OBJECTIVE. To review the outcome after surgical resection for primary liver cancer.

DESIGN. Retrospective study.

SETTING. Private community hospital, Hong Kong.

PATIENTS. Sixty-one consecutive patients who underwent liver resection for primary cancer from 1992 through 1997.

MAIN OUTCOME MEASURES. Clinicopathological features, type of resection, duration of hospital stay, and actuarial overall and disease-free 5-year survival rates.

RESULTS. Cirrhosis was present in 46 (75%) of the patients, and 42 (69%) were positive for hepatitis B surface antigen. The median tumour diameter was 8 cm (range, 1-16 cm). Liver resections consisted of hemihepatectomy (n=37), trisegmentectomy (n=4), segmentectomy (n=11), and wedge resection (n=9). Postoperative death and major morbidity occurred in 0% and 36% of patients, respectively; ascites was the most common complication. The median hospital stay was 11 days. The actuarial overall and disease-free 5-year survival rates were 36.0% and 22.8%, respectively. These results are similar to or better than those recently reported from local or overseas centres. Multivariate analysis showed that the Child-Pugh class significantly influenced the development of complications and the length of hospital stay, whereas a well-circumscribed tumour margin, the tumour-node-metastasis stage of the tumour, and the Child-Pugh class were independent predictors of survival.

CONCLUSION. Surgical resection for primary liver cancer can be performed with acceptable safety and efficacy in a suitably staffed and equipped private community hospital.

Key words: Carcinoma, hepatocellular/surgery; Hepatectomy; Liver neoplasms/surgery; Postoperative complications

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OBJECTIVE. To study the feasibility of making an early diagnosis of adult polycystic kidney disease by using genetic linkage analysis in Hong Kong.

DESIGN. Genetic linkage study.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. Six members of a Chinese family with a history of adult polycystic kidney disease.

MAIN OUTCOME MEASURES. The inheritance pattern of adult polycystic kidney disease, as detected by polyacrylamide gel electrophoresis of polymerase chain reaction products using radioactively labelled primers specific to six microsatellite DNA markers that are closely linked to the PKD1 gene on chromosome 16.

RESULTS. Four of the six members of the family studied were shown to be positive for disease-linked markers, and the inheritance of adult polycystic kidney disease could be traced in this family with a higher degree of precision (93.7%) using genetic linkage analysis, than could be predicted otherwise.

CONCLUSION. The success of genetic linkage analysis in providing an early diagnosis of adult polycystic kidney disease is dependent on having a sufficient number of family members whose disease status has been established by imaging methods to allow the disease-linked marker haplotype to be determined. The establishment of a genetic data bank for families with adult polycystic kidney disease should be considered to maximise the effectiveness of this diagnostic approach.

Key words: Chromosomes, human, pair 16; Genotype; Kidney, polycystic/genetics; Linkage (genetics); Prognosis

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OBJECTIVE. To review the management of medically intractable epilepsy by performing temporal lobe resection.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Eleven patients: seven women and four men (mean age, 28 years; range, 19-49 years) who underwent temporal lobe resection for intractable epilepsy from 1994 through 1998.

MAIN OUTCOME MEASURES. Preoperative and operative aspects of treatment, postoperative complications, mortality, and seizure control before and after surgery.

RESULTS. All but one patient had long-standing medically intractable temporal lobe epilepsy; the duration between the onset of seizure and surgery ranged from 12 to 27 years (mean, 17.2 years). A total of 12 resections were performed without any mortalities or major postoperative complications. After surgery, two patients became seizure-free without the need for antiepileptic medication; six patients were seizure-free but required medication; and two patients showed >90% of improvement in seizure control, whereas one patient showed between 50% and 90% of improvement. Nine (81%) of the 11 patients reported significant improvement in their social life and performance of daily activities. Two (18%) patients, including one with improved seizure control, reported no improvement in their performance of daily functions.

CONCLUSIONS. Temporal lobe resection can produce significant improvements in patients who have medically intractable epilepsy. The risks of surgery are relatively small and justifiable.

Key words: Brain diseases; Epilepsy/surgery; Epilepsy, temporal lobe; Temporal lobe/surgery; Treatment outcome

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OBJECTIVE. To examine the prevalence of glomerular disease in Hong Kong.

DESIGN. Prospective review.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. All patients who presented with suspected glomerular disease from 1993 through 1997.

MAIN OUTCOME MEASURES. Histopathological diagnosis from biopsy examination and clinical features of presentation.

RESULTS. A total of 1629 consecutive percutaneous renal biopsies of native kidneys showed glomerular disease in 1413 cases. The most common clinical indication for renal biopsy was persistent proteinuria (n=735; 52.0%), while the most frequently found glomerular lesion was immunoglobulin A nephropathy (n=338; 23.9%). Minimal-change nephrotic syndrome (n=125; 8.8%) and immunoglobulin M nephropathy (n=11; 0.8%), were the most common glomerular diseases that presented with nephrotic syndrome. The male to female ratio for lupus nephritis was 1:14 (n=290), whereas for minimal-change nephrotic syndrome, the ratio was 1.8:1 (n=125). Immunoglobulin A nephropathy and membranous glomerulonephritis (n=117) affected approximately equal numbers of male and female patients. Familial fibrillary glomerulonephritis, a disease hitherto unknown in Hong Kong, was diagnosed in two siblings.

CONCLUSION. Immunoglobulin A nephropathy was the most common glomerular disease in this survey and represents an important cause of end-stage renal failure in the Hong Kong population.

Key words: Biopsy; Glomerulonephritis; Kidney diseases/pathology

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OBJECTIVE. To determine why invasive cervical carcinoma still occurs despite the availability of cervical smear screening.

DESIGN. Questionnaire survey and retrospective study of patient records of women who attended a gynaecological oncology out-patients clinic from 13 February 1997 to 30 June 1997.

SETTING. Public hospital, Hong Kong.

PATIENTS. Ninety-nine women (median age 53 years; range, 30-79 years) who gave a history of squamous cervical carcinoma.

MAIN OUTCOME MEASURES. The date of the last cervical smear test prior to the development of cervical carcinoma; reasons for non-attendance; attitudes to screening; and the stage and histological diagnosis of disease.

RESULTS. Only 19 (19.2%) of the 99 patients had received routine cervical smear testing during the previous 3 years prior to their disease; 76 (76.8%) had not been tested within the past 10 years. The major reasons for not having been tested included being unaware that cervical carcinoma is preventable by screening or can be asymptomatic, being too busy to go for screening, and not knowing where to go for screening. After receiving treatment, 17 (17.2%) of the 99 patients still thought screening was unnecessary and 20 (20.2%) had no idea how frequently smears should be taken.

CONCLUSION. The greatest barrier to effective cervical screening is patient ignorance. Public education about cervical smear screening in Hong Kong is needed.

Key words: Carcinoma, squamous cell; Cervix neoplasms; Knowledge, attitudes, practice; Mass screening; Patient acceptance of health care; Questionnaires

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