Breast reconstruction with transverse rectus abdominis musculocutaneous (TRAM) flap in young women with breast cancer

Since its introduction in 1982, the transverse rectus nbdominis musculocutaneous (TRAM) flop has become the standard for autogenous breast reconstruction. However, it has serious potential complications. In this article, the 10 TRAM flaps performed at Princess Margaret Hospital from December 1993 to September 1994 for young women with breast carcinoma were evaluated to assess the safety and complications of this technique. Majority of the patients were satisfied with the cosmetic outcome.published_or_final_versio

Ischaemic stroke related to branch artery disease: a missing link?

INTRODUCTION: Clinicians and researchers often classify atherosclerotic cerebral infarctions into large artery atherothrombotic disease (LAD) and small artery lacunar infarction (LACI), but this system of ‘dichotomisation’ cannot account for a substantial proportion of stroke cases. Twenty years ago, a third mechanism for cerebral infarction - branch artery disease (BAD) - was proposed. However, this concept was understudied and still remains an obscure entity. METHODS: Stroke patients admitted under the Neurology Unit of Queen Mary Hospital over a 24- month period were studied retrospectively. Patients with ischaemic stroke presumably due to atherosclerotic disease were classified according to their imaging +/– clinical findings into three groups: LAD, BAD, and LACI. Patients with BAD were further categorised into five BAD stroke syndromes based on radiological criteria. Clinical characteristics, vascular risk factors, results of vascular workup, and outcome among the various stroke subgroups were compared. RESULTS: A total of 720 patients with a diagnosis of stroke were admitted during the study period, including 123 LAD (17% of all stroke patients or 33% of all studied patients), 147 BAD (20% or 40%), and 102 LACI (14% or 27%). Among the BAD patients, the number of cases involving Heubner’s artery, lenticulostriatal arteries, anterior choroidal artery, thalamoperforating/geniculate arteries or paramedian pontine infarction were 0, 47, 45, 15 or 40 (0, 32, 31, 10 or 27%), respectively. Patients with BAD were the youngest among the three groups. As compared to LAD patients, BAD patients had lower NIHSS scores, were less often diabetic, and carotid stenosis was less common, while stenosis of the intracranial arteries were more frequently seen in BAD as compared to LACI patients. Mean follow-up period was 1085 days, and outcome of BAD patients was intermediate between LAD and LACI. Comparison of variables among the BAD stroke syndromes showed that they were a homogenous group of conditions. CONCLUSION: Despite being a rarely applied concept, BAD is the most prevalent subtype of ischaemic stroke in our study. The homogeneity among the BAD syndromes suggests they might represent a distinctive stroke entity. Although patients with BAD and LACI had similar degrees of neurological deficits on presentation, outcome in the former group was significantly worse than the latter.published_or_final_versionThe 15th Medical Research Conference; Department of Medicine, The University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16 suppl. 1, p. 30, abstract no. 4

Herpes simplex encephalitis: how good are we in diagnosing this condition?

INTRODUCTION: Herpes simplex encephalitis (HSE) is the commonest sporadic infective encephalitis in Hong Kong. Early recognition of HSE, which relies on a high index of suspicion, is important as effective treatment is available. Empirical acyclovir is advocated for all cases of clinically suspected viral encephalitis. Electroencephalography (EEG) is a routine investigation in suspected HSE. METHODS: The EEG database of Neurodiagnostic Unit, Queen Mary Hospital, was reviewed retrospectively. All referrals from April 2006 to March 2009 with a diagnosis of suspected HSE treated with empirical intravenous acyclovir were identified. Their presenting features, imaging and laboratory findings, and final diagnoses were reviewed. RESULTS: During the study period, 60 patients (mean age, 51 years; range, 18-90 years, M:F ratio=13:7) underwent EEG for suspected HSE. Presenting features included fever (n=39), confusion (n=39), impaired consciousness (n=31), focal signs (n=15, seizure in 8), and headache (n=13). All patients underwent brain CT and 45 had MRI. The commonest imaging findings were unrelated old changes (n=20) and normal study (n=16). Lobar inflammation was detected in four patients. EEG was normal, showed diffused abnormalities, or focal/ multifocal abnormalities in 16, 31, or 13 patients, respectively. Lumbar puncture was performed in 59 patients. Total cell count was ≤10×106 /L in 68% of patients and CSF protein was <0.8 g/L in 51% of patients. Polymerase chain reaction for herpes simplex virus was positive in one out of 56 requests. Viral encephalitis was the final diagnosis in three patients (HSE=1, Japanese encephalitis=1, other virus=1). Other common diagnoses included meningitis (n=9), non-CNS sepsis (n=9), psychiatric illnesses (n=8), epileptic seizure (n=6), and acute stroke (n=5). CONCLUSION: Our findings demonstrate that we were exercising a high index of suspicion for diagnosing HSE. Our liberal use of empirical acyclovir was also consistent with the IDSA (Infection Diseases Society of America) recommendations. Despite our low threshold of investigating for HSE, only one case was identified over 3 years, suggesting HSE is an uncommon condition.published_or_final_versionThe 15th Medical Research Conference; Department of Medicine, The University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16 suppl. 1, p. 29, abstract no. 4

