1
|
Wu JCY, Chan AOO, Cheung TK, Kwan ACP, Leung VKS, Sze WC, Tan VPY. Consensus statements on diagnosis and management of chronic idiopathic constipation in adults in Hong Kong. Hong Kong Med J 2020; 25:142-148. [PMID: 30971503 DOI: 10.12809/hkmj187692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - A O O Chan
- Department of Gastroenterology and Hepatology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | | | | | - V K S Leung
- Department of Gastroenterology and Hepatology, Hong Kong Baptist Hospital, Kowloon Tong, Hong Kong
| | | | - V P Y Tan
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
2
|
Chau TN, Mok MY, Chan EYT, Luk WH, Lai KB, Li FTW, Leung VKS, Wong R. Evaluation of performance of measurement of faecal α(1)-antitrypsin clearance and technetium-99m human serum albumin scintigraphy in protein-losing enteropathy. Digestion 2012; 84:199-206. [PMID: 21757911 DOI: 10.1159/000327914] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/22/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Our study aimed to compare the performance of faecal α(1)-antitrypsin clearance (AATC) and radiolabelled human serum albumin (HSA) scintigraphy in protein-losing enteropathy (PLE). METHODS Patients studied by both AATC and technetium-99m ((99m)Tc)-labelled HSA scintigraphy were recruited and categorized into PLE and non-PLE groups based on clinical and laboratory findings. The performance of AATC and (99m)Tc-labelled HSA scintigraphy was evaluated using clinical diagnosis of PLE as a gold standard. RESULTS 29 patients were recruited and 13 patients were considered to have definite PLE (PLE group). In the PLE group, all patients had a positive HSA scinigraphy and 10 (77%) had demonstrable positive tracing in the early phase. Conversely, only 6 of them (46%) had elevated AATC level (>13 m/day). Results of (99m)Tc-labelled HSA scan (but not AATC) showed significant agreement with the clinical diagnosis (κ 0.35, p = 0.013). (99m)Tc-labelled HSA scintigraphy carried higher sensitivity (100 vs. 46%) and negative predictive value (100 vs. 63%) compared to AATC in diagnosing PLE. The correlation between the results of these two investigations was only modest (κ 0.27, p = 0.04). The area under the receiver operating characteristic curve of AATC level showed no optimal diagnostic cut-off for PLE. CONCLUSION (99m)Tc-labelled HSA scintigraphy was superior to AATC in diagnosing PLE.
Collapse
Affiliation(s)
- T N Chau
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, SAR, China.
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Leung VKS, Lee CK, Chau TN, Cheung WI, Lo FH, Lai KB, Lin CK. A probable case of transfusion-transmitted hepatitis B virus infection in an immunosuppressed recipient caused by an occult HBV-infected donor with negative ID-NAT. Transfus Med 2010; 20:276-7. [DOI: 10.1111/j.1365-3148.2010.00997.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
Leung VKS, Ng WL, Luk ISC, Chau TN, Chan WH, Kei SK, Loke TKL. Unique hepatic imaging features in a patient with nodular regenerative hyperplasia of the liver associating with systemic lupus erythematosus. Lupus 2007; 16:205-8. [PMID: 17432107 DOI: 10.1177/09612033707076513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nodular regenerative hyperplasia (NRH) of the liver, characterized by regenerative nodules distributed throughout the liver in the absence of fibrosis, is a rare but important complication of systemic lupus erythematosus (SLE). The main consequence of NRH is non-cirrhotic portal hypertension. We describe a female patient who had immune thrombocytopenia in association with elevated liver enzymes and evidence of portal hypertension as initial manifestations of SLE. Computed tomographic scan and magnetic resonance imaging of the liver in this patient showed enhancing periportal tubular structures distributed throughout the liver. The diagnosis of NRH was eventually disclosed by transcutaneous needle liver biopsy. The pattern of radiological abnormality in this patient has not been described previously in NRH. In addition, we believe this is a first reported case of SLE presenting with immune thrombocytopenia in association with NRH.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, SAR, China.
| | | | | | | | | | | | | |
Collapse
|
5
|
Leung VKS, Chan WH, Chow TL, Luk ISC, Chau TN, Loke TKL. Oesophageal tuberculosis mimicking oesophageal carcinoma. Hong Kong Med J 2006; 12:473-6. [PMID: 17148804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Tuberculous involvement of the oesophagus is rare, and is usually caused by direct spread from adjacent afflicted structures. We report an 83-year-old male patient with oesophageal tuberculosis secondary to tuberculous mediastinal lymphadenitis who presented with non-specific symptoms of anorexia and lethargy. Upper gastro-intestinal endoscopy revealed an ulcerative tumour-like lesion in the mid-oesophagus suggesting oesophageal carcinoma. Repeated endoscopic biopsies revealed a non-specific acute-on-chronic inflammation consisting of non-caseating granulomas, with no evidence of malignancy. Endoscopic ultrasonography demonstrated that the oesophageal lesion was secondary to direct extension of mediastinal lymphadenopathy. The diagnosis of tuberculosis was eventually confirmed by histological and microbiological analysis of a surgically excised cervical lymph node. The patient responded promptly to treatment with antituberculous drugs. We suggest that oesophageal tuberculosis has to be kept in mind in the differential diagnosis of oesophageal ulcerohypertrophic lesions.
