wong CWY, Tse WL, Ho PC. Cross-sectional area of the median nerve at the wrist: Comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019; 47:122-127. [PMID: 30597562 DOI: 10.1002/jcu.22647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 07/13/2018] [Accepted: 09/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study compares median nerve cross-sectional area (CSA) measurements at the wrist obtained with ultrasound (US) and magnetic resonance imaging (MRI) using cadaveric measurements as the gold standard. METHODS Median nerve CSA was measured using US and MRI in 9 cadaveric wrists obtained from 5 subjects at 5 locations: distal forearm, proximal to tunnel inlet, at tunnel inlet, at tunnel outlet, and distal to tunnel outlet and then on identical cadaveric transverse sections obtained with a bandsaw. All US, MRI, and cadaveric measurements were repeated to determine reliability. Median nerves of 10 patients with clinical carpal tunnel syndrome (CTS) were measured with US and MRI using an identical method US. RESULTS Median nerve CSA MRI measurements correlated better (Pearson correlation: 0.80-0.95, P < .05) with cadaveric measurements than with US measurements (Pearson correlation: 0.61-0.79, P < .05). Median nerve CSA US measurements (8.6-12.5 mm2 , P < .05) were smaller at all levels than MRI (11.3-14.7 mm2 ) or cadaveric (11.0-14.9 mm2 ) measurements while MRI and cadaver measurements were similar at all levels. Median nerve CSA MRI measurements in CTS patients were larger than US measurements at all levels. CONCLUSION Median nerve CSA measurements by MRI are larger than US measurements and correlated better with cadaveric measurements. Median nerve CSA criteria used for diagnosing CTS on US are not likely to be applicable to MRI.
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Affiliation(s)
- Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - George L Tipoe
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong Island, Hong Kong
| | - Anthony W H Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - Clara W Y Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Wing Lim Tse
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
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17
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Yung SSF, Cheng MMC, Ma PWS, Ho PC. Candida glabrata chorioamnionitis and fungaemia complicating pregnancy following intrauterine insemination. Hong Kong Med J 2018. [DOI: 10.12809/hkmj164800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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18
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Abstract
The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3-10) preoperatively to 1.59 (range, 0-3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.
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Affiliation(s)
- Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University – Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk
| | - Kwang-Wook Choi
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University—Biomedical Research Institute of Chonbuk National University Hospital, Jeonju
| | - Sang-Hyun Woo
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, Republic of Korea
| | - Pak Cheong Ho
- Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Malrey Lee
- The Research Center for Advanced Image and Information Technology, School of Electronics & Information Engineering, Chonbuk National University, JeonJu, Chonbuk, Republic of Korea
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Abstract
The synthesis of mifepristone, an antiprogestin blocking the action of progesterone at the receptor level, started a new era of medical termination of pregnancy (MTOP). The initial results of MTOP with mifepristone alone were disappointing; however, mifepristone can sensitise the myometrium to the action of prostaglandins. Clinical trials have shown that the sequential administration of mifepristone followed 1-2 days later by a prostaglandin analogue is a safe, effective, and acceptable method for MTOP. This article will review the events and challenges leading to the development of the current evidence-based and yet off-label regimen for first-trimester MTOP. TWEETABLE ABSTRACT This article reviews the events and challenges in the development of medical termination of pregnancy.
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Affiliation(s)
- P C Ho
- Centre of Reproductive Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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20
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Ng AWH, Griffith JF, Fung CSY, Lee RKL, Tong CSL, Wong CWY, Tse WL, Ho PC. MR imaging of the traumatic triangular fibrocartilaginous complex tear. Quant Imaging Med Surg 2017; 7:443-460. [PMID: 28932701 DOI: 10.21037/qims.2017.07.01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cindy S Y Fung
- Department of Diagnostic Imaging, North District Hospital, Hong Kong, China
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Clara W Y Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Lim Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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21
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Chow JF, Yeung WS, Lee VC, Lau EY, Ho PC, Ng EH. Preimplantation genetic diagnosis and screening by array comparative genomic hybridisation: experience of more than 100 cases in a single centre. Hong Kong Med J 2017; 23:129-33. [PMID: 28211357 DOI: 10.12809/hkmj164883] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation. METHODS This study of case series was conducted in a tertiary assisted reproductive centre in Hong Kong. Patients who underwent preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening between 1 April 2012 and 30 June 2015 were included. They underwent in-vitro fertilisation and intracytoplasmic sperm injection. An embryo biopsy was performed on day-3 embryos and the blastomere was subject to array comparative genomic hybridisation. Embryos with normal copy numbers were replaced. The ongoing pregnancy rate, implantation rate, and miscarriage rate were studied. RESULTS During the study period, 133 cycles of preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening were initiated in 94 patients. Overall, 112 cycles proceeded to embryo biopsy and 65 cycles had embryo transfer. The ongoing pregnancy rate per transfer cycle after preimplantation genetic screening was 50.0% and that after preimplantation genetic diagnosis was 34.9%. The implantation rates after preimplantation genetic screening and diagnosis were 45.7% and 41.1%, respectively and the miscarriage rates were 8.3% and 28.6%, respectively. There were 26 frozen-thawed embryo transfer cycles, in which vitrified and biopsied genetically transferrable embryos were replaced, resulting in an ongoing pregnancy rate of 36.4% in the screening group and 60.0% in the diagnosis group. CONCLUSIONS The clinical outcomes of preimplantation genetic diagnosis and screening using comparative genomic hybridisation in our unit were comparable to those reported internationally. Genetically transferrable embryos replaced in a natural cycle may improve the ongoing pregnancy rate and implantation rate when compared with transfer in a stimulated cycle.
