Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome

Objective: To review and compare initial high resolution computed tomography (HRCT) findings in patients with metapneumovirus pneumonia and severe acute respiratory syndrome (SARS-Coronovirus). Materials and methods: 4 cases of metapneumovirus pneumonia (mean age of 52.3 years) in an institutional outbreak (Castle Peak Hospital) in 2008 and 38 cases of SARS-coronovirus (mean age of 39.6 years) admitted to Tuen Mun hospital during an epidemic outbreak in 2003 were included. HRCT findings of the lungs for all patients were retrospectively reviewed by two independent radiologists. Results: In the metapneumovirus group, common HRCT features were ground glass opacities (100%), consolidation (100%), parenchymal band (100%), bronchiectasis (75%). Crazy paving pattern was absent. They were predominantly subpleural and basal in location and bilateral involvement was observed in 50% of patients. In the SARS group, common HRCT features were ground glass opacities (92.1%), interlobular septal thickening (86.8%), crazy paving pattern (73.7%) and consolidation (68%). Bronchiectasis was not seen. Majority of patient demonstrated segmental or lobar in distribution and bilateral involvement was observed in 44.7% of patients. Pleural effusion and lymphadenopathy were of consistent rare features in both groups. Conclusion: Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS. © 2011 Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex

超聲引導細針穿刺抽吸活檢病變組織量不足乳腺病變

Objective: To reassess 'quantity insufficient' fine-needle aspiration cytology breast lesions and explore ways to minimise such reporting. Methods: Ultrasonography-guided fine-needle aspiration cytology of breast lesions performed in 2009 and labelled 'quantity insufficient' were reviewed. The nature and size of lesion, the fine-needle aspiration cytology needle size, the number of passes, years of sampling experience of the respective radiologist, and outcome of the lesion / patient were assessed. Results: A total of 593 women, having 673 breast lesions of Breast Imaging-Reporting and Data System of R2 or above, underwent ultrasonography-guided fine-needle aspiration cytology during the defined period. In all, 88 lesions (all hypoechoic) in 76 women (24-78 years old) with at least one 'quantity insufficient' report in 2009 were identified. Most fine-needle aspiration cytology was performed by two passes with a 22G hypodermic needle. All were performed by radiologists with experience in such biopsies ranging from 1 to more than 10 years. Most lesions were 5 mm to less than 10 mm in size. The fine-needle aspiration cytology reported as 'quantity insufficient' had a rate of 15%, and the mean number of aspiration attempts for each lesion was 1.8. Five lesions eventually underwent core biopsy or excision. Of the 88 lesions, 40 (45%) were benign lesions, 12 (14%) were cysts, and 3 (3%) were fat lobules. Based on interval ultrasounds, 20 (23%) of the lesions were static or shrunken, and 5 (6%) were not found; the remainders were pending interval ultrasound. Conclusion: The rate at which ultrasonography-guided fine-needle aspiration breast lesion cytology reported as 'quantity insufficient' could be minimised by remarking the nature of lesion, modifying the method of sampling, and maximising interdepartmental communication. More than 90% of 'quantity insufficient' lesions were eventually found to be benign or static on repeated fine-needle aspiration cytology or follow-up. © 2011 Hong Kong College of Radiologists.目的：探討乳腺病變細針穿刺抽吸活檢病變組織量不足的情況，及找出方法盡量減少此類問題出現。 方法：回顧2009年在本院進行乳腺病變超聲引導細針穿刺抽吸活檢被認為病變組織抽吸量不足的病例。並評估病灶的類別及大小、用針的大小、穿刺的次數、放射科醫生對抽取有關組織的經驗年資、及病灶/病人的結果。 結果：2009年期間有593名女性，共673個乳腺病變，於乳腺影像報告和數據系統（BI-RADS）達R2級或以上，進行超聲引導細針穿刺抽吸活檢。當中發現76名介乎24至78歲的病人中，88個乳腺病變（均為低回聲灶）有至少一次抽吸量不足的報告。大部份檢查都以22G皮下穿刺針穿刺兩次。所有活檢均由有一年至超過十年的相關經驗放射科醫生進行。多數病灶為5毫米至少於10毫米不等。被認為是病變組織抽吸量不足的比率為15%，每個病灶平均有1.8次的活檢。有5個病灶最終進行小切片或切除手術。88個乳腺病變中，40個（45%）為良性、12個（14%）為囊腫、3個（3%）為脂肪小葉。中期超聲檢顯示有20個（23%）病灶呈靜止狀態或縮小，5個（6%）為陰性；其餘的病灶有待進一步超聲檢結果。 結論：要減少超聲引導細針穿刺抽吸活檢中乳腺病變組織量不足的情況發生，須要知悉病變的類別、修改抽取組織的方法、並加強各部門間的溝通。超過九成抽吸量不足的病變通過重複細針穿刺細胞學或隨訪後發現為良性組織或呈靜止狀態。link_to_subscribed_fulltex

Prosthodontic Complications of Metal-Ceramic and All-Ceramic, Complete-Arch Fixed Implant Prostheses with Minimum 5 Years Mean Follow-Up Period. A Systematic Review and Meta-Analysis

