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Chui AKK, Chui JN, Antonio GE, Lam KC. Extended middle pancreatectomy for a large pancreatic cystic neoplasm: a case report. Hong Kong Med J 2020; 26:535-537. [PMID: 33350968 DOI: 10.12809/hkmj208372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 N Chui
- School of Medicine, University of Sydney, Sydney, Australia
| | - G E Antonio
- Department of Radiology, St Teresa's Hospital, Hong Kong
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2
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Hui DSC, Wong KT, Antonio GE, Ahuja A, Sung JJY. Correlation of clinical outcomes and radiographic features in SARS patients. Hong Kong Med J 2009; 15 Suppl 8:24-28. [PMID: 20393209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- D S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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3
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Hui DSC, Wong KT, Antonio GE, Tong M, Chan DP, Sung JJY. Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment. Hong Kong Med J 2009; 15 Suppl 8:21-23. [PMID: 20393208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- D S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Abstract
We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA). The first one was located in the superomedial geniculate artery and resolved after compression dressing and warfarin cessation. The second one was located in the superolateral geniculate artery and was successfully treated with transarterial embolisation. There was no recurrence in both cases. The rare occurrence and delayed presentation of pseudoaneurysms pose a diagnostic challenge. A high index of suspicion is required to make the diagnosis. Early duplex Doppler ultrasonography is recommended when patients present with atypical knee pain and prolonged swelling after a TKA.
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Affiliation(s)
- K Y Law
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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5
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Abstract
The use of a navigation system in musculoskeletal tumour surgery enables the integration of pre-operative CT and MRI images to generate a precise three-dimensional anatomical model of the site and the extent of the tumour. We carried out six consecutive resections of musculoskeletal tumour in five patients using an existing commercial computer navigation system. There were three women and two men with a mean age of 41 years (24 to 47). Reconstruction was performed using a tumour prosthesis in three lesions and a vascularised fibular graft in one. No reconstruction was needed in two cases. The mean follow-up was 6.9 months (3.5 to 10). The mean duration of surgery was 28 minutes (13 to 50). Examination of the resected specimens showed clear margins in all the tumour lesions and a resection that was exactly as planned.
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Affiliation(s)
- K C Wong
- The Prince of Wales Hospital, Hong Kong, China.
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6
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Rainer TH, Lee N, Ip M, Galvani AP, Antonio GE, Wong KT, Chan DPN, Ng AWH, Shing KK, Chau SSL, Mak P, Chan PKS, Ahuja AT, Hui DS, Sung JJY. Features discriminating SARS from other severe viral respiratory tract infections. Eur J Clin Microbiol Infect Dis 2007; 26:121-9. [PMID: 17219094 PMCID: PMC7088160 DOI: 10.1007/s10096-006-0246-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had “ground-glass” radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0–94.0) and the specificity was 98.0% (95%CI 95.4–99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of >8, the sensitivity was 80.7% (95%CI 72.4–87.3) and the specificity was 94.5% (95%CI 90.9–96.9). Certain clinical manifestations and laboratory changes may help to distinguish SARS from other influenza-like illnesses. Scoring systems may help identify patients who should receive more specific tests for influenza or SARS.
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Affiliation(s)
- T H Rainer
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Rooms 107/113, 1st Floor, Shatin, NT, Hong Kong.