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Affiliation(s)
- J Fc Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W Sb Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - V Cy Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
| | - E Yl Lau
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Hy Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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22
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Ko JK, Chai J, Lee VC, Li RH, Lau E, Ho KL, Tam PC, Yeung WS, Ho PC, Ng EH. Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong. Hong Kong Med J 2016; 22:556-62. [PMID: 27687508 DOI: 10.12809/hkmj154710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE There are currently no local data on the sperm retrieval and pregnancy rates in in-vitro fertilisation and testicular sperm extraction cycles, especially with regard to the presence of genetic abnormalities. This study aimed to determine the sperm retrieval and pregnancy rates in infertile couples who underwent in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia. METHODS This retrospective case series was conducted at a tertiary assisted reproduction unit in Hong Kong. Men with non-obstructive azoospermia who underwent in-vitro fertilisation and testicular sperm extraction between January 2001 and December 2013 were included. The main outcome measures were sperm retrieval and pregnancy rates. RESULTS During the study period, 89 men with non-obstructive azoospermia underwent in-vitro fertilisation and testicular sperm extraction. Sperm was successfully retrieved in 40 (44.9%) men. There was no statistically significant difference in the sperm retrieval rate of those with karyotypic abnormalities (2/5, 40.0% vs 28/61, 45.9%; P=1.000) and AZFc microdeletion (3/6, 50.0% vs 28/61, 45.9%; P=1.000) compared with those without. Sperms were successfully retrieved in patients who had mosaic Klinefelter syndrome (2/3, 66.7%) but not in the patient with non-mosaic Klinefelter syndrome. No sperms were found in men with AZFa or AZFb microdeletions. Pregnancy test was positive in 15 (16.9%) patients and the clinical pregnancy rate was 13.5% (12/89) per cycle. The clinical pregnancy rate per transfer was 34.3% (12/35). CONCLUSIONS The sperm retrieval rate and clinical pregnancy rate per initiated cycle in men undergoing in-vitro fertilisation and testicular sperm extraction in our unit were 44.9% and 13.5%, respectively. No sperms could be retrieved in the presence of AZFa and AZFb microdeletions, but karyotype and AZFc microdeletion abnormalities otherwise did not predict the success of sperm retrieval in couples undergoing in-vitro fertilisation and testicular sperm extraction. Genetic tests are important prior to testicular sperm extraction for patient selection and genetic counselling.
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Affiliation(s)
- J Ky Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - J Chai
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - V Cy Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - R Hw Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Lau
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - K L Ho
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.,Private practice
| | - P C Tam
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.,Private practice
| | - W Sb Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Hy Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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23
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Lee VC, Chow JF, Lau EY, Kwong A, Leung SY, Yeung WS, Ho PC, Ng EH. Preimplantation genetic diagnosis for hereditary cancer syndrome: local experience. Hong Kong Med J 2016; 22:289-91. [PMID: 27305697 DOI: 10.12809/hkmj144499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- V Cy Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - J Fc Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - E Yl Lau
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - A Kwong
- Hong Kong Hereditary Breast Cancer Family Registry; Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - S Y Leung
- Hereditary Gastrointestinal Cancer Genetic Diagnosis Laboratory, Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W Sb Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - E Hy Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
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24
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Yung SSF, Lai SF, Lam MT, Lee VCY, Li RHW, Ho PC, Ng EHY. Randomized, controlled, double-blind trial of topical lidocaine gel and intrauterine lidocaine infusion for pain relief during saline contrast sonohysterography. Ultrasound Obstet Gynecol 2016; 47:17-21. [PMID: 26434382 DOI: 10.1002/uog.15775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the efficacy of topical lidocaine gel and intrauterine lidocaine infusion administered prior to saline contrast sonohysterography (SCSH) in reducing pain level during the procedure. METHODS This was a randomized, double-blind, placebo controlled trial. We recruited 120 women scheduled to undergo SCSH and randomized them into one of three groups according to administration of gel and intrauterine infusion immediately prior to the procedure: (1) the 'lidocaine gel' group received 3 mL 2% lidocaine gel applied to the cervix and intrauterine infusion, using an infant feeding tube without balloon, of 5 mL normal saline; (2) the 'lidocaine infusion' group received 3 mL gel lubricant applied to the cervix and intrauterine infusion of 5 mL 2% lidocaine; (3) the placebo group received 3 mL gel lubricant applied to the cervix and intrauterine infusion of 5 mL normal saline. The tube was left in place for the SCSH procedure. The primary outcome measure was the overall pain level (on a scale of 0-100) reported by the women during the SCSH procedure. Women also rated their pain levels at various other time points and an observer assessed visible signs of the women's discomfort during the procedure, producing a distress score. RESULTS There were no significant differences among the three groups in baseline characteristics, volume of saline solution infused, tenaculum use and duration and difficulty level of the SCSH procedure. The median (range) pain scores during normal saline infusion for the SCSH procedure were 0 (0-65) in the placebo group, 2.5 (0-80) in the lidocaine gel group, and 0 (0-70) in the lidocaine infusion group. The pain scores at other time points, the overall pain score and the distress score were also comparable for the three groups. No significant adverse events were reported. CONCLUSIONS SCSH performed with an infant feeding tube without balloon is associated with very low pain levels. Topical lidocaine gel application and intrauterine lidocaine infusion do not further reduce pain levels during SCSH.
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Affiliation(s)
- S S F Yung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - S F Lai
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - M T Lam
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - V C Y Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - R H W Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - P C Ho
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Yeung T, Chai J, Li R, Lee V, Ho PC, Ng E. A double-blind randomised controlled trial on the effect of dehydroepiandrosterone on ovarian reserve markers, ovarian response and number of oocytes in anticipated normal ovarian responders. BJOG 2015; 123:1097-105. [PMID: 26663817 DOI: 10.1111/1471-0528.13808] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effect of dehydroepiandrosterone (DHEA) on antral follicle count (AFC), ovarian response to a standard low dose of gonadotrophin stimulation and number of oocytes in anticipated normal responders undergoing in vitro fertilisation (IVF). DESIGN Randomised, double-blind, placebo-controlled study. SETTING Tertiary reproductive unit. POPULATION Seventy-two subfertile women with AFC of 5-15 scheduled for IVF. METHODS Eligible women were randomised into the DHEA group (n = 36), who received DHEA (GNC(®) , 25 mg three times a day), or the placebo group (n = 36), who received placebo, starting from 12 weeks before the scheduled IVF treatment according to a computer-generated randomisation list. Monthly assessment of AFC, serum anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) levels, ovarian response to a standard dose of gonadotrophin stimulation at week 8 and the number of oocytes obtained were compared. MAIN OUTCOME MEASURES The primary outcome was AFC after 12 weeks of DHEA or placebo. RESULTS DHEA for 12 weeks prior to IVF treatment in anticipated normal responders leads to significantly higher serum and follicular DHEA-S and testosterone relative to placebo. However, no significant differences in AFC, AMH and FSH, ovarian response to standard-dose ovarian stimulation and IVF cycle outcomes can be detected. CONCLUSION No significant differences in AFC, ovarian response to a standard low dose of gonadotrophin stimulation and number of oocytes obtained were detected in anticipated normal responders receiving 12 weeks of DHEA prior to IVF treatment relative to placebo. TWEETABLE ABSTRACT No difference in ovarian response markers in normal responders receiving 12 weeks of DHEA.
