Chi-Wing Chan

Comparison of the effectiveness of placebo, clomiphene citrate, mesterolone, pentoxifylline, and testosterone rebound therapy for the treatment of idiopathic oligospermia

Forty-six subfertile men with idiopathic oligospermia were randomly assigned to 6 months of treatment with a placebo, clomiphene citrate (25 or 50 mg/day), mesterolone (100 mg/day), or pentoxifylline (1200 mg/day) or 4 months of testosterone enanthate treatment (100 or 250 mg on alternate weeks). Treatment with the placebo, mesterolone, pentoxifylline, and testosterone rebound therapy did not result in a significant increase in the mean sperm concentration or pregnancy in the partners. Clomiphene citrate at both dosages significantly increased the mean sperm concentration without improving sperm motility or morphology during the 6-month treatment period. Pregnancy rates of 36.4% and 22.2% were observed in partners of men receiving clomiphene citrate 25 mg/day and 50 mg/day, respectively. This study also illustrates the difficulties in identifying suitable patients for and assessing the efficacy of different treatment regimens.

Nasopharyngeal carcinoma. Pattern of tumor regression after radiotherapy

The primary tumor regression pattern of 50 patients with nasopharyngeal carcinoma was reported. The tumor regression was monitored either by indirect nasopharyngeal mirror examination and biopsy or fiberoptic endoscope and biopsy. Fiberoptic endoscope and biopsy was found to be more accurate in noting residual tumor. It is recommended that booster radiation dose to the residual primary tumors be withheld unless positive biopsy samples persist at 10 or more weeks after radiotherapy.

Multimodal Periarticular Injection Vs Continuous Femoral Nerve Block After Total Knee Arthroplasty: A Prospective, Crossover, Randomized Clinical Trial

This study compares the efficacy of pain control using continuous femoral nerve block (FNB) and multimodal periarticular soft tissue injection. This is a randomized, crossover, clinical trial. Sixteen patients having bilateral osteoarthritis of the knee scheduled for staged total knee arthroplasty were randomized to receive either FNB (0.2% ropivacaine), via indwelling catheter for 72 hours, or multimodal periarticular soft tissue injection in the first stage. In the second stage, they received the opposite treatment. The primary outcome measure was morphine consumption by patient-controlled analgesia in the first 72 hours postoperatively. Cumulative morphine consumption as well as rest pain and motion pain in the first 72 hours was comparable between the 2 groups. The functional outcomes did not differ significantly. We conclude that multimodal periarticular soft tissue injection provides comparable analgesia to continuous FNB after total knee arthroplasty.

Fiberoptic endoscopic examination and biopsy in determining the extent of nasopharyngeal carcinoma.

This is a prospective study on the use of flexible endoscope and multiple biopsies in the assessment of nasopharyngeal carcinoma in 72 patients. This study confirmed the presence of submucosal growth pattern in nasopharyngeal carcinoma and this occurred in 13.8% of patients. Occult microscopic extension of tumor not detectable by fiberoptic endoscopy occurred in another 51.4% of patients. It has also been shown that multiple biopsy is superior to clinical examination in evaluating the extent of disease in nasopharyngeal carcinoma. Multiple biopsies are suggested for the early detection of nasopharyngeal carcinoma in high‐risk cases. Although the better‐defined tumor extent do not currently influence the treatment policy of nasopharyngeal carcinoma, and it is too early to assess its prognostic significance, it betters our understanding of the behavior of this tumor. Future analysis in correlation with long‐term follow‐up data may help to improve the stage classification systems and treatment strategy.

Extent of nasopharyngeal carcinoma involvement inside the nasopharynx. Lack of prognostic value on local control.

A study on the use of fiberscopic examination and multiple biopsy specimens taken from the nasopharynx in the assessment of the extent of nasopharyngeal carcinoma (NPC) involvement inside the nasopharynx found that the involvement often was more extensive than that detected with conventional methods. In the current study, 247 patients with NPC were studied with the use of fiberscopic examination, and multiple biopsy specimens were taken from the superior wall, posterior wall, and lateral wall of the nasopharynx on both sides. It was confirmed that the tumor often involved the nasopharynx extensively. Also, the extent of primary tumor involvement inside the nasopharynx was correlated with the American Joint Committee (AJC) T stage and the degree of paranasopharyngeal extension of the tumor (P = 0.0100 and 0.0009, respectively), as well as with the size of the largest node and the lowest neck level involved by the node in the ipsilateral neck (P = 0.0005 and 0.005, respectively). However, the extent of primary tumor involvement inside the nasopharynx, expressed as either the number of the six standard sites or the number of the AJC subsites that were involved, had no predictive value on the control of the primary tumor (P = 0.3773 and 0.7794, respectively) at a median follow‐up time of 27 months. Except when salvage brachytherapy is contemplated for persistent or recurrent NPC, the extent of primary tumor involvement inside the nasopharynx should not be routinely studied. Cancer 1992; 69:854–859.

Malignant fibrous histiocytoma of the mediastinum

A patient with malignant fibrous histiocytoma (MFH) of the mediastinum is reported. This is a very unusual site for MFH. Erosion of the thoracic aorta led to the formation of a false aneurysm, which ended fatally with rupture into the left lung. Clinical features of two other reported cases of MFH of the lung are also reviewed.

Intraosseous glomus tumor-Case report

This case of an intraosseous glomus tumor reported in a 42-year-old Chinese housewife is believed to be the tenth case in medical literature. It was discovered on review of bone biopsy material examined at the Department of Pathology, Queen Mary Hospital, Hong Kong.

Radiation therapy for nasopharyngeal carcinoma: histologic appearances and patterns of tumor regression.

Nasopharyngeal carcinoma is a common malignancy in Hong Kong and is treated by external radiotherapy. After 6.5 weeks of radiotherapy, the nasopharynx of 100 patients was examined and biopsy specimens were taken. All patients had repeated examination and biopsies done every 2 weeks until exophytic tumor was not seen and biopsy samples were negative on more than one examination of the nasopharynx. The interval between the cessation of therapy and biopsy ranged from 1 day to 11 weeks. Twenty-three patients had atypical findings and five of these had residual tumor requiring gold grain implantation brachytherapy. We identified a number of distinct pathologic changes in the post-biopsy material. Most of these changes disappeared 8 weeks after the cessation of therapy, but the presence of residual tumor after this time was an indication for subsequent therapy. If the date of the first biopsy was delayed until 6 weeks after the completion of radiotherapy, the percentage of atypical biopsies containing residual tumor rose from 21% to 55%. The posttreatment biopsy should be performed twice, as four patients had negative biopsy findings due to sampling error.

Amyloidosis at the ampulla of Vater and recurrent pyogenic cholangitis: cause or effect?

Amyloidosis is uncommon, in our experience, amongst the Chinese in Hong Kong. Amyloidosis localized to the ampulla of Vater is very rare in any population. On the other hand, recurrent pyogenic cholangitis (RPC) (Cook et al. 1954) as a primary suppurative disease of the bile ducts is commonly seen in Orientals (Maki 1961, Wen & Lee 1972, Hutt & Gibson 1973), but not reported in Occidentals. The aetiology and pathogenesis of both amyloidosis and RPC are uncertain. We report here a unique case of a Chinese patient with both conditions coexisting and discuss the implications.