Pub Date : 1999-11-01DOI: 10.1046/J.1442-2034.1999.00028.X
Chui Akk
Objective: To review the Australian National Liver Transplantation Unit’s (ANLTU) experience with chronic rejection (CR) in liver transplantation (LTx) in order to establish a better management strategy. Materials and Methods: Clinical records and prospective data on the ANLTU database were reviewed. Statistical analysis was performed on microcomputer. Results: Between January 1986 and June 1997, 17 patients (6.4%) (9 male, 8 female) were diagnosed with CR at a median 0.83 years (0.21–6.33 years) after LTx. Prior to the diagnosis of CR, all had a background of increasingly cholestatic liver function tests. The total number of prior acute rejection episodes was 42 (mean 2.5, range 1–5) with 18 episodes (42%) being steroid resistant. Other co-morbid factors included: cytomegalovirus infection 10 (58%); low levels of immunosuppression 7 (41%); and biliary complications 6 (35%). Mortality was high at 14 (82%). Conclusions: The outcome is poor in adults with CR, with or without re-Tx. Efforts should be made to avoid septic complications that require lowering the dosage of immunosuppression. Early diagnosis and prompt treatment of acute rejection are recommended. In cases of early CR, conversion to FK506 regimen is worthwhile.
{"title":"Single centre experience of chronic rejection in liver transplantation","authors":"Chui Akk","doi":"10.1046/J.1442-2034.1999.00028.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00028.X","url":null,"abstract":"Objective: To review the Australian National Liver Transplantation Unit’s (ANLTU) experience with chronic rejection (CR) in liver transplantation (LTx) in order to establish a better management strategy. \u0000 \u0000 \u0000 \u0000Materials and Methods: Clinical records and prospective data on the ANLTU database were reviewed. Statistical analysis was performed on microcomputer. \u0000 \u0000 \u0000 \u0000Results: Between January 1986 and June 1997, 17 patients (6.4%) (9 male, 8 female) were diagnosed with CR at a median 0.83 years (0.21–6.33 years) after LTx. Prior to the diagnosis of CR, all had a background of increasingly cholestatic liver function tests. The total number of prior acute rejection episodes was 42 (mean 2.5, range 1–5) with 18 episodes (42%) being steroid resistant. Other co-morbid factors included: cytomegalovirus infection 10 (58%); low levels of immunosuppression 7 (41%); and biliary complications 6 (35%). Mortality was high at 14 (82%). \u0000 \u0000 \u0000 \u0000Conclusions: The outcome is poor in adults with CR, with or without re-Tx. Efforts should be made to avoid septic complications that require lowering the dosage of immunosuppression. Early diagnosis and prompt treatment of acute rejection are recommended. In cases of early CR, conversion to FK506 regimen is worthwhile.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"79 1","pages":"112-114"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89294306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00017.X
J. Faylona, S. Chung
Tuberculosis is still a major problem in Asia. An increase in transglobal migration, ageing patients, socioeconomic deprivation and the acquired immune deficiency syndrome thwart efforts in disease control. With failure to control pulmonary tubercular disease, increasing numbers of cases of extra-pulmonary tuberculosis, such as abdominal tuberculosis, have been seen. Abdominal tuberculosis remains a diagnostic problem for surgeons. The signs and symptoms of abdominal tuberculosis are non-specific and there is no specific diagnostic test. Helpful tests would include analysis of ascitic fluid, polymerase chain reaction test, the findings at laparoscopy and endoscopy and histology. Primary treatment is medical with surgery reserved for those patients developing complications. For biliary tuberculosis, a combination of endoscopy, surgery and medical treatment is required.
{"title":"Abdominal Tuberculosis Revisited","authors":"J. Faylona, S. Chung","doi":"10.1046/J.1442-2034.1999.00017.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00017.X","url":null,"abstract":"Tuberculosis is still a major problem in Asia. An increase in transglobal migration, ageing patients, socioeconomic deprivation and the acquired immune deficiency syndrome thwart efforts in disease control. With failure to control pulmonary tubercular disease, increasing numbers of cases of extra-pulmonary tuberculosis, such as abdominal tuberculosis, have been seen. Abdominal tuberculosis remains a diagnostic problem for surgeons. The signs and symptoms of abdominal tuberculosis are non-specific and there is no specific diagnostic test. Helpful tests would include analysis of ascitic fluid, polymerase chain reaction test, the findings at laparoscopy and endoscopy and histology. Primary treatment is medical with surgery reserved for those patients developing complications. For biliary tuberculosis, a combination of endoscopy, surgery and medical treatment is required.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"2 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74287994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00022.X
K. Ng, K. Cheung
A case of brachial plexus injury occurring during axillary dissection as part of breast conservative surgery for breast cancer is reported. The mechanisms, diagnosis and management of such injury are discussed. Proper positioning of the patient is the key to preventing brachial plexus injury.
{"title":"Brachial plexus injury occurring during breast surgery","authors":"K. Ng, K. Cheung","doi":"10.1046/J.1442-2034.1999.00022.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00022.X","url":null,"abstract":"A case of brachial plexus injury occurring during axillary dissection as part of breast conservative surgery for breast cancer is reported. The mechanisms, diagnosis and management of such injury are discussed. Proper positioning of the patient is the key to preventing brachial plexus injury.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"1 1","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86936562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00019.X
K. Chung, M. Poon, W. Chick, C. Tse, K. Kwok, Nh Chia, Jst Hwang
Objective: This study evaluated whether a significant reduction in unnecessary appendectomies is possible by performing diagnostic laparoscopy before appendectomy in female patients of child-bearing age, leaving behind the normal-looking appendix. Materials and methods: Sixty-one consecutive female patients between the ages of 15 and 45 years with clinical diagnosis of acute appendicitis were studied prospectively. Diagnostic laparoscopy was performed to detect whether the appendix was inflamed. The appendix was then removed and the result of laparoscopic diagnosis was matched with histological diagnosis. Results: Ten out of the 42 laparoscopically diagnosed appendicitis cases had normal appendices on histological examination. Six out of the 19 laparoscopically diagnosed normal appendices had histological evidence of appendicitis. The sensitivity of laparoscopy was 84% and the specificity was 56.5%. Conclusions: Discrepancies existed between laparoscopic appearance and histological examination in acute appendicitis. The appendices of all those with clinically suspected appendicitis should be removed and sent for histological confirmation.
{"title":"Laparoscopic appendectomy in young female patients: Should we remove the normal-looking appendix?","authors":"K. Chung, M. Poon, W. Chick, C. Tse, K. Kwok, Nh Chia, Jst Hwang","doi":"10.1046/J.1442-2034.1999.00019.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00019.X","url":null,"abstract":"Objective: This study evaluated whether a significant reduction in unnecessary appendectomies is possible by performing diagnostic laparoscopy before appendectomy in female patients of child-bearing age, leaving behind the normal-looking appendix. \u0000 \u0000 \u0000 \u0000Materials and methods: Sixty-one consecutive female patients between the ages of 15 and 45 years with clinical diagnosis of acute appendicitis were studied prospectively. Diagnostic laparoscopy was performed to detect whether the appendix was inflamed. The appendix was then removed and the result of laparoscopic diagnosis was matched with histological diagnosis. \u0000 \u0000 \u0000 \u0000Results: Ten out of the 42 laparoscopically diagnosed appendicitis cases had normal appendices on histological examination. Six out of the 19 laparoscopically diagnosed normal appendices had histological evidence of appendicitis. The sensitivity of laparoscopy was 84% and the specificity was 56.5%. \u0000 \u0000 \u0000 \u0000Conclusions: Discrepancies existed between laparoscopic appearance and histological examination in acute appendicitis. The appendices of all those with clinically suspected appendicitis should be removed and sent for histological confirmation.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"294 1","pages":"85-87"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77029631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00024.X
A. Chan, J. Griffith, S. Leung, S. Chung
Cancer of the oesophagus is notorious for its grave prognosis of an overall 5-year survival rate of 10–20%. Surgical resection with curative intent remains the most effective treatment for this disease. To improve survival, a multimodality treatment strategy was adopted for managing patients with oesophageal cancer. The use of pre-operative adjuvant chemotherapy did not confer any survival benefit to patients with localized oesophageal cancer, as is proven by most randomized studies; however, the preliminary results of pre- operative chemotherapy with radiotherapy is encouraging but needs to be verified in a randomized trial. For patients with incurable diseases, endoscopic stenting offers effective palliation of dysphagia with minimal morbidity and mortality.