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Affiliation(s)
- Twy Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - J Chai
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Rhw Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Vcy Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Ehy Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
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Li HWR, Lam KSL, Tam S, Lee VCY, Yeung TWY, Cheung PT, Yeung WSB, Ho PC, Ng EHY. Screening for dysglycaemia by oral glucose tolerance test should be recommended in all women with polycystic ovary syndrome. Hum Reprod 2015. [PMID: 26202923 DOI: 10.1093/humrep/dev166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/31/2022] Open
Abstract
STUDY QUESTION Should fasting glucose (FG) or an oral glucose tolerance test (OGTT) be used to screen for dysglycaemia in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER A full OGTT should be recommended as the screening method for dysglycaemia in women with PCOS, regardless of BMI or family history of diabetes mellitus (DM). STUDY DESIGN, SIZE, DURATION A cross-sectional study on 467 Chinese women diagnosed with PCOS by the Rotterdam criteria between January 2010 to December 2013. PARTICIPANTS, SETTING, METHODS The study was done at a university hospital in Hong Kong. All subjects underwent a 75 g OGTT after overnight fasting. We evaluated the performance of FG alone, when compared with the full OGTT, in identifying subjects with dysglycaemia (prediabetes or DM, according to the 2010 diagnostic criteria of the American Diabetes Association). MAIN RESULTS AND THE ROLE OF CHANCE Of the 467 subjects, 58 (12.4%) had dysglycaemia, among which 46 (9.8%) had prediabetes and 12 (2.6%) had DM, including 4 with known DM. Of the 46 subjects with prediabetes, 25 (54.3%) had normal FG and of the 8 subjects with screened DM in this study, 1 (12.5%) had normal FG. The sensitivity of FG alone in screening for prediabetes, DM and overall dysglycaemia were 45.7, 87.5 and 48.1%, respectively, i.e. missing 54.3% of prediabetes and 12.5% of DM cases as defined by the OGTT. Among the 54 subjects with screened dysglycaemia, 20 (37.0%) had BMI < 25 kg/m(2) and 35 (64.8%) had no family history of DM. LIMITATIONS, REASONS FOR CAUTION We only reported on the biochemical diagnosis of DM based on a single time point. In clinical practice, confirmatory results at another time point is required for definitive diagnosis in asymptomatic subjects. WIDER IMPLICATIONS OF THE FINDINGS There is an ongoing debate as to whether FG or an OGTT should be used as a screening method for dysglycaemia in women with PCOS. Some guidelines also recommend glucose screening only in those who are overweight and/or having family history of diabetes (DM). There have been scarce data on this issue in the Chinese population, which the current study aims at addressing. STUDY FUNDING/COMPETING INTERESTS The study was supported by a research grant from the Hong Kong Obstetrical and Gynaecological Trust Fund, as well as internal research funding of the Department of Obstetrics and Gynaecology, The University of Hong Kong. All authors have no competing interests.
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Affiliation(s)
- H W R Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - K S L Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - V C Y Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
| | - T W Y Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
| | - P T Cheung
- Department of Paediatric and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W S B Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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Chow JFC, Yeung WSB, Lee VCY, Lau EYL, Ho PC, Ng EHY. Experience of more than 100 preimplantation genetic diagnosis cycles for monogenetic diseases using whole genome amplification and linkage analysis in a single centre. Hong Kong Med J 2015; 21:299-303. [PMID: 26044869 DOI: 10.12809/hkmj144436] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To report the outcomes of more than 100 cycles of preimplantation genetic diagnosis for monogenetic diseases. DESIGN Case series. SETTING Tertiary assisted reproductive centre in Hong Kong, where patients needed to pay for the cost of preimplantation genetic diagnosis on top of standard in-vitro fertilisation charges. PATIENTS Patients undergoing preimplantation genetic diagnosis for monogenetic diseases at the Centre of Assisted Reproduction and Embryology, Queen Mary Hospital-The University of Hong Kong between 1 August 2007 and 30 April 2014 were included. INTERVENTIONS In-vitro fertilisation, intracytoplasmic sperm injection, embryo biopsy, and preimplantation genetic diagnosis. MAIN OUTCOME MEASURES Ongoing pregnancy rate and implantation rate. RESULTS Overall, 124 cycles of preimplantation genetic diagnosis were initiated in 76 patients, 101 cycles proceeded to preimplantation genetic diagnosis, and 92 cycles had embryo transfer. The ongoing pregnancy rate was 28.2% per initiated cycle and 38.0% per embryo transfer, giving an implantation rate of 35.2%. There were 16 frozen-thawed embryo transfer cycles in which, following preimplantation genetic diagnosis, cryopreserved embryos were replaced resulting in an ongoing pregnancy rate of 37.5% and implantation rate of 30.0%. The cumulative ongoing pregnancy rate was 33.1%. The most frequent indication for preimplantation genetic diagnosis was thalassaemia, followed by neurodegenerative disorder and cancer predisposition. There was no misdiagnosis. CONCLUSIONS Preimplantation genetic diagnosis is a reliable method to prevent couples conceiving fetuses severely affected by known genetic disorders, with ongoing pregnancy and implantation rates similar to those for in-vitro fertilisation for routine infertility treatment.
