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Biomedical subjects

K Lam

Publications and source records attributed to K Lam.

At least 19 recordsLinked to original sources
PubMed2005

The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults.

AIM: To report two new, useful computed tomography (CT) signs of the hypovolaemic shock complex (HSC) in adults admitted after blunt abdominal trauma: the halo sign (ring of fluid around a collapsed intra-hepatic inferior vena cava (IVC)), and peripancreatic retroperitoneal fluid. MATERIALS AND METHODS: CT images of 498 consecutive patients admitted after blunt abdominal trauma were reviewed, of which 27 had CT signs of the HSC. The CT images of these 27 patients were analysed. A control group of 101 patients examined using CT for suspected blunt abdominal trauma who did not have the HSC were chosen for comparison. RESULTS: The most common features involved the vascular compartment: diminished IVC diameter n = 27 a positive halo sign n = 21 diminished anteroposterior diameter of the aorta n = 13 and abnormal vascular enhancement n = 10. Peripancreatic retroperitoneal fluid in the absence of pancreatic injury, pancreatitis or pancreatic disease was observed in eight patients. Hollow visceral abnormalities included: diffuse increased mucosal enhancement of both the small and large bowel n = 19 diffuse thickening of the small bowel wall n =11 and small bowel dilatation n = 7. Solid visceral abnormalities included both decreased and or increased enhancement. Several concomitant intra- and extra-abdominal injuries were also identified. CONCLUSION: In the setting of blunt abdominal trauma, early abdominal CT can show diffuse abnormalities due to the HSC, which occasionally may alert clinicians of unsuspected shock. Recognition of these signs as distinguished from injured viscera is important in order to avoid unnecessary laparotomy. Two new signs are described: the halo sign and peripancreatic retroperitoneal fluid.

Abdominal Injuries↗
PubMed2005

An epidemiological study of motor neuron disease in Hong Kong.

Worldwide, the incidence of motor neuron disease (MND) has been increasing steadily over recent decades. We reported a follow-up epidemiology study of MND in this locality. We identified the subjects from the computer database of the government hospital system between 1 January 1997 and 31 January 2002 by searching the ICD code starting from 335.xx. Every retrieved case or their records were reviewed and validated by neurologist(s) of the responsible regional hospitals which the patients attended. One hundred and twenty cases from seven regional hospitals (serving 48.05% of the HKSAR population) were identified, validated and confirmed to be MND or related diseases. Ninety-eight new cases were diagnosed during the study period. Average age of onset was 58.76 years; SD 14.12 (28-89) years. Male to female ratio was 1.72:1. Peak age of onset was 60-64 years without sex difference. The adjusted incidence rate was 0.60/100,000/year. The adjusted point prevalence at the prevalence date (31 January 2001) was 3.04/100,000. Despite the incidence and prevalence of MND among Hong Kong Chinese, it remained low compared to worldwide figures, and our data suggested a significant rise of MND or related disease in the last decade. A territory-wide prospective epidemiological study is indicated.

Adult↗
PubMed2005

Japanese encephalitis in Hong Kong.

OBJECTIVES: To review past and present patterns of occurrence of Japanese encephalitis in Hong Kong and across Asia. A better understanding of the disease should facilitate the formulation of an effective strategic plan to prevent a future epidemic. DATA SOURCES: Report of local cases, and literature search of MEDLINE up to November 2004. STUDY SELECTION: Literature and data related to Japanese encephalitis. DATA EXTRACTION: Relevant information and data were reviewed by the authors. DATA SYNTHESIS: Since 16 July 2004, under the ordinance of Hong Kong, Japanese encephalitis has been a notifiable disease. In the past, Japanese encephalitis has reached epidemic proportions in Japan, South Korea, and some areas in China. It has spread globally and has a worldwide incidence of 35 000 to 50 000 cases per year with 10 000 deaths. Mortality is about 30% and survivors often suffer serious long-term morbidity. In 2004, there were five local cases of Japanese encephalitis in Hong Kong. Subsequent serological surveillance of serum samples from 1547 local inhabitants revealed that 37 were positive, ie 2.4% of local inhabitants had been exposed to the Japanese encephalitis virus in the past. Most local inhabitants are immunologically naive to Japanese encephalitis virus. Most infections in endemic areas are asymptomatic. Patients with symptomatic Japanese encephalitis usually present with fever, headache, and confusion. Other signs include neurosis, poliomyelitis, and convulsion. Investigations including magnetic resonance imaging, electroencephalography, and single photon emission computed tomography are not specific. A definitive diagnosis depends on serological studies. Treatment is mainly supportive. CONCLUSIONS: The control of Japanese encephalitis in Hong Kong relies on an accurate surveillance system, vector control, vector avoidance, and vaccination of the at-risk population. At present, vaccination should be limited to travellers to endemic areas who would stay for longer than 1 month.

