Differences Between the East and the West in Managing Advanced-Stage Non-small Cell Lung Cancer.

Lung cancer is a common cancer associated with high mortality rates worldwide. Unfortunately, it usually presents at a late stage, precluding the chance of curative therapy. The discovery of oncogenic driver mutations in patients with non-small cell lung cancer over the past 20 years has led to new molecular targeted therapies that have dramatically improved treatment efficacy and quality of life. New generations of therapy that target the drug-resistant mutations have also quickly evolved, benefiting patients who are refractory or intolerant to first-line targeted therapy. Eastern patients, from Southeast Asia, Japan and China, are known to have a higher incidence of epidermal growth factor receptor mutation. Therefore, compared with the West, more patients would benefit from these recent advances. In contrast, survival of patients without driver mutations has benefited from advances in novel therapeutics, including the immune checkpoint inhibitors. The current review aims to highlight the recent developments in the management of advanced-stage non-small cell lung cancer and to compare the differences in clinical practice between Eastern and Western countries.

Management and prevention of spontaneous pneumothorax using pleurodesis in Hong Kong.

BACKGROUND: The practice of pleurodesis for the management and prevention of spontaneous pneumothorax (SP) is uncertain. DESIGN: A retrospective multicentre analysis of patients admitted to 12 hospitals in Hong Kong with SP in 2004 and who subsequently underwent pleurodesis for the same episode. RESULTS: Pleurodesis was performed in 394 episodes. Initial medical chemical pleurodesis was performed for 258 (65.5%) patients ('initial medical group'), while 136 (34.5%) underwent initial surgical pleurodesis ('initial surgical group'). Secondary spontaneous pneumothorax (SSP; 237 episodes, 60.2%) was the most common indication for pleurodesis; it was also performed after a first episode of primary spontaneous pneumothorax (PSP) in 22 episodes (5.6%). Tetracycline derivatives (172 episodes, 66.7%) were the most popular sclerosing agents in the initial medical group. Those in the initial medical group were older and were more likely to be males, have SSP, chronic obstructive pulmonary disease and a history of past pleurodesis (P < 0.05) compared to the initial surgical group. Compared to the tetracycline group, more patients who initially received talc slurry had the procedure performed by surgeons, had larger (≥2 cm) pneumothorax or required suction during initial drainage (P < 0.05). CONCLUSIONS: Despite the availability of international guidelines, there is considerable variation in pleurodesis for SP.

Minocycline and talc slurry pleurodesis for patients with secondary spontaneous pneumothorax.

SETTING: Few studies have evaluated the sclerosing efficacy of minocycline, and none have specifically compared its sclerosing efficacy and safety profiles with talc slurry in secondary spontaneous pneumothorax (SSP). DESIGN: A retrospective analysis was conducted in patients with SSP who underwent chemical pleurodesis from January to December 2004 with minocycline or talc slurry in 12 public hospitals of Hong Kong. RESULT: There were 121 episodes of minocycline pleurodesis and 64 episodes of talc slurry pleurodesis. Immediate procedural failure were similar in the minocycline and talc slurry groups (21.5% vs. 28.1%, P = 0.31). Presence of interstitial lung disease, ≥ 2 previous episodes of pneumothorax, requiring mechanical ventilation during pleurodesis and persistent air leak before pleurodesis were independently associated with procedural failure. Pain was experienced in respectively 44.6% and 37.5% of the minocycline and the talc slurry groups. Pain was more common in patients receiving high doses of talc (≥ 5 g; P = 0.03). Respiratory distress was found in respectively 1.7% and 1.6% of the minocycline and talc slurry groups. CONCLUSION: Minocycline and talc slurry had comparable sclerosing efficacy in SSP, with immediate success rates of >70%. Pain was the most common adverse effect and respiratory distress was uncommon. Both appeared to be effective and safe for chemical pleurodesis in SSP.

Management of patients admitted with pneumothorax: a multi-centre study of the practice and outcomes in Hong Kong.