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Affiliation(s)
- Judy F C Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - William S B Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Vivian C Y Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
| | - Estella Y L Lau
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Li W, Yang J, Zhu XS, Li SC, Ho PC. Correlation between tea consumption and prevalence of hypertension among Singaporean Chinese residents aged ⩾40 years. J Hum Hypertens 2015; 30:11-7. [PMID: 26016594 DOI: 10.1038/jhh.2015.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 02/07/2023]
Abstract
By a cross-sectional epidemiology study, we attempted to correlate the consumption of tea and/or health supplements, living habits and socio-demographic factors to the prevalence of hypertension among Singaporean Chinese residents. Singaporean Chinese residents aged ⩾40 years were randomly selected and interviewed face-to-face by clinical research assistants. Hypertension was defined as measured systolic blood pressure at least 140 mm Hg and/or diastolic blood pressure at least 90 mmHg or self-reported history/treatment for hypertension. The prevalence of hypertension among the whole investigated population (N=1184, 58.27% females) was 49.73% and the prevalence increased to 66.47% in the sub-population aged ⩾60 years. High risk of hypertension was associated with age ⩾60 years (odds ratio (OR): 4.15-4.19, P<0.01), obesity (body mass index >25 kg m(-2), OR: 2.10-2.11, P<0.01), family history of hypertension (OR: 2.69-2.76, P<0.01), diabetes history (OR: 2.29-2.33, P<0.01), hyperlipidemia history (OR: 1.79-1.80, P<0.01), male (OR: 1.56-1.59, P<0.01) and coffee intake (OR: 1.44-1.46, P<0.05). In contrast, drinking green tea at least 150 ml per week was associated with lower hypertension risk (OR: 0.63, 95% confidence interval (CI): 0.43-0.91, P<0.05). Drinking combination of green tea and British tea was associated with higher reduction in the risk of hypertension (OR: 0.58, 95% CI: 0.39-0.85, P<0.05). This cross-sectional study suggests that consumption of tea, especially green tea and British tea, was associated with lowering the risk of hypertension. On the other hand, consumption of coffee could be a risk factor of hypertension. These findings may provide useful information for health promotion to reduce risk of hypertension and warrant further study to confirm and elucidate such association.
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Affiliation(s)
- W Li
- Singapore College of Traditional Chinese Medicine, Singapore, Singapore.,Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - J Yang
- National University Hospital of Singapore, Singapore, Singapore
| | - X S Zhu
- Centre for Complementary Medicine Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - S C Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - P C Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
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Liu WH, Lok J, Lau MS, Hung YW, Wong CWY, Tse WL, Ho PC. Mechanism and epidemiology of paediatric finger injuries at Prince of Wales Hospital in Hong Kong. Hong Kong Med J 2015; 21:237-42. [PMID: 25953929 DOI: 10.12809/hkmj144344] [Citation(s) in RCA: 7] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012. DESIGN Comparison of two case series. SETTING University-affiliated teaching hospital, Hong Kong. PATIENTS This was a retrospective study of two cohorts of children (age, 0 to 16 years) admitted to Prince of Wales Hospital with finger injuries during two 3-year periods. Comparisons were made between the two groups for age, involved finger(s), mechanism of injury, treatment, and outcome. Telephone interviews were conducted for parents of children who sustained a crushing injury of finger(s) by door. RESULTS A total of 137 children (group A) were admitted from 1 January 2003 to 31 December 2005, and 109 children (group B) were admitted from 1 January 2010 to 31 December 2012. Overall, the mechanisms and epidemiology of paediatric finger injuries were similar between groups A and B. Most finger injuries occurred in children younger than 5 years (group A, 56%; group B, 76%) and in their home (group A, 67%; group B, 69%). The most common mechanism was crushing injury of finger by door (group A, 33%; group B, 41%) on the hinge side (group A, 63%; group B, 64%). The right hand was most commonly involved. The door was often closed by another child (group A, 37%; group B, 23%) and the injury often occurred in the presence of adults (group A, 60%; group B, 56%). Nailbed injury was the commonest type of injury (group A, 31%; group B, 39%). Fractures occurred in 24% and 23% in groups A and B, respectively. Traumatic finger amputation requiring replantation or revascularisation occurred in 12% and 10% in groups A and B, respectively. CONCLUSIONS Crushing injury of finger by door is the most common mechanism of injury among younger children and accounts for a large number of hospital admissions. Serious injuries, such as amputations leading to considerable morbidity, can result. Crushing injury of finger by door occurs even in the presence of adults. There has been no significant decrease in the number of crushing injuries of finger by door in the 5 years between the two studies despite easily available and affordable preventive measures. It is the authors' view that measures aimed at promoting public awareness and education, and safety precautions are needed.
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Affiliation(s)
- W H Liu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Johann Lok
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - M S Lau
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Y W Hung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Clara W Y Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W L Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - P C Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Kwok SK, Ho PC, Leung SF, Sonal KF. Surgical result of radiation-induced cataract in Chinese patients with nasopharyngeal carcinoma. Dev Ophthalmol 2015; 26:14-8. [PMID: 7895876 DOI: 10.1159/000423757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S K Kwok
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital
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Hung YW, Ko WS, Liu WH, Chow CS, Kwok YY, Wong CWY, Tse WL, Ho PC. Local review of treatment of hand enchondroma (artificial bone substitute versus autologous bone graft) in a tertiary referral centre: 13 years' experience. Hong Kong Med J 2015; 21:217-23. [PMID: 25810024 DOI: 10.12809/hkmj144325] [Citation(s) in RCA: 6] [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
OBJECTIVE To evaluate the treatment outcomes of enchondroma of the hand with artificial bone substitute versus autologous (iliac) bone graft. DESIGN Historical cohort study. SETTING Tertiary referral centre, Hong Kong. PATIENTS A total of 24 patients with hand enchondroma from January 2001 to December 2013 who underwent operation at the Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital in Hong Kong were reviewed. Thorough curettage of the tumour was performed in all patients, followed by either autologous bone graft impaction under general anaesthesia in 13 patients, or artificial bone substitute in 11 patients (10 procedures were performed under local or regional anaesthesia and 1 was done under general anaesthesia). The functional outcomes and bone incorporation were measured by QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire) scores and radiological appearance, respectively. The mean follow-up period was 59 months. RESULTS There were eight men and 16 women, with a mean age of 40 years. Overall, 17 cases involved phalangeal bones and seven involved metacarpal bones. Among both groups of patients, most of the affected digits had good range of motion and function after surgery. One patient in each study group had complications of local soft tissue inflammation. One patient in the artificial bone substitute group was suspected to have recurrence 8 years after operation. Among the autologous bone graft group, four patients had persistent donor site morbidity at the last follow-up. In all patients, radiographs showed satisfactory bone incorporation. CONCLUSIONS Artificial bone substitute is a safe and effective treatment option for hand enchondroma, with satisfactory functional and radiographic outcomes. Artificial bone substitute offers the additional benefits of enabling the procedure to be done under local anaesthesia on a day-case basis with minimal complications.
