Radiological conference. Colonic obstruction due to sigmoid tumour

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The value of flexible sigmoidoscopy for patients with bright red rectal bleeding

Objective. To review the diagnostic yield of flexible sigmoidoscopy in patients presenting with bright red rectal bleeding. Design. Retrospective study. Setting. University teaching hospital, Hong Kong. Subjects and methods. Patients who underwent flexible sigmoidoscopy between January 1995 and April 1996 for investigation of bright red rectal bleeding were recruited. The extent of the endoscopic examination, complications, and endoscopic findings were recorded. Results. A total of 1052 patients were included in the study. The mean length of endoscopic examination was 55 cm. There were no complications attributed to the procedure. Thirteen (1.2%) patients aged from 41 to 87 years were found to have malignant tumours that were not palpable on digital examination. All the tumours were moderately differentiated adenocarcinoma. Two patients had synchronous liver metastasis at presentation. Adenomatous polyps were detected in 81 (7.7%) patients, of whom 76 were older than 40 years. The majority of polyps were tubular adenomas associated with mild or moderate dysplasia. Other endoscopic findings included hyperplastic and juvenile polyps, proctocolitis, diverticulosis, irradiation colitis, ischaemic colitis, rectal ulcers, and infective colitis. The overall diagnostic yield was 21.1%. No mucosal lesion was detected by flexible sigmoidoscopy in 78.9% of patients in whom the rectal bleeding was due to either haemorrhoids or anal fissure. Conclusions. Cancer was detected in 1.2% and adenomatous polyps in 7.7% of patients with bright red rectal bleeding using flexible sigmoidoscopy. All cancers and 94% of adenomatous polyps were detected in patients older than 40 years. Flexible sigmoidoscopy appears to be a valuable initial investigation for bright red rectal bleeding in patients older than 40 years.published_or_final_versio

Implementing knowledge management in school environment: Teachers' perception

Knowledge Management (KM) can be used as an alternative strategy by schools to help teachers equipped with relevant skills to face the challenges to improve performance as its uses in commercial sectors. However, little research has been undertaken on how KM can be applied to school environment. To put KM into action, it is crucial to understand teachers' perception of KM at the outset. The study was carried out in a typical Hong Kong secondary school. Interviews, based on relevant KM models, were conducted to understand teachers' perception of KM. We found that knowledge sharing, people, culture and knowledge storage with IT support were regarded as important from the interviewees' points of view. Most interviewees might accept that KM can help improve their practice but it needs the support of various dimensions such as people, culture, IT and management. The findings may provide insights for KM implementation in the school.published_or_final_versio

Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation

Aim: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. Methods: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed. Results: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. Conclusion: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for surgical intervention. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Ambulatory stapled haemorrhoidectomy: A safe and feasible surgical technique

Objective. To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure. Design. Prospective non-randomised study. Setting. University affiliated hospitals, Hong Kong. Subjects and methods. Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients. Results. There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete 'doughnut' after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures. Conclusions. Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with in-patient care.published_or_final_versio

Total mesorectal excision for rectal cancer decreases local recurrence

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Maintaining a reputation for consistently beating earnings expectations and the slippery slope to earnings manipulation

This paper investigates whether maintaining a reputation for consistently beating analysts’ earnings expectations can motivate executives to move from “within GAAP” earnings management to “outside of GAAP” earnings manipulation. We analyze firms subject to SEC enforcement actions and find that these firms consistently beat analysts’ quarterly earnings forecasts in the three years prior to the manipulation period and continue to do so by smaller “beats” during the manipulation period. We find that manipulating firms beat expectations around 86 percent of the time in the twelve quarters prior to the manipulation period (versus 75 percent for control firms) and that manipulation often ends with a miss in expectations. We document that executives of manipulating firms face strong stock market and CEO pressure to perform. Prior to the manipulation period, these firms have high analyst optimism, growing institutional interest, and high market valuations, along with powerful CEOs. Further, we find that maintaining a reputation for beating expectations is more important than CEO overconfidence and is incremental to CEO equity incentives for explaining manipulation. Our results suggest that pressure to maintain a reputation for beating analysts’ expectations can encourage aggressive accounting and, ultimately, earnings manipulation