Central Nervous System Inflammatory Demyelinating Disorders in the Hong Kong Chinese

Central nervous system inflammatory demyelinating disorders (CNS IDD) include classical multiple sclerosis, neuromyelitis optica (NMO) spectrum disorders, a single attack of/recurrent acute disseminated encephalomyelitis, a single attack of idiopathic acute transverse myelitis, optic neuritis (ON) and brainstem encephalitis. CNS IDD are potentially serious disorders with risks of mortality and significant disability. Typical relapsing forms of CNS IDD are relapsing remitting multiple sclerosis and relapsing NMO. Relapsing NMO is typified by recurrent longitudinally extensive transverse myelitis and severe unilateral or bilateral ON. Early diagnosis of CNS IDD is important as long-term treatment for different forms varies. Recognition of clinical, radiological and serological characteristics of different forms of CNS IDD facilitates early diagnoses. A significant proportion of NMO patients are seropositive for autoantibodies against aquaporin-4, the most abundant water channel in the CNS; this supports the hypothesis that NMO is an autoimmune disorder. Is NMO an autoantibody-mediated disorder sharing similar pathogenesis with myasthenia gravis (MG), a classical autoantibody-mediated autoimmune disease? An interesting observation is that paraneoplastic NMO associated various tumours is recognised recently, suggesting similarity with MG which is associated with thymoma in about 15 to 20% of patients.published_or_final_versio

Plasma amyloid beta peptides and oligomers antibodies in Alzheimer's disease

INTRODUCTION: Various forms of amyloid beta (Aβ) including Aβ peptides, oligomers, protofibrils and fibrils are thought to be pathogenic in Alzheimer’s disease (AD). The exact pathophysiological role of endogenous Aβ autoantibodies (Ab) in healthy subjects and AD patients are uncertain. Potential protective role ...published_or_final_versio

Human coronavirus NL63 infection and other coronavirus infections in children hospitalized with acute respiratory disease in Hong Kong, China

Background. Human coronavirus NL63 (HCoV-NL63) is a recently discovered human coronavirus found to cause respiratory illness in children and adults that is distinct from the severe acute respiratory syndrome (SARS) coronavirus and human coronaviruses 229E (HCoV-229E) and OC43 (HCoV-OC43). Methods. We investigated the role that HCoV-NL63, HCoV-OC43, and HCoV-229E played in children hospitalized with fever and acute respiratory symptoms in Hong Kong during the period from August 2001 through August 2002. Results. Coronavirus infections were detected in 26 (4.4%) of 587 children studied; 15 (2.6%) were positive for HCoV-NL63, 9 (1.5%) were positive for HCoV-OC43, and 2 (0.3%) were positive for HCoV-229E. In addition to causing upper respiratory disease, we found that HCoV-NL63 can present as croup, asthma exacerbation, febrile seizures, and high fever. The mean age (± standard deviation [SD]) of the infected children was 30.7 ± 19.8 months (range, 6-57 months). The mean maximum temperature (± SD) for the 12 children who were febrile was 39.3°C ± 0.9°C, and the mean total duration of fever (± SD) for all children was 2.6 ± 1.2 days (range, 1-5 days). HCoV-NL63 infections were noted in the spring and summer months of 2002, whereas HCoV-OC43 infection mainly occurred in the fall and winter months of 2001. HCoV-NL63 viruses appeared to cluster into 2 evolutionary lineages, and viruses from both lineages cocirculated in the same season. Conclusions. HCoV-NL63 is a significant pathogen that contributes to the hospitalization of children, and it was estimated to have caused 224 hospital admissions per 100,000 population aged 6 years each year in Hong Kong. © 2005 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

Brainstem encephalitis in neuromyelitis optica spectrum disorders

Poster: abstract no. 41published_or_final_versionThe 17th Medical Research Conference (MRC), Department of Medicine, the University of Hong Kong, Hong Kong, 14 january 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 3

Population Factors Affecting Initial Diffusion Patterns of H1N1

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Cerebral involvement in neuromyelitis optica spectrum disorders among Hong Kong Chinese

published_or_final_versionThe 16th Medical Resarch Conference (MRC), The University of Hong Kong, Hong Kong, China, 22 January 2011. In Hong Kong Medical Journal, 2011, v. 17, suppl. 1, p. 55, abstract no. 8

Effects of geographic scale on population factors in acute disease diffusion analysis

Objective To explore socio-demographic data of the population as proxies for risk factors in disease transmission modeling at different geographic scales. Methods Patient records of confirmed H1N1 influenza were analyzed at three geographic aggregation levels together with population census statistics. Results The study confirmed that four population factors were related in different degrees to disease incidence, but the results varied according to spatial resolution. The degree of association actually decreased when data of a higher spatial resolution were used. Conclusions We concluded that variables at suitable spatial resolution may be useful in improving the predictive powers of models for disease outbreaks.published_or_final_versio