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Affiliation(s)
- Y W Hung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - W S Ko
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - W H Liu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - C S Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Y Y Kwok
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Clara W Y Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - W L Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - P C Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
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Cheung JPY, Tse WL, Ho PC. IRREDUCIBLE VOLAR SUBLUXATION OF THE PROXIMAL INTERPHALANGEAL JOINT DUE TO RADIAL COLLATERAL LIGAMENT INTERPOSITION: CASE REPORT AND REVIEW OF LITERATURE. ACTA ACUST UNITED AC 2015; 20:153-7. [DOI: 10.1142/s0218810415720053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Irreducible volar subluxation should be considered when assessing a patient with flexion deformity of the proximal interphalangeal finger joint (PIPJ). Primary assessment requires careful examination of the collateral ligaments and extensor tendon. Preoperative imaging such as ultrasound and MRI can help identify the interposed structures and plan the subsequent operation. Although rare, irreducible volar subluxation due to radial collateral ligament interposition is an important entity to be aware of. Prompt and appropriate management can prevent joint stiffness and loss of function.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong SAR, P. R. China
| | - Wing Lim Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong
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Yeung TW, Chai J, Li RH, Lee VC, Ho PC, Ng EH. Reply: Endometrial injury and reproductive outcomes: there's more to this story than meets the horse's blind eye. Hum Reprod 2015; 30:749-50. [PMID: 25605702 DOI: 10.1093/humrep/deu366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T W Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - J Chai
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - R H Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - V C Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
| | - E H Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
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Abstract
Malignant schwannoma (MPNST) is a rare tumor. Many of these cases occur in patients with neurofibromatosis type I (NF-1) and they usually present as a mass lesion which rapidly increase in size with or without neurological symptoms. Here we present an unusual case of MPNST along the radial nerve in which the patient has no underlying neurofibromatosis type I.
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Affiliation(s)
- Yu Chung Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China
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Lee VCY, Chow JFC, Lau EYL, Yeung WSB, Ho PC, Ng EHY. Comparison between fluorescent in-situ hybridisation and array comparative genomic hybridisation in preimplantation genetic diagnosis in translocation carriers. Hong Kong Med J 2014; 21:16-22. [PMID: 25345996 DOI: 10.12809/hkmj144222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the pregnancy outcome of the fluorescent in-situ hybridisation and array comparative genomic hybridisation in preimplantation genetic diagnosis of translocation carriers. DESIGN Historical cohort. SETTING A teaching hospital in Hong Kong. PATIENTS All preimplantation genetic diagnosis treatment cycles performed for translocation carriers from 2001 to 2013. RESULTS Overall, 101 treatment cycles for preimplantation genetic diagnosis in translocation were included: 77 cycles for reciprocal translocation and 24 cycles for Robertsonian translocation. Fluorescent in-situ hybridisation and array comparative genomic hybridisation were used in 78 and 11 cycles, respectively. The ongoing pregnancy rate per initiated cycle after array comparative genomic hybridisation was significantly higher than that after fluorescent in-situ hybridisation in all translocation carriers (36.4% vs 9.0%; P=0.010). The miscarriage rate was comparable with both techniques. The testing method (array comparative genomic hybridisation or fluorescent in-situ hybridisation) was the only significant factor affecting the ongoing pregnancy rate after controlling for the women's age, type of translocation, and clinical information of the preimplantation genetic diagnosis cycles by logistic regression (odds ratio=1.875; P=0.023; 95% confidence interval, 1.090-3.226). CONCLUSION This local retrospective study confirmed that comparative genomic hybridisation is associated with significantly higher pregnancy rates versus fluorescent in-situ hybridisation in translocation carriers. Array comparative genomic hybridisation should be the technique of choice in preimplantation genetic diagnosis cycles in translocation carriers.
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Affiliation(s)
- Vivian C Y Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Judy F C Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Estella Y L Lau
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - William S B Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Lam SC, Hung YW, Chow ECS, Wong CWY, Tse WL, Ho PC. Digital ischaemia: a rare but severe complication of jellyfish sting. Hong Kong Med J 2014; 20:460-3. [DOI: 10.12809/hkmj134155] [Citation(s) in RCA: 6] [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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Ko JKY, Huang VW, Li RHW, Yeung WSB, Ho PC, Chiu PCN. An in vitro study of the effect of mifepristone and ulipristal acetate on human sperm functions. Andrology 2014; 2:868-74. [PMID: 25168311 DOI: 10.1111/j.2047-2927.2014.00261.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 05/19/2014] [Revised: 07/13/2014] [Accepted: 07/25/2014] [Indexed: 01/11/2023]
Abstract
Ulipristal acetate (UPA) and mifepristone are currently well-established agents for emergency contraception. Both drugs are selective progestogen receptor modulators which have been shown to have better efficacy than the widely used levonorgestrel in prevention of pregnancy. However, there is only limited information on the action of UPA on sperm function. The present study compared the in vitro biological effects of mifepristone and UPA on human sperm functions. Spermatozoa from semen samples with normal semen parameters were isolated. Capacitated spermatozoa were pre-incubated with 0.04, 0.4, 4 and 40 μM mifepristone or UPA for 1 h. Sperm motility, viability, DNA integrity, capacitation, spontaneous acrosome reaction, spontaneous hyperactivation, zona pellucida (ZP) binding capability and intracellular calcium concentration ([Ca(2+)]i) were determined. The effects of mifepristone and UPA on progesterone-induced acrosome reaction, hyperactivation and [Ca(2+)]i were also studied. Our results showed that mifepristone and UPA dose-dependently suppressed progesterone-induced acrosome reaction, hyperactivation and [Ca(2+)]i at concentrations ≥0.4 μM in human spermatozoa. Both compounds did not affect sperm motility, viability, DNA integrity, capacitation, spontaneous acrosome reaction, spontaneous hyperactivation, ZP binding capability and [Ca(2+)]i. This study demonstrated that UPA and mifepristone modulate human sperm functions by acting as progesterone antagonists. The results enable us to gain a better understanding of the mechanisms by which mifepristone and UPA work for emergency contraception, and provide a scientific basis for their clinical application.
