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Biomedical subjects

T Y Leung

Publications and source records attributed to T Y Leung.

At least 19 recordsLinked to original sources
PubMed2001

Screening for postnatal depression: are specific instruments mandatory?

BACKGROUND: Few studies have examined the utility of rating scales developed in non-puerperal context in detecting postnatal depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for depression among recently delivered women in Hong Kong. METHODS: A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting postnatal depression was assessed using the receiver operating characteristic (ROC) curves. RESULTS: Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting postnatal depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS. LIMITATION: The study was conducted in Chinese women using translated version of the rating scales. CONCLUSIONS: The GHQ and BDI are useful for detecting postnatal depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for postnatal depression.

Adolescent↗
PubMed2001

Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong.

We conducted a cross-sectional survey using a self-administered questionnaire among attendees of a well women clinic in Hong Kong during June and July 1998. The study aimed to examine the factors associated with the past and future use of screening services among Chinese women in Hong Kong and their perception of service providers. Of the 430 respondents (64% response rate), 87% were aged 31-50 y, 85% married, 93% attained education to upper secondary school level, and 96% were non-smokers. Nearly all respondents (99%) reported having sexual experience and most of them (87%) had such experience with only one partner; 59% reported having a pap-smear test, 28% a mammogram and 44% a breast self-examination. Women who were health conscious (ate a lower fat diet and performed regular exercise) were more likely to have used the screening service (mammogram and pap-smear test) and performed breast self-examination. Staff manner, privacy and cost were the most common contributing factors for respondent's desire for future use of the screening service. Respondents showed a preference for doctors (70%) over nurses (30%), and females (80%) over males (20%) as their service providers. The findings suggest the need to disseminate appropriate information on screening services among the public to dispel misconceptions about the preference for doctors over nurses and females over males. Improving clinician- and other staff-patient communication would be important for breast and cervical screening programs in Hong Kong.

Adult↗
PubMed2001

Whole blood mercury concentrations in sub-fertile men in Hong Kong.

We aimed to investigate the association between whole blood mercury concentrations and semen quality in sub-fertile men. Fifty-nine male partners of infertile couples attending the Assisted Reproduction Unit of the Chinese University of Hong Kong between 1997 and 1998 were recruited into our study. Blood was taken from each subject for whole blood mercury concentration and hormone profile. Semen samples were obtained for computer assisted semen analysis using the Hobson sperm tracker. The semen parameters and hormone profile were compared between subjects with normal and those with elevated mercury concentrations. Twenty-one subjects (35.6%) had a whole blood mercury concentration higher than the normal range (0-50 nmol/l). All parameters of the semen analysis including the concentration of sperm, percentage of morphologically normal sperm, percentage of motile sperm, curvilinear velocity, straight-line velocity, average path velocity, and amplitude of lateral head displacement, were reduced in those with elevated blood mercury concentrations, although the difference was not statistically significant. We failed to demonstrate a statistically significant effect on the measurement of semen quality, but other adverse effects cannot be excluded. From a public heath perspective, these findings confirm that mercury toxicity is a potentially serious problem affecting the local community.

Adult↗
PubMed2001

Risk and prediction of preterm delivery in pregnancies complicated by antepartum hemorrhage of unknown origin before 34 weeks.

OBJECTIVE: To assess the timing and risk factors of preterm delivery in pregnancies complicated by antepartum hemorrhage of unknown origin (APHUO) before 34 weeks of gestation, and to formulate a clinical management protocol. METHODS: A retrospective study involving singleton pregnancies with APHUO occurring before the 34th week of gestation was performed over a 4-year period at a university teaching hospital. RESULTS: Seventy-five cases were identified. Fifty-nine (78.7%) did not have any associated uterine contractions, 74.7 and 90.7% of the cases were classified as having mild bleeding according to history and physical examination, respectively. The number of cases delivering before 37 weeks of gestation and before 34 weeks were 28 (37.3%) and 22 (29.3%), respectively. Eighteen cases (24%) delivered within the first week of APHUO, and 4 (5.3%) within the first day. The number of cases delivering within the first week was significantly higher when there were uterine contractions (62.5 vs. 13.6%, p < 0.001). The severity of bleeding was not shown to be related to the time of delivery. CONCLUSION: APHUO that occurs before 34 weeks is associated with a high risk of preterm delivery before 34 weeks (29.3%). The chance of delivery within the first week is 62.5% when there are coexisting uterine contractions. Even if contractions are absent, the risk is still high (13.6%) and persists beyond the first week. We suggest that this group of patients should be managed with a course of steroid injection and hospitalization for 4 days.

Female↗
PubMed2000

Effect of external cephalic version at term on fetal circulation.

