www.hkmacme.

org January 2018

B U L L E T I N
持 續 醫 學 進 修 專 訊

Haemorrhoids and anal Management of Malignant

fissure Pleural Effusion
Dr. Yee-Man LEE Dr. CHUI Wing Hung
Dr. Kin-Wah CHU
 Once-daily
TRESIBA ®

ULTRA-LONG
DURATION OF ACTION 3,4

Successful reductions in HbA1c1,2

Lower risk of nocturnal
hypoglycaemia versus glargine U1001,2*
Flexibility in day-to-day
dosing time when needed 3*
...delivered in a once-daily dose.

Abbreviated prescribing information * Applies to the adult population only

Tresiba® (insulin degludec) 100U (100 units/mL insulin solution for to be used for optimising glycaemic control. In elderly patients and patients with renal/ < 1/100); rare (≥ 1/10.000 to < 1/1.000); very rare (< 1/10.000); not known (cannot be
®
) Consult Summary of Product estimated from the available data). Very common: Hypoglycaemia. Common: Injection
Characteristics before prescribing.Presentation: Tresiba® FlexTouch®. All on an individual basis. Tresiba® ®
, designed to be site reactions. Uncommon: Lipodystrophy and peripheral oedema. Rare: Hypersensitivity
presentations contain insulin degludec. Tresiba® 100 units/mL – 1 mL of solution used with NovoFine®/NovoTwist® needles. Contraindications: Hypersensitivity to and urticaria. With insulin preparations, allergic reaction may occur; immediate-type
the active substance or any of the excipients. Special warnings and precautions: allergic reactions may potentially be life threatening. Injection site reactions are usually
contains 300 units of insulin degludec in 3 mL solution. Indications: Treatment of Too high insulin dose, omission of a meal or unplanned strenuous physical exercise mild, transitory and normally disappear during continued treatment.
diabetes mellitus in adults. Posology and administration: Tresiba® is a basal may lead to hypoglycaemia. Reduction of warning symptoms of hypoglycaemia may
insulin for once-daily subcutaneous administration at any time of the day, preferably be seen upon tightening control and also in patients with long-standing diabetes.
References: 1. Rodbard HW, et al. on behalf of the BEGIN Once Long Trial Investigators.
at the same time of day. On occasions when administration at the same time of the Administration of rapid-acting insulin recommended in situations with severe Comparison of insulin degludec with insulin glargine in insulin-naive subjects with Type 2
day is not possible, Tresiba® hyperglycaemia. Inadequate dosing and/or discontinuation of treatment in patients diabetes: a 2-year randomized, treat-to-target trial.DIABETIC Medicine 2013;30(11):1298–304.
A minimum of 8 hours between injections should be ensured. In patients with type requiring insulin may lead to hyperglycaemia and potentially to diabetic ketoacidosis. 2. Bode BW, et al. on behalf of the BEGIN Basal–Bolus Type 1 Trial Investigators. Insulin
2 diabetes mellitus, Tresiba® can be administered alone, in combination with oral Concomitant illness, especially infections, may lead to hyperglycaemia and thereby cause degludec improves glycaemic control with lower nocturnal hypoglycaemia risk than
anti-diabetic medicinal products as well as in combination with bolus insulin. In type 1 an increased insulin requirement. Transferring to a new type, brand or manufacturer insulin glargine in basal–bolus treatment with mealtime insulin aspart in Type 1 diabetes
diabetes mellitus, Tresiba® is to be used with short-/rapid-acting insulin. Administration of insulin should be done under strict medical supervision. When using insulin in (BEGIN Basal–Bolus Type 1): 2-year results of a randomized clinical trial. DIABETIC
Medicine 2013;30(11):1293–297. 3. Tresiba® Packing Insert. 4. Jonassen I, et al. Design of
by subcutaneous injection only. Tresiba® is available in 100 units/mL. For Tresiba® 100 combination with pioglitazone, patients should be observed for signs and symptoms the novel protraction mechanism of insulin degludec, an ultra-long-acting basal insulin.
units/mL a dose of 1–80 units per injection, in steps of 1 unit, can be administered. of heart failure, weight gain and oedema. Pioglitazone should be discontinued if any Pharmaceutical Research. 2012;29(8):2104-2114.
When initiating patients with type 2 diabetes mellitus the recommended daily starting deterioration in cardiac symptoms occurs. Patients must be instructed to always check
dose is 10 units. Transferring from other insulins; in type 2 diabetes changing the the insulin label before each injection to avoid accidental mix-ups between the two
basal insulin to Tresiba® can be done unit-to-unit, based on the previous basal insulin strengths of Tresiba® and other insulins. Hypoglycaemia may constitute a risk when
component; in type 1 diabetes the same applies apart from where transferring from driving or operating machinery. Pregnancy and lactation: There is no clinical
twice-daily basal insulin or patients with an HbA1c <8.0%, the Tresiba® dose needs experience with use of Tresiba® in pregnant women and during breastfeeding. Animal
to be determined on an individual basis with a dose reduction considered. Doses and reproduction studies with insulin degludec have not revealed any adverse effects on
timing of concomitant treatment may require adjustment. In all cases doses should be fertility. Undesirable effects: Refer to SmPC for complete information on side
adjusted based on individual patients’ needs; fasting plasma glucose is recommended effects. Very common (≥1/10); common (≥1/100 to < 1/10); uncommon (≥1/1.000 to

FlexTouch®, NovoFine®, NovoTwist®, and Tresiba® are registered trademarks of Novo Nordisk A/S.

At Novo Nordisk, we are changing diabetes. In our approach to developing treatments, in our commit-
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Further information is available from
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Unit 519, 5/F, Trade Square, 681 Cheung Sha Wan Road, Kowloon, Hong Kong
Tel: (852) 2387 8555 Fax: (852) 2386 0800 www.novonordisk.com
HKMA CME Bulletin
持續醫學進修專訊

Contents
Editorial 2
Spotlight 1 3
Haemorrhoids and
anal fissure
Spotlight 2 7
Management of Malignant
Pleural Effusion
Cardiology 9
A patient with acute limb swelling Spotlight 1
Dermatology 12 Haemorrhoids and
A Six-year-old child with multiple itchy anal fissure
papule on his trunk
Answer Sheet 13
CME Notifications 16
Meeting Highlights 19
CME Calendar 22

Spotlight 2
Management of Malignant
Pleural Effusion

HKMA CME Bulletin – MONTHLY SELF-STUDY

SERIES to help you grow!
Please read the following articles and answer the
questions. Participants in the HKMA CME Programme
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www.hkmacme.org)
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The Hong Kong Medical Association is dedicated to providing a coordinated CME
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 www.hkmacme.org January 2018

CME Bulletin & Online Editorial Board

EDITORIAL B U L
持 續 醫 學 進 修 專 訊
L E T I N

Chief Editor
Dr. WONG Bun Lap, Bernard 黃品立醫生

Executive Committee Happy New Year! Haemorrhoids and anal

fissure
Dr. Yee-Man LEE
Management of Malignant
Pleural Effusion
Dr. CHUI Wing Hung
Dr. Kin-Wah CHU

Dr. CHAN Yee Shing, Alvin 陳以誠醫生

Dr. CHENG Chi Man 鄭志文醫生 Happy New Year!
Dr. CHEUNG Hon Ming 張漢明醫生
Dr. CHOI Kin 蔡 堅醫生
Dr. HO Chung Ping, MH, JP 何仲平醫生 Happy learning!
Dr. HO Hung Kwong, Duncan 何鴻光醫生
Dr. LAM Tzit Yuen, David 林哲玄醫生 In 2018, we are facing some changes in CME activities. Some
Dr. LI Sum Wo, MH 李深和醫生
Dr. TSE Hung Hing, JP 謝鴻興醫生
of them are good, some are not as good. Among the better
Dr. WONG Bun Lap, Bernard 黃品立醫生 ones, we are working on a new mode of CME delivery. As you
may aware, for doctors who are not specialists, if they want to
attain the CME Certified status, they need to obtain 30 CME
points a year for 3 consecutive years. For the 30 CME points,
Cardiology Neurology
20 can be obtained via self-study, such as reading this Bulletin
Dr. CHEN Wai Hong 陳偉康醫生 Dr. FONG Chung Yan, Gardian 方頌恩醫生
Dr. HO Hung Kwong, Duncan 何鴻光醫生 Dr. TSANG Kin Lun, Alan 曾建倫醫生 and answering the assessment questions. For the remaining 10
Dr. LEE Pui Yin 李沛然醫生 points, you have to be physically present to attend lectures. That
Dr. LI Siu Lung, Steven 李少隆醫生 Neurosurgery would transcribe to 10 hours or 10 one-hour sessions. One of
Dr. WONG Bun Lap, Bernard 黃品立醫生 Dr. CHAN Ping Hon, Johnny 陳秉漢醫生
Dr. WONG Shou Pang, Alexander 王壽鵬醫生
the reasons for such arrangement is to have interactions and
Dr. WONG Wai Lun, Warren 黃煒倫醫生 Obstetrics and Gynaecology discussions for a topic studied.
Dr. CHAN Kit Sheung 陳潔霜醫生
Cardiothoracic Surgery However, insisting on the physical presence poses limitations to
Dr. CHENG Lik Cheung 鄭力翔醫生 Ophthalmology
Dr. CHIU Shui Wah, Clement 趙瑞華醫生 Dr. LIANG Chan Chung, Benedict 梁展聰醫生
CME activities in terms of costs and venues; and it also cause
Dr. CHUI Wing Hung 崔永雄醫生 Dr. PONG Chiu Fai, Jeffrey 龐朝輝醫生 inconvenience to doctors. We are now developing a new mode
Dr. LEUNG Siu Man, John 梁兆文醫生 of CME delivery which fits in the 10 points of attendance while
Orthopaedics and Traumatology
Colorectal Surgery
addressing the above limitations. In 2018, we shall launch on-
Dr. IP Wing Yuk, Josephine 葉永玉醫生
Dr. CHAN Cheung Wah 陳長華醫生 Dr. KONG Kam Fu 江金富醫生 line live CME by broadcasting CME lectures in real time via
Dr. LEE Yee Man 李綺雯醫生 Dr. POON Tak Lun 潘德鄰醫生 internet. Doctors can “attend” CME activities in their office and
Dr. TSE Tak Yin, Cyrus 謝得言醫生 Dr. TANG Yiu Kai 鄧耀楷醫生 join in the discussion sessions by posing questions on-line.
Dermatology Paediatrics
Dr. CHAN Hau Ngai, Kingsley 陳厚毅醫生 Dr. CHAN Yee Shing, Alvin 陳以誠醫生 Please look out for further announcement.
Dr. HAU Kwun Cheung 侯鈞翔醫生 Dr. FUNG Yee Leung, Wilson 馮宜亮醫生
Dr. TSE Hung Hing, JP 謝鴻興醫生 Dr. CHENG Chi Man
Endocrinology Dr. YEUNG Chiu Fat, Henry 楊超發醫生
Dr. LEE Ka Kui 李家駒醫生
Chairman, CME Organizing Sub-Committee
Dr. LO Kwok Wing, Matthew 盧國榮醫生 Plastic Surgeon
Dr. NG Wai Man, Raymond 吳偉民醫生
ENT
Dr. CHOW Chun Kuen 周振權醫生 Psychiatry
Dr. LAI Tai Sum, Tony 黎大森醫生
Family Medicine Dr. LEUNG Wai Ching 梁偉正醫生
Dr. LAM King Hei, Stanley 林敬熹醫生 Dr. WONG Yee Him, John 黃以謙醫生
Dr. LI Kwok Tung, Donald, SBS, JP 李國棟醫生
Radiology
Gastroenterologist Dr. CHAN Ka Fat, John 陳家發醫生
Dr. NG Fook Hong 吳福康醫生 Dr. CHAN Yip Fai, Ivan 陳業輝醫生

General Practice Respiratory Medicine

Dr. YAM Chun Yin 任俊彥醫生 Dr. LEUNG Chi Chiu 梁子超醫生
Dr. WONG Ka Chun 黃家進醫生
General Surgery Dr. YUNG Wai Ming, Miranda 容慧明醫生
Dr. LAM Tzit Yuen, David 林哲玄醫生
Dr. LEUNG Ka Lau 梁家騮醫生 Rheumatology
Dr. CHAN Tak Hin 陳德顯醫生
Geriatric Medicine Dr. CHEUNG Tak Cheong 張德昌醫生
Dr. KONG Ming Hei, Bernard 江明熙醫生
Dr. SHEA Tat Ming, Paul 佘達明醫生 Urology
Dr. CHEUNG Man Chiu 張文釗醫生
Haematology Dr. KWOK Ka Ki 郭家麒醫生
Dr. AU Wing Yan 區永仁醫生 Dr. KWOK Tin Fook 郭天福醫生
Dr. MAK Yiu Kwong, Vincent 麥耀光醫生
Vascular Surgery
Hepatobiliary Surgery Dr. TSE Cheuk Wa, Chad 謝卓華醫生
Dr. CHIK Hsia Ying, Barbara 戚夏穎醫生 Dr. YIEN Ling Chu, Reny 顏令朱醫生
Dr. LIU Chi Leung 廖子良醫生
HKMA Secretariat
Medical Oncology Ms. Jovi LAM 林偉珊女士
Dr. TSANG Wing Hang, Janice 曾詠恆醫生 Miss Alison HUI 許家欣小姐
Miss Irene GOT 葛樂詩小姐
Nephrology
Dr. CHAN Man Kam 陳文岩醫生
Dr. HO Chung Ping, MH, JP 何仲平醫生
Dr. HO Kai Leung, Kelvin 何繼良醫生