Collapse
Affiliation(s)
- V K S Leung
- United Christian Hospital, Hong Kong: Department of Medicine and Geriatrics.
| | | | | | | | | | | |
Collapse
|
6
|
Leung VKS, Chu W, Lee VHM, Chau TN, Law ST, Lam SH. Tuberculosis intestinal perforation during anti-tuberculosis treatment. Hong Kong Med J 2006; 12:313-5. [PMID: 16912360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. We report on a 63-year-old HIV-negative man who developed terminal ileal perforation approximately 3.5 months following initiation of anti-tuberculous treatment for pulmonary tuberculosis and a concomitant tuberculous perianal abscess. Clinical and radiological improvements were initially evident following commencement of anti-tuberculous treatment, and the paradoxical response phenomenon was suspected. The patient subsequently underwent surgical resection of the affected bowel segment with primary anastomosis, and made an uneventful recovery. Anti-tuberculous medication was continued for another 12 months, and after a further 12 months there was no evidence of recurrent tuberculosis. This case illustrates that tuberculous intestinal perforation can develop during chemotherapy for tuberculosis. Prompt diagnosis and appropriate surgical treatment are essential to avoid morbidity and mortality.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
| | | | | | | | | | | |
Collapse
|
7
|
Leung VKS, Law ST, Lam CW, Luk ISC, Chau TN, Loke TKL, Chan WH, Lam SH. Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience. Hong Kong Med J 2006; 12:264-71. [PMID: 16912352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To study the clinical and pathological characteristics of patients with intestinal tuberculosis. DESIGN Retrospective study. SETTING United Christian Hospital, Hong Kong. PATIENTS Patients with intestinal tuberculosis diagnosed between January 1995 and December 2004 inclusive. RESULTS The median age of the 13 male and 9 female patients was 53 years (range, 12-81 years). Nineteen (86%) had a definitive diagnosis of intestinal tuberculosis confirmed by the presence of caseating granulomas and/or acid-fast bacilli in histological specimens. In three (14%) the diagnosis was based on histology revealing non-caseating granulomas and a positive response to anti-tuberculous treatment. Common symptoms included abdominal pain (82%), diarrhoea (55%), weight loss (55%), and fever (45%). Three (14%) of the patients were complicated by intestinal obstruction, and another two (9%) had intestinal perforation. Four (18%) had concomitant active pulmonary tuberculosis. The most frequently involved site was the ileocaecal region, which was affected in 19 (86%) patients. Other sites included the jejunum, ascending and sigmoid colon. The diagnosis of intestinal tuberculosis was facilitated by examination of colonoscopic biopsy specimens (11 patients), and by examination of resected surgical specimens in the remainder. Two patients died from terminal malignancy. The remainder completed anti-tuberculous therapy and responded satisfactorily. CONCLUSIONS The diagnosis of intestinal tuberculosis is difficult due to the lack of specific signs or symptoms. Colonoscopy with ileoscopy are useful tools in the search for colonic and terminal ileal tuberculosis. Surgical exploration is reserved for equivocal cases and for those who present as emergencies.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Chau TN, Yim KF, Mok NS, Chan WK, Leung VKS, Leung MF, Lai ST. Clopidogrel-induced hepatotoxicity after percutaneous coronary stenting. Hong Kong Med J 2005; 11:414-6. [PMID: 16219965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in acute coronary syndrome and percutaneous coronary stenting. The occurrence of hepatotoxicity is rare. We describe the occurrence of symptomatic liver disease in a 74-year-old man 5 weeks following commencement of therapy with clopidogrel. The reported cases of clopidogrel-induced hepatotoxicity are reviewed and the clinical significance of this event are discussed.
