Knowledge and attitude regarding organ donation among medical students in Hong Kong: a cross-sectional study.

OBJECTIVES: The rate of organ donation in Hong Kong is among the lowest in developed regions. Since medical students will play an important role in counselling patients for organ donation and identifying potential donors in the future, their knowledge, attitudes and action for organ donation are important. This study aims to understand knowledge, attitudes and actions with regard to organ donation among medical students and investigate the factors determining the knowledge and attitudes. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: Medical students in Hong Kong were invited to complete a questionnaire. 377 medical students participated in the study. METHODS: The questionnaire assessed their attitudes, knowledge, action of organ donation, belief and perception on organ donation, and other factors. Linear regression analyses and logistic regression were performed to analyse the effect of the variables on knowledge, attitudes and action for organ donation. RESULTS: Almost all medical students (99.5%) held a positive attitude towards organ donation, but only 28.1% have signed up as organ donors. Determinants of knowledge of organ donation included belief in preservation of intact body after death (ß = -0.14, 95% CI = -0.24 to -0.04) and perceived confidence and competence of organ donation discussion (ß = -0.12, 95% CI = -0.22 to -0.02). Predictors of organ donor registration status included knowledge of organ donation (OR=1.03, 95% CI=1.00 to 1.06), perceived convenience of organ donation registration (OR=3.75, 95% CI=1.62 to 8.71), commitment to organ donation (OR=3.81, 95% CI=2.01 to 7.21) and exposure to organ donation (OR=4.28, 95% CI=2.37 to 7.74). CONCLUSIONS: Knowledge is positively associated with organ donation action. The above determinants of organ donation could be emphasised in medical education.

Association of clinicopathological features and prognosis of TERT alterations in phyllodes tumor of breast.

Phyllodes tumor (PT) of the breast is a rare but clinically important fibroepithelial tumor with potential risks of recurrence and metastasis. Recent studies identified recurrent TERT promoter mutations in PTs. However, the clinical significance of this alteration has not been fully examined. Two hundred and seven PTs from two intuitions were included. All cases were subjected to immunohistochemical analysis for TERT expression. Analysis of TERT promoter mutations was further performed by Sanger sequencing targeting the hotspot mutation region on cases from one of the involved institutions. The expression of TERT was correlated with clinicopathologic features, mutation status and recurrence. There was an association of TERT expression and its promoter mutation. Both stromal TERT expression and its promoter mutation correlated with PT grading and older patient age. Recurrence free survival (RFS) of PT patients with high stromal TERT expression was shorter if the excision margin was positive. Our findings suggested a possible pathogenic role of TERT alteration in PT malignancy. Currently there is no consensus for re-excision for PT patients with positive surgical margin, particularly for low grade cases. Stromal TERT expression could be potentially useful to guide management patients with benign PTs.

Auditory brainstem implantation improves speech recognition in neurofibromatosis type II patients.

This prospective study aimed to determine speech understanding in neurofibromatosis type II (NF2) patients following implantation of a MED-EL COMBI 40+ auditory brainstem implant (ABI). Patients (n = 32) were enrolled postsurgically. Nonauditory side effects were evaluated at fitting and audiological performance was determined using the Sound Effects Recognition Test (SERT), Monosyllable-Trochee-Polysyllable (MTP) test and open-set sentence tests. Subjective benefits were determined by questionnaire. ABI activation was documented in 27 patients, 2 patients were too ill for testing and 3 patients were without any auditory perception. SERT and MTP outcomes under auditory-only conditions improved significantly between first fitting and 12-month follow-up. Open-set sentence recognition improved from 5% at first fitting to 37% after 12 months. The number of active electrodes had no significant effect on performance. All questionnaire respondents were 'satisfied' to 'very satisfied' with their ABI. An ABI is an effective treatment option in NF2 patients with the potential to provide open-set speech recognition and subjective benefits. To our knowledge, the data presented herein is exceptional in terms of the open-set speech perception achieved in NF2 patients.

Prevalence of pH-documented laryngopharyngeal reflux in Chinese patients with clinically suspected reflux laryngitis.