NOTICE
Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research
and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary
or appropriate. Readers are advised to check the most current product information provided by the manufacturer
of each drug to be administered to verify the recommended dose, the method and duration of administration, and
contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to
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Haemorrhoids and
anal fissure
Haemorrhoids:
Introduction
Haemorrhoids, also known as piles, develop from anal
cushions which normally play a role in stool control. 1 The
exact etiology of haemorrhoidal disease is unknown, factors
that increase abdominal pressure may increase the risk of
having haemorrhoids, these include constipation which leads
to straining, chronic diarrhea or frequent bowel motions, sit
on the toilet for long time and pregnancy.2,3 During pregnancy,
pressure from the fetus on the abdomen and hormonal
changes can cause congestion of the haemorrhoidal vessels,
spontaneous delivery of baby causes significant increase
in intra-abdominal pressure and straining, as a result, there
may be severe prolapse of haemorrhoids but most subside
quickly.4
Pathophysiology
Anal cushions are a part of normal anatomical structure
in the anal canal, there are three main cushions located
classically at left lateral, right anterior and right posterior
positions. 5,6 Imagine the patient in left lateral position, then
the three cushions sit at 3, 7 and 11 o’clock positions. They
are composed of sinusoids, connective tissue, and smooth
muscle. Sinusoids do not have muscle tissue in their walls and
this set of blood vessels is known as the hemorrhoidal plexus.
Anal cushions are important for continence as they contribute
15-20% of anal closure pressure at rest.7 Symptoms occur
when the cushions slide downwards or the venous pressure
increased excessively, clinically manifested as prolapse of
haemorrhoids and per rectal bleeding.8 There are two types
of hemorrhoids known as internal haemorrhoids which
develop from the superior hemorrhoidal plexus and external
haemorrhoids which develop from the inferior hemorrhoidal
plexus. 7 The terminology is confusing as the two types of
haemorrhoids are not really “in” or “out” of the anus, indeed
they are divided by the dentate line which is located at 1.5-
2cm from the anal opening.
www.hkmacme.org
SPOTlight-1
Dr. Yee-Man LEE Dr. Kin-Wah CHU
MBBS FRCS (Edin) MBBS FRCS (Edin)
FCHK FHKAM (Surgery) FCHK FHKAM (Surgery)
Specialist in General Surgery Specialist in General Surgery
Symptoms
Not all patients with haemorrhoids have symptoms. The
aggravating factors for attack include constipation, diarrhoea,
significant straining and consumption of spicy food. Unlike
colonic polyps, haemorrhoids will not turn into colorectal
cancers.
External haemorrhoids situate below the dentate line, they
are covered by anoderm and distally by perianal skin, therefore
they are more sensitive. 8 External haemorrhoids can bleed
but seldom profuse. One classical symptom is thrombosis
typically caused by straining, the patient presented with
sudden perianal swelling and marked
pain due to contained blood clots,
especially in the first 48 hours after
attack. The swelling then subsides
gradually and may leave a skin tag at
the anus. 7 Thrombosed haemorrhoid
cannot and should not be reduced,
attempt would only result in pain. Other
common complaints related to external
haemorrhoids include bleeding,
pruritus ani, swollen perianal skin tags
and difficulty in cleansing around the Thrombosed haemorrhoid
anus. with erosion
Internal haemorrhoids situate above the dentate line and
usually present with painless bright red rectal bleeding.9 They
are covered by columnar epithelium and lack of pain receptors.
Internal haemorrhoids can cause significant bleeding, some
patients may present with painless rectal bleeding for a few
days or up to a week and result in acute anaemia. According to
the severity of prolapse, it can be classified into four grades:1,5
Grade I: no prolapse, prominent vessels that can cause
bleeding
Grade II: prolapse after defecation, but can be spontaneously
reduced
Grade III: prolapse after defaecation and required manual
reduction
Grade IV: prolapse and cannot be reduced
Management
The management should be tailored to patient according to
their main symptoms and aggravating factors, not only the
severity of prolapse which may not cause any symptom.
HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 3
 SPOTlight-1

Conservative:

• Life style modification: avoid straining to defaecate,

reduce toilet time
• Diet: sufficient intake of fibre and water to avoid
constipation, avoid spices and food that can cause
diarrhoea, also avoid “hot” food such as hotpot,
barbeque, deeply fried food10
• Sitz bath: bathing with warm water at 40 0 C or 50 0 C for
ten minutes can relieve anorectal pain11
• Medical: Topical ointment and suppository which Stapled haemorrhoidopexy: the stapler A circumferential cuff of haemorrhoidal
include a combination of active ingredient, these include is inserted via the anus, the number tissue is resected using the
markings on the stapler is guideline on the haemorrhoidopexy stapler
steroid, local anaesthetic, vasoconstrictor and barrier
position of the stapled line from anus.
cream. Daflon is an oral medication, it is a micronized
purified fraction containing 90% diosmin and 10% other
flavonoids expressed as hesperidin. It is a venotonic and
effective for reliving symptom of thrombosed haemorrhoid
Anual fissure:
and haemorrhoidal bleeding.12,13

Office based procedures:

