bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete resolution of recurrent calciphylaxis with long‐term intravenous sodium thiosulfate
Authors: Subramaniam Kavitha , Wallace Hilary , Sinniah Rajalingam , Saker Barry
Published: August 2010

A 35‐year‐old morbidly obese woman on home haemodialysis presented with painful indurated subcutaneous nodules histologically characteristic of calciphylaxis. After failing to respond to conventional treatment, she was commenced on an intravenous infusion of 25 g of sodium thiosulfate three times per week. Two weeks after commencing sodium thiosulfate, the pain resolved completely. By 12 weeks, the lesions had healed and the infusions were ceased. Two months later, skin lesions recurred, but resolved again within 3 months of recommencement of sodium thiosulfate treatment, which was continued for 8 months. The treatment was well tolerated. There has been no recurrence of lesions in the 18 months since the cessation of sodium thiosulfate. Clinical trials to determine the optimum dose and duration of therapy for sodium thiosulfate treatment of calciphylaxis should be given priority because of its high rate of success in treating what is otherwise a severe and mostly lethal condition.
Nephrogenic systemic fibrosis in a gadolinium‐naive renal transplant recipient
Authors: Anavekar Namrata S , Chong Alvin H , Norris Richard , Dowling John , Goodman David
Published: August 2010

A 36‐year‐old woman presented with a 2‐year history of multiple, raised, brown papules and indurated skin over her lower legs. She had received a renal transplant 11 years earlier, and had a history of recurrent deep vein thromboses despite a negative thrombophilic screen. The patient had no history of exposure to gadolinium. Histology at this time revealed a light perivascular lymphoid infiltrate, activated fibroblasts and prominent capillary vessels. The patient re‐presented 1 year later with persistence of these lesions, in the setting of worsening renal function requiring haemodialysis. Repeat skin biopsies demonstrated increased dermal collagen and angiogenesis. The dermatopathological findings, in association with renal insufficiency and multiple deep vein thromboses, led to the diagnosis of nephrogenic systemic fibrosis.
Progressive trichodysplasia spinulosa in a patient with chronic lymphocytic leukaemia in remission
Authors: Lee Joyce S‐S , Frederiksen Peter , Kossard Steven
Published: August 2010

A 70‐year old Caucasian man with chronic lymphocytic leukaemia developed trichodysplasia spinulosa 2 months after ceasing chemotherapy. Histological features characteristic to this condition include dilated and enlarged hair follicles, hyperplastic hair bulbs, hyperplasia of inner root sheath cells with numerous large, eosinophilic, trichohyaline granules, and hypercornification. Although he was in remission for chronic lymphocytic leukaemia, lesions were slowly progressive 15 months after cessation of chemotherapy. We also describe a painless pull‐test where spicules can be easily plucked and assessed microscopically for inner root sheath keratinization, or observed with surface microscopy in a clinic setting.
Nephrogenic systemic fibrosis associated with liver transplantation, renal failure and gadolinium
Authors: Caccetta Tony , Chan Jonathan J
Published: August 2010

A 47‐year‐old man underwent liver transplantation for cirrhosis secondary to hepatitis C and alcoholism. This was complicated by primary donor liver dysfunction and acute renal failure requiring dialysis. Gadolinium magnetic resonance cholangiopancreatography was performed 2 weeks post transplant, and a second successful liver transplant was performed 1 week later. Shortly after this, the patient developed rapidly progressive erythematous plaques over his abdomen, lower and upper limbs. There was marked oedema and skin induration. Fibrosis severely limited his mobility, leaving him wheelchair‐bound. An abdominal plaque biopsy revealed increased dermal mucin and cellularity, with proliferation of spindled fibroblastic cells. Paraprotein was not detected in the serum. Facial sparing, the absence of serum paraprotein and the histopathological findings confirmed the diagnosis of nephrogenic systemic fibrosis. Immunohistochemical stains revealed CD34‐positive spindle‐shaped cells, and electron microscopy did not detect free gadolinium. Following improvement in renal function and various treatments, his plaques softened, fibrosis slowed and mobility partially improved. Gadolinium magnetic resonance cholangiopancreatography was performed following this improvement. Six weeks later, further progression of nephrogenic systemic fibrosis occurred despite normal renal function.
Successful surgical management of lipoedematous alopecia
Authors: Yip Leona , Mason Graham , Pohl Miklos , Sinclair Rodney
Published: August 2010

A 67‐year‐old Caucasian woman presented with an area of alopecia over the right occipital scalp, which had slowly expanded over the last 10 years. The skin beneath the alopecia felt soft and boggy although the epidermis looked unremarkable. Ultrasound showed thickening of the underlying subcutaneous tissue. Scalp histology showed enlarged fat lobules within the subcutis that infiltrated along fibrous tracts into the mid‐dermis. There was a complete loss of hair follicles. These findings were consistent with lipoedematous alopecia of the scalp. Surgical debulking with scalp reduction produced an acceptable result in our patient with no evidence of relapse after 12 months.
Meeting the educational needs of fieldwork supervisors: A collaborative workshop developed by New South Wales occupational therapy fieldwork coordinators
Authors: Mackenzie Lynette , Zakrzewski Lee , Walker Claudia , McCluskey Annie
Published: August 2010

