1997年 · 第110卷第06期

OBJECTIVE To compare whole body magnetic resonance imaging (MRI) using fast sequences with radioisotope bone scintigraphy (BS) for the detection of metastases in the entire skeleton. MOTHODS and RESULTS In forty-four patients suffering from carcinoma of lung, breast and prostate whole body MRI could generally be accomplished in about 39 minutes and it was shown to have a higher skeletal metastases detection compared with BS in the spine, pelvis, limb bones, sternum, scapula, and clavicle, but lower in the ribs and skull. CONCLUSIONS We think for addressing the status of skeletal metastases only, bone scintigram is still preferred over whole body MRI. When bone scintigram is unavailable, whole body MRI is a practical and acceptable alternative especially when extra-osseous metastases are also of concern.

OBJECTIVE To evaluate the strategy of the management of patients with fulminant hepatic failure at Queen Mary Hospital. METHODS In the period 1994 through 1996, 30 patients with fulminant hepatic failure were managed by active supportive treatment in the Intensive Care Unit in preparation for liver transplantation. Liver transplantation was performed in 14 patients (aged 17-47), 3 of whom received liver grafts from brain-stem dead donors and 11 received live-related grafts from family members. The median duration from admission to liver transplantation was 3 days (range: 1-6 days). RESULTS Thirteen patients (93%) survived the liver transplantation and are well after a median period of follow-up of 7 months. The only mortality was in a patient with pre-exiting renal transplantation and hepatitis B infection, who died from intra-abdominal candidiasis. CONCLUSIONS The strategy of active supportive treatment and early liver transplantation using live-related liver graft is probably the key to the success of the management of fulminant hepatic failure in our series.

OBJECTIVE To evaluate the efficacy of subzonal insemination (SUZI) as applied to unfertilized oocytes after initial insemination. METHODS Unfertilized oocytes at metaphase II obtained after conventional IVF from 14 patients were selected for reinsemination by SUZI. The fertilization rate and pregnancy outcome were assessed. RESULTS Of the 57 unfertilized oocytes at metaphase II, 10 (17.5%) became fertilized after SUZI. Eight of the 10 (80%) oocytes showed normal fertilization with two pronuclei while the other two (20%) oocytes were polyspermic. Five (35.7%) of the 14 patients had embryo transfer resulting in two (14.3%) pregnancies. One patient had a spontaneous abortion and the other had a live birth at term. CONCLUSIONS Reinsemination of unfertilized oocytes by SUZI could be of value when fertilization fails after initial insemination.

OBJECTIVE To study the mode of presentation, the tumor, nodes, metastasis (TNM) staging and the efficacy of multimodal treatment of breast cancer among Chinese women treated in Queen Mary Hospital. METHODS The available records of all breast cancer patients treated between January 1980 and December 1994 were reviewed. The mode of presentation, the TNM staging of the disease, estrogen receptor status and the mode of surgical and adjuvant treatment were studied. Statistical correlation was performed between the factors studied and the survival time. RESULTS Seven hundred and one cases of breast cancer were identified. The mean age of the patients was 56.6 years (range, 20-98 years). The most common complaint was the presence of a mass which occurred in 635 (90.6%) patients and 454 (71.5%) of these patients were painless. The majority of patients had T2 tumours (51.8%) and stage II disease (59.6%), but only 86 (12.3%) patients underwent breast conservative therapy (BCT). Estrogen receptor was positive in 43% of patients. Two hundred and ninety (41.4%) patients were node positive and the mean number of involved nodes was 3.8 per patient. Adjuvant chemotherapy was given to 125 node positive patients, adjuvant tamoxifen to 188 patients and both to 63 patients. Univariate analyses of factors possibly affecting survival showed that advanced stage disease and nodal involvement were associated with a significantly lower survival time. Among the node positive patients, those with seven or more involved nodes had a shorter survival. The types of surgery and adjuvant treatment (for node positive patients) had no direct correlation with survival. CONCLUSIONS Our results showed that the majority of our patients presented with a painless mass and the final outcome was determined by the tumour load at the time of presentation (TNM staging and nodal status).

OBJECTIVE This study was designed to examine the genetic variation and levels of apolipoprotein (a) [apo(a)] in Chinese living in two different geographical regions of China and the influence of the apo(a) size polymorphism on plasma apo(a) levels. METHODS An immunoradiometric assay was used to determine plasma apo(a) levels and a simplified and sensitive SDS-agarose gel electrophoresis method followed by immunoblotting with chemiluminescent detection for apo(a) phenotyping was employed to compare the frequency distributions of apo(a) levels and phenotypes in southern (Hong Kong) and northern (Henan) Chinese populations. RESULTS Distributions of plasma apo(a) levels were highly skewed in both population groups. Although plasma apo(a) levels were generally higher in northern Chinese than in southern Chinese this was not explained by differences in K-IV repeats allele frequencies between these two population groups. The association of K-IV repeat length with apo(a) levels is similar in the two populations. CONCLUSIONS We conclude that besides the apo(a) size polymorphism, which is similar in these two Chinese populations, other factors affect apo(a) levels to a certain degree. Most likely, this is the sequence variation in apo(a) gene which may not be the same in different Chinese populations.