Pathophysiology
1. Rubber band ligation: suitable for grade I-III internal Anal fissure is a tear on the skin of anus, the patient usually
haemorrhoids with bleeding, 8 never band an external complained of sharp pain and small amount of per rectal
haemorrhoid which can cause excruciating pain bleeding after defecation. The most common sites of fissure
immediately and the band should be cut to relieve the are located at anterior (12 o’clock) and posterior site (6
pain!1 The mechanism is to insert a rubber band to the o’clock) due to less blood supply. 18,19 Acute fissure is usually
base of the haemorrhoid using a metal or suction ligator, caused by passing hard or large bulk of stool and chronic
as a result, the haemorrhoid tissue necrotizes due to poor diarrhea. When there is spasm of the underlying internal
blood supply and sloughs off few days later. It is common sphincter muscles, the blood supply will be reduced, the
that there may be mild bleeding from the banding site fissure may not heal and become chronic.
ulcer and is usually self-limited. However, this procedure
should be avoided in patients taking anticoagulant. If the fissure is located at
2. Injection sclerotherapy: the commonly used sclerosing unusual sites or it is multiple,
agent is phenol, the agent is injected directly into the other differential diagnoses
haemorrhoidal vessels, the vessel wall then collapse should be considered. These
jeopardizing the blood supply and the haemorrhoidal diagnoses include inflammatory
tissue shrinks slowly.1 bowel disease (Crohn’s
3. Other less effective procedures include electrocautery, disease and ulcerative colitis),
infrared treatment, laser surgery or cryosurgery.12 Acute anal fissure present at tuberculosis, carcinoma,
posterior site of anus (6 o’clock) acquired immunodeficiency
Surgery: syndrome and anal sex trauma.

1. Haemorrhoidal artery ligation (HAL) or transanal

h a e m o r r h o i d a l d e a r t e r i a l i z a t i o n ( T H D ) : 14,15 i n t h i s
procedure an ultrasound doppler is used to accurately
locate the position of haemorrhoidal vessels which are
then ligated to achieve dearterialization. The prolapsed
tissue is sutured back to its normal position. This
procedure can also be done in clinic, it has higher
recurrence if compared to haemorrhoidectomy, but less
complications.
2. Conventional haemorrhoidectomy: this procedure is
usually performed under general anaesthesia, all internal-
external haemorrhoids and perianal skin tags are excised.16
Post-operative pain is expected to last for 1-2 weeks and
full recovery needs 3-4 weeks for most patients.
3. Stapled haemorrhoidopexy: this procedure is usually
performed under general anaesthesia. This procedure
should be considered in patients with mainly internal
haemorrhoids, it is less desirable for external
haemorrhoids. A circular stapler is introduced via the
anus to remove the haemorrhoidal tissue and the
prolapsed tissue is fixed to its original position. As the
wound is usually located above the dentate line, post-
operative pain is usually less and recovery is quicker.
However, the chance of relapse is higher when compared
to conventional haemorrhoidectomy.17
Management
Non-surgical:
• Encourage water and fibre intake, stool softeners to
prevent constipation. Treat the underlying cause for
diarrhoea
• Topical ointment composes of local anesthetic and
muscle relaxing agents to reduce sphincter muscle
spasm, such as nitroglycerine (may cause headache)20,21
and calcium channel blockers (nifedipine, diltiazem)22
• Injection of botulinum toxin A (Botox), effect fades with
time and repeated treatment may be needed23-25
For acute anal fissures, it takes days to few weeks to heal.
If the fissure become chronic, surgical treatment should be
considered:
Surgical:
• Lord’s dilatation: this is stretching of anal canal and aim at
reducing the muscle spasm, however this procedure may
cause flatus incontinence.26 This procedure is getting less
popular nowadays.

