Imatinib-induced interstitial lung disease and sunitinib-associated intra-tumour haemorrhage

ABSTRACT

Hong Kong Med J 2008;14:495-8 | Number 6, December 2008
CASE REPORT
Imatinib-induced interstitial lung disease and sunitinib-associated intra-tumour haemorrhage
Herbert H Loong, Winnie Yeo
Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
An ethnically Chinese patient with newly diagnosed metastatic gastro-intestinal stromal tumour initially treated with imatinib mesylate developed severe interstitial lung disease. As his condition improved after cessation of imatinib mesylate and treatment with corticosteroids, he was started on sunitinib malate. His clinical course was then unfortunately complicated with intra-tumour bleeding. This case report illustrates the dilemmas and complexities associated with treating patients with gastro-intestinal stromal tumours with the new tyrosine kinase inhibitors.
 
Key words: Gastrointestinal stromal tumors; Proteintyrosine kinases
 
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Persistent sciatic artery complicated by aneurysm formation and thrombosis

ABSTRACT

Hong Kong Med J 2008;14:492-4 | Number 6, December 2008
CASE REPORT
Persistent sciatic artery complicated by aneurysm formation and thrombosis
HS Fung, S Lau, MK Chan, KW Tang, YL Cheung, Susan CH Chan
Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong
 
 
A persistent sciatic artery is a rare embryological anomaly. We report a case of a persistent sciatic artery with aneurysm formation and thrombosis in a patient with rheumatoid arthritis/ systemic lupus erythematosus overlap syndrome and Raynaud's phenomenon. The diagnosis and complete, accurate evaluation of the arterial anatomy of the lower limb were achieved using computed tomographic angiography.
 
Key words: Aneurysm; Angiography; Femoral artery; Iliac artery; Popliteal artery
 
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Blast injury: lessons learned from an autopsy

ABSTRACT

Hong Kong Med J 2008;14:489-91 | Number 6, December 2008
CASE REPORT
Blast injury: lessons learned from an autopsy
Dilek Durak, Recep Fedakar, Nursel Türkmen, Bülent Eren
Uludag University Medical Faculty, Forensic Medicine Department, Görükle 16059, Bursa, Turkey
 
 
Blast injury is becoming more common in the non-military population but it is still rare to see such injuries and deaths unrelated to terrorist acts. The exact mechanisms involved in blast injuries are unclear. Civilian physicians and surgeons need to have a basic understanding of the patho-mechanics and physiological effects of blast injuries. We report a case where a 31-year-old male accidentally detonated a diesel storage tank. His autopsy findings provide useful information for those who investigate explosive-related deaths.
 
Key words: Blast injuries; Explosions
 
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Superselective embolisation of bilateral superior vesical arteries for management of haemorrhagic cystitis

ABSTRACT

Hong Kong Med J 2008;14:485-8 | Number 6, December 2008
CASE REPORT
Superselective embolisation of bilateral superior vesical arteries for management of haemorrhagic cystitis
CL Cho, Miranda HY Lai, HS So, Kimmy KM Kwok, James CS Chan, Venu Velayudhan
Division of Urology, Department of Surgery, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong
 
 
Bladder haemorrhage is common and sometimes life-threatening. Management options include bladder irrigation and supportive transfusion, intravesical instillation, endourological intervention, and surgical intervention which has poor success and high morbidity rates. Percutaneous arterial embolisation offers another minimally invasive option. We report two patients with severe haemorrhagic cystitis treated with superselective embolisation of bilateral superior vesical arteries. The technique is safe and effective for achieving immediate control of refractory bladder haemorrhage. The long-term efficacy of the procedure requires further investigation.
 
Key words: Cystitis; Embolization, therapeutic; Hemorrhage; Urinary bladder diseases
 
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Fracture of a Broviac catheter in a low-birth-weight infant

ABSTRACT

Hong Kong Med J 2008;14:411-3 | Number 5, October 2008
CASE REPORT
Fracture of a Broviac catheter in a low-birth-weight infant
Surasak Puvabanditsin, Eugene Garrow, Rungtiwa Weerasethsiri, Nisha Patel, Suzanne E Davis, Moe-Akahira Azuma
Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, US
 
 
Central venous catheters are widely used in children, particularly in very-low-birth-weight infants in whom long-term access to the venous system is required. This may be achieved by using peripherally inserted central catheters or tunnelled central venous lines (eg Broviac or Hickman lines). Previous case reports of fractured central catheters in premature neonates have involved peripherally inserted silastic catheters. Fractures and embolisation of Broviac central venous fragments have not been previously reported in preterm neonates. We describe a premature neonate with this rare complication along with the retrieval technique used.
 
