We report three paediatric cases of suspected heavy metal poisoning that presented with non-specific symptoms. Hair samples of the three patients were sent overseas for analysis; results showed abnormal levels of many elements, including some heavy metals. A diagnosis of heavy metal poisoning was made and chelation therapy was offered to each patient. Blood levels for some heavy metals were subsequently checked and all were within the normal range. The original diagnosis of heavy metal poisoning was therefore not substantiated. The patients did not have a history of exposure to heavy metals or specific clinical features of heavy metal poisoning. The non-invasive nature of hair analysis is tempting, but the validity of such testing in diagnosing heavy metal poisoning is questionable.

This study reviews the presentation and management of extremity soft tissue sarcoma after unplanned incomplete resection in a musculoskeletal tumour centre in Hong Kong. Medical records of 18 patients who were referred to our centre for further management from January 1995 to May 2001 after inadequate tumour excision were reviewed. Fourteen patients had been referred from private clinics and four from public hospitals. At initial presentation, 10 patients had lesions exceeding 5 cm, nine had a tumour deep in the subfascial plane, and eight had tumours that had recently increased in size. Sixteen had no preoperative radiological assessment or biopsy performed before excision. All except two patients needed additional skin and muscle reconstruction in a subsequent re-resection, and 12 required postoperative radiotherapy. Two patients subsequently developed distant metastases, and one patient died of an unrelated cause. No amputations were required, and no major complications arose from second surgery. Physicians' alertness towards the possible malignancy of soft tissue masses in extremities is important to avoid a potentially mutilating second resection. Well-planned re-resection in a specialised tumour centre can achieve satisfactory local control of disease.

Magnetic resonance imaging has an increasing role in the assessment of ischaemic heart disease. Its superb spatial and temporal resolution currently allows accurate assessment of cardiac function, regional wall motion, and the extent of myocardial infarction. Regional myocardial perfusion can also be assessed, most commonly by a first-pass technique. Non-invasive imaging of the coronary arteries by various magnetic resonance imaging techniques represents a major advance in recent years. In the foreseeable future, magnetic resonance imaging may become a single, comprehensive examination for the assessment of ischaemic heart disease.

A person’s decision-making capacity is pivotal when a doctor determines whether a person has the ability to make his or her own decisions, and thus it has major clinical, ethical, and legal significance, especially in Hong Kong, where the Mental Health Ordinance has introduced Guardianship provisions and provisions for the treatment of mentally incapacitated persons. This paper examines the legal concept of decision-making capacity and its clinical assessment within the local context. It is important for doctors to be aware of the legal mechanisms under which both urgent and non-urgent treatment can be given to mentally incapacitated persons, provided that the treatment is necessary and given in the best interests of the patient.

In recent years there has been a considerable increase in the use of complementary therapies in the field of learning disabilities. This paper describes the use of a Snoezelen (multisensory) room for adults with learning disabilities in a psychiatric setting in Hong Kong. Theoretical and operational issues are discussed. The demographic and clinical data of a cohort of 96 patients who had used the room were reviewed. Rating forms were completed by their carers or staff at the end of the course to provide a subjective evaluation of the effectiveness of treatment. This is followed by three case reports. In view of the rising popularity of the multisensory room for people with learning disabilities, more research of the impact and therapeutic values is recommended.