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Biomedical subjects

H Ngan

Publications and source records attributed to H Ngan.

At least 19 recordsLinked to original sources
PubMed2000

Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence.

BACKGROUND AND OBJECTIVES: The role of transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC) has remained controversial, and its efficacy for postresection intrahepatic recurrence has not been fully assessed. A study was performed to evaluate the treatment results and prognostic factors of TACE treatment in these patients. METHODS: Clinicopathologic data and treatment results of 384 patients with inoperable HCC and 100 patients with postresection recurrent HCC treated with TACE were collected prospectively and analyzed. RESULTS: TACE was associated with an overall treatment morbidity rate of 23% (112/484) and mortality rate of 4.3% (21/484). A particularly high mortality rate of 20% (9/45) was observed among patients with tumors > 10 cm and pretreatment serum albumin level </= 35 g/L. The overall 1-year, 3-year, and 5-year survival rates from the time of first TACE treatment were 49%, 23%, and 17% respectively. Tumor size </= 10 cm and serum albumin level > 35 g/L were independent favorable prognostic factors. TACE in patients with postresection recurrent HCC was associated with less morbidity, mortality, and a better survival outcome compared with patients with primary inoperable HCC, but this was largely related to smaller tumor size and better liver function in the former group at the time of TACE treatment. CONCLUSIONS: TACE in patients with inoperable HCC was associated with significant morbidity and mortality, and the survival benefit was limited. Better patient selection in terms of tumor size and liver function may improve treatment results. Patients who have a tumor > 10 cm and poor liver function (serum albumin </= 35 g/L) may not be suitable candidates for TACE treatment.

Adult↗
PubMed2000

Serial HRCT lung changes after 3-field radiation treatment of breast cancer.

AIMS: To document serial high resolution computed tomography (HRCT) features of lung injury after 3-field radiotherapy for breast cancer. MATERIALS AND METHODS: Thirty women who received opposing tangential chest wall and supraclavicular field (SCF) irradiation after breast surgery were recruited. Thoracic HRCT was performed before and at 1, 3, 6 and 12 months after radiotherapy (RT). Lung injury at 3 months was quantified by applying a scoring system to each HRCT section. Findings were correlated with spirometric lung function tests. RESULTS: There was HRCT evidence of lung injury in 27 (90%) women at 1 month and in all 30 patients at 3 months. Spirometric lung function declined post-RT (P < 0.05), correlating with an increased SCF acute lung injury score at 3 months [r = -0.54 and -0.46, P = 0.01 and 0.03 for forced expiratory volume in 1st (FEV(1)) and forced vital capacity (FVC), respectively]. Lung injury on HRCT progressed from ground glass opacification at 1 month to nodular consolidation (3 months), increasing linear densities (6 months), and finally to residual subpleural linear and dense opacities (12 months). CONCLUSION: There is a high incidence of lung injury associated with 3-field radiotherapy for breast cancer, with concurrent SCF irradiation increasing the risk of lung damage and functional impairment. A characteristic sequence of HRCT changes is seen in most patients receiving this type of radiotherapy.Ooi, G. C. (2000). Clinical Radiology55, 817-824.

Adult↗
PubMed1999

Confluent hepatic fibrosis in monozygotic twins.

The MRI and CT features of confluent hepatic fibrosis (CHF) are reported in two 6-year-old twins. This is the first case report in children of this little known entity, which may mimic mass lesions, and the first to describe an association of CHF with anti-tuberculous drugs.

Antitubercular Agents↗
PubMed1999

Qualitative and quantitative magnetic resonance imaging in haemoglobin H disease: screening for iron overload.

OBJECTIVES: To evaluate the clinical utility of magnetic resonance imaging (MRI) in screening for iron overload in non-transfusion dependent Haemoglobin (Hb) H disease. PATIENTS AND METHODS: Thirty-six non-transfusion dependent HbH patients were evaluated with axial spin echo T1 and gradient echo T2 MRI of the abdomen and heart. The ratios of signal intensities (SIR) of the liver, spleen, pancreas and heart to paraspinous muscles were calculated. SIR <1 was taken as indicative of iron overload. Qualitative grading (0-4 scale) of iron overload was also performed. The relationship between T1 and T2 SIR and serum ferritin, and that between qualitative grading and serum ferritin were examined using standard statistical methods. Comparisons were also made between qualitative grading and quantitative T1 and T2 SIR data in diagnosing iron overload. Six patients underwent liver biopsies. RESULTS: T2 SIR was more sensitive in detecting iron overload than T1 SIR. Thirty-three livers, 13 spleens, six pancreas and one heart were diagnosed as having iron overload with T2 SIR, including three patients with normal serum ferritin. A positive diagnosis by T2 SIR was more closely related to that of qualitative grading than T1 SIR. Serum ferritin was negatively correlated with hepatic SIR (T1 and T2), and with T2 SIR of the spleen and pancreas, even after adjustment for age. Liver haemosiderosis was confirmed in all six patients who underwent liver biopsies. Liver iron concentration of only one and a half times the normal was found in one patient with positive MR findings. CONCLUSION: MR is a non-invasive, effective method for early detection of iron overload particularly in the liver and spleen. Qualitative grading and quantitative T2 SIR data are equivalent in diagnosing iron overload. Routine screening of non-transfusion dependent HbH patients will identify high risk patients in whom early therapeutic intervention may prevent further complications and morbidity.

Adult↗
PubMed1999

Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management.

OBJECTIVE: This study evaluated the results of surgical and nonsurgical treatments of hepatocellular carcinoma (HCC) in the elderly to determine the optimal management strategy. METHODS: Clinicopathological data and treatment results of 222 elderly (> or = 70 yr) and 1116 younger patients with HCC managed between 1989 and 1997 were prospectively collected and compared between the two groups. RESULTS: The resection rate in the elderly (14%) was lower than in younger patients (27%) (p < 0.001). Among patients who underwent resection, there were no significant differences in morbidity rate (48% vs 40%, p = 0.354), hospital mortality rate (10% vs 6%, p = 0.431), or long-term survival (median, 38 vs 42 months, p = 0.940). Comparing the periods 1989-1992 and 1993-1997, hospital mortality rate in the elderly was reduced from 25% to 4% (p = 0.079). Sixty-seven elderly and 317 younger patients underwent transarterial oily chemoembolization (TOCE), with similar morbidity rate (24% vs 26%, p = 0.775), mortality rate (7% vs 5%, p = 0.365), and long-term survival (median, 12 vs 9 months, p = 0.277). The results of other nonsurgical treatments were also similar between the two groups. CONCLUSIONS: Hepatic resection for HCC is safe in selected elderly patients, and the improved results in recent years indicate that more elderly patients could benefit from surgical management. TOCE is well tolerated in elderly patients and is the treatment of choice for unresectable HCC. The overall management strategy of HCC in the elderly should not be different from that in younger patients.

Age Factors↗
PubMed1998

The role of hepatic arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma.

Thirty-three patients presenting with spontaneous rupture of hepatocellular carcinomas (HCCs) were referred for emergency transcatheter arterial embolization. Blood was present in the ascitic fluid on abdominal paracentesis in all 33 patients. Seventeen patients underwent emergency computed tomography (CT). HCCs were demonstrated on CT in all 17 patients. Blood was detected in the peritoneal cavity or around the liver surface on CT in 15 patients (88.2%), one of whom also had active extravasation of the contrast medium into the peritoneal cavity. Vascular tumours were present in the hepatic angiograms prior to embolization in all 33 patients but extravasation of the contrast medium from the HCC was seen on angiography in only six patients (18.2%). Bleeding from the ruptured HCC was stopped at the end of the procedure in 32 patients who had undergone successful embolization. The overall median survival time was 9 weeks. The median survival time of patients with a serum total bilirubin level of 50 micromol/l or below was 15 weeks, while that of patients with a serum total bilirubin level above 50 micromol/l was only 1 week, the difference being statistically significant. Embolization is therefore the treatment of choice in arresting life-threatening bleeding in ruptured HCC in patients with a serum total bilirubin level of 50 micromol/l or below, but the procedure is rarely effective in prolonging survival in patients with a serum total bilirubin above this critical level.