Characteristics of nonmethane hydrocarbons (NMHCs) in industrial, industrial-urban, and industrial-suburban atmospheres of the Pearl River Delta (PRD) region of south China

In a study conducted in late summer 2000, a wide range of volatile organic compounds (VOCs) were measured throughout five target cities in the Pearl River Delta (PRD) region of south China. Twenty-eight nonmethane hydrocarbons (NMHCs; 13 saturated, 9 unsaturated, and 6 aromatic) are discussed. The effect of rapid industrialization was studied for three categories of landuse in the PRD: Industrial, industrial-urban, and industrial-suburban. The highest VOC mixing ratios were observed in industrial areas. Despite its relatively short atmospheric lifetime (2-3 days), toluene, which is largely emitted from industrial solvent use and vehicular emissions, was the most abundant NMHC quantified. Ethane, ethene, ethyne, propane, n-butane, i-pentane, benzene, and m-xylene were the next most abundant VOCs. Direct emissions from industrial activities were found to greatly impact the air quality in nearby neighborhoods. These emissions lead to large concentration variations for many VOCs in the five PRD study cities. Good correlations between isoprene and several short-lived combustion products were found in industrial areas, suggesting that in addition to biogenic sources, anthropogenic emissions may contribute to urban isoprene levels. This study provides a snapshot of industrial, industrial-urban, and industrial-suburban NMHCs in the five most industrially developed cities of the PRD. Increased impact of industrial activities on PRD air quality due to the rapid spread of industry from urban to suburban and rural areas, and the decrease of farmland, is expected to continue until effective emission standards are implemented. Copyright 2006 by the American Geophysical Union

Is ultrasonography-guided modified coaxial core biopsy of the breast a better technique?

Objective: To compare the diagnostic rate, patient comfort, and complications of ultrasonography-guided breast biopsy using a modified coaxial technique with ultrasonography-guided fine needle aspiration and traditional core biopsy. A secondary objective was to describe the use of the coaxial technique for the biopsy of breast lesions and our initial experience. Design: Retrospective study. Setting: A regional hospital in Hong Kong. Patients: Patients, who were referred for ultrasonography-guided fine needle aspiration or biopsy from 23 November 2007 to 19 March 2008, were divided into three groups. For breast lesions of 8 mm or smaller, fine needle aspirations were performed. For breast lesions larger than 8 mm, the patients were randomly divided into groups receiving traditional core biopsies and coaxial biopsies. The pathological reports were reviewed. Main outcome measures: Diagnostic rate, patient comfort assessed in terms of pain, and any procedural complications. Results: A total of 45 ultrasonography-guided fine needle aspirations or biopsies of breast lesions were performed. All core biopsies using the traditional core technique (n=15) and coaxial technique (n=16) were diagnostic. While for fine needle aspirations, three (21%) of 14 were not diagnostic and repeat biopsies were undertaken for the corresponding patients. Except for one breast lesion biopsied with the coaxial technique that revealed invasive ductal carcinoma, all others yielded benign lesions. The average pain score for coaxial biopsies was 2.2, while for traditional core biopsies and fine needle aspirations, average scores were 3.7 and 3.8, respectively (P=0.022). No procedure-related complication was documented with either of the three techniques. Conclusion: Modified coaxial core biopsy of the breast has an optimal diagnostic rate and hence avoids the need for repeat biopsies. It is associated with better patient comfort and no increase in the risk of complications.published_or_final_versio

Halocarbons in the atmosphere of the industrial-related Pearl River Delta region of China

Author name used in this publication: Chu, K. W.Version of RecordPublishe