Encephalitis, Japanese↗
PubMed2004

Clinical features of hereditary spinocerebellar ataxia diagnosed by molecular genetic analysis.

OBJECTIVE: To assess the frequency and clinical features of different types of hereditary spinocerebellar ataxia in Hong Kong. DESIGN: Cross-sectional study using a questionnaire and clinical examination, with the majority of the information retrospectively collected. SETTING: Three regional hospitals, Hong Kong. PARTICIPANTS: All patients with spinocerebellar ataxia that was confirmed by molecular genetic tests between January 2001 and October 2003. MAIN OUTCOME MEASURES: History, latest physical examination results, clinical investigation results, and genetic profiles. RESULTS: A total of 16 Chinese patients had received diagnoses of spinocerebellar ataxia. These patients had spinocerebellar ataxia type 1 (n=3), spinocerebellar ataxia type 3 (Machado-Joseph disease; n=12), and dentatorubro-pallidoluysian atrophy (n=1). The most common manifestation was ataxia (15/16), followed by pyramidal signs (12/16). Other features such as bulbar dysfunction, ophthalmoplegia, neuropathy, and cognitive impairment were present but variable. CONCLUSIONS: The clinical manifestations of different types of spinocerebellar ataxia overlap, and genetic study is necessary to confirm the diagnosis. The frequency of spinocerebellar ataxia type 3 is greater than that of other types among these Chinese patients. The age of onset of this type may correlate inversely with the number of CAG repeats.

Adult↗
PubMed2002

Cerebral activation by the signals ascending through unmyelinated C-fibers in humans: a magnetoencephalographic study.

Cerebral processing of first pain, associated with A delta-fibers, has been studied intensively, but the cerebral processing associated with unmyelinated C-fibers, relating to second pain, remains to be investigated. This is the first study to clarify the primary cortical processing of second pain by magnetoencephalography, through the selective activation of C-fibers, by the stimulation of a tiny area of skin with a CO2 laser. In the hemisphere contralateral to the side stimulated, a one-source generator in the upper bank of the Sylvian fissure (secondary somatosensory cortex, SII) or two-source generators in SII and the hand area of the primary somatosensory cortex (SI) were the optimal configurations for the first component 1M. The onset and peak latency of the two sources in SI and SII were not significantly different. In the hemisphere ipsilateral to the stimulation, only one source was estimated in SII, and its peak latency was significantly (approximately 18 ms on average) longer than that of the SII source in the contralateral hemisphere. From our findings we suggest that parallel activation of SI and SII contralateral to the stimulation represents the first step in the cortical processing of C-fiber-related activities, probably related to second pain.

Adult↗
PubMed2002

Energy expenditure and physical activity of obese children: cross-sectional study.