OBJECTIVE: To examine the management practice of pneumothorax in hospitalised patients in Hong Kong, especially the choice of drainage options and their success rates, as well as the factors associated with procedural failures. DESIGN: Retrospective study. SETTING: Multi-centre study involving 12 public hospitals in Hong Kong. PATIENTS: All adult patients admitted as an emergency in the year 2004 with a discharge diagnosis of 'pneumothorax' were included. Data on the management and outcomes of the various types of pneumothoraces were collected from their case records. RESULTS: Altogether these patients had 1091 episodes (476 primary spontaneous pneumothoraces, 483 secondary spontaneous pneumothoraces, 87 iatrogenic pneumothoraces, and 45 traumatic pneumothoraces). Conservative treatment was offered in 182 (17%) episodes, which were more common among patients with small primary spontaneous pneumothoraces (71%). Simple aspiration was performed to treat 122 (11%) of such episodes, and had a success rate of 15%. Aspiration failure was associated with having a pneumothorax of size 2 cm or larger (odds ratio=3.7; 95% confidence interval, 1.2-11.5; P=0.03) and a smoking history (4.1; 1.2-14.3; P=0.03). Intercostal tube drainage was employed in 890 (82%) episodes, with a success rate of 77%. Failure of intercostal tube drainage was associated with application of suction (odds ratio=4.1; 95% confidence interval, 2.8-5.9; P<0.001) and presence of any tube complications (1.55; 1.0-2.3; P=0.03). Small-bore catheters (<14 French) were used in 12 (1%) of the episodes only. Tube complications were encountered in 214 (24%) episodes. CONCLUSION: Notwithstanding recommendations from international guidelines, simple aspiration and intercostal tube drainage with small-bore catheters were not commonly employed in the management of hospitalised patients with the various types of pneumothoraces in Hong Kong.

Characteristics of false-negative ThinPrep cervical smears in women with high-grade squamous intraepithelial lesions.

OBJECTIVE: To examine the cellular characteristics and other possible factors affecting the correct prediction of ThinPrep cervical smears from patients with high-grade squamous intraepithelial lesions. DESIGN: Retrospective study. SETTING: Private anatomical pathology service, Hong Kong. PATIENTS: Patients (n=98) with biopsy-confirmed high-grade squamous intraepithelial lesion of the uterine cervix encountered between 2004 and 2006. MAIN OUTCOME MEASURES: Correct prediction of the cervical ThinPrep Papanicolaou tests. RESULTS: There were no significant differences in age, hormonal status, degree of inflammation, and the presence or absence of endocervical/metaplastic cells between the true-positive and false-negative groups. There was a significant difference in the number of abnormal cells present and the screening time between the two groups. Approximately 79% (34/43) false-negative smears had 100 or less abnormal cells, while only 11% (5/45) true-positive smears had 100 or less abnormal cells (P<0.001). The true-positive smears were also more likely to contain koilocytic cells and abnormal cells with hyperchromatic nuclei. CONCLUSIONS: The number of abnormal cells present, the presence or absence of koilocytic cells, and the presence or absence of abnormal cells with nuclear hyperchromasia appeared to be independent factors affecting the correct prediction of smears from patients with high-grade squamous intraepithelial lesions.

Breakage of intramedullary femoral guide rod during total knee arthroplasty: a case report.

We report a rare complication during primary total knee arthroplasty. An intramedullary femoral guide rod was broken during insertion. The broken part jammed into the isthmus of the femur. An initial attempt to push the broken rod via the proximal femur by a guide wire to the distal femur was unsuccessful because the broken rod was lodged in the isthmus. Ultimately, the isthmus was opened using a flexible 9-mm end-cutting reamer, and the broken rod was pushed down to the distal femoral entry site in an antegrade fashion under image intensification. Selecting a more medial entry site on the intercondylar notch with a smaller valgus cutting angle and using a shorter guide rod can avoid such a breakage.

Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study.

PURPOSE: To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty--a procedure associated with significant postoperative blood loss. METHODS: Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n = 26) or a control group (n = 34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery. RESULTS: There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p = 0.022). CONCLUSION: Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences.

OBJECTIVE: To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003. MAIN OUTCOME MEASURES: Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed. RESULTS: A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted. CONCLUSION: All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Reliability of Hong Kong Chinese version of the Patient-rated Forearm Evaluation Questionnaire for lateral epicondylitis.