This paper describes the collaborative preparation and implementation of a workshop for occupational therapy fieldwork supervisors which has been developed by the four occupational therapy programmes in New South Wales. The workshop was primarily designed to meet the education needs of new and inexperienced fieldwork supervisors who could subsequently be prepared to supervise students from any of the four occupational therapy programmes in the state. The workshop was also offered to more experienced fieldwork supervisors who were interested in adapting their fieldwork programmes to incorporate the needs of students from the four occupational therapy programmes. The process of constructing the workshop is outlined. Results from pre‐workshop questionnaires (n = 237) and post‐workshop evaluations (n = 257), during the first year of presentation of the workshop, suggested that the workshop was effective in meeting the objectives of preparing fieldwork supervisors to supervise students from a variety of educational programmes. In addition, the collaboration between the occupational therapy programmes during the workshops has enabled other state‐wide fieldwork issues to be identified, and further projects have been undertaken to address fieldwork concerns.
The association between leisure motivation and recovery: A pilot study
Authors: Lloyd Chris , King Robert , McCarthy Maree , Scanlan Melissa
Published: August 2010

Background and aims:  Recovery from mental illness may be facilitated by participation in activities that provide meaning and purpose in the lives of consumers. Leisure participation can be a major source of enjoyment as well as mental and physical well‐being.

Methods and results:  This study examined the association between consumers’ motivation to engage in leisure and their self‐reported perception of recovery in a sample of 44 Clubhouse members. The Leisure Motivation Scale and the Recovery Assessment Scale were used to measure the association between leisure motivation and recovery. The results indicated a statistically significant association between leisure motivation and recovery.

Conclusion:  These findings have implications for service delivery within mental health settings, as occupational therapists may be able to design leisure‐based programs more effectively if they can understand the needs and motives for participation. More emphasis should be placed on supporting consumers to re‐integrate and be socially included within the community through leisure‐based initiatives.
Use of time in childhood and adolescence: A literature review on the nature of activity participation and depression
Authors: Desha Laura N. , Ziviani Jenny M.
Published: August 2010

Despite a philosophical belief in the health benefits of balanced participation in everyday activities, occupational therapists have devoted scant research attention to the relationship between mental health and activity participation in childhood and adolescence. Time use studies offer valuable insights into this relationship. In this literature review the methodologies employed in time use studies are described, and empirical findings linking depression to the distribution of time to leisure, productive and self‐care activities, and sleep are then outlined. The relevance of findings to occupational therapy assessment and intervention is discussed. Therapists are challenged to further research the area, as gaining thorough knowledge of young people's time use has implications for both professional practice and broader public health policy.
The occupational careers of men living with HIV infection in the United Kingdom: Insights into engaging in and orchestrating occupations
Authors: Molineux Matthew
Published: August 2010

Background:  Human immunodeficiency virus (HIV) emerged as an entity in the mid‐1980s. Since that time, medical developments have greatly improved the detection and management of infection and the associated acquired immunodeficiency syndrome (AIDS). As such, HIV infection is now seen as a chronic yet life‐threatening condition. Although occupational therapists have worked with people infected with HIV since quite early in the history of the disease, an understanding of living with HIV infection from an occupational perspective has been limited. However, as a chronic condition HIV infection is likely to have significant occupational implications.

Methods:  Five men living with HIV infection in the UK were recruited through personal contacts and information sent to HIV/AIDS organisations. Each man was interviewed using an extended oral history model, recording detailed individual life histories from early childhood until the time of the interview. Interviews were recorded and transcribed verbatim. A process of narrative analysis was developed and used to analyse each oral history. The result was a story of each man's life, centred around an occupational plot.

Results:  The narratives are textual representations of each man's occupational career as they reveal the complexity of each man's life as a web of occupations, as well as the individual careers of particular occupations. The production of each man's occupational career made it possible to first explore living with HIV infection from an occupational perspective and provide an example of how an occupational perspective of humans and health can be operationalised. They tell the story of each man's life centred around occupation, and highlight how the men not only engaged in occupations but also orchestrated their engagement over time and within various environments. In addition, the occupational careers give a contextualised insight into the meaning of occupations. Second, this research has enabled an appreciation of the difference between biomedical and occupational views of living with HIV infection. Adopting an occupational perspective illustrated how the twists and turns of life living with HIV infection may not be marked wholly by such markers as blood tests and medication side‐effects. For some men in this study, living with HIV infection was marked by occupational engagement; ceasing, commencing, resuming, or requiring more effort to perform occupations. Third, this research has enabled an understanding of each man's response to HIV infection as part of his lifelong process of occupational adaptation. It was possible to appreciate how each man had responded to challenges in the past in order to achieve and maintain occupational adaptation. Although this was not predictive, it did provide a valuable insight into how each man responded to HIV infection.
Benefits and challenges of supervising occupational therapy fieldwork students: Supervisors’ perspectives
Authors: Thomas Yvonne , Dickson David , Broadbridge Jacqueline , Hopper Linda , Hawkins Rachel , Edwards Ann , McBryde Cathy
Published: August 2010

Background/aim:  Increased enrolments in occupational therapy education programs, together with changes in the employment patterns of practising occupational therapists, have resulted in a crisis in fieldwork education in Australia. This study aimed to investigate fieldwork supervisors’ perspectives regarding the benefits and challenges of providing fieldwork placements, explore the potential link between providing student placements and later workforce recruitment, and document currently employed models of fieldwork supervision.

