Percutaneous transluminal angioplasty for stenosis of arteriovenous fistulae: a review of local experience

The stenosis and subsequent thrombosis of the arteriovenous fistula may lead to a loss of vascular access sites; this a major problem in chronic haemodialysis patients. Percutaneous transluminal angioplasty has been a popular way of correcting such lesions in recent years. We have reviewed patients who underwent this operation from 1993 to 1996 at the Queen Mary Hospital. Among 11 patients who were documented as having arteriovenous fistula stenosis, 60% of lesions were in the anastomotic area while 40% were in the venous limb. All patients had abnormal dialysis blood line pressures corresponding to the actual site of stenosis. The initial success rate of percutaneous transluminal angioplasty in treating the stenotic lesions was 73%. This method is thus a promising form of semi-invasive treatment for symptomatic arteriovenous fistula stenosis.published_or_final_versio

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation

Aim: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) 3 cm in diameter were adverse prognostic factors in multivariate analysis. Conclusion: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Portal vein embolisation prior to extended right-sided hepatic resection

Objectives. To determine whether preoperative portal vein embolisation improves the operative outcome of patients undergoing extended right-sided hepatic resection for hepatobiliary malignancy. Design. Prospective non-randomised study. Setting. University teaching hospital, Hong Kong. Patients. Ninety-two patients underwent extended right-sided hepatic resection for hepatobiliary malignancy during a 45-month period (January 2000 to September 2003). Among them, 15 (16%) underwent portal vein embolisation via a percutaneous ipsilateral approach (n=9) or through the ileocolic vein with a mini-laparotomy (n=6). The remaining 77 (84%) patients underwent hepatic resection without portal vein embolisation. Main outcome measures. Operative morbidity and mortality. Results. Patients undergoing portal vein embolisation were older (69 years vs 55 years; P=0.009), and had significantly worse preoperative renal function (creatinine, 96 μmol/L vs 86 μmol/L; P=0.039) and liver function (bilirubin, 23 μmol/L vs 12 μmol/L; P<0.001). Portal vein embolisation resulted in an increase in the future liver remnant of 9% (interquartile range, 7-13%) of the estimated standard liver volume. The operating time for patients receiving portal vein embolisation was significantly longer (medium, 660 min vs 420 min; P<0.001) with more complicated surgery performed in terms of concomitant caudate lobectomy and hepaticojejunostomy. There was no hospital mortality in patients who underwent portal vein embolisation whereas five without the treatment died (P=0.587). The operative morbidity of patients who underwent portal vein embolisation and those who did not was 20% and 30%, respectively (P=0.543). Conclusions. In older patients who have worse preoperative liver and renal functions, portal vein embolisation enhances the possibility to perform extended right-sided hepatic resection for hepatobiliary malignancies with potentially lower operative mortality and morbidity.published_or_final_versio

Prophylactic thyroidectomy in ethnic Chinese patients with multiple endocrine neoplasia type 2A syndrome after the introduction of genetic testing

