Liver transplantation for chronic hepatitis B with lamivudine-resistant YMDD mutant using add-on adefovir dipivoxil plus lamivudine.

Lamivudine treatment in patients with chronic hepatitis B virus (HBV) infection may improve clinical state and suppress viral replication before liver transplantation. Emergence of lamivudine-resistant YMDD mutant is common. We report the results of liver transplantation in 16 patients with pretransplantation YMDD mutants after receiving lamivudine treatment for a median of 738 days (range, 400-1799 days). Adefovir dipivoxil (10 mg daily) was added on to lamivudine for a median of 20 days (range, 8-271 days) before (n = 11) or at (n = 5) liver transplantation, and the combination was continued indefinitely thereafter. Eight patients received additional intravenous hepatitis B immune globulin (HBIG) for a median of 24 months. Fifteen patients with known pre-adefovir HBV DNA levels had a median titer of 14,200 x 10(3) copies/mL (2 x 10(3) to 4,690,000 x 10(3) copies/mL), and 14 had HBV DNA >10(5) copies/mL. All but 1 patient remained positive for HBV DNA (by quantitative polymerase chain reaction [qPCR]) at the time of liver transplantation, and the titer was greater than10(5) copies/mL in 8 patients. The median follow-up after liver transplantation was 21.1 (range, 4.4-68.9) months. One patient (6%) died of an unrelated cause 12.2 months after transplantation, and 15 patients (94%) were alive with the original graft. All patients cleared HBV DNA and had no detectable HBV DNA by qPCR at the latest follow-up. Fourteen patients had cleared hepatitis B surface antigen (HBsAg), but 2 patients who received only adefovir dipivoxil and lamivudine without HBIG remained HBsAg positive after 7.7 and 9.5 months. Serum HBV DNA, however, was negative, and there was no biochemical or histological evidence of recurrence. Adefovir dipivoxil was well tolerated with no significant renal toxicity. In conclusion, a combination of add-on adefovir dipivoxil plus lamivudine therapy provides effective prophylaxis in patients with pretransplantation YMDD mutant that may be actively replicating. The cost effectiveness of additional passive immunoprophylaxis remains to be defined.     

Hong Kong nurses' health-related behaviours: implications for nurses' role in health promotion

The health-related behaviours of a random sample (n=92) of Hong Kong nurses were assessed by a questionnaire written either in English or in English and Chinese. Hong Kong nurse reported negligible smoking or a alcohol use, low levels of breast self-examination, cervical screening behaviour and regular exercising, seat belt use and driving within the speed limit. The sample reported high levels of making efforts to avoid foods high in cholesterol, eating foods high in fibre and eating fruit daily. Dental hygiene was reported to be high. Just over half the sample reported sleeping 7–8 hours each night and eating breakfast daily. Most nurse reported maintaining their body weight at a healthy level and eating snacks between meals. The English language version of the questionnaire produced a slightly better response rate than the bilingual questionnaires. The results are discussed with reference to previous studies of females' health-related behaviours in Hong Kong and elsewhere. The implications for Hong Kong nurses' role in health promotion is discussed.     

Medialization thyroplasty for cancer-related unilateral vocal fold paralysis.

OBJECTIVE: To justify the application of medialization thyroplasty in Chinese patients with symptomatic cancer-related unilateral vocal fold paralysis (UVFP). STUDY DESIGN AND SETTING: Retrospective chart review from February 2000 to March 2006. RESULTS: Eighty-seven Chinese patients undergoing medialization thyroplasty for UVFP were included; there were no significant differences between the cancer-related and benign groups in terms of the speech and swallowing rehabilitation outcome and the perioperative complication rate (P > 0.05). The median survival time of cancer-related UVFP patients from the date of medialization to death was 129 days. Age more than 65 years was identified as the only factor for a shorter survival period after medialization (P = 0.040). CONCLUSION: Medialization thyroplasty restores satisfactory speech and swallowing and has a low perioperative complication rate in Chinese patients with cancer-related UVFP. Postmedialization survival period was also reasonable. SIGNIFICANCE: Medialization thyroplasty is a justifiable treatment option for cancer-related UVFP.     

Respiratory symptoms and lung function effects of domestic exposure to tobacco smoke and cooking by gas in non-smoking women in Singapore.

STUDY OBJECTIVES--To investigate the effects of passive exposure to tobacco smoke and gas cooking at home on respiratory symptoms and lung function of non-smoking women. SETTING--Evidence on the effects of passive smoking and exposure to nitrogen dioxide from gas cooking on the respiratory health of adults is limited and variable. Over 97% of women in Singapore do not smoke, and a principal source of indoor air pollution for housewives is passive smoking and gas cooking. DESIGN--This was a cross sectional (prevalence) study of a population based sample of 2868 adults aged 20 to 74 years in Singapore. A structured questionnaire administered by trained interviewers was used to collect data on passive smoking, gas cooking, respiratory symptoms, and other relevant variables. Passive smoking was defined as exposure to cigarette smoke from one or more members of the household who had ever smoked. Gas cooking was defined in terms of the weekly frequency of gas cooking, as well as the frequency with which the respondent's kitchen was filled with heavy cooking fumes (rarely, occasionally, often). Forced expiratory volume in one second (FEV1) was measured by using a portable Micro-spirometer. Multivariate analyses were used to estimate relative odds of association for respiratory symptoms and FEV1 effect, with adjustment for potential confounding variables. PARTICIPANTS--Of a total of 1438 women in the sample, 1282 women who had never smoked provided questionnaire data and 1008 women provided acceptable readings of FEV1 for analysis. MAIN RESULTS--Passive smoking was significantly associated with greater relative odds of usual or chronic cough and phlegm, wheezing, and breathlessness on exertion, as well as lower FEV1. Greater relative odds of respiratory symptoms were also associated with the weekly frequency of gas cooking, although these results were statistically insignificant. Chronic cough and phlegm and breathlessness on exertion, however, were significantly associated with the frequency with which the kitchen was filled with heavy cooking fumes. A lower FEV1 was found in women who cooked frequently (more than thrice a week). CONCLUSION--Domestic exposure to cigarette smoke and gas cooking is associated with increased risks of respiratory symptoms and impairment of lung function in non-smoking women in Singapore.     

Mediastinal teratoma in a neonate

A neonate with severe respiratory distress due to a benign mediastinal teratoma (MT) is reported. Despite early and easy surgical excision of the tumor, the child died due to poor cardiac function. Only ten cases of MT in neonates have been reported in the literature so far. While the tumor has been known to interfere with lung development in utero, postnatal myocardial dysfunction due to poor heart development has not been previously documented. Accepted: 22 September 1997     

The effect of high sodium intake on bone mineral content in rats fed a normal calcium or a low calcium diet

The effect of high sodium intake on bone mineral content of rats fed a normal (0.6% Ca) or a low (0.02% Ca) calcium diet was studied. Rats on a normal calcium diet given 1.8% sodium chloride to drink showed persistent and significant hypercalciuria and subnormal bone mineral content. Total calcium content of femur was significantly lower after 4 months (p<0.02) and 12 months (p<0.001). In rats maintained on a low calcium diet (0.02% Ca), a high sodium diet for 8 weeks caused a significant loss of calcium in bone similar to that seen in animals fed a normal calcium diet for 4 months. We conclude that high sodium intake reduces bone mineral content, especially if the diet is low in calcium.     

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large chalky and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.