Methods:  Participants included past, present and potential future fieldwork supervisors, sourced from fieldwork coordinators’ databases at The University of Queensland and James Cook University. Using an online, purpose‐designed questionnaire, descriptive data (frequencies and percentages) were gathered from forced‐choice questions. For open‐ended questions, content analysis was conducted to identify categories and themes.

Results:  One hundred and thirty‐two surveys were completed. Benefits of fieldwork placements related to opportunities for later recruitment of fieldwork students, students conducting projects and developing resources, a sense of contributing to the occupational therapy profession, and the development of employee skills. Challenges related to staffing issues, lack of physical resources and prohibitive workload pressures. Multiple models of supervision were employed in supervisors’ workplaces, and almost all participants responsible for workplace employment had employed fieldwork students they had previously supervised.

Conclusions: The results demonstrate a strong link between supervision and later recruitment of fieldwork students, suggesting that supervision of students is of considerable advantage to the host organisations in the recruitment of appropriately prepared employees. The study also demonstrates additional benefits to be promoted to supervisors and organisations to encourage and support fieldwork placements.
Informing fieldwork design: Key elements to quality in fieldwork education for undergraduate occupational therapy students
Authors: Kirke Pamela , Layton Natasha , Sim Jenny
Published: August 2010

Aim:  In this current climate of escalating student fees, students as paying consumers expect a quality fieldwork experience. However, the ability of universities to deliver quality fieldwork programs is compromised by the increasing pressure experienced by fieldwork educators to meet productivity targets in the face of diminishing resources. This paper details how one university, Monash University, sought input from stakeholders to design a fieldwork program.

Methods:  This qualitative study utilised focus groups to inform the researchers of stakeholders’ perceptions of what constitutes quality fieldwork education. A total of five focus groups were held, involving 47 occupational therapists practising in Victoria.

Results:  The major findings include the need to provide ongoing professional development for fieldwork educators, the need to develop tangible strategies in recognition of their contribution towards fieldwork education, and the imperative for closer collaboration between universities and fieldwork educators.

Conclusions:  Based on literature and in response to the focus group discussions, Monash University has implemented a number of measures to ensure the successful implementation of quality fieldwork education. These include providing ongoing professional development for fieldwork educators to enhance their role, addressing fieldwork educators’ concerns about project placements and supporting students with fieldwork relocation. Most importantly, this study demonstrates the need for educational institutions to take the lead in dialogue with the profession to enhance a collaborative response to constant changes in health‐care directions. The importance of ongoing research to inform quality fieldwork education is critical to moving the profession forward.
The Collaborative Model of Fieldwork Education: Implementation of the model in a regional hospital rehabilitation setting
Authors: Bartholomai Simone , Fitzgerald Cate
Published: August 2010

Aim:   This paper describes the implementation of a Collaborative Model of Fieldwork Education in a regional hospital occupational therapy department.

Methods:  The literature on models of fieldwork education for occupational therapy students is reviewed, and an approach to the implementation of the collaborative model with three students to one clinical educator is described after piloting of this model's recommendations, arising from the pilot placement, are proposed.

Conclusions:  The implementation of a Collaborative Model of Fieldwork Education requires careful planning, close links with the university fieldwork team and a willingness on the behalf of occupational therapist clinical educators to explore alternative approaches to the provision of fieldwork education.
Learning style preferences of Australian occupational therapy students
Authors: French Glenys , Cosgriff Tessa , Brown Ted
Published: August 2010

Background/aim:  The learning styles and teaching implications for nursing and health science students have been well researched in other countries. Less research has considered the learning styles and implications for occupational therapy students. The current study examines the learning styles of occupational therapy students at one Australian university.

Methods:  The learning style preferences of first year undergraduate occupational therapy students (n = 120) were investigated. The students completed the Kolb Learning Style Inventory (LSI) and Fleming's VARK (Visual, Aural, Read/Write, and Kinaesthetic) Questionnaire in the first weeks of their course.

Results:  The response rate was 97% (n = 116). Learning style preferences as determined by the Kolb LSI were spread over all four Kolb LSI learning styles with ‘diverging’ (30.2%) and ‘converging’ (28.4%) being the most preferred. Instructional preference as measured by the VARK Questionnaire was kinaesthetic learning (33%), followed by the multimodal preference VARK (18.1%). Visual and aural categories were these students’ least preferred methods of learning.

Conclusions:  The results of the current study support previous research indicating a range of teaching methods should be utilised to accommodate for the variability of students’ learning styles within educational programs. To accommodate the range of learning experiences encountered in fieldwork and later in professional practice, students need to strengthen their capacities to use a variety of learning styles. This paper proposes that student learning for evidenced‐based practice be facilitated by a range of learning opportunities including practical experiences.
Extensive primary malignant melanoma of the oesophagus
Authors: Chung Chi‐Kin , AhChong Ah‐Kian , Mak Andrew Wai‐Chun , Yip Kong‐Ling
Published: August 2010

Primary malignant melanoma of the oesophagus (PMME) is a rare tumour. It has characteristic pathological and immunohistochemical features and diagnosis and management is difficult. This paper reports a patient with PMME, with a review of literature. The literature search was made with the Index Medicus/MEDLINE database using ‘melanoma’ and ‘oesophagus’ as key words, and cross‐referencing of other articles on the subject. Three‐phase oesophagectomy was performed and the patient died 2 months afterwards with respiratory failure and bone metastasis. Primary malignant melanoma of the oesophagus is a highly lethal tumour. Radical surgery is the treatment of choice.
Clinical and pathological features of early gastric cancer in Singapore
Authors: So Jimmy Bok‐Yan , Samarasinghe Kapila , Raju Gangaraju Changal , Ti And Thiow‐Kong
Published: August 2010

Objective: The incidence of early gastric cancer (EGC) is increasing gradually in countries such as Japan and Korea. Knowledge of EGC in other Asian countries, however, is limited. This study aims to describe the characteristics of this disease in Singapore.

