OBJECTIVES. To evaluate treatment outcomes following interstitial brachytherapy for cancers of the lip, buccal mucosa, or nose.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. A cohort of 13 patients treated uniformly by a simple interstitial brachytherapy technique employing plastic angiocatheters as carriers for Iridium-192 wires: all but one patient had T1 or T2 tumours and all but one had N0 disease.

MAIN OUTCOME MEASURES. Local and loco-regional control rates.

RESULTS. Six of the 13 patients received external radiotherapy prior to interstitial brachytherapy. A median brachytherapy dose of 70 Gy was delivered to those treated with brachytherapy alone, while 35 Gy was delivered after a median external radiotherapy dose of 50 Gy to those receiving combined treatment. The 3-year actuarial local control rate was 75%. No significant late complications were observed.

CONCLUSIONS. Employing a simple brachytherapy technique using angiocatheters and Iridium-192 wires, in conjunction with external radiotherapy when appropriate, produces good outcomes for patients with early lip, nasal vestibule, and buccal mucosa cancers.

Key words: Brachytherapy; Carcinoma, squamous cell; Head and neck neoplasms; Iridium radioisotopes; Treatment outcome

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OBJECTIVES. To identify the characteristics of Hong Kong Chinese women with polycystic ovarian syndrome and to compare different diagnostic criteria.

DESIGN. Retrospective study.

SETTING. Gynae-endocrinology Clinics in the Prince of Wales Hospital, Hong Kong.

PATIENTS. Ninety Hong Kong Chinese women with polycystic ovarian syndrome who were diagnosed according to the hospital's criteria.

MAIN OUTCOME MEASURES. Prevalence of typical features of polycystic ovarian syndrome, including anovulation and hyperandrogenism (with other endocrine causes excluded), polycystic ovarian features on ultrasonography, luteinising hormone predominance, obesity, and insulin resistance.

RESULTS. Almost all (98.9%) patients with polycystic ovarian syndrome presented with anovulation, only 48.9% of them had clinical or biochemical evidence of hyperandrogenism. Typical ultrasound appearances of polycystic ovaries were observed in 86.7% of patients. Luteinising hormone predominance and insulin resistance were demonstrated in 67.8% and 40.7% of the cohort, respectively. Eight-six (95.6%) patients should have also been diagnosed with polycystic ovarian syndrome based on the 2003 Rotterdam new criteria. About 60% of patients who screened positive for insulin resistance had normal fasting serum glucose levels. The same proportion who had full screening for insulin resistance by oral glucose tolerance tests and fasting serum glucose to insulin ratios had discordant results of these two tests.

CONCLUSIONS. The 2003 Rotterdam new diagnostic criteria for polycystic ovarian syndrome are generally applicable to the Hong Kong Chinese population. Early detection of insulin resistance in patients with polycystic ovarian syndrome can be ensured by performing an oral glucose tolerance test combined with measurement of fasting serum glucose to insulin ratio.

Key words: Chinese; Polycystic ovarian syndrome; Reference standards

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OBJECTIVE. To assess the efficacy and safety of combined orbital irradiation and systemic steroids in the management of moderate-to-severe Graves' ophthalmopathy.

DESIGN. Single-blind randomised prospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Sixteen patients with active moderate-to-severe Graves' ophthalmopathy who were randomly assigned to steroid therapy (ST group) or combination therapy of orbital irradiation and systemic steroids (SRT group) between June 2000 and June 2003.

MAIN OUTCOME MEASURES. NOSPECS scoring system, total eye score, subjective eye score, and extra-ocular muscle thickness as determined by either computed tomographic or magnetic resonance imaging scans.

RESULTS. The study was completed by 15 of 16 patients. Both groups experienced improvement in total eye score, soft tissue swelling, ocular motility, visual acuity, and subjective eye score at 52-week follow-up. Total eye score improved earlier in the SRT group, achieving statistical significance (P<0.05) at as early as 4 weeks of follow-up. Improvement in ocular parameters was greater and led to a significantly greater reduction in total eye score than in the ST group at weeks 16, 24, and 52. Maximum extra-ocular muscle thickness was significantly reduced in the SRT group only. No change was observed in proptosis in either group. No serious adverse effect was observed with the addition of orbital irradiation to steroid therapy.