4 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
 SPOTlight-1

• Lateral internal sphincterotomy: this is the gold standard 12. Review. “Daflon 500mg in the management of acute and recurrent
surgical treatment for chronic anal fissure.27,28 The internal haemorrhoidal disease”. Phlebolymphology 281-282. Retrieved 10 April
2015.
sphincter muscle is exposed via a small skin incision at 13. Misra, MC; Imlitemsu, (2005). “Drug treatment of haemorrhoids”. Drugs. 65
right lateral position of anus, the muscle is then divided (11): 1481–91.
up to the proximal margin of the fissure or not exceeding 14. Dal Monte PP, Tagariello C, Sarago M, et al. (December 2007). “Transanal
haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of
the dentate line. The aim is to reduce muscle spasm and haemorrhoidal disease”. Tech Coloproctol. 11 (4): 333–8; discussion 338–9.
improved blood supply so that the fissure can heal itself. PMID 18060529
15. Infantino A, Bellomo R, Dal Monte PP, et al. (August 2010). “Transanal
haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for
Per rectal bleeding is a common complaint encountered in II and III degree haemorrhoids: a prospective multicentric study”. Colorectal
daily consultations, local citizens are now very aware of the Dis. 12 (8): 804–9. PMID 19508513
symptom as the annual incidence of colorectal cancer is rising 16. Sneider EB, Maykel JA. Diagnosis and management of symptomatic
hemorrhoids. Surg Clin North Am. 2010;90:17–32
rapidly in Hong Kong. In the clinical setting, there is limited 17. Jayaraman, S; Colquhoun, PH; Malthaner, RA (Oct 18, 2006). “Stapled
investigative tools to differentiate colorectal cancers from other versus conventional surgery for hemorrhoids”. Cochrane database of
benign perianal diseases that cause per rectal bleeding. The systematic reviews (Online) (4): CD005393.
18. American Gastroenterological Association. American Gastroenterological
table below gives some hint on when to refer the patient to Association medical position statement: Diagnosis and care of patients with
specialist for further investigation. For all patients presented anal fissure. Gastroenterology 2003; 124:233.
with per rectal bleeding, a digital examination should always 19. Schouten WR, Briel JW, Auwerda JJ. Relationship between anal pressure
and anodermal blood flow. The vascular pathogenesis of anal fissures. Dis
be performed to exclude low rectal cancer! Colon Rectum 1994; 37:664.
20. Gorfine SR. Topical nitroglycerin therapy for anal fissures and ulcers. N Engl
J Med 1995; 333:1156.
Haemorrhoids Anal fissure Colorectal cancer 21. Lund JN, Scholefield JH. Glyceryl trinitrate ointment for chronic anal fissure
(letter). Lancet 1997; 349:573.
Color of blood Fresh Fresh Altered to dark red 22. Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of
chronic anal fissure. Br J Surg 2001; 88:553.
Amount of blood Can be large Usually spots or Usually small 23. Fruehauf H, et al. (2006). Efficacy and safety of botulinum toxin A injection
Usually passed few drops of blood amount and mix compared with topical nitroglycerin ointment for the treatment of chronic
out before or after Noticed after bowel with stool anal fissure: A prospective randomized study. American Journal of
Gastroenterology, 101(9): 2107–2112.
bowel motion motion or on toilet 24. Brisinda G, et al. (2007). Randomized clinical trial comparing botulinum toxin
paper injections with 0.2 per cent nitroglycerin ointment for chronic anal fissure.
British Journal of Surgery, 94(2): 162–167.
Perianal discomfort May or may not Sharp pain Painless 25. Nelson R (2006). Non-surgical therapy for anal fissure. Cochrane Database
present of Systematic Reviews (4).
26. Yucel, T.; Gonullu, D.; Oncu, M.; Koksoy, F. N.; Ozkan, S. G.; Aycan, O.
Aggravating factor Constipation, Hard stool None (June 2009). “Comparison of Controlled-intermittent Anal Dilatation and
diarrhoea, straining, Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissures:
A Prospective, Randomized Study”. International Journal of Surgery. 7 (3):
spicy food 228–23