Key words: Catheterization, central venous; Equipment failure; Infant, low birth weight
 
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Magnetic resonance imaging for ureteral fibroepithelial polyp

ABSTRACT

Hong Kong Med J 2008;14:408-10 | Number 5, October 2008
CASE REPORT
Magnetic resonance imaging for ureteral fibroepithelial polyp
Thomas KK Lai, Cathy HS Chung, Angus CW Chin, Petrus S Szeto, WC Wong, Ronee YY Chan, Henry YH Huang, WF Ng
Department of Radiology, Tseung Kwan O Hospital, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
 
 
Ureteric tumours are rare and most of them are malignant. Of benign tumours, ureteral fibroepithelial polyps are the most common but are still considered clinical rarities. In the past, most benign ureteric tumours were only diagnosed after surgical removal. With technological advance, magnetic resonance imaging has become an effective means of assessing ureteric lesions. Non-contrast enhanced magnetic resonance urography can produce an image comparable to an intravenous urogram without use of intravenous water-soluble contrast. A polyp can be diagnosed on imaging if there is an elongated filling defect inside the ureter. Nevertheless, a definitive diagnosis relies on ureteroscopic examination with biopsy. When a non-obstructive polyp is being managed conservatively, imaging is helpful for monitoring. Equally, the information obtained from imaging can be used to plan operative treatment.
 
Key words: Magnetic resonance imaging; Neoplasms, fibroepithelial; Polyps; Ureter
 
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Grayanotoxin poisoning from Rhododendron simsii in an infant

ABSTRACT

Hong Kong Med J 2008;14:405-7 | Number 5, October 2008
CASE REPORT
Grayanotoxin poisoning from Rhododendron simsii in an infant
WT Poon, CH Ho, KL Yip, CK Lai, KL Cheung, Rita YT Sung, Albert YW Chan, Tony WL Mak
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report a case of severe poisoning in a 57-day-old infant who presented with vomiting, convulsions, and shock after ingesting a bottle of milk containing a decoction of Rhododendron simsii (紅杜鵑). The grandmother collected this toxic plant from a cultivated area, believing it was good for the airways. Grayanotoxin was detected in both the urine and plant specimens. The infant made a good recovery after requiring ventilatory support for 2 days. Rhododendron is a common gardening shrub in Hong Kong. Some Rhododendron species are poisonous and contain grayanotoxin. Intentional or accidental ingestion of toxic plants can be severe or even life-threatening. It is therefore essential that clinicians be familiar with local toxic plant species.
 
Key words: Flowers; Plant poisoning; Rhododendron; Toxins, biological
 
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Clinical and radiological features of generalised lymphangiomatosis

ABSTRACT

Hong Kong Med J 2008;14:402-4 | Number 5, October 2008
CASE REPORT
Clinical and radiological features of generalised lymphangiomatosis
CS Wong, Tiffany YC Chu
Department of Diagnostic Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report a paediatric patient who presented with fever, shortness of breath, and vague abdominal discomfort. Lesions removed surgically proved to be generalised lymphangiomatosis and were treated conservatively. The spectrum of abnormalities and radiological features are discussed.
 
Key words: Lymphangioma, cystic; Magnetic resonance imaging; Tomography, X-ray computed
 
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Cystinuria: a rare diagnosis that should not be missed

ABSTRACT

Hong Kong Med J 2008;14:399-401 | Number 5, October 2008
CASE REPORT
Cystinuria: a rare diagnosis that should not be missed
Peter KF Chiu, Eddie SY Chan, Simon SM Hou, CF Ng
Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
Cystinuria is a rare autosomal recessive defect causing recurrent urinary tract stone formation. Morbidity from stone formation and repeated urological interventions can be reduced by early diagnosis and adequate medical treatment. In this review, we illustrate these points by discussing three patients with cystinuria and give a brief review of its management.
 
Key words: Cystine; Cystinuria; Treatment outcome; Urinary calculi
 
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The first nocturnal home haemodialysis patient in Hong Kong

ABSTRACT

Hong Kong Med J 2008;14:395-8 | Number 5, October 2008
CASE REPORT
The first nocturnal home haemodialysis patient in Hong Kong
HL Tang, Candic MK Tang, KH Chu, W Lee, A Cheuk, KF Yim, KS Fung, Hilda WH Chan, KL Tong
Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
We report our experience of the first use of nocturnal home haemodialysis in Hong Kong. The patient, a 40-year-old man with end-stage renal failure, was recruited into the Nocturnal Home Haemodialysis Programme at Princess Margaret Hospital in 2006. He received haemodialysis at home on alternate nights (3.5 sessions per week) for 5.5 to 6 hours per session. After 1 year of nocturnal home haemodialysis, his recombinant human erythropoietin requirement had been reduced by more than 50%. His serum phosphate level decreased by 35% and calcium phosphate product by 34%. After nocturnal home haemodialysis, his blood pressure control has been excellent and he was able to cease taking anti-hypertensive medications soon after commencing nocturnal home haemodialysis. Regression of his left ventricular hypertrophy has also been noted, with a 39% decrease in his left ventricular mass index. The haemodialysis adequacy index, weekly single-pool Kt/V, increased by 59% after switching to nocturnal home haemodialysis and his quality-of-life indices also showed significant improvement. Nocturnal home haemodialysis holds promise as an alternative dialytic therapy for patients on chronic haemodialysis in Hong Kong.
 
Key words: Blood pressure; Hemodialysis, home; Kidney failure, chronic; Phosphates; Quality of life
 
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