Unilateral epistaxis after swimming in a stream

A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swum in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.published_or_final_versio

Hybrid endovascular operation for ruptured thoracic aortic aneurysm

The rupture of a thoracic aortic aneurysm is a life-threatening emergency. Conventional open surgical repair carries a high mortality and morbidity. We report an elderly patient who suffered from rupture of a proximal descending thoracic aortic aneurysm close to the aortic arch. A hybrid operation consisting of a right-to-left carotid bypass followed by endovascular repair of the descending thoracic aorta was carried out. The patient recovered uneventfully. A hybrid endovascular repair should be considered the treatment of choice for rupture of a thoracic aortic aneurysm near the arch.published_or_final_versio

香港977位慢性鼻炎患者的過敏原皮膚點刺測試結果

OBJECTIVES: To evaluate the prevalence of aetiological allergens identifiable by skin prick test alone in patients suffering from chronic rhinitis in Hong Kong, and also compare the clinical history and symptoms of skin prick test-positive versus skin prick test-negative patients. DESIGN: Prospective study. SETTING: Otorhinolaryngology clinic in Queen Mary Hospital of Hong Kong. PATIENTS: A total of 977 patients suffering from chronic rhinitis were recruited into the study. Skin prick test was performed with a panel of allergens including house dust mites, cockroach, cat, dog, moulds, and pollens. MAIN OUTCOME MEASURES: Skin prick test results and their correlation with symptoms. RESULTS: Of the 977 patients, 651 (67%) had positive skin prick test reactions. The commonest allergen was house dust mite which was positive in 63% of the 977 patients and 95% of those 651 skin prick test-positive patients. The other allergens were in order of cockroach (23%), cat (14%), dog (5%), pollen (4%), and mould (3%). Compared with skin prick test-negative patients, skin prick test-positive patients were more likely to have earlier age of onset of the chronic rhinitis, association with asthma, more severe symptom in the morning, more severe symptoms of itchy nose, sneezing, nasal discharge, itchy eye, and watery eye. CONCLUSIONS: Identifiable aeroallergens could be detected in 67% chronic rhinitis patients by skin prick test alone. House dust mites were the most prevalent causative allergen. There were significant differences of patterns of clinical history and symptoms severity between skin prick test-positive and skin prick test-negative patients.published_or_final_versio

Angioplasty and primary stenting of high-grade, long-segment superficial femoral artery disease: Is it worthwhile?

The purpose of this study was to determine the long-term results and efficacy of angioplasty and stenting of long-segment, high-grade superficial femoral artery disease. Seventy-three consecutive primary balloon angioplasty procedures with immediate stenting in 70 patients with SVS/ISCVS grade B2 or C superficial femoral artery (SFA) disease exceeding 5 cm in length were evaluated. The mean lesion length was 16 cm and occlusion constituted 62%, with a runoff score of 8. Forty-nine procedures (67%) were performed for critical ischemia. A total of 135 stents were placed. Follow-up was with 3-month duplex ultrasound; stenosis >50% was considered the end point for failure. Mean follow-up time was 26 months. Initial technical success with intent to treat was 90%. Initial success according to anatomic, hemodynamic, and clinical criteria was 90%, 88%, and 88%, respectively, with intent to treat. Limb salvage in the critical ischemia group was 71%. Overall cumulative primary patency rates at 12, 24, and 48 months were 56%, 35%, and 22%, and secondary patency rates were 69%, 47%, and 37%, respectively. A stented segment length >10 cm and procedure in claudicants incurred an inferior patency rate. Treatment of high-grade SFA lesions with angioplasty and primary setting results in lower long-term patency rate than those with surgery, but combined with secondary interventions this treatment option may be an acceptable alternative in selected patients with critical ischemia. Femoropopliteal bypass remains the procedure of choice.link_to_subscribed_fulltex