Method: A retrospective analysis of the operative results of a personal series of EGC was undertaken. The clinical and pathological characteristics were examined.

Results: From 1979 to 1997, 226 patients with gastric cancer were operated on and 21 patients (9.3%) were diagnosed as having EGC by histological examination. All 21 patients received radical gastrectomy and lymphadenectomy. There were 12 males and 9 females with a median age of 59 years (range: 36–65). The presenting symptom was epigastric pain (15 patients), bleeding (two patients), weight loss (two patients), vomiting and incidental (one patient each). The majority of the tumours (76%) were located at the antrum and were intestinal type. Macroscopically, most of the tumours were either depressed (type IIc) or excavated (type III) type. Four cases were combined type. The lesion was limited to the mucosa in 10 cases. Only one patient had lymph node metastasis. There was no operative mortality and the morbidity rate was 14%. Nineteen patients had complete follow up for 3 months to 13 years. No patient developed tumour recurrence in the series.

Conclusion: Early gastric cancer remains uncommon in Singapore. However, for these patients, radical gastrectomy yields excellent results with minimal morbidity.
A rare cause of gastrointestinal bleeding: Blue rubber bleb nevus syndrome
Authors: Wong Wai‐Man , Cheung Chin‐Cheung , Lau Kwok‐Wai
Published: August 2010

A 33‐year‐old Chinese female patient with blue rubber bleb nevus syndrome presenting with anaemia and fresh per‐rectal bleeding is reported. This is a rare disease, but the associated distinctive cutaneous haemangiomas should alert every clinician of the diagnosis. The clinical presentation, investigation and management of this rare syndrome is discussed.
Beware of ‘the vein that easily bleeds’: Accessory right colic vein
Authors: Meng William Chia‐Shing , Lau Patrick Ying‐Yu , Lau Patrick Ying‐Yu
Published: August 2010

In this short article, we highlight the venous drainage of the right colon with special emphasis on the accessory right colic vein. This vein is easily torn during mobilization of the right colon. It is, however, seldom mentioned in the Western anatomy or surgical textbooks.
SPINAL TUMOUR IN PYNEH
Authors: Lee W.Y.M. , Ho W.S.W. , Pang K.Y.V. , Wong C.K.
Published: August 2010

During the period from December 1995 to December 2000, there were 35 patients with spinal tumours operated by the Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong. The patterns of referral, presenting symptomatology, pathology and outcome were reviewed. Interesting cases would be discussed.
TECHNIQUE OF HANDOSCOPIC COLECTOMY
Authors: Lam C.Y.W. , Chiu P.W.Y. , Lam D.T.Y. , Lam S.C.W. , Kwok S.P.Y.
Published: August 2010

Introduction and aim: Ever since the introduction of laparoscopic surgery, the disadvantage of lack of tactile sensation has not been overcome. Over the past months, we had performed 16 handoscopic colectomies, we hereby demonstrate this method which can overcome the above problem by the following video.

Method and material: We performed handoscopic right hemicolectomy for a patient suffered from carcinoma of right colon. After being anaesthesized, the patient was put in a modified lithotomy position. Pneumoperitoneum was created by the open method followed by a diagnostic laparoscopy. The air tight hand port system (Smith & Nephew, MA USA) was then inserted in the infraumbilical region with skin incision length equivalent to the width of the surgeon's wrist (6.5 cm in our case). A 12 mm working port was then introduced in the supraumbilical region for the harmonic scalpel. Dissection proceeded in the usual order with the hand retracting, bluntly dissecting and the harmonic scalpel cutting. The bowel was then exteriorized for resection and anastomosis.

Results: The surgery completed in 145 minutes with 10 mL blood loss. The patient resumed normal diet on day 4 and was then discharged on day 5. After 12 weeks of follow up, she encountered no adverse outcome.

Discussion: The handoscopic technique provides tactile sensation and allows blunt dissection that are not possible for the purely laparoscopic technique. Any bleeding can be effectively controlled by fingers rapidly before definitive haemostatic measures. The enlarged view provides by the laparoscope enhances meticulous dissection for apical lymphadenectomy. Furthermore, the hand port itself is an effective protector of the wound minimizing wound contamination.