Esophageal cancer is very popular in Hong Kong. The tumor is often prevalent in males and has a modal peak of occurrence in the 7th decade. The pathogenesis of the esophageal neoplasm is still uncertain but likely to be multi-factorial. The commonest histological subtype is squamous cell carcinoma. Besides, mucoepidermoid carcinoma/adenosquamous carcinoma, adenocarcinoma, small cell carcinoma, sarcomatoid carcinoma, adenoid cystic carcinoma, undifferentiated carcinoma, melanoma and gastrointestinal autonomic nerve tumor are also found in a minority of patients. The proportion of various histologic subtypes is different from the Western populations. Concerning the genetic alternation, P53 mutation is common in esophageal squamous cell carcinoma. Esophageal cancer has its unique pattern of P53 mutations in Hong Kong. In addition, intramural metastasis and multiple lesions are characteristic features in esophageal squamous cell carcinoma. Important pathologic factors in determining the prognosis of patients with esophageal cancer includes completeness of surgical resection, stages, tumor dimension as well as MIB-1 scores and the presence of P53 mutations.

Purpose To review the experience of an assisted reproduction program. Data sources Department of Obstetrics and Gynaecology, University of Hong Kong. Study selection Assisted reproduction in a tertiary referral centre. Data extraction Results of assisted reproduction from 1986-1996. Results In the past ten years, 1561 treatment cycles of in vitro fertilization and embryo transfer (IVF), 257 of gamete intrafallopian transfer (GIFT) and 217 of pronuclear stage tubal transfer (PROST) were initiated. The clinical pregnancy rates per cycle started were 10.8% for IVF, 16.3% for GIFT and 15.7% for PROST. As a result of improvement in ovarian stimulation and embryo culture, the success rate of the program increased in recent years. The pregnancy rate of IVF per embryo transfer was 20.2% in 1995. Embryo cryopreservation program was started in 1992. Since then, 664 cycles of replacement of frozen-thawed embryos were completed with a pregnancy rate of 14.6% per cycle. One hundred and forty-three cycles of assisted fertilization using various techniques, namely partial zona dissection, subzonal sperm injection and intracytoplasmic sperm injection, were performed. The success rate was the highest for the latter technique with a pregnancy rate of 14% per transfer cycle. A prospective randomized control trial on the use of coculture in assisted reproduction had also been done. Results indicated that coculture of embryos with human oviductal cells improved the implantation rate of the embryos. Conclusion Various technique development have been made to improve the success rate of assisted reproduction as well as the quality of treatment of infertility.

OBJECTIVE The management strategies after acute myocardial infarction (AMI) have been evolving from simple supportive treatment to various protocols of thrombolytic therapies, and then to mechanical revascularization by balloon angioplasty in recent years. However, controversies still exist between which is the best treatment approach. METHODS An extensive analysis was carried out in over 120 articles reported recently in the literature. RESULTS Most reported series have shown that direct angioplasty is a feasible and safe option for the management of acute myocardial infarction. Large scale randomised studies comparing direct angioplasty versus thrombolytic therapy in acute myocardial infarction have also reported very favourable acute and long term outcomes by direct angioplasty as compared to thrombolytic therapy. The results are at least equivalent, if not better, by direct angioplasty. Acute results include better reperfusion rate of infarct related artery, less bleeding and stroke complications, shorter hospital stay, and most importantly, lower in-patient mortality (around 2% in direct PTCA group versus 6% in thrombolysis group) and less recurrent ischaemic event (around 10% in direct PTCA group versus 30% in thrombolysis group). Despite some delay in the commencement of treatment by direct angioplasty than thrombolytic therapy, the left ventricular function remains comparable in the two groups and the overall long term outcomes are very favourable with direct angioplasty. Specific indications for direct angioplasty include patients with cardiogenic shock after AMI and patients with contraindications to thrombolysis. No reflow phenomenon is still an issue of concern. It is in general contraindicated to use angioplasty after failure of thrombolysis. The cost implication is not far exceeding that of thrombolysis therapy. CONCLUSIONS Direct angioplasty for acute myocardial infarction should be established as a treatment option if the circumstances allow. Planning should be carried out at the hospital and community level in order to make direct angioplasty a high priority treatment option for patients with acute myocardial infarction.