In addition to the usual complications there were two cases of early pulmonary tuberculosis and one rare case of delayed fungal sternotomy infection. The 1-year, 3-year and 5-year survival rates were 100%, 100% and 76.2%, respectively. All fatalities were related to the consequences of chronic rejection or its treatment. Conclusions: Despite the limited experience and the small case volume, the survival of patients was good and comparable with international experience.
Two ladies with history of carcinoma of tongue presenting with un-resolving pneumonia were ultimately diagnosed to have lipoid pneumonia, and both were subsequently found to be associated with the practice of oil pulling which is a popular complementary therapy. Apart from cessation of oil pulling, they were treated with repeated therapeutic lobar broncho-alveolar lavage. despite the potential benefits of oil pulling on oral health, people especially those at risk of aspiration, should be properly informed of this potential risk when considering this form of complementary therapy.
Clinical lung transplant was first performed in Hong Kong in 1995. In the early years, the volume of activity was very low. There has been a clear trend of increasing volume in the past few years. The recipient pathology is very different from the International Society for Heart and Lung Transplantation (ISHLT) database, with complete absence of cystic fibrosis and alpha-1-antitrypsin deficiency, and a predominance of diseases of the pulmonary circulation. Lymphangioleiomyomatosis (LAM) has a much higher representation on the waiting list than the ISHLT. The survival of patients who received a lung transplant in Hong Kong compares favorably with international data.
Two cases of a rare and uncommonly described form of Aspergillus lung disease were diagnosed from incidental CXR abnormalities. This strange presentation has been described in the literature as 'tumour-like blocked pulmonary cavities with liquid content infected by aspergilli'. The details of these two cases are reported together with a discussion of the diagnostic features of the disease and its position in the spectrum of pulmonary diseases caused by Aspergillus.
A 79 year-old patient with lung cancer underwent a standard thoracotomy and lobectomy. Postoperatively, he developed low-grade fever and dyspnoea. Chest X-rays showed progressive lung infiltrates, which was subsequently diagnosed to be Bronchiolitis Obliterans Organizing Pneumonia (BOOP) by transbronchial lung biopsy. He responded well to corticosteroid therapy. The case report is followed by a brief discussion on BOOP in association with lung cancer and thoracotomy.
Severe pulmonary hypertension (PH) is not common even in patients with severe chronic lung disease (CLD) but data on hemodynamic characteristics among patients with severe CLD is scarce. All adult patients who had right heart catheterization for lung transplant assessment for severe CLD in the only lung transplant service and for PAH management in the only tertiary pulmonary hypertension service in Hong Kong from 2010 to 2020 were included and classified into CLD group and PAH group. Patient characteristics and hemodynamic parameters were analyzed. There were 153 patients included with 106 patients in the CLD group and 47 in the PAH group. There were only 19.8% of the patients in the CLD group had severe pulmonary hypertension. Patients in the CLD group had significantly lower systolic pulmonary arterial pressure (PAPs), lower mean pulmonary arterial pressure (PAPm), higher cardiac index, and lower PVR when compared with the PAH group (
p
< 0.001). The area under curve (AUC) of PAPs, PAPm, and PVR were excellent, 0.973, 0.970, and 0.938, respectively for discrimination between CLD and PAH on receiver operator characteristics curve analysis. Optimal cutoff values were 55.5 mmHg, 35.5 mmHg, and 6.1 Wood Units for PAPs, PAPm, and PVR with Youden Index 0.85, 0.80, and 0.82, respectively. There were distinct hemodynamic characteristics between the CLD group and the PAH group. Systolic pulmonary arterial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance are useful to discriminate between the phenotype of severe CLD and PAH.
Both were licensed for oncology indications. These agents have received generally positive HTA appraisals: SMC have accepted both (Xofigo® conditional on a Patient Access Scheme [PAS]) and NICE recommended both (conditional on PAS; Xofigo® received an 'optimized' recommendation). G-BA deemed Xofigo® offered a 'considerable' additional benefit in one population and Lutathera® received automatic additional benefit as an orphan drug. Lutathera® attained ASMR III by HAS and the only identified negative HTA outcome was that by HAS of Xofigo® (ASMR IV). The ICER body had not evaluated either radiopharmaceutical. The mean time from EC-approval to positive HTA decision was 182.8 days. Conclusions: The limited number of therapeutic radiopharmaceuticals available have achieved broad and rapid reimbursement in major European markets. Their additional handling, manufacturing and storage costs have not outweighed the value of their patient benefits.
Lung transplantation in Hong Kong: history and settingLike many western countries, organ transplant in Hong Kong is regulated under the Ordinance which, inter alia, prohibits commercial dealings in human organs intended for transplanting and restricts the transplanting of imported organs. Currently, all cadaveric organ transplants are from brain-death donors. The cadaveric organ donation and transplant are coordinated under the Hospital Authority, which is a government funded public body responsible for all public hospital medical services. An opt-in system is
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