Biomedical subjects
Publications and source records attributed to H K Ma.
Retroperitoneal sarcoma can occur in the female pelvis and be confused with other pelvic masses. Its diagnosis depends on an awareness of its occurrence. Aggressive surgery to completely excise the tumor determines survival.
Sixty patients who developed persistent or metastatic gestational trophoblastic disease (GTD) received primary oral etoposide therapy (VP 16-213). Twelve patients had metastatic GTD. Fifty-nine patients achieved biochemical remission. One patient had marked nausea and vomiting and the therapy was switched to a methotrexate/folinic acid regimen. Three patients developed relapse of GTD, giving a relapse rate of 5.1%. Etoposide is an active drug against choriocarcinoma. Its use should not be restricted to drug-resistant GTD.
Lymphocyte counts, T-cell counts, B-cell counts, helper T-cell counts, and suppressor-cytotoxic T-cell counts were performed in 38 patients with gestational trophoblastic neoplasia and 38 normal control subjects. Natural killer cell activity was also assayed in 30 patients and 30 control subjects. The percentage and count of lymphocytes and the absolute counts (but not the percentages) of T cells, helper T cells, and suppressor-cytotoxic T cells in patients with gestational trophoblastic neoplasia were significantly lower than those of normal control subjects. In high-risk patients with gestational trophoblastic neoplasia, there was also a significant reduction of the helper T cell to suppressor-cytotoxic T-cell ratio in comparison with that in normal control subjects. There was no significant difference in the B-cell counts or natural killer cell activity. The measurement of these parameters was not useful in predicting the response to chemotherapy.
In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.
A case of persistent trophoblastic disease (PTD) is presented in whom pelvic sonography demonstrated persistent uterine abnormality and dilated adnexal vessels after cessation of chemotherapy. Hysterectomy was performed on account of subsequent uterine bleeding. A viable tumour was not demonstrated in the hysterectomy specimen. In the absence of haemorrhagic complications persistent sonographic abnormality should not necessarily indicate hysterectomy, especially when hCG levels are normal.
Nine patients with gestational trophoblastic disease resistant to multiagent chemotherapy, CHAMOCA, received methotrexate, bleomycin, and etoposide (VP 16-213) combination therapy. Eight patients achieved complete remission. There was no drug-related death. The importance of vigilant search and prevention of sepsis was emphasized. Alternative combination chemotherapy for drug-resistant choriocarinoma was discussed.
Fifty patients with high-risk gestation trophoblastic disease received primary multiagent chemotherapy (CHAMOMA). Forty-one patients (82%) achieved sustained completed biochemical remission. The importance of recognizing the high-risk factors and the effectiveness of primary multiagent chemotherapy are demonstrated.
Forty-five patients with Stages II and III cervical carcinoma were randomized to receive either radiation or cis-dichlorodiammine platinum (II) (cis-DPP) with radiation. Cis-DPP was administered in bolus injections of 25 mg/m2 at weekly intervals until completion of radium application. Complete response was noted in 11/20 (55%) patients in the radiochemotherapy group compared to 5/25 (20%) patients in the radiation group (P less than 0.025). No enhanced toxicities were observed with the addition of cis-DPP to radiation. The combined use of cis-DPP and radiotherapy offers promising potential in improving local-regional control of advanced cervical carcinoma.
Six cases of intractable lymphocyst occurred in a series of 108 patients undergoing radical hysterectomy, an incidence rate of 5.6%. The complexities of pelvic lymphocyst are illustrated by their unusual presentation and problems in their management. Large lymphocysts should initially be treated by percutaneous catheter drainage before resorting to peritoneal marsupialization.
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Explore the source record for details and available documents.
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Intrauterine growth standards for Hong Kong Chinese were derived from birth-weight data between 28 and 42 weeks' gestation in 15,815 livebirths delivered in 1982 to 1984 at 2 maternity teaching hospitals in Hong Kong. Normal distribution of birth-weights was noted in each of the gestational weeks studied. The mean birth-weight was 3,237g at 40 weeks which was similar to the mean weights reported in other populations for this gestation. The trend of the median weight curve was also similar to that in other Caucasian and Asian reports. The growth pattern for males and females were similar and males were on the whole heavier than females throughout the gestational period studied. At 40 weeks, the 10th percentile weight also showed wide variations between reports, which would have important bearing on the studying of intrauterine growth retardation. When the mean weight at term as derived from the present study was compared to a previous report on birth-weight data in 1970-1972 in the same hospital, a significant increase in birth-weight was observed over the 12-year period. The importance of having up-to-date intrauterine weight standards for a specific population is discussed.
One thousand five hundred and twenty-six records of deliveries with vacuum extractor in 1982 and 1983 in the Hong Kong University Department of Obstetrics and Gynaecology were reviewed. Vacuum extractor was found to be easy and safe to use even by inexperienced house-staff. Vacuum extractor was especially useful in the delivery of malpositioned fetal heads because of its mechanism of allowing autorotation. Its advantage of not occupying extra space in the pelvis was most beneficial to the relatively smaller Chinese pelvis. Maternal injury was uncommon. Fetal scalp injury like cephalhaematoma was not uncommon but serious scalp injury was infrequent. Perinatal mortality rate attributed to the instrument was low (0.6/1,000). However, in order to achieve safety to the mother and fetus, strict rules in application of the vacuum extractor must be observed.
From 1975 to 1983, 195 patients were treated for persistent or metastatic gestational trophoblastic disease. Fifteen patients with liver metastases were analyzed. All were treated with chemotherapy alone, none received hepatic irradiation, and no patient bled from her hepatic metastases. Thus, the need for prophylactic hepatic irradiation to prevent hemorrhage is doubtful. The good results obtained in the studied patients emphasize the significance of using vigorous primary multiagent chemotherapy in high-risk gestational trophoblastic disease patients.
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Plasma prolactin, progesterone, and 17 beta-estradiol were measured by radioimmunoassay in 58 patients with complete moles, 17 patients with partial moles, and the same number of maturity-matched pregnant control subjects. In both complete and partial moles in the first trimester, the pre-evacuation plasma levels of these hormones were similar to those of pregnant control subjects, but in the second trimester they were all significantly lower than those of pregnant controls. There was no significant difference in the regression patterns of these hormones between complete and partial moles, but the serum beta-subunit of human chorionic gonadotropin (beta hCG) was higher in complete moles. Patients who subsequently developed persistent gestational trophoblastic tumors had higher plasma estradiol, prolactin, and serum beta hCG than those without persistent gestational trophoblastic tumors both before and after evacuation, but the difference in plasma estradiol and prolactin disappeared by nine weeks after evacuation. The levels of these hormones in patients with theca-lutein cysts were higher than those without theca-lutein cysts in the first few weeks after evacuation. Plasma estradiol, progesterone, and prolactin returned to normal nonpregnant levels before serum beta hCG, and they were not useful as tumor markers.