Infectious complications of liver transplantation

Sixteen (50%) of the 32 patients who received liver transplantations from October 1991 to March 1993 at Queen Mary Hospital, Hong Kong, developed viral, bacterial, or fungal infections. The viral infections were largely a result of immunosuppression while accidental bowel perforation, bile leak at the anastomosis, and delayed onset of stricture of the bile duct anastomosis were responsible for the intra-abdominal bacterial or fungal infections. Although the incidence of infectious complications was high, all patients were managed effectively and only one patient with lymphoproliferative disorder died. Infectious complications can lead to a prolonged hospital stay and a substantially increased hospital cost. The adoption of new immunosuppressive regimes that can better prevent acute graft rejection and adherence to meticulous surgical technique will help to reduce the infectious complications of liver transplantation in the future.published_or_final_versio

A case-control study on environmental and familial risk factors for colorectal cancer in Hong Kong: physical activity reduces colorectal cancer risk

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A case-control study on environmental and familial risk factors for colorectal cancer in Hong Kong: dietary determinants of colorectal cancer risk

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A case-control study on environmental and familial risk factors for colorectal cancer in Hong Kong: chronic illnesses, medication and family history

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Colonoscopic surveillance and screening for familial colorectal cancer: experience of a regional registry

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Phenotype and management of patients with familial adenomatous polyposis in Hong Kong: perspective of the Hereditary Gastrointestinal Cancer Registry.

OBJECTIVES: To report on the phenotypic spectrum and clinical management of Chinese patients suffering from the rare autosomal dominant colorectal cancer syndrome of familial adenomatous polyposis. DESIGN: Analysis of prospectively collected data from the database of a regional registry. SETTING: The Hereditary Gastrointestinal Cancer Registry, Hong Kong. PARTICIPANTS: One hundred and eight patients with proven familial adenomatous polyposis from 36 local Chinese families with the condition recruited to the Registry from 1995 to 2001. INTERVENTIONS: Screening programme for at-risk family members, prophylactic surgery at presymptomatic diagnosis, and surveillance programme for extracolonic lesions in affected individuals. MAIN OUTCOME MEASURES: Rate of colorectal cancer, type of surgical treatment, spectrum of extracolonic lesions, and management of the syndrome. RESULTS: Fifty patients suffered from colorectal cancer with a mortality rate of 78.0%. The strategy of presymptomatic diagnosis by screening and appropriate prophylactic surgery reduced the incidence of colorectal cancer. Affected individuals were prone to develop potentially serious extracolonic lesions including thyroid cancer (5.7%), desmoid tumour (15.7%), gastroduodenal adenomas (7.1%), duodenal microadenoma (17.1%), and pouch polyposis (17.4%). CONCLUSIONS: Screening and prophylactic surgery are effective ways to prevent colorectal cancer for patients with familial adenomatous polyposis. Lifelong regular surveillance is necessary to detect and manage extracolonic lesions. A dedicated registry is essential to coordinate clinical management and to compile data for furthering knowledge of this rare but complex syndrome.published_or_final_versio

Genetic-guided screening programme for familial adenomatous polyposis: result of a regional registry

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Persistence of hepatic hepatitis B virus after serological clearance of HBsAG with autologous peripheral stem cell transplantation

Delayed clearance of hepatitis B surface antigen was previously reported in a 38 year old woman after high dose chemotherapy with autologous peripheral blood stem cell rescue. Sixteen months later, this patient remained hepatitis B surface antigen negative, hepatitis B surface anti-body positive, and serum hepatitis B DNA negative by polymerase chain reaction. Serial liver biopsies (one at hepatitis B e antigen positive stage, one at hepatitis B e antibody positive stage, and one at hepatitis B surface antigen negative and hepatitis B surface antibody positive stage) showed a gradual resolution of the inflammatory activity with loss of hepatitis B e antigen and then hepatitis B surface antigen in the serum. However, the degree of fibrosis, though mild, remained the same. With the serological clearance of hepatitis B surface antigen, a small amount of hepatitis B virus DNA was still detectable in the nuclei of liver cells.published_or_final_versio

The prevalence of Helicobacter pylori carrier rates among the healthy blood donors in Hong Kong

A serological assay was employed in this study to assess the Helicobacter pylori carrier rates among the healthy blood donors (all Chinese) in Hong Kong. The commercial kit for detecting anti-H. pylori antibody titres was found to have a sensitivity of 84% and a specificity of 85% by using the histochemistry results as the gold standard. Elevated anti-H. pylori antibody titres were observed in 42.4%, 53.2% and 72.2% of the healthy blood donors of age below 20, 21 to 30 and 31 to 40 years respectively. This indicates a steady rise of H. pylori carrier rates with age. The overall H. pylori prevalence rate was 54.9%. The positivity of H. pylori in teenagers appeared to be double that reported in Western countries. Whether this is related to the younger age of peptic ulcer presentation in Hong Kong compared with Western countries is not known. However, there was no significant difference of the H. pylori rates between males and females of each age group although a male predominance has been well established for peptic ulcer in Hong Kong.published_or_final_versio

Outpatient laparoscopic cholecystectomy in Hong Kong Chinese - An outcome analysis

BACKGROUND: Laparoscopic cholecystectomy (LC) is now the procedure of choice for symptomatic gallbladder disease. Although many recent studies, mostly from abroad, report that it can be performed safely in the outpatient setting, the experience of outpatient LC in Hong Kong is still limited. This retrospective study evaluated the feasibility, safety and patient acceptance of outpatient LC in Hong Kong Chinese patients. PATIENTS AND METHODS: The data of 73 consecutive patients who had undergone outpatient LC between February 2000 and October 2002 in the Day Surgery Centre of Tung Wah Hospital were prospectively collected and reviewed. The selection criteria for patients undergoing outpatient LC included American Society of Anesthesiologists risk classification I or II, age less than 70 years, and the availability of a competent adult to accompany the patient home and look after them for 24 hours. No effort was made to exclude complicated cases. After assessment by the operating surgeon, patients were discharged from the Day Surgery Centre in the afternoon when their clinical condition satisfied pre-defined discharge criteria. All patients were followed up in the Day Surgery Centre in the first and fourth postoperative weeks. RESULTS: The same-day discharge rate was 88% and the conversion rate was 4%. Six patients (8.2%) with uneventful LC required hospitalization after the procedure. There was no major complication and no unplanned admission. Two patients had port site wound infection requiring hospital admission at the first follow-up. Patient satisfaction was high, pain acceptance was good, and analgesic consumption was minimal. Mild fat intolerance was common in patients postoperatively (> 50%), but this had almost all resolved by postoperative week four. All patients were able to resume their usual daily activities within 2 weeks after surgery. CONCLUSIONS: LC is a safe and feasible outpatient procedure in Hong Kong, with high levels of patient satisfaction. A prospective study with a larger patient population is warranted to verify whether it should be recommended as treatment for gallstone disease in selected patients in future.postprin