Conclusion: Handoscopic colectomy is a feasible and promising procedure that enjoys the benefits of both the laparoscopic and open techniques.
ULTRASOUND GUIDED ASPIRATION AND THROMBOLYSIS OF PUTAMINAL HEMORRHAGE
Authors: Ho Wilson W.S. , Wong C.K.
Published: August 2010

We review our experience with patients harbouring putaminal intracerebral haematoma treated by intraoperative ultrasound guided aspiration and thrombolysis with Urokinase. We assessed the feasibility and safety of the procedure and compared the results with a similar group of patients previously treated in our unit by craniotomy and clot evacuation. From September 1998 to May 2000, eighteen consecutive patients with putaminal haemorrhage without suspected underlying structural aetiology or coagulopathy were included. Under general anesthesia, a catheter was inserted into the centre of the haematoma through a frontal burr hole under ultrasound guidance. An external ventricular catheter was also inserted for intracranial pressure monitoring. After maximally aspirating the haematoma, the catheter was left in place and 30 000 units of urokinase instilled. Further instillation of 20 000 units of urokinase was performed every 12 hours. The resolution of haematoma was followed with serial CT scan. The mean age was 55 years; mean haematoma size was 50 mL. The mortality rate was 11% (2/18); both deaths were not procedure related. Twenty‐four patients were in the craniotomy; there were three deaths (13%). Other outcomes of the two groups were similar. We concluded that ultrasound guided aspiration and thrombolysis appears safe and effective in treating putaminal haemorrhage.
THE USE OF SPLIT CALVARIUM BONE GRAFT CRANIOPLASTY IN TREATING CRANIUM BIFIDUM: A CASE REPORT
Authors: Ng W.K. , Pang K.Y. , Ho W.W.S. , Wong C.K.
Published: August 2010

Various methods and material have been used to treat cranium bifidum. We report the use of split calvarium bone graft in the treatment of the condition in a 3‐year‐old girl with a large bilateral parieto‐occipital defect. Early follow up reveals satisfactory results.
THE IMPACT OF AN ARMLESS FRAMELESS NEURONAVIGATION SYSTEM ON ROUTINE BRAIN TUMOUR SURGERY: A PROSPECTIVE ANALYSIS OF 52 CASES
Authors: Wong K.C. , Lam M.K. , Poon W.S.
Published: August 2010

A passive infrared armless and frameless neuronavigation system (BrainLab VectorVision) was introduced in routine intracranial and skull base surgery in 1998 in the Prince of Wales Hospital, and its impact on 51 cases in a 1‐year period was assessed. Three categories of operation were compared, which were transphenoidal surgery, supratentorial glioma excision and meningioma excision. Data were compared between navigated group and non‐navigated group during the same time period. Operating time was not significantly lengthened except for transphenoidal cases (255 ± SD 168 min vs 185 ± SD 119 min, P = 0.02). Length of stay was shorter in navigation cases in supratentorial glioma (12 ± SD 7.3 days vs 15 ± SD 7.9 days) and meningioma (11 ± SD 5.3 days vs 16 ± SD 6.7 days, P = 0.01). Outcome at 3 months was comparable in both the supratentorial glioma and meningioma group. Problems such as set‐up time and brain shift as well as future direction will also be discussed.
OUTCOME OF ACUTE EPIDURAL HAEMATOMA IN A TERTIARY TRAUMA CENTRE *
Authors: Wong Alec Tak Yeung , Ka Kit Leung Gilberto , Fan Yiu Wah
Published: August 2010

Epidural haematoma (EDH) is a well‐recognized complication of head injury which may result in severe secondary brain injury, or even death if not treated properly. In the majority of cases, the haematoma arises from injured meningeal vessels.1,2 Primary parenchymal brain insult is often minimal and all patients should in theory be saved if the epidural haematoma is evacuated promptly.3,4 Indeed, EDH is considered by some authorities as one of the most suitable disease entity for verifying the effectiveness of head injury management.5 Until recently, the lack of local data has limited our appraisal of the standard and demand of neurotrauma service in Hong Kong.6,7 We report here the clinical features and outcome of 110 patients with post‐traumatic EDH treated at a local tertiary trauma centre over a period of 5 years.

A retrospective analysis was performed on 110 consecutive patients with post‐traumatic EDH admitted between January 1995 and December 1999. The diagnosis of EDH was made on computerized tomography (CT) in all cases and confirmed during operation in surgical cases. Patients with other associated intra‐cranial lesions (e.g. acute subdural haematoma and cerebral contusion) were also included as long as they were not considered to predominate over the EDH. Epidural haematoma which were not related to head trauma (e.g. spontaneous, post‐craniotomy complications) were excluded.
OUTCOME OF INTRAVENTRICULAR HAEMORRHAGE AND THE EFFECT OF THROMBOLYTIC TREATMENT WITH INTRAVENTRICULAR UROKINASE INSTILLATION
Authors: Tong Daniel King Hung , Ka Kit Leung Gilberto , Fan Yiu Wah
Published: August 2010

We performed a retrospective analysis of patients admitted with the primary diagnosis of spontaneous intraventricular haemorrhage between January 1997 and December 1999. All patients who required external ventricular drainage were further divided into those managed with drainage alone and those who also received intraventricular instillation of urokinase solution. Patient outcome in terms of mortality, functional recovery, CSF shunting requirement and associated complications were reviewed.
DECOMPRESSIVE CRANIECTOMY FOR MASSIVE CEREBRAL INFARCTION—A JOINT‐CENTRE EXPERIENCE *
Authors: Leung Gilberto Ka Kit , Wing Yau Lee Michael , Man Lui Wai , Wai Shing Ho Wilson
Published: August 2010

Massive cerebral infarction often carries a high mortality rate despite the best medical treatment.1 Over the recent years there has been renewed interest in the use of decompressive surgery for the treatment of malignant cerebral oedema secondary to cerebral infarction.2–5 The procedure involves the fashioning of a large craniectomy and dural augmentation which creates extra space to accommodate the brain swelling so as to relieve or prevent life‐threatening transtentorial herniation. In this review, we report our experience with this treatment modality at two local neurosurgical centres.