Differences on presentation between colorectal cancers and 27. Bailey RV, Rubin RJ, Salvati EP (1978). “Lateral internal sphincterotomy”.
Dis. Colon Rectum. 21 (8): 584–6
other benign perianal conditions 28. Nelson, Richard L. (2010-01-20). “Operative procedures for fissure in ano”.
The Cochrane Database of Systematic Reviews (1)
References
Complete Spotlight, 1 CME Point
1. Beck, David E. (2011). The ASCRS textbook of colon and rectal surgery (2nd will be awarded for at least five correct

Q&A Self-Assessment
ed.). New York: Springer. p. 175. ISBN 978-1-4419-1581-8. Archived from
the original on 2014-12-30. answers
2. Gibbons CP, Bannister JJ, Read NW. Role of constipation and anal Questions:
hypertonia in the pathogenesis of haemorrhoids. Br J Surg. 1988 Jul.
75(7):656-60 Answer these on page 13 or make an online submission at: www.hkmacme.org.
3. Abramowitz L, Batallan A. Epidemiology of anal lesions (fissure and Please indicate whether the following statements are true or false.
thrombosed external hemorroid) during pregnancy and post-partum.
Gynecol Obstet Fertil. 2003;31(6):546–9. 1. Bleeding from internal or external haemorrhoids is always
4. National Digestive Diseases Information Clearinghouse (November 2004). accompanied with pain.
“Hemorrhoids”. National Institute of Diabetes and Digestive and Kidney 2. The choice of management for haemorrhoids is governed by
Diseases (NIDDK), NIH. Archived from the original on 2010-03-23. Retrieved the severity of prolapse.
18 March 2010. 3. When a patient develops thrombosis of haemorrhoid, the first
5. Lorenzo-Rivero, S (August 2009). “Hemorrhoids: diagnosis and current treatment is manual reduction.
management”. Am Surg. 75 (8): 635–42. PMID 19725283. 4. Haemorrhoidal bleeding can lead to acute anaemia, especially
6. Kaidar-Person, O; Person, B; Wexner, SD (January 2007). “Hemorrhoidal internal haemorrhoids.
disease: A comprehensive review” (PDF). Journal of the American
College of Surgeons. 204 (1): 102–17. PMID 17189119. doi:10.1016/ 5. Rubber band ligation is an effective treatment for all prolapsed
j.jamcollsurg.2006.08.022. Archived from the original (PDF) on 2012-09-22. haemorrhoids.
7. Schubert, MC; Sridhar, S; Schade, RR; Wexner, SD (July 2009). “What every 6. Stapled haemorrhoidopexy is superior to conventional
gastroenterologist needs to know about common anorectal disorders”. haemorrhoidectomy regarding to the chance of recurrence.
World J Gastroenterol. 15 (26): 3201–9. ISSN 1007-9327. PMC 2710774 . 7. Acute anal fissure is caused by anal sphincter muscle spasm.
PMID 19598294. doi:10.3748/wjg.15.3201. 8. Single injection of Botulinum toxin A (Botox) can be a definitive
8. Rivadeneira, DE; Steele, SR; Ternent, C; Chalasani, S; Buie, WD; Rafferty, treatment for chronic anal fissure.
JL; Standards Practice Task Force of The American Society of Colon
and Rectal Surgeons (September 2011). “Practice parameters for the 9. Lateral internal sphincterotomy is the gold standard surgical
management of hemorrhoids (revised 2010)”. Diseases of the colon and treatment for acute anal fissure.
rectum. 54 (9): 1059–64. 10. For all patients who present with per rectal bleeding, it is
9. Dayton, senior editor, Peter F. Lawrence; editors, Richard Bell, Merril T. important to perform digital rectal examination to exclude low
(2006). Essentials of general surgery (4th ed.). Philadelphia;Baltimore: rectal cancers.
Williams & Wilkins. p. 329. ISBN 978-0-7817-5003-5. Archived from the
original on 2017-09-08. Answer to December 2017
10. Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q,
Johanson JF, et al. Fiber for the treatment of hemorrhoids complication: Spotlight 1 – Long-Term Care of Kidney Transplant Recipients –
a systematic review and meta-analysis. Am J Gastroenterol.
2006;101(1):181–8. can we do better?
11. Shafik A. Role of warm-water bath in anorectal conditions. The “thermo- 1) T 2) F 3) T 4) F 5) T 6) T 7) T 8) F 9) F 10) T
sphincteric reflex. J Clin Gastroenterol. 1993;16(4):304–8.
Spotlight 2 – Childhood febrile seizures
1) T 2) T 3) F 4) F 5) T 6) T 7) F 8) F 9) T 10) F
www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 5

