OBJECTIVES. To determine the development rate of hepatocellular carcinoma and survival of patients diagnosed to have regenerative, and low-grade and high-grade dysplastic liver nodules.

DESIGN. Retrospective descriptive study.

SETTING. Acute public hospital, Hong Kong.

PATIENTS. Patients with non-malignant liver nodules confirmed by imagingguided liver biopsy between January 1997 and December 2008.

MAIN OUTCOME MEASURES. Rates of hepatocellular carcinoma development and survival.

RESULTS. A total of 147 patients with non-malignant liver nodules were followed up over a median duration of 29 months. The initial histological diagnosis included regenerative nodules (n=74), low-grade dysplastic nodules (n=34), and high-grade dysplastic nodules (n=39). The respective cumulative hepatocellular carcinoma development rate during the first, second, third, and fourth year were 3%, 5%, 9% and 12% for simple regenerative nodules, 29%, 35%, 38% and 44% for low-grade dysplastic nodules, and 38%, 41%, 51% and 51% for high-grade dysplastic nodules. The hepatocellular carcinoma development rate was highest in those with high-grade dysplastic nodules. Multivariate analysis showed that histological dysplastic changes were associated with increased alpha-fetoprotein levels and advanced age, which were both independent predictors of hepatocellular carcinoma development. Histological dysplastic changes, male sex, advanced age, prolonged prothrombin time, and ultrasound appearances were independent predictors of mortality.

CONCLUSION. The presence of dysplastic change in liver nodules increased the risk of hepatocellular carcinoma development and death.

Key words: Carcinoma, hepatocellular; Cell transformation, neoplastic; Liver cirrhosis; Liver neoplasms; Survival rate

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OBJECTIVE. To test our hypothesis that there is inadequate knowledge and awareness of hepatitis B infection among the general population in Hong Kong.

DESIGN. A random telephone survey using a structured multiple-choice questionnaire.

SETTING. Hong Kong community.

PARTICIPANTS. Hong Kong residents aged 18 years or above.

RESULTS. A total of 506 respondents were successfully interviewed in February 2010. Approximately half of respondents (55%) were aware that hepatitis B virus is the most common cause of chronic viral hepatitis in Hong Kong. Regarding knowledge about the mode of transmission, mother-to-infant transmission and blood contact were recognised as risk factors by 67% and 65% of respondents, respectively. Transmission by sexual contact, sharing a razor or toothbrush, and tattooing or body piercing were appreciated by 44%, 41%, and 37% of respondents, respectively. A majority (73%) had the mistaken belief that the virus is transmitted by eating contaminated seafood. Over half of respondents (53%) knew nothing about the clinical presentation of acute hepatitis B. Only 35% of respondents realised that periodic abdominal ultrasonographic examinations are indicated for asymptomatic hepatitis B carriers. While 51% of respondents reported being tested for hepatitis B virus infection, only 36% acknowledged being vaccinated against the infection. Education level, occupation, and marital status were factors associated with both hepatitis B virus screening and vaccination.

CONCLUSION. These findings support our hypothesis that there is inadequate knowledge and awareness about hepatitis B infection in the general population in Hong Kong.

Key words: Awareness; Health knowledge, attitudes, practice; Health surveys; Hepatitis B

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OBJECTIVE. To report Hong Kong's experience on the use of extracorporeal membrane oxygenation for the treatment of acute respiratory distress syndrome caused by influenza A (H1N1).

DESIGN. Multi-centred, retrospective observational study.

SETTING. Intensive care units in Hong Kong.

PATIENTS. Recipients of extracorporeal membrane oxygenation for confirmed influenza A (H1N1) infection from 1 May 2009 to 28 February 2010.

MAIN OUTCOME MEASURE. Hospital mortality.

RESULTS. During the study period, 120 patients were mechanically ventilated in intensive care units, among whom seven received veno-venous extracorporeal membrane oxygenation. The median (interquartile range) age of the latter patients was 42 (39-50) years, four had various chronic illnesses and one had a body mass index of greater than 30 kg/m2. The median (interquartile range) time from symptom onset to hospital admission was 5 (4-7) days. Corresponding values for the duration of extracorporeal membrane oxygenation, mechanical ventilation, intensive care unit stay, and hospital stay were 6 (6-10), 19 (11-25), 19 (18-30), and 31 (25-55) days, respectively. One patient died (hospital mortality, 14%) and six made full recoveries. All seven patients received oseltamivir; in addition three received intravenous zanamivir, four received convalescent plasma, and one received hyperimmune immunoglobulin. Nosocomial infection was the commonest complication. There was no life- or limb-threatening complication directly attributable to extracorporeal membrane oxygenation.