OBJECTIVES: To investigate the total daily energy expenditure and physical activity pattern of a group of obese and non-obese Hong Kong children. DESIGN: Cross-sectional study. SETTINGS: University teaching hospital, Hong Kong. PARTICIPANTS: Eighteen obese children aged 6 to 17 years and 18 age- and sex-matched non-obese children in the local Hong Kong community. MAIN OUTCOME MEASURES: Total daily energy expenditure and physical activity pattern were estimated for 3 days using heart rate monitoring. Body composition was measured by dual-energy X-ray absorptiometry. RESULTS: In obese children, both total fat mass and fat-free mass were greater than in non-obese children. Total daily energy expenditure and its sleep and sedentary components were higher in absolute terms (by 42%, 43%, and 126%, respectively) for obese children. When normalised for body weight, the basal metabolic rate was no different between obese and non-obese children, while the total daily energy expenditure of the obese children was significantly lower (by 22%) than that of non-obese children. When normalised for fat-free mass, the basal metabolic rate and the sedentary component of total daily energy expenditure were significantly higher for obese children. Obese children spent 12% less time asleep, but 51% more time in sedentary activity and 30% less time physically active: a ratio of active-to-sedentary waking time of 0.6 for obese children and 1.9 for non-obese children. CONCLUSIONS: Although the basal metabolic rate may be influenced by body composition, the finding of a normal basal metabolic rate when normalised for body weight suggests that an intrinsic difference of metabolic rate is not a major contributory cause of obesity. The study pointed particularly to the potential benefit of increasing physical exercise time relative to sedentary activities to reduce the prevalence of childhood obesity. Obese and non-obese children had similar basal metabolic rates when adjusted by fat-free mass and fat mass. Obese children spent more time in sedentary activities.

Adolescent↗
PubMed2001

A new method for measuring the conduction velocities of Abeta-, Adelta- and C-fibers following electric and CO(2) laser stimulation in humans.

The conduction velocities of Abeta-, Adelta- and C-fibers of a peripheral nerve of the upper limb in normal subjects were measured by a combination of conventional electric stimulation, painful CO(2) laser stimulation and non-painful CO(2) laser stimulation of a tiny skin surface area, respectively. The values obtained were 69.1+/-7.4 m/s, 10.6+/-2.1 and 1.2+/-0.2 m/s, respectively. These findings demonstrated that the combined methods are useful for experimental and clinical exploration of the physiological function and pathophysiological role of Abeta-, Adelta- and C-fibers of a given peripheral nerve.

Adult↗
PubMed2001

Adhesion of epithelial cells to fibronectin or collagen I induces alterations in gene expression via a protein kinase C-dependent mechanism.

Adhesion of human salivary gland (HSG) epithelial cells to fibronectin- or collagen I gel-coated substrates, mediated by beta1 integrins, has been shown to upregulate the expression of more than 30 genes within 3-6 h. Adhesion of HSG cells to fibronectin or collagen I for 6 h also enhanced total protein kinase C (PKC) activity by 1.8-2.3-fold. HSG cells expressed PKC-alpha, gamma, delta, epsilon, mu, and zeta. Adhesion of HSG cells to fibronectin or collagen I specifically activated PKC-gamma and PKC-delta. Cytoplasmic PKC-gamma and PKC-delta became membrane-associated, and immunoprecipitated PKC-gamma and PKC-delta kinase activities were enhanced 2.5-4.0-fold in HSG cells adherent to fibronectin or collagen I. In addition, adhesion of fibronectin-coated beads to HSG monolayers co-aggregated beta1 integrin and PKC-gamma and PKC-delta but not other PKC isoforms. Thus, integrin-dependent adhesion of HSG cells to fibronectin or collagen I activated PKC-gamma and PKC-delta. The role of this PKC upregulation on adhesion-responsive gene expression was then tested. HSG cells were treated with the specific PKC inhibitor bisindolylmaleimide I, cultured on non-precoated, fibronectin- or collagen I-coated substrates, and analyzed for changes in adhesion-responsive gene expression. Bisindolylmaleimide I strongly inhibited the expression of seven adhesion-responsive genes including calnexin, decorin, S-adenosylmethionine decarboxylase, steroid sulfatase, and 3 mitochondrial genes. However, the expression of two adhesion-responsive genes was not affected by bisindolylmaleimide I. Treatment with bisindolylmaleimide I did not affect cell spreading and did not significantly affect the actin cytoskeleton. These data suggest that adhesion of HSG cells to fibronectin or collagen I induces PKC activity and that this induction contributes to the upregulation of a variety of adhesion-responsive genes.