Adult↗
PubMed1998

Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization.

BACKGROUND: Transarterial oily chemoembolization (TOCE) is frequently employed as a non-operative treatment for hepatocellular carcinoma (HCC). Serious complications of TOCE are well known but ruptured HCC as a fatal complication of TOCE has not been reported previously. METHODS: A retrospective study was performed on all patients who received TOCE for treatment of HCC from January 1989 to October 1996; the complication of ruptured HCC within 2 weeks from the procedure was recorded. RESULTS: During the study period, 391 patients received a total of 1443 sessions of TOCE (mean 3.7 sessions per patient) for the treatment of HCC, with an overall median survival of 10.4 months. Six patients developed ruptured tumour within 2 weeks after TOCE, resulting in an overall incidence of 1.5 per cent per patient or 0.4 per cent per procedure. All except one patient died 1-25 days after tumour rupture. Factors common to these six patients included: (1) male sex; (2) large tumour size (range 8-17 cm in diameter); (3) tumour located in the right lobe of the liver; (4) tumour ruptured after the first session of TOCE; and (5) TOCE performed as primary treatment without previous hepatic resection. CONCLUSION: Ruptured HCC is a serious complication of TOCE although the incidence is low. It occurred predominantly in men after the first session of TOCE for a large irresectable tumour of the right lobe.

Carcinoma, Hepatocellular↗
PubMed1998

Imaging of follicular dendritic cell tumours of the liver.

Follicular dendritic cell tumour of the liver is a recently recognized entity. To date, only two cases have been described, both in the pathology literature. Histologically, it resembles an inflammatory pseudotumour and immunohistochemical and ultrastructural studies are required for its diagnosis. The ultrasound, computed tomography and angiographic features of two cases of follicular dendritic cell tumour of the liver are described in detail. One of the patients had multiple recurrences of this tumour. The imaging features are very similar to those of hepatocellular carcinoma. As follicular dendritic cell tumour is considered to be of low-grade malignant potential, in contrast to the dismal prognosis for hepatocellular carcinoma, it is important to be able to accurately distinguish between the two types of tumour prior to initiating definitive therapy.

Adult↗
PubMed1998

Clinical profiles of Chinese patients with diffuse panbronchiolitis.

BACKGROUND: Diffuse panbronchiolitis (DPB), characterised by progressive sinobronchial sepsis, is well characterised in Japanese subjects but not in other ethnic groups. The experience with DPB in seven Chinese patients is described and the clinical profiles compared with those of Japanese subjects. METHODS: Seven Chinese patients (three women; mean (SD) age 48(18.6) years, all never smokers) who attended a teaching hospital centre and fulfilled the diagnostic criteria for DPB were assessed prospectively for clinical, radiological, lung function, microbiological, and other "characteristic" laboratory parameters. RESULTS: Lung function assessment showed a typical obstructive pattern (n = 5) and air trapping (n = 7). Typical bronchiolar infiltration by lymphocytes and plasma cells and accumulation of foamy macrophages in the intraluminal tissue were detected in open lung biopsy specimens (n = 2). Chest radiographs and high resolution computed tomographic scans revealed hyperinflation, diffuse nodules, bronchial thickening and dilatation, peripheral hypoattenuation, and bronchiolectasis. Radiological improvement, manifest as a reduction in nodular density and bronchial thickening, and persistence of other abnormalities such as air trapping were not accurately depicted by the classical Nakata or Akira classifications. The other "characteristic" features such as HLA-B54, IgG subclass deficiency, raised CD4/CD8 T lymphocyte ratio, cold haemagglutinaemia, raised IgA, IgG, and rheumatoid factor were not present. Treatment with erythromycin led to excellent responses in symptoms, lung function indices, and the radiological picture. A review of the non-Japanese cases in the literature reveals that this absence of typical "additional features" in DPB might also be applicable to non-Japanese patients. CONCLUSIONS: We report the only series of non-Japanese Mongoloid patients with well characterised DPB who had uncharacteristic investigation profiles. This experience should help other clinicians in the investigation and management of DPB in non-Japanese patients.

