Thesis (M. Phil.)--University of Hong Kong, 1983.

Based on figure from American Association for Cancer Research (2010) & Global Cancer Statistics (2011), Liver cancer (HCC) is the sixth most frequently diagnosed cancer globally and third leading cause of cancer death (Jemal, A. et al., 2011; Jemal, A., Center, M. M., DeSantis, C. et al., 2010). In Hong Kong, Liver Cancer caused 1488 deaths in 2009 in total; it is 2nd and 4th leading killer of cancer death among Hong Kong male and female respectively (Hong Kong Cancer Registry, 2010). However, surgical resection for HCC remains as mainstream treatment modality and extensive studies on post-operative surgical outcomes for different HCC treatment modalities have been published. Nevertheless, the influence of kidney function on surgical outcomes on HCC patient stays novel and it emerges a need to explore on the relation. This study aims to compare the surgical outcomes of post hepatectomy HCC patients between reduced kidney function and normal kidney function in terms of (1) Length of hospital stay, (2) Survival rate, (3) Hospital Mortality and (4) Overall post operative complications. The kidney function can be reflected by the glomerular filtration rate (Thomas, R., Stanley, B. & Datta, S., 2007; Daugirdas, J. T., 2011). The direct measurement of GFR is a complicated and expensive procedure, which is not clinical possible to screen every patient. Thus this study adopted modified Cockcroft- Gault (CG) Formula, one type of creatinine based glomerular filtration rate estimation formulas with normalization to body surface area. Modified CG formula calculate the estimated glomerular filtration rate (eGFR) based on age, body weight, body height, gender and serum creatinine level (Himmelfarb, J. & Sayegh, M. H., 2010; Daugirdas, J. T., 2011; Joanna, Q. H. & Heather A. N., 2011). The eGFR of 452 HCC patients with major hepatectomy was evaluated and categorized into different kidney function groups according to the chronic kidney disease staging system suggested by K/DOQI, National Kidney Foundation. Hence, the surgical outcomes from different kidney function groups are analyzed and compared. Length of hospital stay was analyzed by Kruskal-Wallis Test. Hospital mortality and incidences of post-op complication are analyzed by Chi-square test. Lastly, the survival rate is analyzed by Kaplan-Meier Log rank test; the result is presented in form of survival curve, then 5-year survival rate of different group of samples are obtained and compared. Result of the study shows no evidence that patients with chronic kidney disease will have a longer hospital stay and more prone to surgical complications post operatively. However, it is indicated that the hospital mortality is associated with the severity of kidney function reduction and suggested that patients with chronic kidney disease are at higher risk of post-operative death than those with normal kidney. Patient with severe reduction of kidney function should be aware of high foreseeable chance of death after the surgery and special caution need to be taken. Surprisingly, the result revealed that the overall survival improves with the severity of kidney function reduction and the patients with worse kidney function are more likely to have a better survival. Nevertheless, the result on survival rate suspected to be biased by possible confounders and underlying co-morbidities of samples. In conclusion, eGFR formula is recommended in clinical estimation of kidney function for the patients. Also, it is suggested that HCC patients with reduced kidney function are more susceptible to hospital death after hepatectomy than normal individuals. Thus, cautious consideration and risk analysis before operation is particularly crucial for HCC patient with chronic kidney disease. / published_or_final_version / Medicine / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Doctor of Medicine

published_or_final_version / abstract / toc / Surgery / Master / Master of Philosophy

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L-carnitine is an endogenous compound that has important roles in fatty acid oxidation. Patients with end-stage renal disease (ESRD) who are undergoing haemodialysis may develop a secondary L-carnitine deficiency. Following oral administration of L-carnitine, enterobacteria generate ??-butyrobetaine and trimethylamine with the latter substance extensively N-oxygenated in the liver, to form trimethylamine-N-oxide. Given that patients with ESRD have qualitatively different and higher bacterial populations in the small intestine as compared with healthy subjects, increased formation of trimethylamine and accumulation of trimethylamine-N-oxide would be expected. The clinical significance of these amines is related to their potential to form the carcinogen N-nitrosodimethylamine, contribution to neurological toxicity and "uraemic breath". / The pharmacokinetics of oral L-carnitine display clear non-linearity above a dose of 0.5 g three times a day with an associated increase in plasma concentrations of trimethylamine and trimethylamine-N-oxide. Oral administration of L-carnitine to patients with ESRD undergoing haemodialysis increased plasma concentrations of this substance to levels seen in individuals with normal kidney function and evidence was provided for the accumulation of trimethylamine-N-oxide. / Thesis (PhD)--University of South Australia, 2006.

Thesis (M Nursing (Advanced Practice))--University of South Australia, 1996

Erratum is pasted on back end paper. / Bibliography: leaves 231-268. / xv, 268 leaves : ill. (chiefly col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis examines the expression of cell adhesion molecules on both endothelial cells (ECs) and circulating leukocytes, and investigates the role of these molecules in renal allograft rejection. The aims of the study are to establish an ovine model of renal allograft transplantation, to generate monoclonal antibodies (mAbs) against ovine endothelial cell adhesion molecules, to examine the efficacy of the mAbs in prolonging the survival of the sheep renal allografts and to study the kinetics of expression of cell adhesion molecules (CAMs) during cellular activation 'in vitro' and 'in vivo' during the onset of allograft rejection. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 1996

L-carnitine is an endogenous compound that has important roles in fatty acid oxidation. Patients with end-stage renal disease (ESRD) who are undergoing haemodialysis may develop a secondary L-carnitine deficiency. Following oral administration of L-carnitine, enterobacteria generate ??-butyrobetaine and trimethylamine with the latter substance extensively N-oxygenated in the liver, to form trimethylamine-N-oxide. Given that patients with ESRD have qualitatively different and higher bacterial populations in the small intestine as compared with healthy subjects, increased formation of trimethylamine and accumulation of trimethylamine-N-oxide would be expected. The clinical significance of these amines is related to their potential to form the carcinogen N-nitrosodimethylamine, contribution to neurological toxicity and "uraemic breath". / The pharmacokinetics of oral L-carnitine display clear non-linearity above a dose of 0.5 g three times a day with an associated increase in plasma concentrations of trimethylamine and trimethylamine-N-oxide. Oral administration of L-carnitine to patients with ESRD undergoing haemodialysis increased plasma concentrations of this substance to levels seen in individuals with normal kidney function and evidence was provided for the accumulation of trimethylamine-N-oxide. / Thesis (PhD)--University of South Australia, 2006.

Thesis (Ph.D.)-- University of Adelaide, Dept. of Pathology, 1981. / Photocopy (Vol. 1).