Radiofrequency ablation (RFA) is a treatment option in the management of unresectable or recurrent hepatocellular carcinoma (HCC). It can be performed either through laparotomy or in a minimally invasive manner by percutaneous, laparoscopic of thoracoscopic routes. Percutaneous RFA is associated with reduced surgical trauma and thus can be performed in patients with significant comorbidities. The procedure can be repeated after short intervals for sequential ablation of multiple liver lesions. However, the associated risks should not be underestimated. This is the first report of a rare complication of duodenopleural fistula after percutaneous RFA of a recurrent subcapsular HCC. The risk of bowel perforation during the ablation of subcapsular HCC requires special attention, since only the position of the tip of the electrode, but not the zone of ablation, can be assessed accurately by imaging during the procedure. Our case demonstrated that there was leakage of bowel content from the duodenal injury site into the pleural cavity through the RFA track. Subsequent uncontrolled infection resulted in empyema thoracis and led to the death of the patient.

Fion S. Chan;Kelvin K. Ng;Ronnie T. Poon;Jimmy Yuen;Wai Kuen Tso;上达 范

Asian Journal of Surgery

2007-10

Ronnie Tung Ping Poon;上达 范

Nutrition

2000-1

The accuracy of differential quantitative blood culture in the diagnosis of central venous catheter sepsis was evaluated in 24 parenterally-fed patients in whom catheter sepsis was suspected. The pour-plate quantitative culture technique was performed immediately before removal of the catheter on blood drawn through the central venous catheter and a peripheral vein. If bacterial colonies in the catheter blood specimen were sevenfold more frequent than identical bacterial colonies in the peripheral blood specimen, the test was considered positive and indicative of catheter sepsis. Catheter-tip culture identified 9 of the 24 patients as positive for catheter sepsis. A positive differential quantitative blood culture result was found for seven of the nine infected catheters. Sensitivity of this test was 77.8%, specificity was 100%, and overall accuracy was 91.7%. It is concluded that differential quantitative blood culture is a reliable method for the exclusion of catheter sepsis.

上达 范;C. H. Teoh-Chan;K. F. Lau

European Journal of Clinical Microbiology and Infectious Diseases

1989-2

Background: Mycobacterium tuberculosis (TB) infection is a serious opportunistic infection especially in live donor liver transplantation (LDLT). Hepatotoxicity of antituberculous agents and hazardous drug interaction with immunosuppressants may render the graft more susceptible to injury. Aim of study: To review our experience of management of TB infection in liver transplant recipients including LDLT. Patients and methods: A total of 397 liver transplantations were performed in the University of Hong Kong Medical Centre from January 1991 to December 2004. Eight patients (2.0%) developed TB infection after transplantation (LDLT: n = 6, DDLT: n = 2) and their clinical courses were reviewed. Result: The mean time of developing TB infection after liver transplantation was 9 months (range 4-20 months). Anti-TB treatment was administered for a mean duration of 12.7 months (11-18 months). None of our patients developed antituberculous drug-induced hepatotoxicity or had unwanted drug interaction. With a mean follow-up of 65 months (range 18-102 months), one patient died due to the recurrence of hepatocellular carcinoma. Conclusion: High index of suspicion for TB infection should be warranted for a history of cough and fever after liver transplantation. No notable difference was observed in the natural history and management of TB infection between LDLT and DDLT. The use of antituberculous drugs is safe in liver transplant recipients provided that liver function is closely monitored and the dosage of immunosuppressants is adjusted accordingly.

Albert C.Y. Chan;Chung Mau Lo;Kelvin Kwok Chai Ng;See Ching Chan;上达 范

Liver International

2007-2

OBJECTIVE: To evaluate the perioperative outcomes of pancreaticoduodenectomy in a tertiary referral centre in Hong Kong. DESIGN: Retrospective case series. SETTING: University teaching hospital, Hong Kong. PATIENTS: One hundred and forty patients who underwent pancreaticoduodenectomy from July 1989 through June 2001. MAIN OUTCOME MEASURES: Mortality and morbidity. RESULTS: Overall hospital mortality among 140 patients was 2.9% (n=4), and 30-day operative mortality was 2.1% (n=3). There was no significant difference in the hospital mortality rate between 43 elderly patients aged 70 years or older and 97 younger patients (2.3% versus 3.1%). The overall morbidity rate was 38.6% (n=54). Intra-abdominal abscess (13.6%) and pancreaticojejunal anastomotic leakage (12.9%) were the two most common complications. Presence of co-morbid illness (risk ratio, 2.823; 95% confidence interval, 1.541-4.385; P=0.01), preoperative cholangitis (risk ratio, 2.565; 95% confidence interval, 1.166-5.643; P=0.02), and intra-operative blood loss >/=1.5 L (risk ratio, 2.236; 95% confidence interval, 1.132-6.213; P=0.03) were independent risk factors for postoperative morbidity. CONCLUSIONS: Pancreaticoduodenectomy is associated with a low risk of operative death when performed in a tertiary referral setting in Hong Kong. The postoperative morbidity rate remains high, however. Further improvement by reducing intra-operative blood loss may help curtail the high postoperative morbidity.