We performed a retrospective analysis of nine consecutive patients who underwent decompressive craniectomy for massive middle cerebral artery (MCA) infarction from January 1999 to June 2000. Five patients were treated at Queen Mary Hospital and four at Pamela Youde Eastern Hospital. Only patients who suffered from supratentorial ischaemic infarction involving the MCA territory, secondary to either thrombo‐embolism or arterial dissection were included. Those who suffered from cerebellar infarction and post‐traumatic brain swelling were excluded.

Decompressive craniectomy is effective in combating malignant cerebral oedema following massive MCA infarction. The procedure can improve patient survival although residual functional deficit may be significant. Timing of surgical intervention and more well‐defined patient selection criteria would be the key to more efficacious and rational application of this treatment option.
A VALIDITY TEST FOR A NOVEL RECOVERY SCORE FOR PERIANAL DISEASES AND TREATMENT
Authors: Lam D.T.Y. , Lam C.Y.W. , Lee V.H.M. , Kwok S.P.Y.
Published: August 2010

Background: Perianal diseases or their treatment are often painful. An objective tool for assessing perianal disease recovery is non‐existent. We designed a novel scoring system (Perianal Recovery Score) to assess perianal disease or treatment recovery and compared it with commonly used visual analog scores (VAS).

Method: The Perianal Recovery Score is made up of 4 sections, relating to pain and ability of ambulation, sitting, lying at rest and defaecation. Ten consecutive patients suffering from acutely thrombosed haemorrhoids answered a standard questionnaire. The questionnaire consisted of the Perianal Recovery Score and 3 visual analog scales, measuring respectively average pain, defaecating pain and subjective degrees of recovery. The patients answered the same questionnaire at intervals starting from the time of hospitalization to 4 weeks thereafter, whether or not emergency haemorrhoidectomy has been performed. The Perianal Recovery Scores were compared with the VASs for average pain, defaecating pain and subjective degrees of recovery.

Results: The Spearman correlation coefficient for Perianal Recovery Score with VAS (average pain) was −0.8537 (−0.9187 to −0.7434). Perianal Recovery Score with VAS (Defaecating Pain) was −0.8121 (−0.9023 to −0.6538), and Perianal Recovery Score with VAS Subjective Recovery) was 0.8249 (0.6578 to 0.9155).

Discussion: The high correlation coefficient indicates that the Perianal Recovery Score measures the same variables as VAS. The Perianal Recovery Score is more objective. It reflects the patient’s ability to perform activities of daily life most affected by pain around the anus. With the obvious benefit, we recommend replacing VAS with Perianal Recovery Score.
COLORECTAL TUBERCULOSIS REVISITED
Authors: Lau P.Y.Y. , Meng W. , Yip A.
Published: August 2010

Introduction: Colorectal tuberculosis occurs uncommonly in Hong Kong and even rarer in the West. Its non‐specific clinical presentation and deceiving endoscopic features poses a diagnostic challenge.

Aim: To review the presentation, diagnosis and treatment of colorectal tuberculosis.

Method: A retrospective review of patients managed in Kwong Wah Hospital between 1995 and 2000. Eleven patients with colorectal tuberculosis were diagnosed and treated at Kwong Wah Hospital.

Results: The age of diagnosis ranges from 18 to 70, with a median age of 46. Weight loss (55%), abdominal pain (55%) and per rectal bleeding (45%) were the most common symptoms. Only three patients (27%) have previous history of pulmonary tuberculosis. Endoscopy with biopsy was useful in making a diagnosis in seven out of eight patients that did not required emergency surgery. Five patients required surgery due to severe lower gastrointestinal bleeding, symptomatic ileocaecal mass or recurrent intestinal obstruction. Successful anti‐tuberculosis treatment was achieved in the other patients.

Conclusion: Confirmation of diagnosis by endoscopy and biopsy is important as medical treatment is associated with good response. Sometimes repeated biopsy may be required to avoid unnecessary major operation. Although rare, the diagnosis of colorectal tuberculosis should not be overlooked.
LYMPHOCYTE SUBPOPULATION AND NATURAL KILLER CELL CYTOTOXICITY AFTER LAPAROSCOPIC ASSISTED RESECTION OF RECTOSIGMOID CARCINOMA—A PROSPECTIVE RANDOMIZED TRIAL
Authors: Leung K.L. , Thung K.H. , Leung K.J. , Tsang K.S. , Ng M. , Lai P.B.S. , Lee J.F.Y. , Lau W.Y.
Published: August 2010

We compared the lymphocyte subpopullation and natural killer cell cytotoxicity in patients after laparoscopic assisted resection with those after open resection of rectosigmoid carcinoma.

Background: Laparoscopic assisted resection of colorectal carcinoma is technically feasible and less traumatic, the postoperative immunosuppression thus may be reduced and potentially beneficial to tumour surgery.

