It is an honour to have been asked to write the foreword to this textbook. Editors and authors of textbooks, primarily directed at the undergraduate student, are all too conscious of the fact that the final version may not travel well from its country of origin. There may be a failure to take account of the geographical variation in incidence of certain diseases or to cover those diseases which are peculiar to or endemic in other parts of the world. The good teacher in Western medical schools may remind the students that, on a worldwide basis, schistosomiasis and not cirrhosis...

Viral hepatitis caused by Hepatovirus remains a significant public health problem in Hong Kong as an important source of morbidity and mortality. The genus Hepatovirus, of which types A, B, C, D and E have been characterized, comprises a group of structurally unrelated, pathogenic human hepatotropic viruses that share the unique property of targeting for hepatocytes producing a diffuse necroinflammatory disease of the liver. Humans appear to be the major natural host although infection of subhuman primates (e.g. chimpanzees and marmosets) has been accomplished experimentally. Acute hepatitides due to other viruses (Table 1.1) are relatively uncommon and are not discussed...

Recurrent pyogenic cholangitis (RPC), as its name implies, is characterized by repeated episodes of bacterial infection of the biliary tract, resulting in attacks of the clinical triad of fever, biliary pain and obstructive jaundice. It is a distinct clinicopathological syndrome of pyogenic cholangitis with primary hepatolithiasis, i.e. stone formation originating in the intrahepatic bile ducts without functional or organic extrahepatic bile duct obstruction. Contrary to bacterial cholangitis in the West, which is most commonly secondary to biliary obstruction complicating gallbladder stones, RPC in the Orient is a primary cholangitis not aetiologically related to gallbladder stone and extrahepatic biliary obstruction. It...

Hong Kong is a fast-paced society which has undergone rapid changes — particularly in the last 30 years — in population, living standards and standards of medical care. Along with this there has been a rapid decline in some diseases, particularly infectious diseases which had been the leading causes of death in the first half of this century. Cardiovascular and cerebrovascular diseases are now the second and third leading causes of death respectively behind malignant disease. The evolution of this process will be discussed in the ensuing paragraphs, with, in the case of cardiovascular disease, particular reference to ischaemic heart...

Cerebrovascular disease (CVD) is at present the third top killer in Hong Kong. The crude mortality has risen from 44.2/100 000 population in 1961 to peak at 67.6/100 000 population in 1980, and then there has been a gradual downward trend, but still higher than the 1961 figures (Fig. 4.1). However, when we look at the age specific mortality, the general trend is a substantial decline in mortality in all ages. The decline is especially obvious in those above 65 years of age, with a brief upward surge around 1980. As cerebrovascular disease mainly affects the older population, on comparing...

Anaemia is a major health problem in Southeast Asia. The most common type is iron deficiency anaemia which is particularly prevalent in the rural poor in many countries due to poor nutrition, endemic malaria, parasitic infestation and multiparity. These predisposing factors are uncommon in Hong Kong due to the high socioeconomic status and the provision of excellent maternal and child care in the territory. Nevertheless iron deficiency anaemia remains the most common cause of anaemia in Hong Kong due to menorrhagia, bleeding from gastrointestinal sites and in the growing child and the elderly. Among other causes of anaemia are two...

Systemic lupus erythematosus (SLE) is a chronic systemic inflammatory disease associated with the production of various autoantibodies that are important for its diagnosis. Some of these autoantibodies also appear to be responsible for the clinical manifestations. The disease course is characterized by alternating exacerbations and remissions with multiple organ involvement occurring during periods of disease activity. The disease is seldom cured although some patients may have prolonged periods of quiescence. Because of its relatively high incidence in many countries and the troublesome morbidity, SLE has become one of the most important connective tissue diseases.

Patients with SLE have been reported...

Glomerular diseases are important causes of end stage renal failure. This chapter describes the current classification of glomerular diseases and the pattern of occurrence in Hong Kong based on recent local data. Particular emphasis is put on the clinico-pathologic correlation of glomerular diseases.

The clinical effects of glomerular injury are either caused by the loss of selective permeability of the normal glomerular capillaries or a decrease in glomerular filtration rate. Patients suffering from glomerular diseases usually present with one of the following.

1. Persistent urinary abnormalities, namely microscopic haematuria and significant proteinuria. These abnormalities are often incidentally picked up when the...

Epidemiology of neoplasia in a geographic location is a broad subject that is impossible to cover in a few pages. One of the reasons is that neoplasia is a collective term for many distinct diseases. Of the most frequent neoplasia in Hong Kong, some are particularly more common locally than elsewhere (e.g. oesophageal, nasopharyngeal and hepatocellular carcinomas) and they are dealt with in separate chapters. The other frequent tumours like bronchogenic, colorectal, breast and uterine carcinomas appear to parallel the epidemiological characteristics of similar tumours elsewhere, although there are minor differences between the local and world data. A bird-eye‘s view...

Primary tumours of the liver can be classified into (a) epithelial and (b) non-epithelial. For epithelial tumours, benign lesions are rare and include liver cell adenoma, bile duct adenoma and bile duct cystadenoma. The malignant tumours are the most common of all primary liver tumours and consist of hepatocellular carcinoma (HCC) and cholangio-carcinoma (CC). Bile duct cystadenocarcinoma and hepatoblastoma are rare. For non-epithelial tumours, haemangioma is remarkably common and its malignant counterpart, haemangiosarcoma, is extremely rare.

HCC is one of the most common cancers in the world, with an incidence or 1 million cases annually, according to the World Health...

The term nasopharyngeal carcinoma (NPC),used in the broadest sense, applies to all carcinomas arising in the nasopharynx. For the purposes of this review, the malignant tumours arising from minor salivary glands, adenocarcinomas, neuroendocrine carcinomas and small cell carcinomas are not included but attention will be given to the carcinomas arising from the mucosal epithelial cells lining the nasopharynx. In 1991/1992 this malignancy constituted the fourth most common neoplasm in Hong Kong with men affected three times more frequently than women. In the Chinese population there is an increasing incidence from the second decade of life and the peak incidence occurs...

Cancer of the oesophagus is the seventh most common tumour in the world (in the year of 1980), with the incidence rising in many regions in recent years, especially among the blacks in the United States, in England and France. However, a peculiar incidence pattern exists worldwide with roughly 500-fold difference in rate between the highest and lowest risk areas. For example, oesophageal cancer is a relatively uncommon neoplasm in western countries but is much more prevalent in the Chinese population, including those in China. Singapore and Hong Kong (Table 11.1). In China, The highest incidence of oesophageal cancer is...

Malignant lymphomas are a group of solid tumours derived from neoplastic growth of lymphocytes and their progenitors. They may occur in the specialized lymphoid organs or at any other site of the body. They are the most common type of neoplasia of non-epithelial origin. In Hong Kong in 1990, lymphomas ranked as the 10th most common neoplasm. This ranking is similar to that in the UK. Every year, about 400-500 new cases are diagnosed locally. There is ample evidence that the incidence of lymphomas is increasing worldwide.

Just as there is a high degree of diversity in lymphocytes so there...

Gestational trophoblastic disease (GTD) is a disease of the trophoblastic tissue and includes hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumour. These lesions are unique, since they can be considered as allografts arising from a conceptus that invade the maternal tissues. Significant differences in the morphology and clinical behaviour have been documented in these closely related entities. Some of these lesions are definitely neoplastic, while some may just be abnormal placentas that are prone to malignant transformation. Recent cytogenetic, immunohistochemical and molecular studies have revealed valuable findings. Since the incidence of hydatidiform moles and choriocarcinomas are higher in...