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Biomedical subjects

H K Ma

Publications and source records attributed to H K Ma.

At least 73 records · Page 4Linked to original sources
PubMed1989

Secondary postpartum haemorrhage.

Eighty-three cases of secondary postpartum haemorrhage managed in this teaching unit over a 3-year period are described. Bleeding occurred most frequently between the 8th and 14th day of the puerperium; 73% of the patients had already been discharged from hospital and required readmission. Suction evacuation was performed in 72 patients and was successful in arresting haemorrhage whether retained placental tissue could be demonstrated on histology or not. There was histological confirmation of retained gestational products in only 30 (42%) of the patients treated surgically. No predictive factors for secondary postpartum haemorrhage could be identified in the obstetric profiles or antenatal course of most of these patients. Patients with retained gestational products could not be distinguished from those without on the basis of history or examination alone apart from 4 patients noted to have incomplete membranes at delivery.

Adult↗
PubMed1989

Place of second-look laparotomy after 18 courses of chemotherapy in epithelial ovarian cancer.

Thirty-two patients with epithelial carcinoma of the ovary underwent a second-look laparotomy after the completion of an average of 18 courses of adjuvant chemotherapy. Nine patients (28%) were found to have persistent disease. This low rate of positive second-look laparotomy is probably because these patients received chemotherapy for 18 months and in those patients whose tumour did not respond to the medication, the disease would progress and the patient died without becoming a candidate for laparotomy. There was no stage Ic patient whose second-look laparotomy was positive and the need for second-look laparotomy is questionable in such patients. Stage III/IV patients and patients with recurrence had a significantly higher positive second-look laparotomy rate than stage Ic/II patients, 44% and 7% respectively. In the present group of patients with positive tumour at second-look laparotomy, 33% responded to further debulking operation and chemotherapy and remained disease free 15-33 months after completion of their second line chemotherapy treatment. For second-look laparotomy to be of maximum benefit to the patient, we recommend that it be performed after 12 courses of chemotherapy.

Adenocarcinoma↗
PubMed1989

A randomized study of high-dose versus low-dose cis-platinum combined with cyclophosphamide in the treatment of advanced ovarian cancer. Hong Kong Ovarian Carcinoma Study Group.

A randomized clinical study of patients with advanced epithelial ovarian cancer after debulking surgery showed that high-dose (120 mg/m2) cis-platinum (DDP) in combination with cyclophosphamide (600 mg/m2) had a significantly higher response and survival rate than the low-dose DDP (60 mg/m2) and cyclophosphamide combination. The 3-year actuarial survival rate of the high-dose group was 60% and that of the low-dose group was 30%. Though moderate to severe marrow toxicity was evident in 80% of the patients in the high-dose group and 40% of the low-dose group, no serious sepsis or death developed as a result of the marrow depression. Mild neurotoxicity was observed in 55% of the patients in the high-dose group and only 20% in the low-dose group. Mild nephrotoxicity was seen in 25 and 17% of patients in the high- and low-dose groups, respectively. It was concluded that the 120 mg/m2 dose DDP and cyclophosphamide combination should be used in the treatment of carcinoma of the ovary in spite of its toxicities. However, it should only be used in institutions with supportive facilities in the management of patients with severe marrow depression.

Adolescent↗
PubMed1988

Assessment of the glucose tolerance test in unselected pregnancy using 75 g glucose load.

A 75 g oral glucose tolerance test (OGTT) was performed in 618 unselected pregnant Chinese women between 24 and 28 weeks gestation. The glucose response at fasting, 1, 2 and 3 h were studied. At 2 h the glucose level at 2-standard deviation and 4-standard deviation above the mean came very close to the criteria of abnormality suggested by the World Health Organization (WHO): 8.3 mmol/l vs. 8.0 mmol/l for impaired glucose tolerance and 10.8 mmol/l vs. 11.0 mmol/l for gestational diabetes mellitus. The area under the glucose response curve also correlates best with the glucose levels at 2 h during the OGTT (y = 2.1x + 4.6, r = 0.885). The 75-g OGTT interpreted with the WHO criteria seems appropriate for pregnant Chinese women. The 75-g test has the added advantages of reducing administration cost and discomfort of the patients.

Adult↗
PubMed1988

Obstetric complications among Chinese parturients with extreme prepregnancy ponderal indices.