Cell Adhesion↗
PubMed2001

Attention and visual interference stimulation affect somatosensory processing: a magnetoencephalographic study.

In our previous study, continuous visual (cartoon and random dot motion) and auditory (music) stimulation changed the somatosensory evoked magnetic fields following electrical stimulation of the median nerve in human subjects. They enhanced the middle-latency components (3M and 4M) generated in the contralateral primary somatosensory cortex, and reduced the MI component generated in the ipsilateral secondary somatosensory cortex. We speculated that such interference effects were caused by activation of polymodal neurons in areas 5 and/or 7 of the parietal lobe as well as in the medial superior temporal region and superior temporal sulcus. However, we could not exclude the effect of attention on such interference effects. In the present study, to know the effect of attention on visual and auditory interference in these changes, we stimulated the bilateral median nerves unilaterally in a random order, and asked subjects to count the number of times the left median nerve was stimulated while visual or auditory interference was applied. Five components (1M-5M) were identified in the hemisphere contralateral to the stimulated nerve and only one component (MI) was found in the ipsilateral hemisphere. The 3M and 4M components (33-75 ms in latency) were enhanced by both attention and visual interference stimulation but not by auditory stimulation. The 5M component (70-115 ms) and MI component (70-133 ms) were enhanced by attention, but were not changed by attention together with visual or auditory interference. Summarizing the results of our previous study and the present study, (1) visual interference alone enhanced the 3M and 4M but reduced the MI, and (2) attention alone also enhanced the 3M and 4M, and enhanced the 5M and MI. As a result, (3) visual interference with attention enhanced the 3M and 4M more, and showed no significant change of the 5M and MI. This was compatible with a summation of the effects caused by visual interference alone and attention alone, but some interactions between visual interference and attention might have taken place. The locations of dipoles of all components were not significantly changed by attention or any interference stimulation. These findings support the idea that there are significant interactions of activities relating to somatosensory stimulation, visual stimulation and cognitive function, in both the primary and the secondary somatosensory cortex in humans.

Acoustic Stimulation↗
PubMed2001

Malignant insulinoma with hepatoid differentiation: a unique case with alpha-fetoprotein production.

Hepatoid carcinomas are uncommon extra-hepatic neoplasms exhibiting features of hepatocellular carcinoma and they are most frequently described in the stomach. We report a 64-year-old woman with a malignant insulinoma showing focal hepatoid differentiation and biochemical evidence of alpha-fetoprotein (AFP) production. The current case is the first malignant insulinoma with hepatoid differentiation. Resection of the primary tumor followed by regional embolization was peformed. The patient died 22 months after initial presentation. Thus, the presence of hepatoid differentiation in pancreatic tumor should be noted as the tumor may be associated with elevated AFP. The features of pancreatic hepatoid carcinomas are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

[Cumulative impact assessment: problems and practice in China mainland and Hong Kong].

Including past, present and future impacts in environmental impact assessment (EIA) of the proposed action, it is the important property of cumulative impact assessment (CIA) that different from traditional EIA. It is also the main trend of EIA improvement. From the area of regulation demands, documentation practice, spatial and temporal boundary, key contents and mitigation measures, this paper analyses the status of CIA both of China Mainland and Hongkong in the practice of EIA. The author suggested that technical guidelines for cumulative effects assessment should be set up in China Mainland and Hongkong, CIA should be included in project, region and strategy environment assessment and cumulative impacts should be list clearly in EIA study executive summary and reported in a separate part of the environmental consequences section. Spatial and temporal boundaries and any cumulative impacts addressed within the CIA process should be provided evidence or analysis to support the conclusion. In order to prevent cumulative effects effectively, the focus on CIA should be put on biodiversity, social and economic impacts and global environmental effects.

China↗
PubMed2000

In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage.