PURPOSE: Laryngopharyngeal reflux (LPR) is one of the main factors behind different laryngeal pathology according to the Western literature. Literature reported that the prevalence of gastroesophageal reflux disease (GERD) in Chinese population was considerably lower than that in Western countries. To date, however, there is no study to evaluate the prevalence of pH-documented LPR in the Chinese ethnicity. MATERIALS AND METHODS: We thus recruited 28 consecutive Chinese patients with reflux symptoms including globus, throat discomfort, throat clearing, chronic cough, or burping lasting more than 1 month in the preceding 1 year, together with stroboscopic evidence suggestive of reflux laryngitis according to the reflux finding score in our study. All patients underwent thorough head and neck examination and transnasal endoscopic assessment. The prevalence of pH-documented LPR and GERD was then documented using ambulatory 24-hour pH biprobe study. RESULTS: Six (21%) of the 28 patients had pH-documented LPR. Four (14%) of the 28 patients had GERD with 3 of them having concomitant LPR. Only burping was associated with pH-documented LPR (P < .05). No relationship was observed between pH-documented LPR and other factors, including age, sex, other reflux symptoms except burping, and the reflux finding score. CONCLUSION: Chinese patients do have and present with symptoms of extraesophageal reflux, and we observed a lower prevalence of pH-documented LPR in Chinese patients with clinically suspected reflux laryngitis compared with white patients.

Short electrode insertion in cochlear implantation: speech perception performance of Cantonese-speaking subjects.

CONCLUSIONS: Subjects with cochlear ossification derived benefits in terms of speech performance similar to those of the non-ossified group. It is thus recommended that the insertion of short electrode arrays should be considered an alternative choice for patients with cochlear ossification. OBJECTIVE: Cochlear ossification has been recognized as a major obstacle to the full insertion of a multichannel cochlear implant electrode array. To alleviate the technical difficulty of placing a standard electrode array and the possibility of causing undesirable trauma to the cochlea, a newly designed electrode array with the same number of electrodes compressed into a shorter length has been made available. The aim of the present study was to examine the speech perception performance of patients implanted with the MED-EL C40+S compressed electrode array and to compare their results with those of matched groups implanted with the MED-EL C40+standard electrode array. MATERIAL AND METHODS: One pre-lingually and two post-lingually deaf subjects using short electrode arrays were matched with three groups of subjects using standard electrode arrays. The pre- and postoperative speech perception scores were evaluated. RESULTS: All three subjects using compressed electrode arrays achieved speech perception scores comparable to those of matched subjects using standard electrode arrays. There was also a tendency for the subjects to show similar patterns of speech perception scores as a function of the difficulty of the tests.

[Auditory brainstem implantation in patient with bilateral acoustic neuromas].

OBJECTIVE: To restore auditory sensation for patient suffering loss of hearing due to bilateral acoustic neuromas. METHOD: One patient of bilateral acoustic neuromas received auditory brainstem implant (ABI) at the same surgery for resection of the second tumor. The retrosigmoid approach was used for resection of the tumor and to exposure the lateral recess of the fourth ventricle for placement of ABI electrode array. Intraoperative 7th and 9th nerves monitoring and electrically evoked auditory brainstem responses (EABR) were recorded to localize the placement of ABI electrode array. RESULT: Initial ABI switch-on was performed eight weeks after the surgery under close monitoring of vital signs. Auditory sensation was perceived on stimulation of all channels. CONCLUSION: The multichannel ABI could effectively restore auditory sensation for patient deafened by bilateral acoustic neuromas. The accurate location of the cochlear complex during surgery was the critical factor for success of ABI.

ENT management of a child with CHARGE association.

The acronym CHARGE is used to describe specific congenital birth defects in children: colobomata, heart defect, atresia of the choanae, retarded growth or development, genital hypoplasia, and ear anomalies or deafness. CHARGE association with hearing impairment is a challenge to ENT surgeons. We report the case of a child with CHARGE association who underwent cochlear implantation using an unconventional surgical approach and review the postoperative speech perception results. The benefits of cochlear implantation in children with multiple congenital defects are discussed.