CONCLUSION. A combination of orbital irradiation and systemic steroids is well tolerated and more effective than steroids alone in the treatment of active moderate-to-severe Graves' ophthalmopathy. It achieves greater and more rapid improvement in soft tissue swelling, ocular motility, and visual acuity.

Key words: Eye diseases; Graves' disease; Orbit/radiation effects; Steroids; Treatment outcome

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OBJECTIVE. To estimate the incidence and type of chromosomal abnormalities in patients with primary and secondary amenorrhoea in Hong Kong.

DESIGN. Cytogenetic analysis and retrospective review.

SETTING. Clinical Genetic Service, Department of Health, Hong Kong.

PATIENTS. Case records of 549 patients with either primary (n=237) or secondary (n=312) amenorrhoea referred to the Clinical Genetic Service from 1 January 1991 to 30 April 2002 were reviewed. All these patients with amenorrhoea would have karyotyping (G banding) performed.

MAIN OUTCOME MEASURES. Clinical characteristics of patients, and incidence and type of chromosomal abnormalities in the local population.

RESULTS. Sex chromosome anomaly was found in 24.5% and 9.9%, respectively, of women with primary and secondary amenorrhoea. In those with primary amenorrhoea, male karyotype was identified in 8.4% and X-chromosome abnormalities in 16.0%.

CONCLUSION. The incidence of chromosomal abnormalities in women with amenorrhoea is similar to that reported in the literature. Chromosomal abnormalities are identified often enough to warrant karyotyping of all women with amenorrhoea.

Key words: Amenorrhea; Chromosome aberrations; Karyotyping; Ovarian failure, premature

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OBJECTIVE. To study the clinical parameters and treatment outcome of medullary thyroid carcinoma in Hong Kong Chinese patients.

DESIGN. Retrospective study.

SETTING. Regional oncology unit, Hong Kong.

PATIENTS. Patients with medullary thyroid carcinoma who were identified among 1656 patients with thyroid malignancies seen in a single institute in Hong Kong from January 1960 to June 2003.

MAIN OUTCOME MEASURES. Ten-year cause-specific survival, locoregional failure-free survival, and distant metastasis failure-free survival.

RESULTS. Twenty-two (1.3%) patients with medullary thyroid carcinoma were identified. The mean age at diagnosis was 43.7 (standard deviation, 16.5) years. The sex ratio was 1:1. The 10-year cause-specific survival, locoregional failure-free survival, and distant metastasis failure-free survival were 75.4%, 82.0%, and 62.4%, respectively. Lymph node metastasis was present in seven (31.8%) patients at diagnosis. Distant metastasis developed in nine (40.9%) patients: lung, 3 (13.6%); bone, 5 (22.7%); liver, 2 (9.1%); mediastinum, 4 (18.2%). Seven (31.8%) patients died of distant metastasis. Mediastinal (n=3) and bone metastases (n=3) were important causes of death. Genetic study confirmed multiple endocrine neoplasia type 2A in 3 (25.0%) of 12 patients who all had bilateral and multifocal diseases. Younger age (<45 years) was associated with better survival, better locoregional control, and less distant metastasis. Patients with pT1N0 disease (n=3) had an excellent prognosis: all were disease-free following total thyroidectomy. Among eight patients who received external radiation therapy, seven achieved good locoregional control. In seven patients with lymph node metastasis, external radiation therapy gave 100% (4/4) locoregional control compared with 33.3% (1/3) in those without external radiation therapy. Chemotherapy using dacarbazine and 5-fluorouracil was tried in three patients with poor response.

CONCLUSIONS. Early stage (T1N0) medullary thyroid carcinoma is associated with a very good prognosis. Postoperative external radiation therapy can achieve good locoregional control in patients with lymph node metastasis or locally advanced disease.

Key words: Carcinoma, medullary; Multiple endocrine neoplasia; Radiotherapy; Thyroid neoplasms

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