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Affiliation(s)
- J K Y Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
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Pan Y, Wang S, Zheng D, Tian W, Tian G, Ho PC, Cheng HS, Zhong Y. Hourglass-Like Constrictions of Peripheral Nerve in the Upper Extremity. Neurosurgery 2014; 75:10-22. [DOI: 10.1227/neu.0000000000000350] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The development of an hourglass-like constriction in the nerve is rare, and its origin is unknown. Its clinical manifestations are not well documented, and the treatment protocol has not been established.
OBJECTIVE:
To identify the cause, presentation, and possible treatment for patients with nerve palsies secondary to an hourglass-like constriction in the affected nerves.
METHODS:
Patients presenting with peripheral nerve palsy caused by an hourglass-like constriction of nerves were retrospectively investigated in 2 hand centers. The patients' presentation and neurological findings were reviewed, and the immunohistochemistry of excised specimens was studied.
RESULTS:
Forty-two patients who presented with 47 nerve palsies were examined. Forty-one patients experienced a sudden onset of pain in the upper limb, followed by flaccid paralysis in the affected muscles. Ten patients had multiple nerve involvement. Surgical exploration found 1 or more hourglass-like constrictions in the nerve. The treatments included internal neurolysis, neurorrhaphy, and nerve grafting. Thirty-one of 42 patients (36 nerves) were followed up for a mean of 48 months (range, 8–157 months). Fifteen of 16 nerves treated by neurolysis, 10 of 13 nerves treated by neurorrhaphy, and 4 of 7 nerves treated by nerve grafting had good recovery. CD8-positive T-lymphocyte infiltration was observed in all the excised specimens.
CONCLUSION:
The clinical presentation of patients with hourglass-like constrictions in their nerves is similar to that of patients with neuralgic amyotrophy. Histochemical analysis suggests that the pathogenesis may be immunological in origin. The role of surgery in this condition is uncertain.
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Affiliation(s)
- Yongwei Pan
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Shufeng Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Danfeng Zheng
- Department of Pathology, Peking University Health Science Center, Xueyuan Rd, Haidian District, Beijing, China
| | - Wen Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Guanglei Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Hi-shan Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Yanfeng Zhong
- Department of Pathology, Peking University Health Science Center, Xueyuan Rd, Haidian District, Beijing, China
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Chai J, Yeung TWY, Lee VCY, Li RHW, Lau EYL, Yeung WSB, Ho PC, Ng EHY. Live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers: Hong Kong experience. Hong Kong Med J 2014; 20:102-6. [PMID: 24531501 DOI: 10.12809/hkmj134065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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
OBJECTIVE To compare the live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers. DESIGN Case series with internal comparisons. SETTING University affiliated hospital, Hong Kong. PARTICIPANTS Between October 2009 and December 2011, 206 women underwent their first in-vitro fertilisation cycle. Elective single embryo transfer was offered to women who were aged 35 years or below, and had endometrial thickness of 8 mm or more and at least two embryos of good quality. MAIN OUTCOME MEASURES Live birth rate, multiple birth rate, and obstetric outcomes. RESULTS Among the 206 eligible women, 74 underwent an elective single embryo transfer and 132 a double embryo transfer. The live birth rate was comparable in the two groups, being 39.2% in the elective single embryo transfer group and 43.2% in the double embryo transfer group, while the multiple pregnancy rate was significantly lower in the elective single embryo transfer group than the double embryo transfer group (6.9% vs 40.4%; P<0.001). Gestational ages and birth weights were comparable in the two groups. There was no significant difference between the two groups with respect to the rate of preterm delivery and antenatal complications (27.6% vs 43.9%, respectively; P>0.05). CONCLUSION In this selected population, an elective single embryo transfer policy decreases the multiple pregnancy rate without compromising the live birth rate. The non-significant difference in antenatal complications may be related to the small sample size.
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Affiliation(s)
- Joyce Chai
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tracy W Y Yeung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Vivian C Y Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Raymond H W Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Estella Y L Lau
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - William S B Yeung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - P C Ho
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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Ng AWH, Griffith JF, Taljanovic MS, Li A, Tse WL, Ho PC. Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union? Skeletal Radiol 2013; 42:983-92. [PMID: 23653220 DOI: 10.1007/s00256-013-1627-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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] [Received: 12/18/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) as a measure of vascularity in scaphoid delayed-union or non-union. MATERIALS AND METHODS Thirty-five patients (34 male, one female; mean age, 27.4 ± 9.4 years; range, 16-51 years) with scaphoid delayed-union and non-union who underwent DCE MRI of the scaphoid between September 2002 and October 2012 were retrospectively reviewed. Proximal fragment vascularity was classified as good, fair, or poor on unenhanced MRI, contrast-enhanced MRI, and DCE MRI. For DCE MRI, enhancement slope, Eslope comparison of proximal and distal fragments was used to classify the proximal fragment as good, fair, or poor vascularity. Proximal fragment vascularity was similarly graded at surgery in all patients. Paired t test and McNemar test were used for data comparison. Kappa value was used to assess level of agreement between MRI findings and surgical findings. RESULTS Twenty-five (71 %) of 35 patients had good vascularity, four (11 %) had fair vascularity, and six (17 %) had poor vascularity of the proximal scaphoid fragment at surgery. DCE MRI parameters had the highest correlation with surgical findings (kappa = 0.57). Proximal scaphoid fragments with surgical poor vascularity had a significantly lower Emax and Eslope than those with good vascularity (p = 0.0043 and 0.027). The sensitivity, specificity, positive and negative predictive value and accuracy of DCE MRI in predicting impaired vascularity was 67, 86, 67, 86, and 80 %, respectively, which was better than that seen with unenhanced and post-contrast MRI. Flattened time intensity curves in both proximal and distal fragments were a feature of protracted non-union with a mean time interval of 101.6 ± 95.5 months between injury and MRI. CONCLUSIONS DCE MRI has a higher diagnostic accuracy than either non-enhanced MRI or contrast enhanced MRI for assessing proximal fragment vascularity in scaphoid delayed-union and non-union. For proper interpretation of contrast-enhanced studies in scaphoid vascularity, one needs to incorporate the time frame between injury and MRI.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong, SAR, People's Republic of China.