Collapse
Affiliation(s)
- T N Chau
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
9
|
Leung VKS, Loke TKL, Luk ISC, Lui PCW, Kung NNS, Lam SH. Recurrent variceal bleeding in a young woman. Hong Kong Med J 2005; 11:295-8. [PMID: 16085947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Congenital hepatic fibrosis is an uncommon fibrocystic disorder affecting the intrahepatic bile ducts. It has autosomal recessive inheritance. The main consequence of this condition is portal hypertension and it is often misdiagnosed as cirrhosis. Patients with congenital hepatic fibrosis usually present during childhood or early adolescence with oesophageal variceal bleeding. Portosystemic shunt surgery is the treatment of choice for these patients as the risk of postoperative hepatic encephalopathy is low. We report a patient with congenital hepatic fibrosis who presented with oesophageal variceal bleeding at the age of 16 years, initially misdiagnosed as having cryptogenic liver cirrhosis. The patient experienced two further episodes of oesophageal variceal bleeding in subsequent years. She eventually underwent portosystemic shunt surgery. One year after the operation, the shunt remained patent on Doppler ultrasonography, and there had been no further episodes of variceal bleeding post-surgery.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
| | | | | | | | | | | |
Collapse
|
10
|
Leung VKS, Lee SW, Yuen NWF, Kung NNS, Loke TKL. Epigastric pain in a patient with neurofibromatosis type 1. Hong Kong Med J 2005; 11:213-5. [PMID: 15951589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Patients with neurofibromatosis type 1 are at increased risk of developing carcinoid tumours of the duodenum, particularly in the ampulla of Vater. Aggressive surgery with pancreatoduodenectomy is recommended for all ampullary carcinoid tumours because of their propensity to metastasise. We report a case of a 43-year-old woman with neurofibromatosis type 1, who presented with recurrent epigastric pain for 15 months. Evaluation using magnetic resonance cholangiopancreatography and side-viewing duodenoscopy revealed a submucosal tumour at the ampulla of Vater causing pancreatobiliary ductal obstruction and dilation. The ampullary tumour was overlooked initially by forward-viewing endoscopy. The patient subsequently underwent pancreatoduodenectomy. Histological examination of the surgically resected specimen confirmed the presence of a carcinoid tumour, with metastasis to peri-pancreatic lymph nodes. She remained asymptomatic 10 months after surgery.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
| | | | | | | | | |
Collapse
|
11
|
Leung VKS, Kan PS, Lai MS. Cholangiocarcinoma presenting as pseudoachalasia and gastroparesis. Hong Kong Med J 2003; 9:296-8. [PMID: 12904620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Cholangiocarcinoma most commonly presents as painless progressive jaundice. We report a case occurring in a 56-year-old Chinese woman with an unusual presentation of progressive dysphagia and vomiting. Oesophageal manometric and barium studies were indicative of achalasia, and computed tomography confirmed the presence of cholangiocarcinoma extending to the gastroesophageal junction and proximal lesser curve of the stomach. In this case, a constricting tumour at the gastroesophageal junction with probable invasion of the vagus nerves led to features of achalasia and gastroparesis.
Collapse
Affiliation(s)
- V K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
| | | | | |
Collapse
|
12
|
Lee YT, Chan FKL, Ching JYL, Lai CW, Leung VKS, Chung SCS, Sung JJY. Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients. Endoscopy 2002; 34:391-8. [PMID: 11972271 DOI: 10.1055/s-2002-25286] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS The role of endosonography (EUS) in the management of portal hypertension is not well defined. We aimed to study the use of a new generation video-echo endoscope in the diagnosis of gastroesophageal varices (GEV) and extraluminal venous abnormalities in cirrhotic patients. PATIENTS AND METHODS Cirrhotic patients were studied by echo endoscopy to assess esophageal varices endoscopically, and gastric varices and extraluminal venous abnormalities sonographically. The results were compared with esophagogastroduodenoscopy (EGD) examination. Dyspeptic patients served as controls. RESULTS A total of 52 cirrhotic and 166 dyspeptic patients were studied. EUS identified esophageal varices (EV) endoscopically in 28 patients (53.8 %), which showed a good correlation with EGD findings (r = 0.855, P < 0.001). The red color sign and portal hypertensive gastropathy were diagnosed in six and seven patients, respectively, by both methods. EUS detected gastric varices sonographically in 16 patients (30.8 %), compared with detection in nine patients by EGD. Extraluminal venous abnormalities were detected in 48 cirrhotic patients (92 %) and in only nine dyspeptic patients (5.4 %) (P < 0.001). The size of extraluminal adventitial venous dilatation was significantly correlated with the severity of GEV and cirrhosis (P < 0.001). Perforating veins were identified in all patients with GEV. CONCLUSION The new generation video-echo endoscope could be used as a single investigation in assessing both the intraluminal GEV and extraluminal venous abnormalities in cirrhotic patients. It may improve the management of patients with portal hypertension.
Collapse
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, China.
| | | | | | | | | | | | | |
Collapse
|