OBJECTIVE. To evaluate the initial presenting symptoms and management of osteosarcoma in Hong Kong Chinese children, in relation to any possible impact on disease outcomes.

DESIGN. Retrospective study.

SETTING. A tertiary referral centre of bone cancer in a university teaching hospital in Hong Kong.

PATIENTS. All children aged younger than 18 years with a diagnosis of osteosarcoma who received treatment from March 1994 to October 2005.

RESULTS. A total of 51 children were studied. The median age of onset was 13 (range, 3-20) years; 61% were males. The tumours were located in the distal femur and proximal tibia, which accounted for 45% and 22% of the cases, respectively; 24% of patients had metastatic disease at presentation. Swelling (76%) and pain (90%) were the most common presenting complaints. Approximately one third of the patients had a preceding history of trauma. The median duration of initial symptoms to first medical consultation of any sort was 30 (range, 0-360) days. The median time from the first consultation to a definitive diagnosis was 21 (range, 0-350) days; 25% were diagnosed more than 52 days after presentation. Bonesetters were initially consulted by 37% of these patients. From presentation to diagnosis, the median duration was 61 (range, 4-361) days. Analysis of the duration of pre-diagnosis symptoms did not correlate significantly with the development of metastatic disease, response to chemotherapy, feasibility of limb salvage surgery, relapse rates, or survival rates.

CONCLUSIONS. In Hong Kong, initial consultation to bonesetters was common. A relatively long delay in between symptom onset and diagnosis of osteosarcoma was encountered. The public and medical practitioners should be made aware of this disease, especially in adolescents.

Key words: Bone neoplasms; Diagnosis, differential; Osteosarcoma; Pelvic neoplasms; Treatment outcome

View this abstract indexed in MEDLINE:

OBJECTIVE. To review the outcomes of frozen-thawed embryo transfer cycles.

DESIGN. Retrospective review.

SETTING. Tertiary assisted reproduction centre, Hong Kong.

PATIENTS. Subfertile patients undergoing frozen-thawed embryo transfer between July 2005 and December 2007.

MAIN OUTCOME MEASURES. Clinical and ongoing pregnancy rates.

RESULTS. A total of 983 frozen-thawed embryo transfer cycles performed during the study period were reviewed. The clinical pregnancy and ongoing pregnancy rates were 35% and 30%, respectively. Factors associated with successful outcome included younger maternal age (<=35 years) and 4 or more blastomeres at replacement, but not the method of insemination, the cause of subfertility, or the type of frozen-thawed embryo transfer cycle. The overall multiple pregnancy rate was 18%. For cycles with a single embryo replaced, embryos having 4-cell or higher stages at replacement gave an ongoing pregnancy rate of 25%, whereas those with less than 4 cells had a significantly lower ongoing pregnancy rate of 5% only. Blastomere lysis after thawing significantly reduced the clinical pregnancy and ongoing pregnancy rates of cycles with one embryo replaced.

CONCLUSIONS. Clinical pregnancy and ongoing pregnancy rates of frozen-thawed embryo transfer cycles were 35% and 30%, respectively. Higher pregnancy rates were associated with younger maternal age (<=35 years), blastomere numbers of 4 or more, and no blastomere lysis after thawing.

Key words: Cryopreservation; Embryo transfer; Fertilization in vitro

View this abstract indexed in MEDLINE:

OBJECTIVE. To review the experience with Onyx embolisation of cerebral arteriovenous malformation.

DESIGN. Prospective study.

SETTING. A regional neurosurgical centre in Hong Kong.

PATIENTS. Data of patients with cerebral arteriovenous malformation who underwent Onyx embolisation over a 14-month period were prospectively collected.

RESULTS. Eleven sessions of Onyx embolisation were performed in nine patients with cerebral arteriovenous malformations, seven of which had ruptured. Total occlusion was achieved in three (33%) of the patients, and subtotal occlusion (over 80% occlusion) in three out of four with Spetzler-Martin grade-III/IV malformations. One patient developed mild permanent neurological deficit.

CONCLUSION. Onyx embolisation of cerebral arteriovenous malformations is feasible in Hong Kong. Careful patient and target selection are important.