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Chan CHY, Chan CLW, Ng EHY, Ho PC, Chan THY, Lee GL, Hui WHC. Incorporating spirituality in psychosocial group intervention for women undergoing in vitro fertilization: a prospective randomized controlled study. Psychol Psychother 2012; 85:356-73. [PMID: 23080528 DOI: 10.1111/j.2044-8341.2011.02040.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined the efficacy of a group intervention, the Integrative Body-Mind-Spirit (I-BMS) intervention, which aims at improving the psychosocial and spiritual well-being of Chinese women undergoing their first IVF treatment cycle. DESIGN The I-BMS intervention facilitates the search of meaning of life in the context of family and childbearing, as well as the letting go of high IVF expectations. A randomized controlled study of 339 women undergoing first IVF treatment cycle in a local Hong Kong hospital was conducted (intervention: n= 172; no-intervention control: n= 167). METHODS Assessments of anxiety, perceived importance of childbearing, and spiritual well-being were made at randomization (T(0) ), on the day starting ovarian stimulations (T(1)), and on the day undertaking embryo transfer (T(2)). RESULTS Comparing T(0) and T(2), interaction analyses showed women who had received the intervention reported lower levels of physical distress, anxiety, and disorientation. They reported being more tranquil and satisfied with their marriage, and saw childbearing as less important compared to women in the control group. CONCLUSIONS These findings suggest that I-BMS intervention was successful at improving the psychosocial and spiritual well-being of women undergoing their first IVF treatment cycle. This study highlights the importance of providing integrative fertility treatment that incorporates psychosocial and spiritual dimensions.
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Affiliation(s)
- Celia H Y Chan
- Department of Social Work and Social Administration, University of Hong Kong, China.
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Lee VCY, Yeung TWY, Tang OS, Ng EHY, Yeung WSB, Ho PC. Effect of letrozole on uterine artery Doppler flow indices prior to first-trimester termination of pregnancy: a randomized controlled trial. Ultrasound Obstet Gynecol 2012; 40:392-397. [PMID: 22302719 DOI: 10.1002/uog.11115] [Citation(s) in RCA: 5] [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: 05/31/2023]
Abstract
OBJECTIVE We previously demonstrated that a sequential regimen of letrozole and misoprostol resulted in a marked reduction in the serum estradiol concentration and in a higher efficacy of first-trimester termination of pregnancy than misoprostol alone. The aim of this study was to evaluate the effect of letrozole on uterine artery Doppler flow indices during early pregnancy. METHODS This was a randomized controlled trial. Thirty women requesting termination of pregnancy up to 63 days' gestation were randomized into two groups: a letrozole group receiving 10 mg of letrozole, daily, for 3 days, and a control group receiving a placebo for 3 days. Serum estradiol, progesterone and human chorionic gonadotropin (hCG) concentrations were measured before drug administration and then daily for 6 days. Ultrasound scanning for fetal viability and measurement of the pulsatility (PI) and resistance (RI) indices of the uterine arteries was performed before drug administration, and then on day 3 and day 7 after starting letrozole or placebo. All pregnancies were terminated by surgical evacuation on day 7 or day 8. RESULTS Uterine artery PI and RI decreased significantly in the letrozole group, but not in the control group. Serum estradiol concentrations were significantly lower in the letrozole group than in the control group from day 2 onwards. Serum progesterone and hCG concentrations were comparable for the two groups throughout the 7 days. There were significantly more women in the letrozole group with vaginal bleeding. CONCLUSION We have demonstrated that the use of letrozole in the first trimester of pregnancy suppresses serum estradiol levels but results in an increase in blood flow to the uterus. Further studies should be carried out to elucidate the mechanism of letrozole pretreatment in medical abortion.
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Affiliation(s)
- V C Y Lee
- Department of Obstetrics & Gynecology, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
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Abstract
The treatment of hypoplastic thumb (modified Blauth's type IIIb and IV) by pollicization is culturally unfavourable in the Chinese population and digit preservation is preferred. An innovative reconstruction method using a nonvascularized hemi-longitudinal metatarsal graft was performed in six cases with an average follow-up of 87.7 months. Overall hand function was good, as assessed using the Jebsen hand function test. Grip strength and pinch power were significantly weaker than the normal contralateral hand. There was no neurovascular or wound complication. The only donor site complication was a metatarsal fracture, which healed uneventfully with casting. There had been no permanent morbidity to the donor site, as all donor metatarsals hypertrophied and regained normal growth potentials. Linear growth of the transferred metatarsals was evident radiologically (average 1.5 mm/year). Free hemi-longitudinal metatarsal transfer is a feasible method with good functional outcome in the attainment of a 5-digit hand in patients with type IIIb/IV hypoplastic thumb.
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Affiliation(s)
- C S Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR.
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Chen ACH, Lee YL, Hou DYC, Fong SW, Peng Q, Pang RTK, Chiu PCN, Ho PC, Lee KF, Yeung WSB. Study of transforming growth factor alpha for the maintenance of human embryonic stem cells. Cell Tissue Res 2012; 350:289-303. [PMID: 22864984 PMCID: PMC3480587 DOI: 10.1007/s00441-012-1476-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 06/25/2012] [Indexed: 11/28/2022]
Abstract
Human embryonic stem cells (hESCs) have great potential for regenerative medicine as they have self-regenerative and pluripotent properties. Feeder cells or their conditioned medium are required for the maintenance of hESC in the undifferentiated state. Feeder cells have been postulated to produce growth factors and extracellular molecules for maintaining hESC in culture. The present study has aimed at identifying these molecules. The gene expression of supportive feeder cells, namely human foreskin fibroblast (hFF-1) and non-supportive human lung fibroblast (WI-38) was analyzed by microarray and 445 genes were found to be differentially expressed. Gene ontology analysis showed that 20.9% and 15.5% of the products of these genes belonged to the extracellular region and regulation of transcription activity, respectively. After validation of selected differentially expressed genes in both human and mouse feeder cells, transforming growth factor α (TGFα) was chosen for functional study. The results demonstrated that knockdown or protein neutralization of TGFα in hFF-1 led to increased expression of early differentiation markers and lower attachment rates of hESC. More importantly, TGFα maintained pluripotent gene expression levels, attachment rates and pluripotency by the in vitro differentiation of H9 under non-supportive conditions. TGFα treatment activated the p44/42 MAPK pathway but not the PI3K/Akt pathway. In addition, TGFα treatment increased the expression of pluripotent markers, NANOG and SSEA-3 but had no effects on the proliferation of hESCs. This study of the functional role of TGFα provides insights for the development of clinical grade hESCs for therapeutic applications.
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Affiliation(s)
- Andy C H Chen
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
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Lo SST, Ho PC. The profile of women who seek emergency contraception from the family planning service. Hong Kong Med J 2012; 18:299-303. [PMID: 22865173] [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
OBJECTIVES. To review the profile of emergency contraceptive users, their reasons for using emergency contraception, and whether they use it correctly. DESIGN. Retrospective analysis of medical records. SETTING. Six Birth Control Clinics and three Youth Health Care Centres of the Family Planning Association of Hong Kong. PARTICIPANTS. Women requesting emergency contraception between 2006 and 2008. MAIN OUTCOME MEASURES. Demographics of emergency contraception users, reasons for requesting emergency contraception, number of times the subject had unprotected intercourse before emergency contraception use, type of emergency contraception provided, coitus-treatment intervals, and outcomes. RESULTS. A total of 11 014 courses of emergency contraception were provided, which included 10 845 courses of levonorgestrel-only pills, 168 intrauterine contraceptive devices, and one course of pills plus an intrauterine contraceptive device. The mean age of the users was 30 years. Two thirds (65.6%) were nulliparous and 64.9% had not had a previous abortion. Their major reasons for requesting emergency contraception were: omission of contraceptive at the index intercourse (38.9%), condom accidents (38.0%), and non-use of any regular contraceptives (20.6%). Non-users of contraceptives were more likely to have had a previous abortion. In all, 97.9% of women took emergency contraception within 72 hours of their unprotected intercourse; 98% had had a single act of unprotected intercourse. None of the intrauterine contraceptive device users became pregnant. The failure rate for emergency contraceptive pills was 1.8%. CONCLUSIONS. Women requested emergency contraception because contraceptives were omitted or condom accidents. Health care providers should focus on motivating women with a history of abortion to use contraceptives, and ensure that condom users know how to use them correctly. Most women followed instructions on the use for emergency contraception and their outcomes were satisfactory.
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Affiliation(s)
- Sue S T Lo
- The Family Planning Association of Hong Kong, 10/F, 130 Hennessy Road, Wanchai, Hong Kong.
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Chow CS, Hung LK, Chiu CP, Lai KL, Lam LN, Ng ML, Tam KC, Wong KC, Ho PC. IS SYMPTOMATOLOGY USEFUL IN DISTINGUISHING BETWEEN CARPAL TUNNEL SYNDROME AND CERVICAL SPONDYLOSIS? ACTA ACUST UNITED AC 2012; 10:1-5. [PMID: 16106494 DOI: 10.1142/s0218810405002425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 03/22/2004] [Accepted: 01/25/2005] [Indexed: 11/18/2022]
Abstract
Hand paraesthesia is a common symptom found in patients either with carpal tunnel syndrome or cervical spondylosis. To differentiate between the two conditions, it is important to identify additional diagnostic symptoms. Ninety-two patients with operated carpal tunnel syndrome and 138 patients with spinal surgery for cervical spondylosis were reviewed. After exclusion of cases co-morbid with both cervical spondylosis and carpal tunnel syndrome or other neurological disorders, 44 patients with carpal tunnel syndrome and 41 patients with cervical spondylosis were compared. There were significant differences in the symptomatology between the two groups. In carpal tunnel syndrome, 84% had nocturnal paraesthesia, 82% hand paraesthesia were aggravated by hand activity, and hand pain occurred in 64%. The incidences were only 10%, 7% and 10%, respectively in cervical spondylosis. Neck pain was present in 76% of cervical spondylosis but only in 14% of carpal tunnel syndrome, and lower limb symptoms were present in 44% of cervical spondylosis and only 9% in carpal tunnel syndrome.
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Affiliation(s)
- C S Chow
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
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Li RHW, Gebbie AE, Wong RWS, Ng EHY, Glasier AF, Ho PC. The use of sex hormones in women with rheumatological diseases. Hong Kong Med J 2011; 17:487-491. [PMID: 22147320] [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] Open
Abstract
A number of rheumatological diseases predominantly affect women of reproductive age. There has always been concern that the use of oestrogen-containing agents such as combined hormonal contraception and hormone therapy might aggravate these conditions. This article reviews the up-to-date evidence regarding the safety of using these agents in women with various rheumatological diseases, with emphasis on systemic lupus erythematosus and rheumatoid arthritis. In the absence of antiphospholipid antibody or other prothrombotic risk factors, combined hormonal contraception is not contra-indicated in most rheumatological conditions including inactive systemic lupus erythematosus. Moreover, hormone therapy is generally not contra-indicated except for women with active systemic lupus erythematosus disease where its effect on disease flare is less clear and individual judgement is required.
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Affiliation(s)
- Raymond H W Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
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Chan WL, Hung LK, Griffith JF, Louis TCC, Ho PC. TENOSYNOVIAL OSTEOCHONDROMATOSIS OF BOTH FLEXOR AND EXTENSOR TENDONS. ACTA ACUST UNITED AC 2011; 9:89-95. [PMID: 15368633 DOI: 10.1142/s0218810404001991] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Accepted: 12/02/2003] [Indexed: 11/18/2022]
Abstract
An unusual case of a 52-year-old woman with tenosynovial osteochondromatosis involving both of the wrist flexor and extensor tendons is reported.
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Affiliation(s)
- W L Chan
- Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
We report a rare case of self-injection of mercury into the subcutaneous tissue of the upper limb. A multi-disciplinary management approach was adopted including cooperation between toxicologists, orthopaedic surgeons, radiologists and environment safety personnel. Surgical removal of mercury under radiological screening and systemic intoxication treated by chelating agents, namely dimercaprol and succimer. Serial serum and urine mercury levels showed an initial rise despite surgical removal and returned to normal after a prolonged period of time. Safety precautions were taken during surgery to avoid inadvertent intoxication of staff. Contamination of the operation theatre was monitored by the amount of mercury vapour released into the air. All personnels involved in the management of the patient did not show any evidence of mercury intoxication.
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Affiliation(s)
- F Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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