Methods: Forty patients with rectosigmoid carcinoma, without evidence of metastatic disease and suitable for laparoscopic assisted resection were randomized to receive either laparoscopic assisted (20 patients) or conventional open (20 patients) resection of the tumour. Clinical parameters were recorded. Blood were collected before operation, 24 hours, 72 hours and 8 days after operation for lymphocyte subsets and natural killer (NK) cell cytotoxicity studies. Data were analyzed by intention to treat.

Results: The demographic data of the two groups were comparable. Clinically the laparoscopic group had significantly earlier return of bowel function, earlier mobilization and required less analgesia. The lymphocyte subpopulations and NK cell cytotoxicity of both groups showed a typical suppression after surgery. The suppression of T cell activation and NK‐like T cells was significantly less after laparoscopic assisted resection than in the open group, while the difference in other lymphocyte subpopulation and NK cell cytotoxicity were not significant.

Conclusion: This study showed that some cellular components of immune system were less suppressed after laparoscopic assisted than conventional open resection of rectosigmoid carcinoma. This may have implication on the patient survival.
ANORECTAL MANOMETRY IN PAEDIATRIC PATIENT WITH BOWEL DYSFUNCTION
Authors: Yip K.F. , Yeung C.K. , Li M.K.W.
Published: August 2010

Introduction: Bowel dysfunction in children presented as abdominal distension, colic, constipation or soiling is common. Besides conventional history and physical examination plus abdominal radiograph, suction rectal biopsy is usually required to rule out Hirschsprung’s disease. We adopted the manometric measurement in the assessment of the children with bowel dysfunction and see whether it helps to manage the problem.

Method: Patients were placed in a calm environment and a microtransducer probe was used to measure the anal pressure. Rectoanal inhibitory reflex was measured with a balloonless method using room air injection as trigger. A conventional anal sphincter pressure profile was measured in several different directions in selected cases.

Results: We have performed 74 measurements from 1996 till now. The procedure was well tolerated by most of the children. Positive rectoanal inhibitory reflex excluded the presence of Hirschsprung’s disease and spared the patients from invasive suction rectal biopsy. Anal dyskinesia was diagnosed with a negative rectoanal reflex plus presence of ganglion in suction rectal biopsy, and bowel management programs could be applied. The anal pressure profile generated important information as a functional assessment of the sphincter integrity especially for those patients received anorectal surgery.

Conclusion: Anorectal manometry is a very useful and noninvasive adjunct in the management of bowel dysfunction in children.
LAPAROSCOPIC ASSISTED RESECTION FOR RECTAL CANCER
Authors: Chan S.W. , Chung C.C. , Tsang W.W.C. , Kwok S.Y. , Li M.K.W.
Published: August 2010

Aim: To share our experience and results with laparoscopic assisted resection for rectal cancer.

Methods: We have started laparoscopic colorectal surgery since 1992, and data was collected prospectively. Patients with proven rectal adenocarcinoma (≤ 15 cm from anal verge) were selected. Patients were excluded if: (1) tumour was palpable per abdomen; (2) PR examination reviewed perirectal fixation; (3) ultrasound or CT scan revealed invasion of adjacent structures; (4) patient did not consent to laparoscopic approach. The postoperative course was carefully followed. Patients were followed up cautiously after discharge and any complications or recurrence were noted.

Results: From May 1992 to June 2000, 159 patients (aged 26–90, mean = 63) had undergone laparoscopic assisted rectal resection. The results were as follows:

M : F

86 : 73

Curative
Palliative
147 : 12

Operation
Anterior resection
88

Low anterior resection

44

Abdomino‐perineal resection

22

Others
5

Operation time (min)

45 − 360 (mean = 130)

Hospital stay (days)

5 − 96 (mean = 7.6)

Conversion

12

Complications
Mortality
1

Anastomotic leakage
3

Ureteric injury
1

Small bowel injury
1

Post‐site herniation
1

Post‐site recurrence
1

Five patients were lost to follow up. 130 patients (84%) were still alive and 111 patients (72%) with curative resection remained disease‐free at an average follow‐up of 48 months.

Conclusion: Laparoscopic surgery in rectal cancer can achieve similar survival results with acceptable operation time and complication rate. With good patient selection, conversion rate should be low. These results speak in favour of laparoscopic approach.
HANDOSCOPIC COLECTOMY: AN INITIAL EXPERIENCE
Authors: Lam C.Y.W. , Chiu P.W.Y. , Lam D.T.Y. , Lam S.C.W. , Kwok S.P.Y.
Published: August 2010

Aim: To evaluate the feasibility of handoscopic colectomy.

Methods: A prospective nonrandomized study was initiated from January 2000 to September 2000 in United Christian Hospital recruiting patients indicated for colectomy.

Results: 16 consecutive patients entered the study including 6 males and 10 females with an average age of 70.3 (ranged 46 to 84). Indications were 14 carcinomas, 1 caecal polyp and 1 caecal ulcer. There were 9 R hemicolectomies, 6 extended R hemicolectomies and 1 L hemicolectomy. One patient also had a cholecystectomy for gallstone. The average wound length was 6.5 cm. There was one conversion in a patient with carcinoma of hepatic flexure invading the liver in which a wedge resection of the liver was performed during laparotomy. The average operative time was 171.5 minutes (ranged 105–240) with an average blood loss of 163.2 mL (ranged 10–550). There was only 1 morbidity of urinary tract infection in the early post‐op period with no mortality encountered. The average day of discharge was 8.2 (ranged 5–12). Within an average follow up of 16.9 weeks (ranged 4–36), there was no adverse outcome noticed except in a patient who was known to has liver metastasis preoperatively.