Objective: To evaluate the impact of genetic testing in the management of familial multiple endocrine neoplasia 2A patients. Design: Retrospective study. Setting: University teaching hospital, Hong Kong. Patients: Twenty-two patients from eight multiple endocrine neoplasia 2A families underwent prophylactic total thyroidectomy based on a positive RET mutation genetic testing. All mutations were located at codon 634 of exon 11. Nineteen patients had preoperative basal serum calcitonin measured, and the 12 with normal levels had pentagastrin stimulation tests. Preoperative thyroid ultrasound examination was performed for 17 patients. Results: There were 13 females and 9 males with a median age of 25.1 (range, 6.1-71.9) years. Histopathology revealed medullary thyroid carcinoma in 17 (77%), C-cell hyperplasia in four (18%), and normal pathology in one (5%) of the patients. Five patients with either C-cell hyperplasia or normal pathology were among the youngest (age range, 6-9 years). The youngest patient with medullary thyroid carcinoma was nearly 9 years old. The median size of medullary thyroid carcinomas was 8.3 (range, 0.1-18) mm, but there were no lymph node metastases. Of 15 patients with normal basal calcitonin levels, 10 had medullary thyroid carcinoma, though two tested negative with the pentagastrinstimulated calcitonin assay. Five of six patients with normal preoperative ultrasonographic examinations had medullary thyroid carcinoma. Three (14%) of the patients were prescribed long-term calcium and vitamin D supplementation. After a median follow-up of 49 (range, 13-128) months, no patient had recurrence of medullary thyroid carcinoma. Conclusions: Genetic testing has replaced conventional biochemical and radiological modalities to identifying multiple endocrine neoplasia 2A carriers, in order to offer them prophylactic thyroidectomy. Chinese multiple endocrine neoplasia 2A patients with codon 634 mutation seem to have less aggressive forms of medullary thyroid carcinoma, for whom prophylactic thyroidectomy can be considered at the age of 8 years.published_or_final_versio

Non-traditional biomarkers in the prediction of cardiovascular events among Chinese

Poster PresentationINTRODUCTION: Biomarkers of subclinical systemic chronic inflammation are increasingly recognised as a key player in atherosclerosis. C-reactive protein, measured using high-sensitivity assay (hsCRP), is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). As obesity is associated with disregulated expression of various adipokines, either pro-inflammatory or anti-inflammatory, such adipokines may also serve as non-traditional biomarkers for the accelerated atherosclerosis associated with obesity. In this prospective cohort study, we examined the predictive value of a variety of non-traditional biomarkers for CVD among Hong Kong Chinese, and determined if they would …published_or_final_versionThe 17th Medical Research Conference, The University of Hong Kong, Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 20, abstract no. 2

High-sensitivity C-reactive protein and other inflammatory markers in predicting cardiovascular risk in Hong Kong Chinese

Poster PresentationINTRODUCTION: Inflammation is increasingly recognised as a key player in atherosclerosis, and C-reactive protein measured using high-sensitivity assay (hsCRP) is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). In this prospective cohort study, we examined the predictive value of hsCRP for CVD in Hong Kong Chinese and determined if other biomarkers would enhance the predictive value of hsCRP. METHODS: Subjects were recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study …published_or_final_versionThe 16th Medical Research Conference, The University of Hong Kong, Hong Kong, 22 January 2011. In Hong Kong Medical Journal, 2011, v. 17 suppl. 1, p. 66, abstract no. 11

Predictors common to cardiovascular and cancer outcomes in a population-based 13-year prospective study in Hong Kong

Oral PresentationINTRODUCTION: Cardiovascular diseases (CVD) and cancer are the two leading causes of death in Hong Kong. Obesity is becoming increasingly prevalent in the local population and has been reported to be associated with CVD and some forms of cancer in the western world. In this study, we attempted to identify the aetiological factors linking obesity to both CVD and cancer among Hong Kong Chinese. METHODS: Subjects were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS) …published_or_final_versionThe 16th Medical Research Conference, The University of Hong Kong, Hong Kong, 22 January 2011. In Hong Kong Medical Journal, 2011, v. 17 suppl. 1, p. 56, abstract no. 9

Serum adiponectin in relation to other obesity-related biomarkers in predicting type 2 diabetes: a 5-year prospective study

Oral PresentationAIMS: To identify obesity-related serum biomarkers associated with the development of type 2 diabetes in a Chinese population and to examine if these biomarkers added values to conventional risk factors in diabetes prediction. METHODS: We studied 1315 non-diabetic subjects from the prospective Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). Serum biomarkers including adiponectin, tumour necrosis …published_or_final_versionThe 17th Medical Research Conference, The University of Hong Kong, Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 57, abstract no. 8

The clinical genetics of multiple endocrine neoplasia type 1 in Chinese

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