{"title":"Multimodality treatment strategy for squamous cell oesophageal cancer","authors":"A. Chan, J. Griffith, S. Leung, S. Chung","doi":"10.1046/J.1442-2034.1999.00024.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00024.X","url":null,"abstract":"Cancer of the oesophagus is notorious for its grave prognosis of an overall 5-year survival rate of 10–20%. Surgical resection with curative intent remains the most effective treatment for this disease. To improve survival, a multimodality treatment strategy was adopted for managing patients with oesophageal cancer. The use of pre-operative adjuvant chemotherapy did not confer any survival benefit to patients with localized oesophageal cancer, as is proven by most randomized studies; however, the preliminary results of pre- operative chemotherapy with radiotherapy is encouraging but needs to be verified in a randomized trial. For patients with incurable diseases, endoscopic stenting offers effective palliation of dysphagia with minimal morbidity and mortality.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"20 1","pages":"59-64"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81682491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00020.X
Yw Chiu, Y. Au
Day-case surgery is a major component of the workload in our hospital (Our Lady of Maryknoll Hospital, Kowloon, Hong Kong). We choose to audit paediatric day-case surgery because the patients’ parents are anxious and therefore likely to reflect the finest details of care. The study was prospective. In a one-year period (1997), the 235 paediatric day-case surgery cases scheduled in our hospital accounted for 90% of all paediatric operations. The patients’ attendance rate was 98.8%. Five patients (2.2%) were kept overnight for observation. Six patients (2.6%) were re-admitted after operation. There were 50 (22%) telephone hotline enquiries. The overall minor complication rate, as defined, was 4.8% and there was no major morbidity. A multidisciplinary approach including anaesthetists and nurses was the key to sucess. Easy access to medical advice was also important in order to avoid unnecessary re-admission and parental anxiety. The well-organized day-surgery service was safe, well-accepted and cost effective.
{"title":"Audit of paediatric day-case surgery in a district general hospital","authors":"Yw Chiu, Y. Au","doi":"10.1046/J.1442-2034.1999.00020.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00020.X","url":null,"abstract":"Day-case surgery is a major component of the workload in our hospital (Our Lady of Maryknoll Hospital, Kowloon, Hong Kong). We choose to audit paediatric day-case surgery because the patients’ parents are anxious and therefore likely to reflect the finest details of care. The study was prospective. In a one-year period (1997), the 235 paediatric day-case surgery cases scheduled in our hospital accounted for 90% of all paediatric operations. The patients’ attendance rate was 98.8%. Five patients (2.2%) were kept overnight for observation. Six patients (2.6%) were re-admitted after operation. There were 50 (22%) telephone hotline enquiries. The overall minor complication rate, as defined, was 4.8% and there was no major morbidity. A multidisciplinary approach including anaesthetists and nurses was the key to sucess. Easy access to medical advice was also important in order to avoid unnecessary re-admission and parental anxiety. The well-organized day-surgery service was safe, well-accepted and cost effective.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"43 1","pages":"94-97"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76832215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-08-01DOI: 10.1046/J.1442-2034.1999.00018.X
Jensen Poon, K. Chan
Omphalocele and gastroschisis are rare congenital abnormalities that always present as challenging problems to clinicians. Antenatal diagnosis provides important information for evaluation of prognosis and planning of management of these conditions. In this article, current application of antenatal diagnosis and perinatal management of omphalocele and gastroschisis are reviewed.
{"title":"Impact of antenatal diagnosis on perinatal management of omphalocele and gastroschisis","authors":"Jensen Poon, K. Chan","doi":"10.1046/J.1442-2034.1999.00018.X","DOIUrl":"https://doi.org/10.1046/J.1442-2034.1999.00018.X","url":null,"abstract":"Omphalocele and gastroschisis are rare congenital abnormalities that always present as challenging problems to clinicians. Antenatal diagnosis provides important information for evaluation of prognosis and planning of management of these conditions. In this article, current application of antenatal diagnosis and perinatal management of omphalocele and gastroschisis are reviewed.","PeriodicalId":7943,"journal":{"name":"Annals of The College of Surgeons Hong Kong","volume":"3 1","pages":"71-75"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84988898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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