bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
VIDEO CONSULTATION: A NEW WAY TO IMPROVE INTER‐HOSPITAL NEUROSURGICAL PATIENT CARE
Authors: Wong H.T. , Poon W.S. , Leung C. , Lam M.K. , Lam F.L. , Chan James , Kwok Samuel , Wai Sara , Ng Stephanie 
Published: August 2010

With the benefit of continuous development of networking technology, the current inter‐hospital patients care can also be improved. The aim of this study was to examine the role of video consultation against conventional modes of telemedicine technologies in managing inter‐hospital referral of neurosurgical patients, especially in terms of diagnostic accuracy, impact of early management and long‐term outcome.Data were collected prospectively from a district hospital (UCH) and a tertiary neurosurgical center (PWH). Totally 282 patients requiring neurosurgical consultation as decided by the doctors in the district hospital were stratified into three groups: head injury (A), stroke (B) and others (C). They were further randomized to three modes of consultation [Telephone consultation (I), teleradiology plus telephone consultation (II), and video consultation (III)] within each group.There are total 72 patients in group A (22.5%), 140 patients in group B (49.6) and 70 patients in group C (24.9). After randomization, patient numbers in mode I, II and III are 98, 98 and 86 respectively. The failure rate of carry out the consultation were low in mode I (1%) and II (3%), but high in mode III (61.6%). The average time from referral to decision make are 25.8 min, 43.2 min and 57 min in mode I, II and III respectively. The mean time need for receiving consultation image are slightly longer in mode III then mode II (54.6 min vs 52.8 min), but the time need to make up decision is much shorten (10.2 min vs 21 min). The diagnostic accuracy and the outcome in one and six month are also analyzed. Comparison of early management benefit of video consultation against conventional telephone consultation is made.The time need for CT image transfer and high failure rate of carry out video consultation still remain the major problems on data interpretation. Early CT scanning and consultation are emphasized. On site research assistant to carry out the randomization and arranging video consultation will improve future study.
TRACHEOSTOMY IN CRITICALLY ILL NEUROSURGICAL PATIENTS
Authors: Goh Keith Y.C. , Teoh Wendy , Chan Chumpon 
Published: August 2010

Objective: To determine the value of early tracheostomy in ventilated neurosurgical patients.Methods:Retrospective review of intubated patients in the Neurosurgical Intensive Care Unit who underwent elective open tracheostomies for prolonged ventilation.Results:Thirty patients over a 2‐year period were analyzed. There were 19 males and 11 females, mean age 53.9 ± 18.1 years (range 14–89), and mean Glasgow Coma Scale (GCS) score on admission, 7.1 ± 3.8 (range 3–15). The underlying disease etiology was cerebrovascular disease in 53% of patients, head trauma in 33% and tumor or infection in 13%. Tracheostomy was performed after a mean period of 8.5 ± 3.5 days (range 2–18), with patients requiring ventilation for a mean duration of 13.5 ± 6.3 days (range 3–31). Complications were minimal; 1 wound infection (3.3%) and 4 tube obstructions (13.3%). Patients who underwent elective early tracheostomy (Group I = within 7 days) had poorer GCS on admission (6.3 ± 2.9 vs 7.7 ± 4.3 in Group II, P = 0.271). Tracheostomy was performed after a mean of 5.3 ± 1.7 days in Group I vs 10.6 ± 2.7 days in Group II. Group I patients had faster recovery from nosocomial pneumonia (12.3 ± 6.2 vs 17.9 ± 12.5 days, P = 0.168), shorter duration of ventilation (9.8 ± 5.9 vs 16.0 ± 5.4 days, P = 0.007), and reduced incidence of multibacterial tracheobronchial colonization (42%vs 72%, P = 0.098). The most prevalent organisms were Acinetobacter baumanii (43.3%), Pseudomonas (40%), Methicillin resistant Staphylococcus Aureus (MRSA) (33%), Klebsiella (30%) and Staphylococcus Aureus (26.7%).Conclusion:Early tracheostomy in selected neurosurgical patients with poor GCS scores was associated with reduced incidence of tracheobronchial colonization by multiple pathogens, improvement in chest infections, and rapid weaning from ventilatory support.