Blood loss and transfusion in elective abdominal aortic aneurysm surgery

Background: Intraoperative blood loss and transfusion are known determinants of mortality and morbidity of elective abdominal aortic aneurysm (AAA) repair. The present study analysed the pattern of blood loss and transfusion and evaluated the risk factors of blood loss during open repair of infrarenal AAA. Methods: Blood loss, transfusion and fluid replacement during elective open repair operation for patients with infrarenal AAA were correlated to demographic data, operative findings and procedural information. Results: A total of 129 patients with a mean age of 71 years was analysed. The mean blood loss was 1000 ± 887 mL (200-6000 mL). Blood transfusion, with a mean transfusion volume of 400 ± 591 mL (0-3000 mL), was required in 46% of patients. Univariate analysis showed that bodyweight, renal impairment, low haemoglobin and platelet counts, iliac artery involvement, large aneurysm, bifurcated graft, large graft diameter, prolonged aortic clamp time and long operation time were associated with a higher blood loss. A haemoglobin level of 50 min (RR: 15), total operation time >200 min (RR: 11) and type of graft (RR: 3.5) were identified as independent determinants of blood loss on multivariate analysis. Conclusion: Intraoperative blood loss in elective infrarenal aneurysm surgery is influenced by patients' haematological parameters, distal involvement of aneurysm and degree of difficulty of operation.link_to_subscribed_fulltex

Endoluminal stent grafts for aortic diseases: Experience at a major teaching hospital in Hong Kong

Background: The purpose of the present paper was to review the initial experience of an endovascular aortic stent graft program at a major teaching hospital in Hong Kong. Methods: Demographics, operative details, complications and follow-up data of all the patients receiving endovascular repair for aortic disease were recorded prospectively. Results: Between July 1999 and December 2001, endovascular repairs were attempted in 39 patients with aortic disease. The procedural success rate was 97.4%. Thirty-three procedures were for abdominal aorto-iliac aneurysms. Graft configuration was bifurcated in 28 patients (85%) while an aorto-uni-iliac device with a femoro-femoral bypass was carried out in the remaining five patients. Thoracic procedures were carried out for one thoracic aortic aneurysm, two traumatic thoracic aortic injuries, one thoracic aortic dissection, and one thoracic aortic pseudoaneurysm with aorto-oesophageal fistula. There was one hospital mortality (2.6%) from a type A thoracic aortic dissection with cardiac tamponade. Postoperative complications were seen in seven patients (18%). With a mean follow-up of 11.6 ± 8.1 months, there was no open conversion or rupture. The endoleak rate was 27% at discharge, 15% at 6 months and 5% at 12 months postoperatively. For aneurysm endografts, the aneurysm sac decreased in size in 21 patients (62%), and remained static in 13 patients (38%). Conclusions: The endoluminal stent graft appears to be a promising device that can be used safely in selected patients with aortic disease. Continued follow-up is required to monitor the presence of endoleak and the size of the aneurysm sac.link_to_subscribed_fulltex

Endovascular repair for abdominal aortic aneurysms: Initial experience of an endograft programme

OBJECTIVE: To evaluate early clinical results of elective endovascular repair of abdominal aortic aneurysms during the initial phase of an aortic endograft programme and to compare them with conventional open surgery. METHODS: Between July 1999 and September 2001, all patients with infrarenal abdominal aortic aneurysms undergoing elective repair were studied. The results of endovascular repair were compared with those of conventional repair. RESULTS: Twenty-seven endovascular repairs (24 men and three women; mean age, 74 yr) and 25 conventional repairs (19 men and six women; mean age, 73 yr) for infrarenal abdominal aortic aneurysms were evaluated. The aneurysm diameters in the two groups were similar (mean, 6.1 cm in the endovascular repair group and 6.6 cm in the conventional repair group). The comorbidities of the two groups were also comparable. The duration of operation was longer in the endograft group (249 ± 86 min vs. 206 ± 56 min), while the blood loss was significantly less (600 ± 486 mL vs. 1074 ± 1220 mL). The length of stay in the Intensive Care Unit (ICU) and the overall duration of hospitalization was also significantly less in the endograft group (1 ± 1 d vs. 3 ± 2 d in ICU; 9 ± 5 d vs. 13 ± 6 d of hospitalization). There was one hospital death in each group (4%), and the complications were similar between the two groups. During a mean follow-up period of 11.6 ± 7.5 months, there was no rupture or open conversion in the endograft group. CONCLUSIONS: In the initial phase of the aortic endograft programme, the mortality and morbidity were acceptable and comparable to that of open surgery.link_to_subscribed_fulltex