Adult↗
PubMed1997

Systemic lupus erythematosus patients with respiratory symptoms: the value of HRCT.

Ten Chinese patients with systemic lupus erythematosus (SLE) and with persistent respiratory symptoms were evaluated with high resolution computed tomography (HRCT), chest radiographs and lung function tests. Fourteen of 15 HRCT scans performed were abnormal. The predominant disease pattern, seen in 60% of patients, was one of chronic interstitial lung disease with honeycombing, architectural distortion, parenchymal bands, pleural irregularity, and a lower zone predominance. Three of 10 patients had histological evidence of either lung fibrosis or interstitial pneumonitis. Airways disease and pleural thickening were seen in 20% and 87% of scans, respectively. Pleural thickening and honeycombing were present in 53% and 20% of chest radiographs, respectively. All concurrent lung function tests were abnormal. Reduced diffusion capacity of carbon monoxide (DLCO/VA) was observed in 60% of lung function tests. There was no correlation between duration of disease and DLCO/VA. However, pathological reduction of DLCO/VA was seen in 71% of patients with honeycombing, and 88% of patients with ground glass opacity. Our study has documented a high incidence of HRCT features of chronic lung destruction and a lower zone predominance in SLE patients with persistent respiratory symptoms.

Adult↗
PubMed1997

Arteriovenous shunting in hepatocellular carcinoma: its prevalence and clinical significance.

Arteriovenous shunting has been reported in hepatocellular carcinoma (HCC) and is a recognized contraindication to treatment by transcatheter arterial chemoembolization. This study aims to determine the prevalence of arteriovenous shunting in patients presenting with HCC and the development of shunts in those with inoperable HCC being treated with repeated chemoembolization. In a group of 292 Chinese patients (251 men, 41 women; mean age 54.7 years) presenting with HCC, hepatic angiograms demonstrated arteriovenous shunting in 91 cases (31.2%); shunting into the portal vein was observed in 84 (28.8%) and shunting into the hepatic vein in seven (2.4%). The hepatic angiograms of a separate group of 171 Chinese patients (144 men, 27 women: mean age 55.4 years) undergoing chemoembolization for inoperable HCC were analysed. Arteriovenous shunting developed during treatment in 20 patients (11.7%). Of these 20 patients, one had shunting into the hepatic vein while 19 (11.1%) had arterioportal shunting. Arteriovenous shunting occurred through the tumour or portal vein tumour thrombus in 13 patients, and occurred at sites remote from the tumour in the other seven patients. Shunting disappeared on repeat angiograms in three patients. Various postulated mechanisms responsible for arteriovenous shunting in HCC are reviewed. The recognition of development of arteriovenous shunting during chemoembolization of HCC is important as it has a direct bearing on patient management and prognosis.

Adolescent↗
PubMed1995

Case report: variable imaging appearances of angiomyolipomas of the liver.

Angiomyolipomas of the liver are rare benign tumours. We describe the variable imaging appearances of these tumours in three women. The first two patients underwent ultrasound, computed tomography (CT) and angiography, which demonstrated lesions resembling focal nodular hyperplasia and hepatocellular carcinoma, respectively. Both had histologically-proven liver angiomyolipomas surgically resected. The third patient was incidentally found to have typical features of multicomponented liver angiomyolipoma on CT. Variable proportions of fatty tissue in these tumours are the most likely explanation for their different imaging appearances on CT.