OBJECTIVE: We sought to investigate the subclinical effect of external cephalic version on fetal circulation. STUDY DESIGN: A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses. RESULTS: There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version (P =.674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version (P =.043), and this difference existed only among multiparous women (P =.029), among those in whom the external cephalic version was considered to be difficult (P =.038), and when the placenta was posteriorly located (P =.028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications. CONCLUSION: External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head.

Bradycardia↗
PubMed2000

Cell-free fetal deoxyribonucleic acid in maternal circulation as a marker of fetal-maternal hemorrhage in patients undergoing external cephalic version near term.

OBJECTIVE: Our aim was to investigate whether external cephalic version performed near term increases the concentration of cell-free fetal deoxyribonucleic acid in maternal plasma. STUDY DESIGN: Forty-five patients who had singleton male fetuses and were undergoing external cephalic version at or beyond 36 weeks of gestation were recruited during a 20-month period. Maternal venous blood samples were taken before and within 10 minutes after external cephalic version. Deoxyribonucleic acid was extracted from the plasma samples. The amount of fetal deoxyribonucleic acid was quantified by means of the SRY gene on the Y chromosome as a fetal marker. The change in SRY gene concentration before and after external cephalic version was compared by paired sample t test. RESULTS: There was a significant increase in the concentration of fetal deoxyribonucleic acid in maternal serum after external cephalic version (before, 296 +/- 209 copies per milliliter; after, 369 +/- 228 copies per milliliter; P =.014). This increase in the concentration of deoxyribonucleic acid was most profound among the nulliparous patients after a successful version and in the presence of a posterior placenta. The location of the placenta was found to be the most significant factor accounting for the change in the deoxyribonucleic acid concentration. CONCLUSIONS: External cephalic version near term imposed a significant disturbance to the maternalplacental interface. Fetal deoxyribonucleic acid is a sensitive marker that is useful in the assessment of subclinical fetal-maternal hemorrhage.

Adult↗
PubMed2000

Thyroid function and psychiatric morbidity in patients with manic disorder receiving lithium therapy.

Euthyroid hyperthyroxinemia as a result of a transient increase in thyroid-stimulating hormone (TSH) levels may contribute to the development of manic disorder. Lithium has a potent short-term antithyroidal effect that may account for its antimanic action. The thyroid function and psychiatric morbidity of 46 adult patients with manic disorder were assessed prospectively before and 1 and 6 months after lithium treatment. At baseline, the free thyroxine level (FT4, 16.23 +/- 3.11 pmol/L) was at the high end of the normal range, whereas the free triiodothyronine (FT3, 4.24 +/- 0.65 pmol/L) and TSH (1.47 +/- 0.73 mIU/L) levels were within the normal range. All patients were clinically euthyroid, but five of them (11%) had elevated FT4 levels. Baseline FT3 and FT4 levels were positively correlated with past psychiatric morbidity. The FT4 level at baseline and after 1 month of treatment was positively correlated with scores on the Brief Psychiatric Rating Scale (p < 0.02) and negatively correlated with scores on the Global Assessment Scale (p < 0.005). During the first month of treatment, the reduction of FT3 and FT4 levels was significantly correlated with a decrease in psychiatric symptoms. By 6 months, the FT3 level was no longer significantly different from that at the baseline, but FT4 levels remained significantly lower. The TSH level increased progressively from baseline to 6 months. Multilevel models showed that FT4 and serum lithium levels were positively and negatively associated with psychiatric symptoms, respectively. The findings of the study lend support to the notion that euthyroid hyperthyroxinemia contributes to acute mania and suggest that lithium's short-term antimanic action may be mediated by its antithyroid effect.

Adult↗
PubMed2000

Outcome of labour after successful external cephalic version at term complicated by isolated transient fetal bradycardia.

OBJECTIVES: To investigate factors associated with the occurrence of transient fetal bradycardia after external cephalic version, and labour outcome after isolated transient fetal bradycardia. DESIGN: Cohort study. SETTING: Teaching hospital with a policy of offering external cephalic version for breech presentation at or beyond 36 weeks of gestation. POPULATION: Four hundred and twenty-nine external cephalic versions performed over a 5-year period. METHODS: Between group differences were compared with the unpaired t test or the chi2 test. Logistic regression analysis was performed to exclude confounding effects. MAIN OUTCOME MEASURES: Incidence of caesarean section for fetal distress. RESULTS: Transient fetal bradycardia occurred in 8.4% of external cephalic versions, and was associated with a successful version (OR 16.45, P < 0.001), a difficult procedure (OR 3.70, P = 0.001), and nulliparity (OR 2.83, P = 0.007). The incidence of intrapartum caesarean section for fetal distress was 16.7% in pregnancies with transient fetal bradycardia, compared with 7.9% in those without (OR 2.34, 95% CI 0.81, 6.71). CONCLUSIONS: Transient fetal bradycardia after external cephalic version may be associated with a higher risk of intrapartum caesarean section for fetal distress.

