Brain tuberculoma in Hong Kong

ABSTRACT

Hong Kong Med J 2002;8:52-6 | Number 1, February 2002
CASE REPORT
Brain tuberculoma in Hong Kong
WY Lee, KY Pang, CK Wong
Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
 
 
We report two cases of brain tuberculoma occurring in patients residing in Hong Kong. Both patients presented with headache and had space-occupying lesions evident on computed tomography scans of the brain. The patients had no history of tuberculosis and no symptoms of concurrent extracranial tuberculosis were evident. The diagnosis of tuberculoma was made at the time of surgical excision. Delayed diagnosis of brain tuberculoma is likely to occur in industrialised countries where tuberculosis is rare. In Hong Kong, however, with a constant influx of foreign domestic workers from endemic regions, a high index of suspicion should be maintained. Imaging studies support, but do not confirm, the diagnosis of brain tuberculoma. We recommend obtaining a definitive histological diagnosis, with computed tomography–guided stereotactic biopsy, before starting antituberculous therapy. Surgical excision is necessary in patients with raised intracranial pressure secondary to the lesion, who are not responding to medical therapy.
 
Key words: Diagnosis, differential; Hong Kong; Magnetic resonance imaging; Tomography, X-ray computed; Tuberculoma, intracranian
 
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Hepatocellular carcinoma with metastasis to the skull base, pituitary gland, sphenoid sinus, and cavernous sinus

ABSTRACT

Hong Kong Med J 2002;8:48-51 | Number 1, February 2002
CASE REPORT
Hepatocellular carcinoma with metastasis to the skull base, pituitary gland, sphenoid sinus, and cavernous sinus
TH Aung, YC Po, WK Wong
Department of Neurosurgery, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Kowloon, Hong Kong
 
 
Two cases of hepatocellular carcinoma, with metastases to the skull base, pituitary gland, sphenoid sinus, and cavernous sinus are reported. Patients presented with diplopia, retro-orbital headache, and multiple cranial nerves palsies. Pituitary metastases may require surgery as palliative treatment, and for the confirmation of histology. One of the current cases was diagnosed with hepatocellular carcinoma prior to transphenoidal resection of the pituitary metastasis. The second patient was found to have hepatocellular carcinoma after review of histology, and the development of signs and symptoms relating to the primary tumour.
 
Key words: Carcinoma, hepatocellular; Cavernous sinus; Pituitary gland; Sphenoid sinus
 
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Severe cow's milk protein allergy in a Chinese neonate

ABSTRACT

Hong Kong Med J 2001;7:442-4 | Number 4, December 2001
CASE REPORT
Severe cow's milk protein allergy in a Chinese neonate
LY Siu, K Tse, YS Lui
Paediatric Department, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
 
 
Cow's milk protein allergy is a growing problem in developed countries. We report the case of a Chinese infant, born at term, who presented on day 28 with severe growth failure, chronic diarrhoea, and metabolic acidosis. Investigations supported a diagnosis of cow's milk protein allergy. This was confirmed by withdrawing and reintroducing the relevant infant formula under controlled clinical conditions. Both acidosis and diarrhoea were seen to resolve, and 'catch-up' growth was evident after introduction of an elemental infant formula. Early recognition of this problem leads to a rapid 'cure', as seen in this case. However, later presentation with other atopic conditions has been reported.
 
Key words: Food hypersensitivity; Milk hypersensitivity
 
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Diagnosis and current management of gastrojejunocolic fistula

ABSTRACT

Hong Kong Med J 2001;7:439-41 | Number 4, December 2001
CASE REPORT
Diagnosis and current management of gastrojejunocolic fistula
DPC Chung, RSK Li, HT Leong
Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong
 
 
Gastrojejunocolic fistula is a late complication of gastroenterostomy and is associated with inadequate gastric resection and incomplete vagotomy. In the past, attempted primary repair had high mortality and staged operations were normally performed. We present two cases of gastrojejunocolic fistula and discuss the modern management of this condition. In both cases, improved nutritional support allowed successful one-stage surgical repair to be performed.
 
Key words: Gastrectomy; Gastric fistula; Gastroscopy; Intestinal fistula
 
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The monoplace hyperbaric chamber and management of decompression illness

ABSTRACT

Hong Kong Med J 2001;7:435-8 | Number 4, December 2001
CASE REPORT
The monoplace hyperbaric chamber and management of decompression illness
RCT Li
Asia Hyperbaric Center, AML, 28A Shum Wan Road, Wong Chuk Hang, Hong Kong
 
 
Three cases of decompression illness are reported. Two patients presented with joint pain and skin signs, while one patient presented with joint pain and neurological signs and symptoms. The patients received emergency recompression therapy in a Hong Kong clinic, using a monoplace hyperbaric chamber. All three patients were treated successfully and no residual signs or symptoms were evident on review at 90 days' post-treatment. Issues concerning the use of monoplace and multiplace hyperbaric chambers are also discussed, along with additional clinical applications of the monoplace hyperbaric chamber.
 