Metachronous multiple non-anastomotic aneurysms in a bifurcated double velour knitted Dacron graft

A case of metachronous non-anastomotic aneurysms in a bifurcated double velour knitted Dacron aortobifemoral graft is reported. The cause of non-anastomotic graft aneurysms is most likely due to a basic structural failure in the graft, as a result of defects in fabrication, Dacron fibre deterioration or a combination of both. Local excision of the graft defect with interposition graft replacement is an accepted treatment for local graft failure. However, as fabrication defects and Dacron fibre deterioration are both factors affecting the whole graft, it is not surprising to find multiple aneurysms in the same graft synchronously or metachronously. Thus, a total graft replacement should be the treatment of choice for graft failure.link_to_subscribed_fulltex

Ultrasonographic screening for occult thyroid cancer

BACKGROUND: It has been shown that occult thyroid carcinoma can be identified in about 10% of thyroid glands in autopsy. The purpose of this study was to evaluate the prevalence of asymptomatic thyroid carcinoma in the Hong Kong Chinese population by ultrasonographic screening. METHODS: Volunteer subjects without symptoms of thyroid disease were recruited for ultrasonographic screening for thyroid cancer. A total of 1140 subjects were recruited in this study. RESULTS: Thyroid nodules were found in 45% subjects (511 of 1140); the mean age was 48 years. Ultrasonographic-guided aspiration cytology was performed in 258 subjects. Twenty-six subjects (2.3%) had cytologic findings suspicious of malignancy. Fourteen subjects (1.2%) had pathologic diagnosis of thyroid cancer, including 13 papillary carcinomas and 1 follicular carcinoma. CONCLUSION: A high incidence of occult thyroid cancer could be identified on ultrasonographic screening. Subjects could benefit with early diagnosis with either early intervention or close monitoring.link_to_subscribed_fulltex

Thyroid dysfunction in laryngectomees - 10 years after treatment

Background. Hypothyroidism is 1 of the complications that follow treatment of various head and neck cancers. In the literature, reviews using different primary sites and differences in treatment modalities make comparison of post-treatment hypothyroidism not possible. The objective of this study was to evaluate the incidence of hypothyroidism in a homogenous group of patients who were treated with total laryngectomy and irradiation for laryngeal carcinoma and to assess the importance of different variables in the occurrence of hypothyroidism. Methods. A retrospective review of 147 total laryngectomy patients between 1993 and 2003 was carried out. Serum thyroxine level and free T4 levels were assessed in all patients. Hypothyroidism was classified as subclinical (increased thyroid-stimulating hormone and normal free T4 levels) and clinical (increased thyroid-stimulating hormone and decreased free T4 levels). Results. The results showed that the overall incidence of hypothyroidism was 49% (44% subclinical and 5% clinical). Hemithyroidectomy and advanced tumor staging were risk factors for the development of hypothyroidism in these patients (p < .05) with a relative risk of 2.1 (CI 95%, 1.4-3.1) and 1.3 (CI 95%, 1.1-1.6), respectively. During follow-up, 19.9% of patients developed hypothyroidism at 3 years, 38.6% at 6 years; at 10 year follow-up, 93.3% of them had hypothyroidism. Conclusions. In conclusion, hypothyroidism is a frequent complication in patients treated with radiotherapy and total laryngectomy for laryngeal cancer, especially when treatment includes hemithyroidectomy. These patients should have their thyroid function evaluated periodically even 10 years after treatment. ©2007 Wiley Periodicals, Inc.link_to_subscribed_fulltex