Nodular regenerative hyperplasia of the liver associated with systemic lupus erythematosus: three cases

ABSTRACT

Hong Kong Med J 2009;15:139-42 | Number 2, April 2009
CASE REPORT
Nodular regenerative hyperplasia of the liver associated with systemic lupus erythematosus: three cases
Vincent KS Leung, Tony KL Loke, Ivy SC Luk, WL Ng, TN Chau, ST Law, James CS Chan
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
 
 
Nodular regenerative hyperplasia of the liver, characterised by regenerative nodules distributed throughout the liver in the absence of fibrosis, is a rare but important complication of systemic lupus erythematosus. The main consequence of nodular regenerative hyperplasia of the liver is non-cirrhotic portal hypertension. This condition is probably underdiagnosed, as many of these patients may remain asymptomatic. Furthermore, nodular regenerative hyperplasia of the liver may be misdiagnosed as cirrhosis. We describe three female patients with nodular regenerative hyperplasia of the liver associated with systemic lupus erythematosus. All three patients have clinical manifestations of portal hypertension, and all were initially misdiagnosed as having cryptogenic cirrhosis.
 
Key words: Focal nodular hyperplasia; Hypertension, portal; Liver; Lupus erythematosus, systemic
 
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Abdominal compartment syndrome after open biopsy in a child with bilateral Wilms' tumour

ABSTRACT

Hong Kong Med J 2009;15:136-8 | Number 2, April 2009
CASE REPORT
Abdominal compartment syndrome after open biopsy in a child with bilateral Wilms' tumour
Patrick HY Chung, Kenneth KY Wong, Lawrence CL Lan, Paul KH Tam
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
Although Wilms' tumour is one of the most common solid malignancies in children, bilateral disease is rare. We report a child with bilateral Wilms' tumour who developed abdominal compartment syndrome after an open biopsy.
 
Key words: Compartment syndromes; Kidney neoplasms; Nephrectomy; Wilms tumor
 
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Large-cell neuroendocrine carcinoma of the uterine cervix complicating pregnancy

ABSTRACT

Hong Kong Med J 2009;15:69-72 | Number 1, February 2009
CASE REPORT
Large-cell neuroendocrine carcinoma of the uterine cervix complicating pregnancy
William WH Li, TN Yau, Carmen WL Leung, WM Pong, May YM Chan
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
Large-cell neuroendocrine cervical carcinoma is a rare and aggressive cancer that tends to spread and recur early despite intensive multimodal treatment. The optimal mode of therapy is still controversial and management during pregnancy is challenging because foetal well-being must also be considered. We report a patient with clinically stage IIB large-cell neuroendocrine cervical carcinoma who presented with a cervical polyp and vaginal bleeding at 18 weeks of pregnancy. The patient received concurrent chemotherapy and radiation after termination of pregnancy and remained in complete remission 21 months after completion of treatment.
 
Key words: Carcinoma, large cell; Carcinoma, neuroendocrine; Pregnancy complications; Uterine cervical neoplasms
 
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Use of closed controlled subcutaneous drainage to manage chronic lower limb oedema in patients with advanced cancer

ABSTRACT

Hong Kong Med J 2009;15:65-8 | Number 1, February 2009
CASE REPORT
Use of closed controlled subcutaneous drainage to manage chronic lower limb oedema in patients with advanced cancer
PT Lam, MS Wong, CY Tse
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Chronic lower limb oedema is common in patients with advanced cancer and can be difficult to manage. In this paper, we present two patients who had severe cancer-related chronic lower limb oedema which was refractory to conventional therapy. It was satisfactorily managed using closed controlled subcutaneous drainage without any skin infections or complications. We also review the prevalence, diagnosis, and management of cancer-related chronic oedema and lymphoedema.
 
Key words: Drainage; Edema; Lymphedema; Neoplasms
 
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Mercury poisoning: a rare but treatable cause of failure to thrive and developmental regression in an infant

ABSTRACT

Hong Kong Med J 2009;15:61-4 | Number 1, February 2009
CASE REPORT
Mercury poisoning: a rare but treatable cause of failure to thrive and developmental regression in an infant
Carline Koh, Karen L Kwong, SN Wong
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong
 
 
An infant presented with failure to thrive and developmental regression. Physical examination revealed an irritable child with swollen, erythematous extremities, and elevated blood pressure. Extensive investigations, including a metabolic work-up and neuroimaging, were unrevealing. Exposure to self-purchased medication was initially denied. The physical signs were suggestive of acrodynia. Mercury poisoning was ultimately established by measuring paired blood and urine mercury levels. On further enquiry, it was revealed that the child had been given a Chinese medicinal product for 4 months. He responded well to a chelating agent. Acrodynia is a childhood disease considered to be of historical interest only, but making a diagnosis of mercury poisoning is rewarding because the response to treatment is good. This case highlights the common misconception that alternative medicines are safe and benign.
 
Key words: Acrodynia; Complementary therapies; Failure to thrive; Hypertension; Mercury poisoning
 
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A rare cause of nephrotic syndrome: lipoprotein glomerulopathy

ABSTRACT

Hong Kong Med J 2009;15:57-60 | Number 1, February 2009
CASE REPORT
A rare cause of nephrotic syndrome: lipoprotein glomerulopathy
CY Cheung, Angel OK Chan, YH Chan, KC Lee, Gordon PT Chan, Gene TC Lau, CC Shek, KF Chau, CS Li
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
Lipoprotein glomerulopathy is a rare kidney disease in which lipoprotein thrombi are seen in the glomerular capillaries. Most of these patients are found in Japan and East Asian countries. The presenting symptoms include proteinuria, an abnormal plasma lipoprotein profile that resembles type III hyperlipoproteinaemia, and a marked increase in serum apolipoprotein E concentration. Previous studies have suggested that lipoprotein glomerulopathy might be related to APOE gene mutation. No effective therapeutic regimen has been established for lipoprotein glomerulopathy. We report the first case of biopsy-proven lipoprotein glomerulopathy in Hong Kong in a patient who presented with nephrotic syndrome and dyslipidaemia. DNA analysis revealed apolipoprotein E Kyoto together with a novel apolipoprotein E mutation, apolipoprotein E (Asp230Tyr) Hong Kong. There was significant improvement in the clinical parameters and resolution of symptoms after the introduction of statins. Further studies will be needed to clarify the role of apolipoprotein E Hong Kong and its interaction with apolipoprotein E Kyoto in the pathogenesis of lipoprotein glomerulopathy.
 
Key words: Apolipoproteins E; DNA mutational analysis; Hyperlipoproteinemias; Kidney glomerulus; Lipoproteins
 
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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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