Ictal (99m)Tc ECD SPECT in paroxysmal kinesigenic choreoathetosis

Paroxysmal kinesigenic choreoathetosis is a rare neurologic disorder characterized by sudden attacks of brief involuntary dyskinetic movement that are precipitated by voluntary movement. A 14-year-old male who presented with frequent brief attacks of hemidystonia triggered by sudden movement is reported. Investigations, including video electroencephalogram and magnetic resonance imaging of brain, were normal. There was excellent and sustained response to carbamazepine. Ictal single-photon emission computed tomography using (99m)Tc ethyl cysteinate dimer revealed increased perfusion of the contralateral basal ganglia, which is associated with onset of choreoathetosis attacks. Our findings provide evidence that hyperactivity of the basal ganglia is associated with the dyskinetic attacks in paroxysmal kinesigenic choreoathetosis.     

Use of diagnostic laparoscopy and laparoscopic ultrasound in the management of upper gastrointestinal malignancy

Background: Despite various preoperative imaging methods, unnecessary laparotomy is still quite common in upper gastrointestinal surgery. There have been some studies demonstrating the use of diagnostic laparoscopy and laparoscopic ultrasound in the detection of small peritoneal seedling and vascular encasement of major vessels respectively, and these are the findings often inadequately assessed by preoperative imaging. Objective: This is a study to evaluate the use of diagnostic laparoscopy and selective laparoscopic ultrasound in the management of upper gastrointestinal malignancy. Method: A prospective study was carried out during the period from January 1996 to December 1997. Patients with upper gastrointestinal malignancy underwent diagnostic laparoscopy and selective laparoscopic ultrasound before resection. The role of laparoscopic staging was evaluated according to the number of patients who avoided unnecessary laparotomy. Results: There were 159 patients of mean age 62.8 years diagnosed with upper gastrointestinal tumours during the study period. These patients had various upper gastrointestinal malignancies: gastric carcinoma (89), oesophageal carcinoma (27), hepatobiliary malignancy (26), peri‐ampullary carcinoma (15) and small bowel tumour (2). Routine diagnostic laparoscopy and selective laparoscopic ultrasound were carried out for these patients unless there were contraindications such as a history of previous upper gastrointestinal surgery or the patient required palliative procedure irrespective of resectability. There were 106 diagnostic laparoscopies and 42 laparoscopic ultrasounds performed. Unnecessary operations were avoided in 32 patients (30%) due to either diffuse carcinomatosis or locally advanced tumour with encasement of major vessels. The role of laparoscopic staging in avoiding unnecessary surgery was particularly pronounced in peri‐ampullary carcinoma (46%) and hepatobiliary malignancy (38%). Conclusion: In summary, diagnostic laparoscopy and selective laparoscopic ultrasound are useful in avoiding unnecessary laparotomy particularly in hepatobiliary and peri‐ampullary malignancy.      

Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability

Misoprostol and mifepristone have been shown to be effective for medical abortion up to 9 weeks of gestation. When used alone, the successful complete abortion rate dropped to approximately 60%. It has been demonstrated that by adding water to misoprostol, the success rate rose to 92%. This is the first randomized study to investigate the efficacy of misoprostol and water versus misoprostol alone for first trimester medical abortion in women at 相似文献   

Dilated Cardiomyopathy with Short QT Interval: Is It a New Clinical Entity?

Short QT syndrome is a rare autosomal dominant channelopathy of structurally normal hearts characterized by atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. We report a case having short QT, dilated ventricles, and severe ventricular dysfunction, an unreported association so far.     

Rare presentation of renal cell carcinoma: Solitary sternal metastasis

Renal cell carcinoma (RCC) may present as metastatic disease. However, RCC with solitary sternal metastasis is rare. We report a rare case of RCC with synchronous solitary sternal metastasis. The patient underwent radical nephrectomy, sternal tumour resection and reconstruction as a one‐stage procedure. The role of open sternal biopsy is also described. Review of the literature was carried out and a reasonably lengthy survival was observed. We concluded that radical surgical resection and reconstruction may offer the best chance of survival in managing RCC with solitary sternal metastasis in renal cell carcinoma.     

Combined endo‐laparoscopic approach in managing patients with gallstones and common bile duct stones: An early experience

Gallstones with common bile duct stones is a common condition in Hong Kong. Management still remains a challenge nowadays. Laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) is a single‐stage approach which improves patient comfort and is associated with less post‐ERCP pancreatitis. With the new endo‐laparoscopic operating theatre in service, the combined endo‐laparoscopic approach becomes simple and practical. We report here our two early experiences using this approach.     

Celecoxib premedication in post-operative analgesia for laparoscopic cholecystectomy

The analgesic effect of celecoxib on postoperative laparoscopic cholecystectomy pain was studied in a prospective, randomized, placebo-controlled, double-blind study. Sixty ASA 1 and 2 patients were randomized to receive celecoxib 200 mg or placebo orally before the operation under a standardised general anaesthetic for the elective surgery. All patients had intravenous morphine via a patient-controlled analgesia device (PCA). Postoperative abdominal and trochar site pain, shoulder pain and morphine consumption were assessed hourly until the 6th hour, and then at the 12th and 24th hour. There was no statistical significance in the pain scores and morphine consumption for the two treatment groups. We conclude that the opioid-sparing effect of celecoxib in acute pain management for laparoscopic cholecystectomy is clinically not useful and a combination of analgesia techniques may be more effective in treatment of multi-factorial post laparoscopic cholecystectomy pain.     

Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia

Impairments of cervico-cephalic kinaesthesia and habitual forward head posture have been considered important in the aetiology of postural neck pain, yet these factors have not been specifically examined in a homogeneous clinical population. The objective of this study was to compare the habitual sitting posture (HSP), perception of good posture and postural repositioning error (PRE) of the cervico-thoracic (CT) spine in individuals with postural neck pain, with a matched group of asymptomatic subjects. Twenty-one subjects with postural neck pain and 22 asymptomatic control subjects were recruited into the study. An optical motion analysis system was used to measure the HSP and perceived ‘good’ sitting posture. PRE was measured over six trials where the subject attempted to replicate their self-selected ‘good’ posture. There was no difference between the groups in the HSP but significant differences were identified in the perception of ‘good’ posture. Posture repositioning error was higher for the head posture variables than for CT and shoulder girdle variables in both groups. However, there was no significant difference in posture repositioning error between groups for any of the posture measures. The findings suggest that individuals with postural neck pain may have a different perception of ‘good’ posture, but no significant difference in HSP or kinaesthetic sensibility compared with matched asymptomatic subjects.     

KOCH'S OR CROHN'S?

Abdominal tuberculosis is not uncommon in the UK, especially in Asian immigrants. It resembles Crohn's disease clinically and radiologically, and it may be difficult to differentiate between them, even at laparotomy or histology. The distinction is important, however, for proper management of the two conditions. Every effort must be made to exclude abdominal tuberculosis before the patient is diagnosed as having Crohn's disease and is treated with steroids.