BUERGER'S DISEASE IN HONG KONG: A REVIEW OF 89 CASES

Background : A retrospective analysis of 103 case records from 1978 to 1996 with a provisional diagnosis of Buerger's disease was undertaken at the Department of Surgery, University of Hong Kong, Queen Mary Hospital. The aim of the study was to elucidate the clinical course and evaluate the results of surgical intervention of Buerger's disease in Hong Kong Chinese people. Methods : Fourteen patients were subsequently excluded from the study because of inability to fulfil our diagnostic criteria. Data on clinical presentation, investigations, indications and results of surgical intervention were reviewed. Sympathectomies and arterial reconstructions were performed on 42 and four patients, respectively, for critical ischaemia or rest pain. Outcome was analysed with respect to the rate of ulcer healing, pattern of recurrence and limb loss. Results : The patients were all young male heavy smokers with a mean age of 36.5 years. The majority of patients (80%) presented with ischaemic ulceration or gangrene. Vascular reconstruction was undertaken in four patients and satisfactory long-term results were obtained in three patients. Sympathectomy was able to relieve symptoms in 87% of operated patients and ischaemic ulceration healed in 2.6 (mean) ± 1.7 (SD) months after the operation. If the patient continued to smoke, surgical intervention did not exempt the patient from a relapse or amputation. Conclusion : Sympathectomy provides short-term pain relief and promotes ulcer healing in patients with Buerger's disease but carries no long-term benefit. Complete abstinence from smoking is the only means of arresting the progression of the disease.     

Pelvic Gliomatosis within Foci of Endometriosis

The third reported case of pelvic gliomatosis found within foci of endometriosis is documented 16 years after the removal of a benign cystic teratoma. Grossly at laparoscopy the lesions appear as typical deep fibrotic endometriotic implants.     

Novel coronary interventional devices: an update.

Interventional cardiologists today are overwhelmed by a hugh array of new high technology investigatory devices at their disposal for the treatment of coronary arterial obstructive disease. These include the various atherectomy and laser devices, developed and introduced into clinical practice with the promise and intent of solving the limitations of conventional balloon angioplasty, namely those of acute closure and restenosis. But as more experience and data are obtained from the application of these devices, it is becoming clear that the latter have generally not been able to accomplish what they were intended to do. Although the immediate success rates have been uniformly high, acute closure has persisted and restenosis remains unabated. Nevertheless, some of these new devices have shown some fairly encouraging results in specific clinical circumstances. The targeted use of these instruments may prove to be a step in the right direction. This article reviews the current state of the art and the potential utility of certain of these devices.     

An Approach to Emergency Department Photography

In the emergency department, photography requires an expedient, portable, adaptable, and relatively simple camera system to take advantage of fleeting opportunities for recording visually educational material. These prerequisites are different from those for traditional medical photography, for which relatively plentiful time and advanced equipment are routinely available. Medical photography departments provide an invaluable service, but are rarely convenient for immediate or spontaneous emergency. department photographs. Although no single system or technique is optimal in all these areas, the authors find certain components and approaches work well. They review photographic equipment, paying attention to speed, ease of use, and quality of output. They also review simple techniques such as film choice, lighting, close-up photography, standardization, copy work, and radiographs. Attention to these details can help the inexperienced photographer obtain a system and begin to enjoy the rewards of effective photography in the emergency department.     

Effects of potassium channel blockers on the negative inotropic responses induced by cromakalim and pinacidil in guinea pig atrium.

The K+ channel openers cromakalim and pinacidil induced a concentration-dependent reduction in atrial contraction force with EC50 values of 25 +/- 2 and 37 +/- 2 mumol/l, respectively. This depressant effect was antagonised by 50 mumol/l tacrine which displaced the concentration-response curves of cromakalim and pinacidil to the right. The respective DR50 values were 3.8 and 2.3. Increasing the tacrine concentration (100 and 500 mumol/l) produced no additional effect on the concentration-response relationships. Addition of 1 mumol/l atropine enhanced the antagonism due to tacrine by increasing the DR50 value from 3.8 to 6.5 for cromakalim and from 2.3 to 5.2 for pinacidil. Glibenclamide, an ATP-sensitive K+ channel blocker, competitively inhibited the negative inotropic effects of cromakalim and pinacidil. The respective dissociation constants for glibenclamide against cromakalim and pinacidil were 0.57 and 0.35 mumol/l. Neither apamin nor variation in external Ca2+ concentration affected the negative inotropic effects of the K+ channel openers. It was suggested that the mechanical effects of cromakalim and pinacidil are mediated through the ATP-sensitive K+ channels in the heart.