Key words: Decompression sickness; Diving; Emergency treatment; Hyperbaric oxygenation
 
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Isolated foetal ascites

ABSTRACT

Hong Kong Med J 2001;7:432-4 | Number 4, December 2001
CASE REPORT
Isolated foetal ascites
WC Leung, YH Lam, MHY Tang
Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital, Sai Ying Pun, Hong Kong
 
 
The prenatal diagnosis and perinatal outcome of two patients with isolated foetal ascites compatible with chyloperitoneum is described. The foetal ascites resolved spontaneously after delivery with good perinatal outcome in both cases. A good prognosis can be anticipated in such cases. Antepartum and intrapartum interventions are seldom necessary.
 
Key words: Ascites; Chyloperitoneum; Fetal diseases; Prenatal diagnosis
 
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Selective foeticide in Hong Kong—lawful or not?

ABSTRACT

Hong Kong Med J 2001;7:429-31 | Number 4, December 2001
CASE REPORT
Selective foeticide in Hong Kong—lawful or not?
KY Leung, WL Lau, KM Law
Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
 
 
There is legal uncertainty as to whether selective foeticide is authorized under section 47A of the Offences Against the Person Ordinance (1967). Medical and legal issues surrounding a case of selective foeticide in a triplet pregnancy are reported.
 
Key words: Abortion, legal; Ethics, medical; Pregnancy, multiple; Pregnancy reduction, multifetal; Triplets
 
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Laparoscopic repair of incisional hernia

ABSTRACT

Hong Kong Med J 2001;7:319-21 | Number 3, September 2001
CASE REPORT
Laparoscopic repair of incisional hernia
H Lau, F Lee, NG Patil
Department of Surgery, University of Hong Kong Medical Centre, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong
 
 
A 75-year-old man developed an incisional hernia over the upper abdomen following a wedge resection of a gastric stromal tumour in 1996. This is the first published report of a successful repair of an incisional hernia via a laparoscopic intraperitoneal on-lay technique using GORE-TEX DualMesh material in Hong Kong. Compared with conventional open repair of incisional hernia, long incisions and wound tension are avoided using the laparoscopic approach. This translates into a reduced risk of wound-related complications and facilitates recovery. In selected cases, minimally invasive surgery is a safe technique for the repair of incisional hernias.
 
Key words: Herniorrhaphy; Laparoscopy; Surgery
 
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Intracerebral haemorrhage and Qigong

ABSTRACT

Hong Kong Med J 2001;7:315-8 | Number 3, September 2001
CASE REPORT
Intracerebral haemorrhage and Qigong
KP Leung, T Yan, LSW Li
Rehabilitation Unit, University Department of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong
 
 
We report on a 65-year-old woman who presented with acute right-sided weakness because of an intracerebral (thalamic) haemorrhage. As a Qigong enthusiast with a long-standing history of hypertension, she developed a stroke syndrome soon after practising Qigong one morning. Following neurological recovery, the patient exhibited erratic blood pressure responses while practising Qigong, despite the fact that resting blood pressure was normal. The haemodynamic responses to exercise are discussed and a review of the therapeutic implications of practising Qigong is presented.
 
Key words: Blood pressure; Breathing exercises; Cerebral hemorrhage
 
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Unmasking of thyrotoxicosis during Anaesthesia

ABSTRACT

Hong Kong Med J 2001;7:311-4 | Number 3, September 2001
CASE REPORT
Unmasking of thyrotoxicosis during Anaesthesia
PC So
Department of Anaesthesiology, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
 
 
Two cases of subclinical and undiagnosed thyrotoxicosis that presented with unexplained tachycardia during surgery are described. Differential diagnosis and logistics in the management of patients presenting with tachycardia, with or without fever during anaesthesia are discussed. It is emphasised that when encountering unexplained tachycardia during anaesthesia, thyrotoxicosis must be suspected. Investigations for thyrotoxicosis must be carried out in the postoperative period.
 
Key words: Preoperative care; Tachycardia/diagnosis; Thyroid crisis/diagnosis; Thyrotoxicosis/diagnosis
 
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