Bradycardia↗
PubMed2000

A survey of pregnant women's attitude towards breech delivery and external cephalic version.

A structured interview survey was carried out in 150 women who came for their first antenatal visit in a university hospital in Hong Kong between June and July 1998. Their opinions and perceptions of fetal and maternal safeties on different modes of delivery for both cephalic and breech presentation, and external cephalic version (ECV) were surveyed. Their decisions on the management of term breech-presenting pregnancy were examined. Most women (92%) preferred vaginal delivery to Caesarean delivery (CS) in case of cephalic presentation, mainly because it was a natural way of parturition. They perceived that vaginal delivery was safer than CS for both mothers and babies, but the reverse was true for breech presentation. About 82% chose ECV as the first choice of managing breech presentation, mainly because a successful version allowed a natural way of delivery. Only 2% of women considered ECV ineffective, and 13.3% and 18.7% considered it not safe for mothers and fetuses respectively. Therefore, ECV should be an available option in all obstetric units. Adequate counselling and explanation would improve the acceptance of ECV.

Attitude to Health↗
PubMed2000

Small bowel herniation through subumbilical port site following laparoscopic surgery at the time of reversal of anesthesia.

Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. Two cases of small bowel herniation at subumbilical port site occurred at the time of withdrawal of the trocar sheath at the end of the laparoscopic procedure are reported. The herniations were precipitated by the coughing movements of the patients as a result of too early reversal of the general anesthesia. Awareness of the complication, precaution at time of sheath withdrawal and a well-timed reversal of the general anesthesia are important in avoiding such a complication.

Adult↗
PubMed2000

Identifying women at risk of postnatal depression: prospective longitudinal study.

OBJECTIVE: To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women. DESIGN: Prospective longitudinal study involving self-report questionnaires and face-to-face interviews. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS: Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997. MAIN OUTCOME MEASURES: Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales. RESULTS: Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn. CONCLUSION: Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Adolescent↗
PubMed1998

Vesicouterine fistula: an updated review.

To ascertain the condition of vesicouterine fistula, a search of the medical literature using the Ovid version (Ovid Technologies Inc., New York, USA) of Medline (1966-1997) was undertaken, using the keywords vesicouterine, vesico-uterine, uterovesico, and utero-vesico fistula. A search of the earlier medical literature was by cross-referencing and is likely to be less complete than the computerized database. Nonetheless, the authors believe the most relevant publications were cited. On reviewing the subject it was noticed that there had been a change in obstetric practice between the first and the latter half of this century, namely an increase in the incidence of cesarean deliveries. However, the literature contains relatively little information on pathophysiology, possibly owing to the relative rarity of the lesion. Emphasis has been given to the most recent 10 years (1987-1997) in order to update the etiology, diagnosis and management of this clinical condition.

Female↗
PubMed1998

Hematuria and clot retention after Burch colposuspension and Cystofix suprapubic catheterization: suprapubic cystotomy as an alternative suprapubic drainage method.

Suprapubic catheterization is a common procedure in continence surgery and hematuria is a common complication after suprapubic catheterization. The authors report an unusual case of acute clot retention after the removal of a Cystofix suprapubic catheter in a patient who had had a Burch colposuspension. Suprapubic cystotomy as an alternate suprapubic method is also discussed.

Adult↗
PubMed1998

Mammogram screening of Chinese women in Kwong Wah Hospital, Hong Kong.

The incidence of primary carcinoma of the breast in Hong Kong has been rising. A screening team including radiologists, breast surgeons, cytopathologists, a full-time gynaecologist and mammographers was set up at Kwong Wah Hospital. The screening method includes a clinical breast examination (CBE) and two-view mammography. The target age group is 40-70. A total of 13,033 women were screened from March 1993 to March 1995 and 8504 mammograms were performed. A double reading system was used, with an experienced mammographer as the first reader. The films were then read by radiologists and were reported. All abnormal films and normal films with palpable masses or clinical symptoms were reviewed in a weekly meeting. A total of 113 biopsies were performed including 86 stereotactic-guided fine needle aspirations (FNA) and 27 stereotactic-guided hook-wire biopsies. Four FNA showed malignant cells and another five showed suspicious cells. Eleven hook-wire biopsies showed carcinoma. The benign to malignant ratio of the hook-wire biopsies was 16:11 (< 1.5). The total number of carcinomas disclosed was 42, and 16 of these were not palpable. Four palpable tumours were not detected by mammography. The overall carcinoma of the breast detection rate was 4.94/1000, with a rate of 4.61/1000 for the 40-49-year age group and a rate of 6.46/1000 for the over 50 years of age group. The incidence of ductal carcinoma in situ plus T1 tumours was 2.82/1000.

Adult↗