Discussions: Handoscopic colectomy has comparable results over conventional technique. The handoscopic technique provides tactile sensation and allows blunt dissection of tissues that are not possible for the laparoscopic technique. Any bleeding can be effectively controlled by fingers accurately and rapidly before definitive haemostatic measures. The enlarged view provided by the laparoscope enhances meticulous dissection of the tissues that is important in apical lymphadenectomy. Furthermore, the hand port itself provides an excellent retractor for intestinal anastomosis and is an effective protector of the wound minimizing wound contamination.
THE MANAGEMENT OF RESIDUAL AND RECURRENT INTRACRANIAL ANEURYSMS AFTER PREVIOUS ENDOVASCULAR OR SURGICAL TREATMENT—A REPORT OF EIGHTEEN CASES.
Authors: Boet R. , Poon W.S. , Yu S.C.H.
Published: August 2010

Background and purpose:

We wish to report our experience in the management of residual or recurrent intracranial aneurysms after previous endovascular or surgical treatment.

Methods:

We performed a retrospective review of the clinical notes, operation records and cerebral angiograms of eighteen patients that were known to have undergone treatment for residual or recurrent aneurysms.

Results:

During the period of April 1994 to May 1999, 210 patients were treated for an intracranial aneurysm either surgically or by endovascular methods. Eighteen of these patients (8.6%) were subsequently retreated for a residual or recurrent aneurysm. Thirteen achieved a complete occlusion. Three patients have residual aneurysms that require further surveillance or management. One patient is not scheduled for further cerebral angiography. One patient died after a second clipping procedure. Complete occlusion was achieved in five of the eight patients who underwent endovascular treatment as a second procedure. Three patients who underwent repeat coiling procedures have remnants that require further surveillance or management. Seven out of ten surgical cases achieved complete occlusion. In the other three surgical cases miscellaneous reasons did not allow us to repeat the angiogram. Fifteen patients made a good recovery according to the Glasgow Outcome Score. Two patients who presented as a poor grade SAH were left severely disabled.

Conclusions:

This report described our experience with those patients in whom we decided to actively treat the residual or recurrent aneurysm. The treatment of remnant cerebral aneurysms can be performed effectively using a variety of modalities. The original purpose of the treatment, which is total occlusion of the lesion, can thus be achieved.
SKULL BASE MENINGIOMA IN CHILDHOOD
Authors: Tan T.C. , Chiu H.M. , Man K.L. , Tsang Y.W. , Chan C.M. , Leung S. , Lee M.K.
Published: August 2010

Meningiomas are rare in childhood and they constitute 1.5% of intracranial meningiomas. We report a case of a left middle cranial fossa meningioma in a 11‐year‐old boy who presented with left‐sided facial weakness and deafness. Neurological examination showed left lower motor neuron facial nerve palsy with sensori‐neural deafness of his left ear.

Computed tomography demonstrated a contrast enhancing extra‐axial tumour in the left middle cranial fossa with calcification. Magnetic resonance imaging confirmed the presence of an extra‐axial tumour measuring 3 × 3.5 × 2.7 cm. The mass was isointense to gray matter on T1‐weighted images, with a markedly hypointense rim on T2‐weighted images. The lesion exhibited homogeneous enhancement with gadolinium. It eroded the petrous base, extending into the left internal auditory meatus and cerebello‐pontine cistern. The preoperative diagnosis was trigeminal schwannoma.

Intraoperatively, a firm tumour was seen arising from the middle cranial fossa attached to the petrous temporal bone. Near‐total excision of tumour was achieved. The histological diagnosis was xanthomatous meningioma. The patient recovered uneventfully without additional neurological deficit. He underwent linac radiosurgery for the 1 cm tumour remnants in the internal acoustic meatus and the left cerebellopontine angle. Follow‐up MRI scans 14 months after radiosurgery showed shrinkage of the remaining tumour. At follow up 20 months after operation the child was well and had resumed his education.

Conclusion: While surgery remains the main therapeutic modality, complete excision is not always possible in skull base meningiomas as it carries significant postoperative morbidity. Radiosurgery is a valuable complementary measure for local control in case of residual or recurrent tumour.
UTILITY AND POTENTIALS OF TEMPORALIS MUSCLE IN NEUROSURGERY
Authors: Chan K.Y. , Datta N.N. , Chan K.W. , Rehman S. , Poon Y.F. , Kwok C.K.
Published: August 2010

Temporalis muscle and fascia have been utilized in various surgical procedures such as tympanoplasty, chronic otitis media, cholesteatoma and sinusitis. Inspired by its use in myosynangiosis for Moya Moya disease, we began to exploit its potentials in other aspects of neurosurgery. In our department, temporalis muscle had been used as adjunct to treat subdural empyema, acute subdural hematoma, chronic subdural hematoma in eight patients, with success. The age range of the patients was from 3 months to 70 years. The idea is that the muscle facilitates the delivery of antibiotics, reabsorption of exudate/hematoma, and to provide dynamic covering of the injured brain.