PURPOSE: The purpose of this systematic review and meta-analysis was to review and analyze the prosthodontic complications, survival, and success of metal-ceramic (MC) and all-ceramic (AC) complete-arch fixed implant dental prostheses (CFIDPs) with a minimum mean follow-up period of 5 years. METHODS: A structured literature search was conducted using 3 electronic databases (MEDLINE, the Cochrane Library, Web of Science) for clinical studies reporting on prosthodontic complications of metal-ceramic and/or all-ceramic CFIDPs published between 2000 and 2016. This was complemented with hand searching in relevant journals, references, as well as searching in grey literature. Risk of bias analysis for randomized controlled trials was done following the recommendations from the Cochrane Collaboration. Quality appraisal for nonrandomized studies was executed according to the Newcastle-Ottawa scale (NOS). The final selection included only studies with a minimum mean follow-up time of 5 years. RESULTS: The electronic databases search yielded 1804 relevant titles and abstracts; 11 studies were finally selected (9 for MC and 2 for AC CFIDPs). Risk of bias in most selected studies was low. Heterogeneity across studies of MC CFIDPs was within acceptable range but not among AC CFIDP studies, so no meta-analysis was performed for the latter. Regarding MC CFIDPs, most studies recorded 100% survival rate (survival range: 92.4-100%, success range: 47-96.7%), with veneer fracture being the most-common complication. Five- and 10-year cumulative complication rates for MC CFIDP veneer fractures were 22.1% and 39.3%, respectively, but with variable confidence intervals. The 2 studies included for AC CFIDPs reported 100% survival rates but differed in success rates, with the one using predominantly monolithic zirconia restorations reporting 90.9%, and the one using bi-layered zirconia reporting 60.4%, with complications attributed to veneer fracture. CONCLUSIONS: MC and AC CFIDPs presented with veneer fractures as primary complication. This may require significant maintenance. Other complications were negligible after a mean follow-up period of at least 5 years. More long-term studies, especially on all-ceramic CFIDPs are needed

GP management of osteoarthritic pain in Hong Kong

Background: Limited information is available about general practitioners' knowledge, attitude and practice in treating osteoarthritis. This study sought to better understand GPs' management of mild to moderate osteoarthritis in Hong Kong. Methods: A cross sectional survey of GPs using a structured questionnaire mailed in three stages. Results: A total of 225 questionnaires were returned. Paracetamol was considered to be an analgesic with lower toxicity and cost, and fewer drug interactions than others; it was also seen to have poor efficacy, short duration of action, and low patient compliance. Most GPs would consider nonselective nonsteroidal anti-inflammatory drugs as first line treatment, followed by paracetamol. Cyclooxygenase-2 inhibitors, physiotherapy and exercise were favoured as second line treatments. Most GPs would choose paracetamol for patients with comorbid conditions. Discussion: General practitioners in Hong Kong have positive views on using simple analgesia and nonpharmacological treatments. Use of paracetamol was particularly preferred for older people and those with comorbidities.link_to_OA_fulltex

Splenic arteriovenous fistula: Unusual cause of portal hypertension complicated with gastric variceal bleeding

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Developing high quality family medicine practice to safeguard the health of our population and towards a healthy development of our health care system

The recent discussion paper on the future service delivery model for our health care system has highlighted the importance of family physicians. It is important to highlight the unique skills of family physicians and explore how best to build up the basic competencies from undergraduate to postgraduate level. A system of certification for family physicians is needed but we must take into account the historical development of Family Medicine in Hong Kong. The certification system must be reasonable in assuring basic standards. It should also be possible for all practicing primary care physicians to achieve without great difficulty. One should use the concept of professional development for doctors already in practice to achieve the basic competencies in Family Medicine. The family physicians must be well positioned in the health care delivery system and the future system should enable them to be more directly involved in chronic disease management, preventive health services and health promotion activities. All these initiatives need to be put in action as soon as possible.link_to_subscribed_fulltex

The Efficacy, Toxicities and Prognostic Factors of Stereotactic Radiotherapy in BCLC Stage C Hepatitis B Related Hepatocellular Carcinoma

Poster Presentation - Oncology Sessio

App-solutely fabulous! But are they effective for oral health promotion?

Session 8: P1-Joseph Lister Award Competition (SEA)Conference Theme: We are the FuturePoster PresentationObjective: To evaluate the effectiveness of ‘apps’ in an oral health promotion initiative to improve knowledge, behaviour and task performance. Method: A case-control study involving 582 6/7-year-old children at two primary schools. The control school received conventional oral health promotion (i.e. talk and leaflet distribution). The test (case) school received conventional oral health promotion plus exposure to an oral health promotion ‘app’. Differences in knowledge, behaviour and task performance were investigated and compared between schools (pre- and post- intervention). Result: The response rate to the study was 97.9% (570/582). There were significant changes in oral health knowledge (p0.05). Greater active participation was observed among the test group compared to the control group. Conclusion: The use of ‘app’ in conjunction with conventional oral health promotion is effective in improving oral health knowledge, oral health behaviour and task performance. However, the adjunct use of ‘app’ does not appear to enhance the effectiveness of conventional oral health promotion methods. ‘Apps’ are great for active participation but may not be 'absolutely fabulous'