Key words: Embolization, therapeutic; Intracranial arteriovenous malformations; Polyvinyls; Treatment outcome

View this abstract indexed in MEDLINE:

OBJECTIVES. To investigate the association between obesity and airway inflammation and spirometric parameters in local children.

DESIGN. Cross-sectional and observational study.

SETTING. Paediatric clinics of a university-affiliated teaching hospital in Hong Kong.

PATIENTS. Chinese subjects aged 6 to 18 years were recruited from the paediatric clinics. Obesity was defined as being 120% or more of the median weight-for-height.

MAIN OUTCOME MEASURES. Airway inflammation assessed by exhaled nitric oxide concentration; lung function evaluated by measuring forced expiratory flow in 1-second and forced vital capacity using spirometry; and peak expiratory flow rate measured by using a mini-Wright peak flow meter.

RESULTS. Fifty-five subjects were recruited into four groups as follows: 13 non-obese controls, 16 obese non-asthmatics, 15 non-obese asthmatics, and 11 obese asthmatics. The median (interquartile range) exhaled nitric oxide concentrations of these groups were 17.6 (14.4-20.9), 33.3 (26.1-75.4), 65.7 (32.0-110.0) and 49.2 (41.1-82.6) parts per billion, respectively (P=0.001 for trend). Post-hoc analysis revealed higher exhaled nitric oxide concentration in the latter three groups (obese and/or asthmatic subjects) than controls (P<=0.002). Exhaled nitric oxide concentration did not differ among obese non-asthmatics, non-obese asthmatics, and obese asthmatics (P>0.1 for all). In non-asthmatics, exhaled nitric oxide concentration correlated positively with age (P=0.048), weight-for-height z-score (P=0.001), and forced vital capacity (P=0.009). Weight-for-height z-score correlated positively with forced vital capacity (P=0.041), but inversely with the forced expiratory flow in 1-second/forced vital capacity ratio (P=0.049). Such correlations were not observed in asthmatic children.

CONCLUSION. Increased airway inflammation as revealed by exhaled nitric oxide concentration was found in obese non-asthmatic children. Weight-for-height z-score as an indicator of childhood obesity correlated with exhaled nitric oxide concentration and spirometric parameters in children without asthma. Nonetheless, concomitant obesity does not influence exhaled nitric oxide concentration in asthmatic children. Further studies are needed to identify the pathophysiologic mechanisms for such associations.

Key words: Asthma; Bronchitis; Child; Obesity; Spirometry

View this abstract indexed in MEDLINE:

OBJECTIVE. To assess the impact of a structured, clinically integrated evidence-based undergraduate medicine training programme using a validated tool.

DESIGN. Before and after study with no control group.

SETTING. A medical school in Malaysia with an affiliated district clinical training hospital.

PARTICIPANTS. Seventy-two medical students in their final 6 months of training (senior clerkship) encountered between March and August 2006.

INTERVENTION. Our educational intervention included two plenary lectures at the beginning of the clerkship, small-group bedside question-generating sessions, and a journal club in the paediatric posting.

MAIN OUTCOME MEASURES. Our primary outcome was evidence-based medicine knowledge, measured using the adapted Fresno test (score range, 0-212) administered before and after the intervention. We evaluated the performance of the whole cohort, as well as the scores of different subgroups that received separate small-group interventions in their paediatric posting. We also measured the correlation between the students' evidence-based medicine test scores and overall academic performances in the senior clerkship.

RESULTS. Fifty-five paired scripts were analysed. Evidence-based medicine knowledge improved significantly post-intervention (means: pre-test, 84 [standard deviation, 24]; post-test, 122 [22]; P<0.001). Post-test scores were significantly correlated with overall senior clerkship performance (r=0.329, P=0.014). Lower post-test scores were observed in subgroups that received their small-group training earlier as opposed to later in the clerkship.

CONCLUSIONS. Clinically integrated undergraduate evidence-based medicine training produced an educationally important improvement in evidence-based medicine knowledge. Student performance in the adapted Fresno test to some extent reflected their overall academic performance in the senior clerkship. Loss of evidence-based medicine knowledge, which might have occurred soon after small-group training, is a concern that warrants future assessment.

Key words: Education, medical, undergraduate; Evidence-based medicine

View this abstract indexed in MEDLINE: