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Biomedical subjects

W Mak

Publications and source records attributed to W Mak.

At least 37 records · Page 2Linked to original sources
PubMed2004

Immunological and electrophysiological investigations of severe ptosis after bone marrow transplantation.

Ocular problems are common in recipients of stem cell transplantation (SCT), but ptosis is rarely reported and investigated. Among 346 consecutive SCT recipients, severe bilateral ptosis was noticed or reported in six cases (five women and one man), all with acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD). On univariate analysis, both aGVHD (P=0.001) and cGVHD (P<0.001) were associated with post SCT ptosis, while a trend was shown for female sex (P=0.086). The median level of anti-acetylcholine receptor antibody was significantly higher in ptosis cases than controls with cGVHD (student's t-test, P=0.01). Antistriated muscle antibody was detected in three cases and was not significantly different from controls (Fisher's exact test, P=0.29). Tensilon tests were uniformly negative. However in five cases, single fibre electromyogram at frontalis muscle showed irregular recruitment effort, suggesting localized neuromuscular transmission defect reminiscent of ocular myasthenia gravis (MG). Two patients were observed, while three patients did not respond to mestinon or steroids treatment and one patient underwent aponeurosis advancement surgery. Transplant physicians and ophthalmologists should be aware of the problem of post SCT ptosis, which may be related to alloimmune causes of neuromuscular transmission block. Diagnosis can be difficult to confirm even with invasive SF-EMG testing. Most cases warrant conservative treatment due to chronicity, benign course and poor response to medication.

Adolescent↗
PubMed2003

Clinical relevance of hydrocephalus as a presenting feature of tuberculous meningitis.

BACKGROUND: Hydrocephalus is a common complication of tuberculous meningitis (TBM). AIM: To study the incidence, associated clinical features, and impact on outcome of hydrocephalus at presentation in TBM. DESIGN: Observational study. SETTING: Regional hospital serving 500,000 people. METHODS: Adult patients with TBM were studied over 57 months. Those with hydrocephalus on initial CT scan were assessed by neurosurgeons. Clinical, neuroradiological, and biochemical features of patients with hydrocephalus upon presentation were compared to those without initial hydrocephalus. RESULTS: Of 31 TBM patients during the study period, nine (29.0%) had hydrocephalus at presentation, and eight of them (25.8% of all) underwent urgent neurosurgical intervention. Of the 22 patients without initial hydrocephalus, hydrocephalus developed after commencement of chemotherapy in one patient only. Hydrocephalus at presentation was associated with a longer duration of presenting symptoms (p = 0.01), ataxia (p = 0.001), later stages of TBM (p = 0.045), a longer delay before commencement of anti-tuberculous chemotherapy (p = 0.001), stroke (p = 0.012), and a poor outcome at 1 year (p = 0.001). DISCUSSION: Hydrocephalus upon presentation is common in our TBM patients. This may be a poor prognostic marker associated with severe TBM and a higher risk of stroke.

Adult↗
PubMed2003

A prevalence study of epilepsy in Hong Kong.

OBJECTIVES: To examine epidemiological data on epilepsy for the Hong Kong west region. DESIGN. Descriptive study. SETTING: Epilepsy clinic, university teaching hospital, Hong Kong. PATIENTS AND METHODS: The epilepsy clinic of Queen Mary Hospital manages the majority of adult patients (aged 15 years or older) with chronic seizure disorders resident in the Hong Kong west area with an adult population of 475,900. All patients underwent electroencephalography examination and each subject was independently assessed by two epileptologists for diagnosis and classified according to the International League Against Epilepsy recommendations. RESULTS: Seven hundred and thirty-six patients (female, 42.9%; male, 57.1%; mean age, 40.8 years; standard deviation, 13.6 years) with epilepsy were enrolled in the study. The prevalence rate of active epilepsy in the population 15 years or older was estimated at 1.54 per 1000 on 1 January 2002. Two hundred and eighty-five (38.7%) patients had idiopathic epilepsy syndromes, 100 (13.6%) had cryptogenic epilepsy, and 285 (38.7%) had a remote symptomatic aetiology. Seizure type was partial in 408 (55.4%) patients and generalised in 285 (38.7%). Thirty-one (4.2%) patients had a positive family history. Idiopathic generalised epilepsy syndromes described as common in the literature, such as juvenile myoclonic epilepsy and childhood absence epilepsy, were infrequently seen at 0.68% and 0.95% of cases, respectively. CONCLUSIONS: This study provides baseline data for epilepsy service development and research in Hong Kong. The prevalence rate of active epilepsy in this Chinese, adult population was low compared with that reported in other developed countries. Further population-based epidemiological research is indicated to confirm the prevalence of seizure disorders in this locality.

Adolescent↗
PubMed2002

Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review.

BACKGROUND: The aim of this study was to determine whether surgical intervention is effective for women with tubal disease who are due to undergo treatment with IVF. METHODS: A systematic review employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken. Three randomized controlled trials were included, the population of women in all three studies having hydrosalpinges. RESULTS: The odds of pregnancy [odds ratio (OR) = 1.75, 95% confidence interval (CI) 1.07-2.86] and of ongoing pregnancy and live birth (OR = 2.13, 95% CI 1.24-3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There were no significant differences in the odds of embryo implantation (OR = 1.34, 95% CI 0.87-2.05), ectopic pregnancy (OR = 0.42, 95% CI 0.08-2.14), miscarriage (OR = 0.49, 95% CI 0.16-1.52) or treatment complications (OR = 5.80, 95% CI 0.35-96.79). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer. CONCLUSION: Laparoscopic salpingectomy should be considered for all women with hydrosalpinges due to undergo IVF; further research is required to assess other pre-IVF surgical interventions (such as needle aspiration of hydrosalpinx fluid, laparoscopic proximal tubal occlusion and laparoscopic salpingostomy) for women with hydrosalpinges.

Controlled Clinical Trials as Topic↗
PubMed2001

Surgical treatment for tubal disease in women due to undergo in vitro fertilisation.

BACKGROUND: Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in-vitro fertilisation (IVF). It has been less clear whether surgical intervention for tubal disease prior to IVF is effective in improving the likelihood of successful outcome. Most data are retrospective or poorly controlled. To date no single prospective randomised trial has shown a significant benefit from such surgical treatment prior to IVF. OBJECTIVES: To assess the value of surgical treatment for tubal disease prior to IVF. SEARCH STRATEGY: The search strategy of the Menstrual Disorders and Subfertility Group was used for the identification of relevant randomised controlled trials. SELECTION CRITERIA: All trials where a surgical treatment for tubal disease was compared with a control group generated by randomisation were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Three randomised controlled trials were identified and included in this review, after an attempt to obtain further information from the authors of all three trials. All trials were assessed for quality criteria. The studied outcomes were live birth (and ongoing pregnancy), pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy, complications, implantation rate and the proportion of IVF cycles resulting in embryo transfer. MAIN RESULTS: The odds of pregnancy (OR 1.75, 95%CI 1.07, 2.86) and of ongoing pregnancy and live birth (OR 2.13, 95%CI 1.24, 3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There was no significant difference in the odds of ectopic pregnancy (OR 0.42, 95%CI 0.08, 2.14), miscarriage (OR 0.49, 95%CI 0.16, 1.52), treatment complications (OR 5.80, 95%CI 0.35, 96.79) or implantation rate (OR 1.34, 95%CI 0.87, 2.05). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer. REVIEWER'S CONCLUSIONS: Laparoscopic salpingectomy should be considered for all women with hydrosalpinges prior to IVF treatment. Currently unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges) should be recommended, although this requires further evaluation. Further randomised trials are required to assess other surgical treatments for hydrosalpinx, such as salpingostomy, tubal occlusion or needle drainage of a hydrosalpinx at oocyte retrieval. The role of surgery for tubal disease in the absence of a hydrosalpinx is unclear and merits further evaluation.

Fallopian Tube Diseases↗
PubMed2001

Circadian variation of stroke onset in Hong Kong Chinese: a hospital-based study.

Circadian variation of onset of transient ischaemic attack (TIA) or stroke during four 6-hourly periods starting from midnight was studied in Hong Kong Chinese patients admitted to a regional hospital between October 1996 and July 1999. The onset was classifiable into one of the 6-hourly periods in 832 of 905 patients; patients with unclassifiable onset were more likely to have lacunar infarct and less likely to have intracerebral haemorrhage (ICH). There was a significant circadian variation of onset in all strokes and TIA, TIA alone, ischaemic stroke (IS), ICH and different IS subtypes. The risk of onset was greatest between 6 a.m. and noon for IS or TIA, but between noon and 6 p.m. for ICH. There was no difference in the circadian variation between patients with and without prior TIA or stroke. This hospital-based study revealed a significant circadian variation of onset in different types and subtypes of stroke.

Adult↗
PubMed2001

The impact of molecular biology on clinical neurology.

Advances in molecular biology have increased our understanding of both inherited and sporadic forms of neurological disease. In this review, the impact of these advances is discussed in relation to specific neurological conditions. These include the hereditary neuropathies and ataxias, Huntington's disease, and the muscular dystrophies, as well as Alzheimer's disease, Parkinson's disease, and motor neuron disease. Genetic channelopathies, such as familial hemiplegic migraine, are also described. Although knowledge in this area overall is still relatively scant, current advances in molecular biology have helped in the reclassification of some neurological disorders, thereby providing a further step towards the development of rational therapies to treat these conditions.

Alzheimer Disease↗
PubMed2000

The Holmes-Adie plus syndrome.

A clinical syndrome of tonic pupil associated with tendon areflexia was first described by Holmes and Adie; autonomic neuropathy and peripheral neuropathy can be associated. The postulated mechanism of areflexia in Holmes-Adie syndrome is a synaptic disorder of the spinal reflex pathways. We report a case of a Holmes-Adie syndrome variant with hitherto unreported cranial neuropathy. A 41 year old woman developed insidious onset of sensory symptoms related to her left trigeminal and chorda tympani nerves over a few months. Physical examination showed generalised tendon areflexia and a left sided Adie's pupil. Imaging did not reveal any structural abnormality. Electrophysiological studies demonstrated an absent blink reflex on stimulating the left supraorbital and infraorbital nerves. These findings were suggestive of a dysfunction affecting the brain stem reflex arc. The pathophysiological process of Holmes-Adie syndrome may be more widespread than previously thought.

Adie Syndrome↗
PubMed1999

Metastatic adenocarcinoma masquerading as basal pontine tuberculoma.

Tuberculous infection of the central nervous system is common in Hong Kong. A 39-year-old woman presented with isolated right sixth nerve palsy which was non-progressive for 10 months. Neuro-imaging revealed a right pontine lesion. Cerebrospinal fluid (CSF) examination showed lymphocytic meningitis with negative bacteriological and cytological studies. Empirical antituberculous drugs with initial corticosteroid resulted in improved CSF parameters. A diagnosis of cerebral tuberculoma complicated by meningitis was made. She subsequently deteriorated clinically and radiologically. Despite a number of clinical features which were atypical of leptomeningeal metastasis, adenosquamous carcinoma was found on biopsy. Her relatively indolent clinical course might be due to the initial corticosteroid treatment. This report illustrates the importance of early tissue diagnosis in uncertain cases of chronic lymphocytic meningitis.

Abducens Nerve Diseases↗
PubMed1999

Cost of epilepsy in Hong Kong: experience from a regional hospital.

To study the economic implications of epilepsy in Hong Kong, a cost-of-illness study was performed on a retrospective cohort of medically treated patients from a regional hospital. A societal perspective was examined. Utilization data from 1992 to 1996 were reviewed to obtain the direct costs. Lost productivity was used as a proxy for estimating the indirect costs. Future cost projected over 10 years was derived by incorporating model parameters. Of 745 records reviewed, total direct costs added up to USD 0.98 million and indirect costs to USD 1.32 million. Regarding the overall direct costs, hospitalization was the most consumptive item among patients with a shorter history of epilepsy and those with suboptimal seizure control. The mean total cost per patient increased steadily from 1992 to 1996 except for those with long-standing remission, and was highest in patients with medically refractory epilepsy in terms of both the actual value and rate of increment. Parameters with the most leverage on future cost would be unemployment rate and annual discount rate. The overall economy of the society would exert a major effect on the future cost of epilepsy, in particular, for patients with poorly controlled disease.

Ambulatory Care↗