9,208 patients who received antenatal care and underwent delivery at a teaching hospital in Hong Kong during 1984 and 1985 were divided into 3 groups of high, normal and low prepregnancy ponderal index. The characteristics of each group were analysed using a computer database. Statistically significant differences were found between the groups. Parturients with high ponderal indices tended to be older, of higher parity, had heavier babies and had increased incidences of gestational diabetes, prolonged gestation, induction of labour, failed induction, Caesarean section and puerperal pyrexia. Parturients with low ponderal indices had an increased incidence of intrapartum fetal distress and instrumental vaginal delivery. These results indicate that the maternal ponderal index in Chinese parturients is a useful indicator of at risk pregnancies.

Body Height↗
PubMed1988

Reproductive performance of patients with gestational trophoblastic disease in Hong Kong.

The reproductive performance of 110 patients who had had gestational trophoblastic disease was reviewed. There were 160 pregnancies and their outcomes were similar to that of the general population. The subfertility rate was also comparable to the general population. The high rate of failure of contraception resulting in a high rate of conception during the first year of follow-up warrants special attention. Reasons for the high failure rate and ways of prevention are discussed. Reasons for the deliberate delay in attempts to conceive in patients after the full year of postmolar human chorionic gonadotropin (hCG) surveillance were explored.

Adolescent↗
PubMed1988

Prenatal diagnosis of alpha- and beta-thalassemias: experience in Hong Kong.

The incidence of alpha-thalassemia trait (alpha-thal-1 and alpha-thal-2) among Southern Chinese in Hong Kong is about 3%. From June 1983 to September 1987, prenatal diagnosis for homozygous alpha-thal-1 was performed in 88 pregnancies at risk, using direct DNA analysis of amniotic fluid cells or chorionic villi. Twenty-one homozygous alpha-thal-1 fetuses were aborted and confirmed as Hb Bart's hydrops fetalis, and two were "Hb H" hydrops fetalis. Of 47 pregnancies delivered, 26 were alpha-thal-1 heterozygotes, 10 normal, eight alpha-thal-1/normal. Twenty-one pregnancies, diagnosed as alpha-thal-1/normal, await delivery. Based on a 6% incidence of beta-thalassemia minor among pregnant women in Hong Kong, the number of pregnancies at risk for beta-thalassemia major should be 288 per annum. However, since February 1984, only 25 diagnoses were performed. Comprehensive screening and education programs need to be implemented. The majority of beta-thalassemia defects in Southern Chinese are point mutations, single nucleotide insertions or minor deletions, not detectable by standard gene mapping techniques. With linkage analysis of the defective gene to polymorphic restriction sites, a definitive diagnosis can be obtained in 50% of the families, while in the remaining there is a 50% exclusion rate. We routinely use the Hind III-3' beta, Bam HI-3' beta, Ava II-beta, and Hinc II-psi beta sites for linkage analysis. For first pregnancies, the marked linkage disequilibrium of the Bam HI polymorphism can be applied in 29% of the cases. In nonconclusive cases, fetal blood beta/gamma globin chain synthetic ratio was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1987

Application of DNA polymorphisms for prenatal diagnosis of beta thalassemia in Chinese.

Forty-seven Chinese suffering from beta thalassemia major and their parents were studied to establish linkage of the beta thal and beta A genes with 11 restriction site polymorphisms. There is marked linkage disequilibrium at the BamH I site 3' to the beta globin gene, such that, in 31% of pregnancies, absence of the site in the fetus can exclude beta thalassemia major. Using four restriction sites (Hinc II psi beta, Ava II beta, Hind III beta, and BamH I beta), prenatal diagnosis is feasible in all families. In 46% of all cases, a definitive diagnosis can be made, and in the remaining cases, a 50% chance of exclusion is possible. Fetal blood globin chain analysis would be required for the failures. Our experience in nine successive beta thalassemia prenatal diagnosis is also reported.

China↗
PubMed1987

Ultrasound evaluation of pregnancies at risk for homozygous alpha-thalassaemia-1.