Adult↗
PubMed1994

Case report: lymphangiomyomatosis with spontaneous peritoneal rupture.

Radiological appearances of pulmonary and retroperitoneal lymphangiomyomatosis in a 47-year-old Chinese woman are described. Onset of abdominal symptoms and development of ascites heralded spontaneous rupture of retroperitoneal lymphangiomyomatosis, which is illustrated on computed tomography.

Ascites↗
PubMed1994

Estrogen and progesterone receptors in normal cervix and primary cervical carcinoma.

Estrogen and progesterone receptors (ER, PR) were measured in 21 specimens of cervical cancer and in 17 specimens of normal cervix by monoclonal enzyme immunoassay (EIA). In normal cervix, 88.2% of specimens were ER-positive ( > 15 fmol/mg protein), 74.5% were PR-positive ( > 15 fmol/mg protein) and 74.5% were both ER- and PR-positive. In cervical cancer, 66.7% were ER-positive, 42.9% were PR-positive and 38.1% were both ER- and PR- positive. There was no significant difference in ER status between the normal cervix and cervical cancer (P > 0.05), but PR status and levels in normal cervix were significantly higher than those in cervical carcinoma (P < 0.05). ER levels in squamous cell carcinoma was not correlated to the tumor stage, histologic grade and menopausal status. PR levels in premenopausal patients with squamous cell carcinoma were significantly higher than those in postmenopausal patients (P < 0.01). Adenocarcinoma of the cervix contained significantly more ER and PR than squamous cell carcinoma (P < 0.01, P < 0.05). In addition, serum E2 level was also assayed in 21 patients with cervical cancer. There was significant difference in E2 levels between the premenopausal and postmenopausal patients (P < 0.01). Patients were stratified according to E2 levels, a significant difference in PR levels and in the ratio of PR/ER was noted (P < 0.05, P < 0.01).

Adenocarcinoma↗
PubMed1994

[Estrogen and progesterone receptors in normal cervix and primary cervical carcinoma].

Estrogen and progesterone receptor levels (ER and PR) were measured in 21 specimens of cervical carcinoma and in 17 normal cervix by monoclonal enzyme immunoassay (ER-EIA and PR-EIA). In normal cervix, 88.2% of specimens were ER-positive (more than 15 fmol/mg protein), 74.5% were PR-positive (more than 15 fmol/mg protein) and 74.5% were both ER and PR-positive. In cervical cancer, 66.7% of malignancies were ER-positive, 42.9% were PR-positive and 38.1% were both ER and PR-positive. There was no significant difference in ER status between the normal cervix and cervical cancer (P > 0.05), but PR status and levels in normal cervix were significantly higher than those in cervical carcinoma (P < 0.05). ER levels in squamous cell carcinoma was not correlated to the tumor stage, histologic grade and menopausal status. PR levels in premenopausal patients with squamous cell carcinoma were significantly higher than those in postmenopausal patients (P < 0.01). Adenocarcinoma of the cervix contained significantly more ER and PR than squamous cell carcinoma (P < 0.01, P < 0.05). In addition, serum E2 level was also assayed in 21 patients with cervical cancer. There was significant difference in E2 levels between the premenopausal and postmenopausal patients (P < 0.01). Patients were stratified according to E2 levels, a significant difference in PR level and in ratio of PR/ER was noted (P < 0.05, P < 0.01).

Adenocarcinoma↗
PubMed1993

Disseminated skeletal tuberculosis with skull involvement.

We report a patient with widespread osteolytic lesions, including extensive involvement of the skull, due to Mycobacterium tuberculosis. Response to treatment with antituberculosis drugs was slow with appearance of new lesions while on therapy despite a sensitive organism. Excision of diseased skull bone was eventually done, after which no new lesions appeared in the ensuing 14 months.

Adolescent↗