R. T. Poon;上达 范;K. M. Chu;J. T. Poon;J. Wong

Hong Kong Medical Journal

2002-8

Familial amyloidotic polyneuropathy type 1 (FAP1, MIM176300) is an autosomal dominant disease caused by mutations in the transthyretin (TTR) gene. An extended Chinese kindred of FAP1 was first reported in Hong Kong in 1989, three of the four histologically proven subjects have deceased. TTR gene mutations were not studied then. A DNA-based diagnosis was performed on FAP1 by restriction analysis and direct DNA sequencing was carried out on a symptomatic member of this family who had undergone a liver transplantation. It showed a substitution of thymine by cytosine in the second base of codon 30 in exon 2 of the TTR gene, with the creation of a novel HhaI restriction endonuclease site. Valine is substituted by alanine (V30A) in the mutant TTR. Both restriction analysis and direct sequencing revealed the same mutation in one of the two asymptomatic siblings. This mutation was first reported in a FAP1 family of German descent.

C. M. Mak;C. W. Lam;上达 范;C. L. Liu;Sidney C. Tam

Acta Neurologica Scandinavica

2003-6-1

Objective: The systemic treatment of advanced hepatocellular carcinoma (HCC) has produced disappointing results thus far. HCC is a hypervascular tumor with over-expression of angiogenic factors such as vascular endothelial growth factor. Thalidomide is an anti-neoplastic agent with anti-angiogenic and other mechanisms of action. We aim to evaluate the efficacy and toxicity of low-dose (100 mg) thalidomide as the first-line treatment of advanced HCC. Methods: Between August 2003 and March 2007, 45 patients who had received thalidomide 100 mg daily as first-line treatment of advanced HCC were reviewed retrospectively. Advanced HCC was defined as either metastatic or not amenable to surgical or locoregional therapies. Diagnosis of HCC was based on clinical, biochemical and radiological grounds. Survival was analyzed by the Kaplan-Meier method. Results: Thirty-eight patients were evaluable for response and toxicity. Two (5%) patients had partial response and 8 (21%) had stable disease. The overall median survival of patients in this cohort was 3.2 months (95% CI: 2.8-3.7 months). The common toxicities were somnolence (13%), peripheral neuropathy (11%) and ankle edema (8%), with no grade 3 or 4 toxicities and treatment-related deaths. Conclusion: Our study shows that a single agent, low-dose thalidomide has a modest clinical activity with good tolerability in treating advanced HCC patients.

Thomas Yau;Pierre Chan;Hilda Wong;Kelvin K. Ng;Siu Ho Chok;Tan To Cheung;Vincent Lam;Richard J. Epstein;上达 范;Ronnie T.P. Poon

Oncology

2007-12

Abstract Lymphangiomas of the pancreas are rare. Only six cases have been reported. An additional case of lymphangioma of the pancreas in a 20 year old male which was demonstrated by computerized tomography and treated with complete surgical excision is reported.

IRENE O.L. NG;上达 范;J. NICHOLLS

Journal of Gastroenterology and Hepatology (Australia)

1989-6

O. Sezer;C. Jakob;K. Niemöller;R. T.P. Poon;上达 范;J. Wong

Journal of Clinical Oncology

2001-7-1

There were 12 hospital deaths in 433 patients (2.8%, 1.6% at 30 days) presenting with bleeding duodenal ulcer. Excluding patients who underwent immediate operation or early elective surgery, where ulcer size was measured at initial endoscopy rebleeding was evident in 40/228 patients (13.9%) and was associated with an increased mortality (0.4% v 12.5%) (p<0.0001). Rebleeding rates for ulcers ≤ 1 cm were respectively 28/239 (11.7%) and 12/49 (24.5%) (p<0.02). Rebleeding occurred in 13/186 patients (7.0%) in whom endoscopic stigmata of recent haemorrhage were absent and in 27/102 (26.5%) with such stigmata was 3/186 patients (7.0%) in whom indoscopic stigmata of recent haemorrhage were absent and in 27/102 (26.5%) with stigmata (p<0.0001). The mortality rate for patients without stigmata was 3/186 (1.6%) whilst mortality figures for patients with ulcers ≤ 1 cm and > 1 cm in size were respectively 0/77 and 3/25 (12.0%) when stigmata were identified. Ulcers > 1 cm were more frequent in the > 60 year age group, more likely to have stigmata and carried an increased risk of rebleeding and mortality

F. J. Branicki;J. Boey;P. J. Fok;C. J. Pritchett;上达 范;E. C.S. Sai;F. P.T. Mok;W. S. Wong;S. K. Lam;W. M. Hui;M. M.T. Ng;A. S.F. Lok;D. K.H. Lam;M. C.K. Tse;A. P.K. Tang;J. Wong

Annals of Surgery

1990