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7
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Li Q, Lu G, Antonio GE, Mak YT, Rudd JA, Fan M, Yew DT. The usefulness of the spontaneously hypertensive rat to model attention-deficit/hyperactivity disorder (ADHD) may be explained by the differential expression of dopamine-related genes in the brain. Neurochem Int 2007; 50:848-57. [PMID: 17395336 DOI: 10.1016/j.neuint.2007.02.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 02/14/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
Spontaneously hypertensive rats (SHR) are considered to represent a genetic animal model for attention-deficit hyperactivity disorder (ADHD). In the present studies, we compared the locomotor activity, learning and memory functions of juvenile male SHR, with age- and gender-matched genetic control Wistar-Kyoto rats (WKY). In addition, we investigated potential differences in brain morphology by magnetic resonance imaging (MRI). In other complimentary studies of the central nervous system, we used real-time PCR to examine the levels of several dopaminergic-related genes, including those coding for the five major subtypes of dopamine receptor (D1, D2, D3, D4 and D5), those coding for enzymes responsible for synthesizing tyrosine hydroxylase and dopamine-beta-hydroxylase, and those coding for the dopamine transporter. Our data revealed that SHR were more active than WKY in the open field (OF) test. Also, SHR appeared less attentive, exhibiting inhibition deficit, but in the absence of memory deficits relative to spatial learning. The MRI studies revealed that SHR had a significantly smaller vermis cerebelli and caudate-putamen (CPu), and there was also a significantly lower level of dopamine D4 receptor gene expression and protein synthesis in the prefrontal cortex (PFC) of SHR. However, there were no significant differences between the expression of other dopaminergic-related genes in the midbrain, prefrontal cortex, temporal cortex, striatum, or amygdala of SHR and WKY. The data are similar to the situation seen in ADHD patients, relative to normal volunteers, and it is possible that the hypo-dopaminergic state involves a down regulation of dopamine D4 receptors, rather than a general down-regulation of catecholamine synthesis. In conclusion, the molecular and behavioural data that we obtained provide new information that may be relevant to understanding ADHD in man.
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Affiliation(s)
- Qi Li
- Department of Anatomy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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8
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Lee N, Rainer TH, Ip M, Zee B, Ng MH, Antonio GE, Chan E, Lui G, Cockram CS, Sung JJ, Hui DS. Role of laboratory variables in differentiating SARS-coronavirus from other causes of community-acquired pneumonia within the first 72 h of hospitalization. Eur J Clin Microbiol Infect Dis 2007; 25:765-72. [PMID: 17077967 PMCID: PMC7088362 DOI: 10.1007/s10096-006-0222-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) recommend that SARS-coronavirus (SARS-CoV) testing be considered in epidemiologically high-risk patients hospitalized with community-acquired pneumonia (CAP) if no alternative diagnosis is identified after 72 h. The aim of this study was to identify routine laboratory variables that might indicate the need for SARS-CoV testing. Routine hematological/biochemical variables in patients with laboratory-confirmed SARS (2003) were compared with those in consecutive patients hospitalized June–December 2004 with radiologically confirmed CAP. Stepwise logistic regression analyses were performed to identify discriminating variables at baseline and by day 3 of hospitalization. Nasopharyngeal aspiration and antigen detection for influenza virus and respiratory syncytial virus using an immunofluorescence assay (IFA) were routinely performed in patients with CAP. Altogether, 181 patients with CAP (who remained undiagnosed by IFA) and 303 patients with SARS were studied. The mean intervals from symptom onset to admission were 3.1 and 2.8 days, respectively (p > 0.05). The etiological agent of CAP was identified retrospectively in only 39% of cases, the majority being bacterial pathogens. At baseline, age and absolute neutrophil count (ANC) were the only independent discriminating variables (p < 0.0001). Using a value of <4.4 × 109/l as the cutoff for ANC, the sensitivity and specificity of ANC for discriminating SARS were 64 and 95%, respectively (AUC 0.90). By day 3 of hospitalization, age (p < 0.0001), change in ANC (p = 0.0003), and change in bilirubin (p = 0.0065) were discriminating variables. A model combining age <65 years, a change in ANC of >−3 × 109/l, and a change in bilirubin of ≥0 mmol/l had a sensitivity of 43% and a specificity of 95% for SARS (AUC 0.90). There are only a few laboratory features (including lymphopenia) that clearly discriminate SARS from other causes of CAP. Nevertheless, when evaluating epidemiologically high-risk patients with CAP and no immediate alternative diagnosis, a low ANC on presentation along with poor clinical and laboratory responses after 72 h of antibiotic treatment may raise the index of suspicion for SARS and indicate a need to perform SARS-CoV testing.