CONCLUSION. In response to the pandemic of influenza A (H1N1), some intensive care units in Hong Kong were able to offer extracorporeal membrane oxygenation to selected cases. In this small series, patient outcomes were similar to those reported in other observational studies, indicating that intensive care units in Hong Kong are capable of successfully introducing this technology. However, the cost-effectiveness and optimal delivery of this strategy remain uncertain.

Key words: Extracorporeal membrane oxygenation; Influenza A virus, H1N1 subtype; Intensive care units; Respiratory insufficiency

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OBJECTIVE. To determine the frequency, risk factors, clinical features, and management of amiodarone-induced thyroid dysfunctions.

DESIGN. Retrospective study.

SETTING. A regional hospital in Hong Kong.

PATIENTS. Patients who had been prescribed amiodarone for at least 6 months from 1 October 2005 to 30 September 2007.

RESULTS. A total of 390 patients (mean age, 70 years; standard deviation, 9 years; 54% male) with a median follow-up of 43 (interquartile range, 25-69) months were studied. Hypothyroidism developed in 87 (22%) of the patients (mean age, 72 years; standard deviation, 7 years; 56% male) and thyrotoxicosis in 24 (6%) of the patients (65 years; 11 years; 54% male). Increased baseline thyrotropin (thyroid-stimulating hormone) level appeared to be predictive of amiodarone-induced hypothyroidism, in which a thyroid-stimulating hormone level of 4 mIU/L or above was associated with a 4.7-fold increase in the risk (95% confidence interval, 1.9-11.7; P<0.001). Compared with those who remained euthyroid on amiodarone, thyrotoxicosis developed in younger patients. In these patients, the classical symptoms of thyroid dysfunction were frequently absent, although worsening of underlying arrhythmias, their cardiac condition, weight loss, and over-warfarinisation were suggestive of amiodarone-induced thyrotoxicosis. In both amiodarone-induced thyrotoxicosis and hypothyroidism, the disease course was benign. Patients with the former showed a good response to anti-thyroid drugs and steroid therapy.

CONCLUSIONS. Amiodarone-induced thyroid dysfunction is common among our population. As the clinical presentations are usually vague and atypical, regular biochemical monitoring of thyroid function is warranted, particularly in patients with elevated baseline thyroid-stimulating hormone level. The disease course of amiodarone-induced thyrotoxicosis is usually benign and remits with timely administration of anti-thyroid medications, with or without corticosteroids.

Key words: Amiodarone; Anti-arrhythmia agents; Hypothyroidism; Thyroid diseases; Thyrotoxicosis

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OBJECTIVE. To compare the use of endorectal plus phased-array coils with use of phased-array coil alone with respect to the accuracy of magnetic resonance imaging for detecting mesorectal involvement of rectal cancer.

DESIGN. Retrospective study.

SETTING. A tertiary referral centre in Hong Kong.

PATIENTS. Ethnic Chinese patients with rectal adenocarcinoma who underwent staging magnetic resonance imaging during the years 2003 to 2008 in our centre were selected; those who received preoperative neoadjuvant therapy were excluded. Unless otherwise contra-indicated, endorectal coils have been used since 2006.

MAIN OUTCOME MEASURES. Magnetic resonance images were retrieved and reviewed by two radiologists blinded to the pathological results. The radiological findings were then correlated with the pathological reports to determine diagnostic accuracy.

RESULTS. A total of 50 patients were studied; 13 of the examinations were in patients having an endorectal coil. The overall accuracy of magnetic resonance imaging in detecting mesorectal tumour involvement was 80%. Subgroup analysis showed higher accuracy in the group with endorectal coils than in those with phased-array coils alone. Over-detection of mesorectal involvement was noted in 12% of the cases, with lower rate being observed in patients with endorectal coils. Underdetection of mesorectal tumour involvement was only noted in the group without endorectal coils. With the use of endorectal coils, the sensitivity reached 100% and the specificity increased to 86%.

CONCLUSION. Use of endorectal coil in staging magnetic resonance imaging of the rectum improves diagnostic accuracy. Whenever feasible, endorectal coil use is therefore recommendable to enhance diagnostic accuracy. The study results substantiate the understanding of staging by magnetic resonance imaging of rectal cancer in the local Chinese population.

Key words: Adenocarcinoma; Magnetic resonance imaging; Neoplasm staging; Rectal neoplams; Sensitivity and specificity

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