OBJECTIVE: To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese. DESIGN: Cross-sectional study. SETTING: District hospital, Hong Kong. PATIENTS: Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows). MAIN OUTCOME MEASURES: Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength. RESULT: The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman's rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01). CONCLUSION: The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.

The shape and size of femoral components in revision total hip arthroplasty among Chinese patients.

OBJECTIVE: 39 sets of preoperative hip X-rays were studied to find out whether Chinese patients need revision femoral components with a different shape and size from western patients. METHODS: From July 1998 to June 2001, the pre-revision X-rays of 39 revision total hip replacements among 38 Chinese patients (21 men and 17 women) were studied. The component size that produced the best distal canal-filling in the anteroposterior X-ray was determined by using templates of 200-mm femoral components used commonly for Caucasian patients. RESULTS: The diameter of the component needed was 13.5 mm or less in 54% of cases, compared with only 17% for Caucasian patients as reported in the literature (p<0.01). When lateral templates of the corresponding size were put over the lateral X-rays, the anterior cortex of the 200-mm straight stem was shown to have thinned by 2.0 mm or more in 36% of hips; for 200-mm bowed stem, there was thinning of the anterior cortex by 2.0 mm or more in only 5% of hips (p<0.01). CONCLUSION: Chinese patients are likely to need smaller femoral components than Caucasian patients, and may benefit from bowed-stem components in femoral revision.

Inhomogeneous optical coatings: an experimental study of a new approach.

Inhomogeneous optical interference coatings offer a potentially superior alternative to their multilayer counterparts in meeting rigid performance requirements. However, their development has been severely hampered by the lack of appropriate design software and process control hardware. The work reported in this paper involved the experimental design and fabrication of a number of inhomogeneous coatings, and some interesting results were obtained. Using customized algorithms and simultaneous codeposition techniques, an inhomogeneous antireflection coating based on germanium and thorium fluoride has been successfully produced. Attempts with other materials such as zinc sulfide were less successful because of discrepancies between predicted and actual deposition rates, and further studies are being conducted.

Roller skating--is it a dangerous sport?

A prospective survey of 111 cases of roller skating injuries within one year are reported. Males were more commonly injured than females. There was a high incidence (86%) of serious injuries, 28% of which required surgical treatment. The wrist (23%) was the commonest region involved, followed by the shoulder (20%), the elbow (15%) and the ankle (12%). Collision with other skaters and loss of control were the main factors leading to injury. Better rink discipline, instruction classes and safety publicity should be helpful in minimising accidents.

Late subcapital fracture of the neck of the femur--a rare complication of Ender nailing.

This appears to be the first report of a late subcapital fracture of the femoral neck after Ender nailing. The contributing factors are stress concentration and osteomalacia. The understanding of this late complication is helpful to the use of Ender nail in stable fixation of selected cases of trochanteric fractures.

The place of the dynamic compression plate in femoral shaft fractures.

A retrospective study of 32 adult patients with fractures of the femoral shaft treated with the AO dynamic compression plate in one centre was carried out. Pathological fractures, transverse and short oblique fractures in the middle third of the femur were excluded from this study. The average follow-up was 3.5 years. The complications were failure of the implant in 6.3 per cent of cases, loosened screws in 3 per cent, refracture in 3 per cent and non-union in 3 per cent. No instance of deep infection was encountered. The average time taken for union was 5.5 months. The overall objective assessment showed excellent or good results in 90.6 per cent of cases. There is a definite place for the AO dynamic compression plate in well-selected cases of fracture of the femoral shaft, provided that close attention to technical details is observed. Timing of the operation and the postoperative care also affect the results.

Closed medullary nailing for fractured shaft of the femur--a comparison between the Küntscher and the AO techniques.

A retrospective review was made of 97 cases of fractured shaft of the femur treated with closed medullary nailing. A comparison was made between the Küntscher and the AO techniques with respect to union of the fracture, rehabilitation, complication and functional results. Patients treated with AO nails enjoyed more rapid recovery: 88 per cent of the fractures united in 12 weeks, 62 per cent walked with full weight bearing in 8 weeks and 78 per cent returned to work within 6 months. However, the functional results in both groups were comparable. The special technical considerations and complications in each group are discussed.