Twenty-six pregnant Chinese women who were at risk of giving birth to a fetus affected with homozygous alpha-thalassaemia-1 were examined serially by ultrasound. Six of these 26 pregnancies were affected. In one third of the affected pregnancies progressive fetal ascites appeared before 24 weeks gestation and these pregnancies were terminated. In the remaining two thirds abnormal estimated fetal weight-placental volume (EFW-PV) ratio and fetal growth retardation as evidenced by a falling biparietal diameter (BPD), femur length (FL) but a normal abdominal circumference (AC) was apparent by 28 weeks gestation. Increased transverse cardiac (TC) diameter was another consistent finding but appeared late. All these features appeared before the onset of fetal ascites. A normal EFW-PV ratio and fetal growth until 28 weeks gestation was a reassuring sign of normality. Abnormal EFW-PV ratio was the earliest sign to appear in affected pregnancies and a normal ratio until 28 weeks gestation had a 100 per cent predictive value.

Female↗
PubMed1987

Glucose and lipid metabolism with triphasic oral contraceptives in women with history of gestational diabetes.

The glucose and lipid metabolism in a group of women with previous history of gestational diabetes were evaluated before and after 6 months treatment with a low-dose triphasic oral contraceptives pill (TP). This group was compared with a control group of women, also with history of gestational diabetes, using intrauterine devices (IUD). In the TP group, 26.7% of the women developed impaired glucose tolerance which reverted to normal in all but one after cessation of the TP. The IUD group showed no change in glucose tolerance. The integrated insulin response to a 75g OGTT in the TP group increased by 48.3% at 6 months compared with an increase of 23.4% for the same period in the IUD group. In the TP group there was a significant decrease in serum total cholesterol without changes in HDL-cholesterol and triglycerides level. We conclude that even low-dose triphasic oral contraceptive pills can cause glucose intolerance in women with previous gestational diabetes mellitus.

Adult↗
PubMed1987

Evaluation of the WHO criteria for 75 g oral glucose tolerance test in pregnancy.

A group of pregnant women at high risk of developing diabetes in pregnancy had paired oral glucose tolerance tests (OGTT) using a 100 g load followed by 75 g load. When the World Health Organization (WHO) criteria and the National Diabetes Data Group (NDDG) criteria were compared, the 2-h plasma glucose value after the 100 g load was the most discriminative in differentiating those with normal glucose tolerance, impaired glucose tolerance and gestational diabetes mellitus. When only the 2-h plasma glucose values were assessed, the WHO test (75 g: 8 mmol/l) agreed with the NDDG test (100 g load: 9.2 mmol/l) in the diagnosis of glucose intolerance in 60% of subjects only. Using the same criteria at 2-h (8 mmol/l) the agreement between these tests was 47%. Reducing the glucose load from 100 g to 75 g produced a reduced glucose response in 49% of the subjects, with a significant decrease in the area under the glucose response curve.

Female↗
PubMed1987

Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial.

The study was designed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group (NDDG) criteria, but normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) by the World Health Organization (WHO) criteria, and to test whether treatment changed the perinatal outcome in those with NGT and IGT. The 216 women with an abnormal 100 g oral glucose tolerance test (OGTT) using NDDG criteria were subjected to a 75 g OGTT. Using the WHO criteria, 111 women (51%) had NGT, 98 (45%) had IGT and 7 (3%) had frank diabetes mellitus. Those with NGT and IGT were randomized into control and treatment groups. The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except, that in those who were treated for IGT, smaller babies were born one week earlier than in the control group (3407 g vs 3110 g, P less than 0.01). This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower, money and patients' time.

Adult↗
PubMed1987

Diagnosis of endometrial carcinoma by histopathological examination of the endometrial aspirate by the Curity-Isaacs sampler.

The Curity-Isaacs Endometrial Cell (CIEC) sampler was used for endometrial tissue and cell sampling in 230 patients before dilatation and curettage to determine the efficacy of its use as an outpatient endometrial sampler. Its use was found to be safe and without complication. It could be easily inserted into the uterine cavity in 92.0% of patients and did not cause undue discomfort in 88.9% of them. Using histopathological diagnostic techniques, there was 100% accuracy in the diagnosis of endometrial carcinoma. However, it was found that diagnostic accuracy of endometrial hyperplasia was only 33.3%. It is suggested that the CIEC sampler could be used as a first-line diagnostic procedure to exclude endometrial carcinoma in patients with abnormal vaginal bleeding.

Adult↗