BACKGROUND: Bacterial adherence and biofilm formation are important factors in the blockage of biliary stents. Clinical studies with oral antibiotic prophylaxis to prevent stent blockage have produced conflicting results. The aim of this study was to evaluate the in vitro effect of single antibiotic (ciprofloxacin, ceftazidime, or ampicillin) treatment on adherence of Escherichia coli and Enterococcus to plastic stents. METHODS: Selected clinical isolates of E coli and Enterococcus were perfused through a modified Robbins device containing segments of polyethylene stents. The stents were removed daily and the number of bacteria attached was measured. The effect of antibiotic treatment on bacterial adherence was tested by the perfusion of individual antibiotics into separate modified Robbins devices using a side-arm adaptor and the results were compared with saline controls. RESULTS: Compared with the saline controls, ciprofloxacin and ceftazidime caused a 10- to 100-fold reduction in the number of E coli attached to the stents, whereas ampicillin had no effect on adherence of E coli. Ampicillin caused a 5- to 10-fold reduction in Enterococcus adherence but there was no change with ceftazidime. Sustained reduction in E coli adherence was observed with prolonged ciprofloxacin perfusion. CONCLUSION: Timely treatment with appropriate antibiotics reduced bacterial adherence in vitro and may be potentially beneficial in the prevention of stent blockage.

Ampicillin↗
PubMed2000

The somatosensory evoked magnetic fields.

Averaged magnetoencephalography (MEG) following somatosensory stimulation, somatosensory evoked magnetic field(s) (SEF), in humans are reviewed. The equivalent current dipole(s) (ECD) of the primary and the following middle-latency components of SEF following electrical stimulation within 80-100 ms are estimated in area 3b of the primary somatosensory cortex (SI), the posterior bank of the central sulcus, in the hemisphere contralateral to the stimulated site. Their sites are generally compatible with the homunculus which was reported by Penfield using direct cortical stimulation during surgery. SEF to passive finger movement is generated in area 3a or 2 of SI, unlike with electrical stimulation. Long-latency components with peaks of approximately 80-120 ms are recorded in the bilateral hemispheres and their ECD are estimated in the secondary somatosensory cortex (SII) in the bilateral hemispheres. We also summarized (1) the gating effects on SEF by interference tactile stimulation or movement applied to the stimulus site, (2) clinical applications of SEF in the fields of neurosurgery and neurology and (3) cortical plasticity (reorganization) of the SI. SEF specific to painful stimulation is also recorded following painful stimulation by CO(2) laser beam. Pain-specific components are recorded over 150 ms after the stimulus and their ECD are estimated in the bilateral SII and the limbic system. We introduced a newly-developed multi (12)-channel gradiometer system with the smallest and highest quality superconducting quantum interference device (micro-SQUID) available to non-invasively detect the magnetic fields of a human peripheral nerve. Clear nerve action fields (NAFs) were consistently recorded from all subjects.

Brain Mapping↗
PubMed2000

Magnetic response of human extrastriate cortex in the detection of coherent and incoherent motion.

Although direction selectivity is a cardinal property of neurons in the visual motion detection system, movement of numerous elements without global direction (incoherent motion) has been shown to activate human and monkey visual systems, as does coherent motion which has global direction. We used magnetoencephalography to investigate the neural process underlying responses to these types of motions in the human extrastriate cortex. Both motions were created using a random dot kinematogram and four speeds (0, 0.6, 9.6 and 25 degrees /s). The visual stimuli were composed of two successive motions at different speeds; a coherent motion at a certain speed that changed to incoherent motion at another speed or vice versa. Magnetic responses to the change in motion consisted of a few components, the first of which was always largest. The peak latency of the first component was inversely related to the speed of the preceding motion, but for both motions it was not affected by the speed of the subsequent motion. For each subject, the estimated origin of the first component was always in the extrastriate cortex, and this changed with the speed of the preceding motion. For both motions, the location for the slower preceding motion was lateral to that for the faster preceding motion. Although the latency changes of the two motions differed, their overall response properties were markedly similar. These findings show that the speed of incoherent motion is represented in the human extrastriate cortex neurons to the same degree as coherent motion. We consider that the human visual system has a distinct neural mechanism to perceive random dots' motion even though they do not move in a specific direction as a whole.

Adult↗
PubMed2000

Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?