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Affiliation(s)
- N. Lee
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - T. H. Rainer
- Accident and Emergency Medicine, Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - M. Ip
- Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - B. Zee
- Center for Clinical Trials, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - M. H. Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - G. E. Antonio
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - E. Chan
- Center for Clinical Trials, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - G. Lui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - C. S. Cockram
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - J. J. Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
| | - D. S. Hui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong
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9
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Chan PN, Antonio GE, Griffith JF, Yu KW, Rainer TH, Ahuja AT. Computed tomography for cervical spine trauma. The impact of MDCT on fracture detection and dose deposition. Emerg Radiol 2005; 11:286-90. [PMID: 16133623 DOI: 10.1007/s10140-005-0407-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2004] [Accepted: 01/24/2005] [Indexed: 11/30/2022]
Abstract
A multidetector computed tomography (MDCT) was installed in our department. Referral rates, examination protocols and detection rates of abnormal findings in CT examinations for cervical spine trauma 6 months before and 6 months after MDCT installation were compared to look for changes in practice. Retrospective analysis of all CT cervical spine examinations in patients with multiple trauma over two contiguous 6-month periods: from July 2003 to December 2003 (helical CT) and from January 2004 to June 2004 (MDCT). Variables recorded were number of CT examinations performed, scan plane coverage and traumatic abnormalities detected. Phantom dosimetry measurements for cervical spine examination in both helical CT and MDCT were compared. One hundred and fifty four patients underwent cervical spine CT during these periods. Helical CT period: of 91 patients undergoing CT cervical spine examination for trauma, 65 (71%) were complete cervical examinations and 26 (29%) were level-specific examinations. Eight patients (9%) had cervical spine fracture, six of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 24.76, 1.86 and 0.21 mGy, respectively, for complete cervical spine examinations. MDCT period: of 63 patients who underwent CT cervical spine examination for trauma, 61 (97%) were complete examinations and 2 (3%) were level-specific examinations. Six patients (11%) had cervical spine fracture, three of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 75.8, 9.7 and 0.7 mGy, respectively, for complete cervical spine examinations, which were notably higher than those for helical CT. After installation of MDCT, clinical requests for complete examination of the cervical spine following trauma increased. This changing trend resulted in a significantly higher radiation dose to thyroid, lens and breast.
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Affiliation(s)
- P N Chan
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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10
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Lee YP, Griffith JF, Antonio GE, Tang N, Leung KS. Early magnetic resonance imaging of radiographically occult osteoporotic fractures of the femoral neck. Hong Kong Med J 2004; 10:271-5. [PMID: 15299173] [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: 04/30/2023] Open
Abstract
Osteoporosis is associated with thinning of cortical and trabecular bone, which reduces bone strength and predisposes individuals to fracture development. Femoral neck fractures in patients with osteoporosis may not be apparent on radiographs. Magnetic resonance imaging is useful at detecting these radiographically occult fractures; yet, the practice has not been widely adopted in Hong Kong. In this article, we review our experience of early magnetic resonance imaging in this clinical context--that is, imaging performed within 48 hours of presentation to hospital. Twenty-eight patients (age range, 69-93 years) over a 3-year period were studied. Magnetic resonance imaging revealed radiographically occult neck fractures in 14 (50%) cases (equivalent to 4% of all femoral neck fractures). These fractures were treated surgically (64%) or conservatively (36%) with good bone healing and clinical outcome. When no femoral neck fracture was present, magnetic resonance imaging revealed an alternative cause for symptoms in all 14 cases. We strongly endorse the use of early magnetic resonance imaging for patients with osteoporosis who have a clinically suspected femoral neck fracture that is not visible radiographically.
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Affiliation(s)
- Y P Lee
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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11
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Antonio GE, Wong KT, Chu WCW, Hui DSC, Cheng FWT, Yuen EHY, Chung SSC, Fok TF, Sung JJY, Ahuja AT. Imaging in severe acute respiratory syndrome (SARS). Clin Radiol 2003; 58:825-32. [PMID: 14581005 PMCID: PMC7176154 DOI: 10.1016/s0009-9260(03)00308-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Revised: 07/09/2003] [Accepted: 07/16/2003] [Indexed: 12/23/2022]
Abstract
Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a novel coronavirus, and has become pandemic within a short period of time. Imaging plays an important role in the diagnosis, management and follow-up of patients with SARS. The current status of imaging in SARS is presented in this review.
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Affiliation(s)
- G E Antonio
- Department of Diagnostic Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.
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12
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Ho SSY, Chan PL, Wong PK, Antonio GE, Wong KT, Lyon DJ, Fung KSC, Li CK, Cheng AFB, Ahuja AT. Eye of the storm: the roles of a radiology department in the outbreak of severe acute respiratory syndrome. AJR Am J Roentgenol 2003; 181:19-24. [PMID: 12818823 DOI: 10.2214/ajr.181.1.1810019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S S Y Ho
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong, China
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