A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy.

BACKGROUND: Earlier reports of the advantages of preservating the posterior branches of the great auricular nerve (GAN) at parotidectomy were conflicting. This prospective study was aimed at clarifying the controversy. METHODS: Eighty-one patients in a university otolaryngology department were recruited. The posterior branches were preserved whenever initial dissection showed that tumor clearance would not be compromised. Touch-pressure sensation was monitored in predefined territories supplied by the GAN using a Semmes-Weinstein aesthesiometer, preoperatively and postoperatively. Minimal pressure thresholds obtained were compared between the two groups. RESULTS: Preservation of the GAN was achievable in 69% of patients; sensory deficit was transient. With the GAN divided, measurable sensory depression occurred up to 2 years after surgery. The difference is statistically significant. Patients' subjective assessment of numbness also conformed to these trends. Additional time taken for preservation of the GAN was about 10 minutes. CONCLUSIONS: The posterior branches should always be preserved if tumor clearance is not compromised.

Superiority of bilateral cochlear implantation over unilateral cochlear implantation in tone discrimination in chinese patients.

PURPOSE: The benefits of bilateral cochlear implants (CIs) versus unilateral CIs were evaluated by comparing the Cantonese lexical tone discrimination scores conducted in a quiet environment and against a background noise. MATERIALS AND METHODS: Four postlingually deafened Cantonese-speaking adults (2 men and 2 women) with bilateral CIs were included in this study. The subjects were their own control in the monaural hearing condition. Both the Cantonese lexical tone stimuli and the speech-weighted background noise were presented at 0(0) azimuth and at a distance of 1 m from the subject. The speech stimuli, which were maintained at 65 dB sound pressure level, were presented in both a quiet environment and against a background noise at signal to noise ratios (SNRs) of +15, +10, +5, 0, -5, -10, and -15. RESULTS: Against a background noise, the bilateral CIs required +5 dB SNR only to obtain significant scores in discriminating Cantonese lexical tones and to achieve discrimination scores that were comparable to the optimal discrimination scores obtained in quiet. No significant difference in the discrimination scores was observed between binaural and monaural hearing conditions when the tests were conducted in quiet. CONCLUSIONS: Our study showed that in the presence of background noise, bilateral CIs were better than unilateral CIs in discriminating Cantonese lexical tones.

[Radiological study of temporal bone in children with profound deafness before cochlear implant: CT vs magnetic resonance imaging].

OBJECTIVE: To evaluate the clinical application of magnetic resonance imaging (MRI) and CT in children with profound deafness before cochlear implant and their impact on surgical decision. METHODS: The pre-operative CT and MRI data from 71 children with bilateral profound deafness planned for cochlear implant were studied. RESULTS: 12 patients showed enlarged vestibular aqueduct (16.9%); 14 patients had Mondini malformation (19.7%); 3 patients demonstrated enlarged internal auditory meatus (4.2%); and 2 patients were suspected to have fistulae (2.8%) on both CT and MRI examinations. In comparison between MRI and CT, unilateral cochlear fibrosis was detected in 5 patients(7%) by MRI, but none by CT scans. Bilateral dehiscent facial nerve was detected in 1 patient(1.4%) by CT scan, while MRI was normal. CONCLUSION: CT and MRI are essential for the pre-operative planning of cochlear implant, especially in patients with enlarged vestibular aqueduct, Mondini malformation, enlarged internal auditory meatus and suspected fistulae. These two imaging modalities are complementary to each other in cases with cochlear fibrosis and facial nerve dehiscence.

Neurothekeoma of the paranasal sinuses in a 3-year-old boy.

Neurothekeoma is a benign soft tissue tumor commonly located on the skin. In this report, a 3-year-old boy presented with restricted right eye movement and decrease in visual acuity. The patient was found to have a 6-cm neurothekeoma involving the maxillary and ethmoid sinuses. To our knowledge, this is the first reported case of neurothekeoma with involvement of the maxillary and ethmoid sinuses. This uncommon lesion should be considered as the differential diagnosis of pediatric soft tissue tumors in the head and neck region.