BACKGROUND: Late stent blockage is a major complication of endoscopic stent insertion for malignant obstructive jaundice. Stents block as a result of bacterial infection and biofilm formation. We report a randomized but unblinded study using an animal model to evaluate the effect of prophylactic ciprofloxacin, which selectively suppresses gram-negative bacteria, in an attempt to prolong stent patency. METHOD: Ten adult cats underwent surgical implantation of 5F polyethylene stents through common bile duct strictures created around the choledochotomy, with the tip of the stent left in the duodenum. Five animals received intravenous ciprofloxacin perioperatively and were then maintained on oral ciprofloxacin 25 mg twice daily. Control cats were not given antibiotics. The animals were sacrificed when signs of biliary obstruction or cholangitis persisted for more than 3 days or at the end of the 16-week study period. Stents were removed and examined for patency. In addition, the stents were cultured to recover the adherent bacteria. RESULTS: All control animals developed stent blockage within 4 weeks. Two ciprofloxacin-treated cats developed stent blockage at 21 and 42 days, respectively, whereas the other 3 cats had patent stents for the entire study period. There was a significant difference between the median stent patency of 112 days for the ciprofloxacin group versus 16 days for the control group (p < 0.02). Bacteriologic cultures showed that the bile and blocked stents from the control group had predominantly gram-negative bacteria, whereas the bile and stents of the ciprofloxacin group had gram-positive and anaerobic bacteria, with an absence of gram-negative bacteria (p < 0.01). CONCLUSION: Ciprofloxacin prophylaxis eliminates gram-negative bacterial infection in bile and minimizes sludge formation and may have a potential benefit in delaying stent blockage.

Administration, Oral↗
PubMed2000

Healing of porcine donor sites covered with silver-coated dressings.

OBJECTIVE: To compare rates of healing of donor sites in pigs between those dressed with silver-coated dressings and those dressed with petrolatum-impregnated absorbent gauze. DESIGN: Open study with each animal acting as its own control. SETTING: University research facility, Canada. ANIMALS: 6 young specific-pathogen-free domestic pigs. INTERVENTIONS: A total of 72 wounds about 1 cm x 2 cm x 0.4 mm were made in rows of eight on each pig with a dermatome. They were divided into three groups of 24, and dressed with petrolatum gauze, or silver-coated dressings moistened with sterile water either once only or daily for 10 days. All dressings were secured in place with an elastic bandage. MAIN OUTCOME MEASURES: Erythema, infection, epidermal migration, and healing. RESULTS: Wounds dressed with moistened silver-coated dressings re-epithelialised significantly more quickly. This resulted in complete re-epithelialisation within 70% of the time taken by those wounds dressed with petrolatum gauze. CONCLUSION: Silver-coated dressings provide a moist environment for the healing wound combined with an effective antimicrobial agent, and this significantly accelerates healing compared with wounds dressed with traditional petrolatum gauze dressings.

Animals↗
PubMed2000

Anaerobic bacteria and intrahepatic stones: detections of Clostridium sp. and Bacteroides fragilis.

OBJECTIVE: To detect anaerobic bacteria Clostridium sp. and Bacteroides fragilis in intrahepatic stones by molecular genetic method. METHODS: DNA was extracted from 59 stone samples and subjected to polymerase chain reaction (PCR) amplification targeting the 16S rRNA gene of Clostridium sp. and the glutamine synthetase gene of Bacteroides fragilis. Single-strand conformational polymorphism (SSCP) analysis was performed to identify the Clostridium sp. RESULTS: 16S rRNA gene sequences for Clostridium sp. were identified in 49 stones (83%, 49/59). The two most common groups were detected in 19 (41%) and 17 (37%) of the 46 samples using SSPC analysis, and 25/59 (42%) stones were tested positive for Bacteroides fragilis. CONCLUSIONS: Anaerobes such as Clostridium sp. and Bacteroides fragilis present in intrahepatic stones and may play a role in stone formation. PCR is a useful technique to detect fastidious pathogens, which are difficult to culture. SSCP of PCR products is a rapid method in differentiating bacterial species.

Adult↗