Management of Malignant
Pleural Effusion
Introduction
Malignant pleural effusion (MPE), which is diagnosed by the
identification of malignant cells in pleural fluid or on pleural
biopsy, represents an advanced malignant disease associated
with high morbidity and mortality precluding the possibility of
a curative treatment approach. Although almost all types of
cancers can cause an MPE, more than 75% of MPEs are due
to metastases originating from tumours in the lung, breast,
ovary as well as from lymphomas. Metastatic adenocarcinoma
is the most frequent histological finding. However, the primary
tumour cannot be identified in approximately 10% of patients
with MPEs (1).
MPE is a common clinical problem faced by physicians,
oncologists and cardiothoracic surgeons. Patients with
MPE can be debilitated with dyspnoea, decreased exercise
tolerance and impaired quality of life. The management
options for MPEs depend on several factors including patient’s
symptoms, performance status, underlying primary tumour and
the potential response to anti-cancer therapy. The overall aim is
for the alleviation of symptoms and improved quality of life (2).
Management of MPE
Management options of MPE include observation,
repeated therapeutic thoracocentesis, tube thoracostomy
with pleurodesis, medical thoracoscopy/video-assisted
thoracoscopic surgery (VATS) with pleurodesis, indwelling
pleural catheter (IPC) and pleuroperitoneal shunting (3). The
ideal management would offer immediate and long-term relief
of symptoms and have minimal side effects. It would involve
a procedure that requires the least amount of time spent in
the hospital and clinic, avoids repeated and uncomfortable
procedures and has the least cost. The British Thoracic
Society (BTS) guidelines suggested that if the patient is
asymptomatic and the tumour type is known to be responsive
to systemic chemotherapy, observation is recommended (4).
Therapeutic thoracocentesis
Thoracocentesis is typically the first step in the management
of newly diagnosed MPE. Although symptoms can improve
after thoracocentesis, almost all patients with MPE experience
reaccumulation of fluid and recurrence of symptoms within 30
days. The potential complications related to thoracocentesis
include vasovagal reactions, cough, chest pain, haemothorax,
pneumothorax and reexpansion pulmonary oedema.
In addition, repeated thoracocentesis can result in fluid
loculation which can make further thoracocentesis or
subsequent pleurodesis difficult. Thus, repeated therapeutic
thoracocentesis should be performed in patients with slowly
reaccumulating pleural effusion, low life expectancy (1-3
www.hkmacme.org
SPOTlight-2
Dr. CHUI Wing Hung
MBBS (HK), FRCS (Edin),
FCSHK, FHKAM (Surgery),
Specialist in Cardiothoracic Surgery
months), cancers that commonly respond to therapy with
resolution of the associated effusions, and who cannot tolerate
other more interventional procedures to control pleural fluid
such as pleurodesis. To prevent reexpansion pulmonary
oedema, the amount of fluid removed by thoracocentesis
should be assessed by patient’s symptoms (cough, chest
discomfort) and limited to 1.5 litres on a single occasion (5).
Tube thoracostomy with pleurodesis
Tube thoracostomy is performed with the intent to evacuate
pleural fluid from the pleural space and enable apposition of
the visceral and parietal pleura. Rarely is complete evacuation
of the pleural cavity sufficient to control the effusion in the
long-term, and compared with instillation of a sclerosing agent,
drainage alone is less effective in preventing reaccumulation (6).
Consequently, the primary role of tube thoracostomy is to
empty the pleural space prior to instillation of a sclerosing
agent, with the goal of obliterating the visceral/parietal space
and preventing reaccumulation of fluid.
The effectiveness of thoracostomy with pleurodesis using
a number of different sclerosing agents has been studied
in clinical trials (7,8) , and all have found thoracostomy with
pleurodesis to be effective in reducing dyspnoea and
improving quality of life. In these trials, with follow-up of
3-12 months, pleurodesis was unsuccessful in up to 10-
30% of patients, mainly due to ongoing or incomplete pleural
drainage (>300 mL/day), presence of trapped lung, chest tube
displacement or death. Once pleurodesis had been obtained,
the rate of sustained pleuordesis (no need for further pleural
interventions) was 68-78%.
Multiple sclerosing agents have been studied including
doxycycline, tetracycline, bleomycin and talc, with the preferred
and most common agent used now being talc (9). A network
meta-analysis published in 2016 reviewed 41 studies evaluating
16 pleurodesis methods and included 2,345 participants (10).
In the majority of cases, there was no evidence to support any
difference among agents in terms of pleurodesis. However,
in 10 direct comparisons of individual methods, a number
of agents were less effective than talc poudrage at inducing
pleurodesis, including bleomycin and doxycycline.
Risks of thoracostomy with pleurodesis include pain and fever in
approximately 26% and 30% respectively (10). Respiratory failure
has been reported in 4% of patients receiving talc slurry (11).
Medical thoracoscopy/Video-assisted
thoracoscopic surgery (VATS) with pleurodesis
Medical thoracoscopy or pleuroscopy is a procedure
performed under conscious sedation and local anaesthesia
whereby one or more trocars are inserted into the pleural
HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 7
 SPOTlight-2
space in the midaxillary line (between the fourth and seventh
ribs), with the patient lying in the lateral decubitus position.
VATS is similar to medical thoracoscopy, except that it is
performed using larger trocars, under general anaesthesia in
the operating room and involves single-lung ventilation through
a dual-lumen tube (3).
Advantages of these two procedures over traditional tube
thoracostomy is that visualization and drainage of the pleural
space can occur, pleural biopsies can be obtained and delivery
of a sclerosing agent can occur before a chest tube is inserted
through the trocar.
There are even more advantages by using the VATS approach.
These include more complete view of the pleural surface
and obtaining pleural and/or lung biopsy as well as obtaining
biopsy of selected hilar lymph nodes. For complicated pleural
spaces, including trapped lung due to adhesions, lysis of
adhesions and surgical pleurodesis can be performed and
in some selected cases, more advanced techniques, such
as pleurectomy and decortication, may be performed (3). In a
retrospective study reporting treatment outcomes for patients
undergoing VATS talc pleurodesis for MPE, successful
pleurodesis was reported in 93% with median follow-up of
64 months (12). Although generally considered safe with low
morbidity, VATS cannot be tolerated by every patient and
would not be an option for patients who could not tolerate
single-lung ventilation or who have poor performance status.
Indwelling pleural catheter (IPC)
IPC is also known as a tunneled or small gauge catheter.
Generally, the IPC system is composed of a silicone catheter,
allowing ambulatory pleural drainage into plastic vacuum
bottles, with fenestrations on the distal margin and a one-
way valve on the proximal margin (13). Placement is simple
and is generally performed on an outpatient basis with local
anaesthesia.
A recent unblinded randomized control study comparing IPC
and talc slurry pleurodesis via chest tube demonstrated that
there was no significant difference in relieving patient-reported
dyspnoea between the two methods (7). However, while the
IPC-treated group spent reduced time in the hospital, it was
associated with an excess number of adverse events. In
light of the limited life span of patients with MPE, IPCs show
promise in requiring fewer hospital stays, improving dyspnoea
and decreasing the need for additional procedures (7, 13).
Long-term IPCs may lead to spontaneous pleurodesis in 40-
58% of patients with IPC (4, 13). Therefore, sclerosants can be
instilled through the catheter if spontaneous pleurodesis does
not occur after several weeks of drainage. In addition, IPC
placement and maintenance are safe and free of complications
in the vast majority of patients. Complications include
infections, clogging of the catheter, or other rare events, such
as empyema or tumour spread along the catheter track (13).
Pleuroperitoneal shunting
Pleuroperitoneal shunting facilitates the transfer of pleural
effusion from the chest to the peritoneal cavity. It requires
8 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018
patient’s compliance to pump up the pleural fluid. With the
availability of IPC, it has now fallen out of favour (2).
Conclusion
The choice of therapy for a patient with MPE is influenced
by many factors, the most crucial being the therapy’s
effectiveness. Given the limited resources faced by almost
every health system, cost and cost-effectiveness have become
the major considerations when new therapeutic options are
adopted. The management options available to patients with
MPE have increased in the past decade, and there have
been a growing number of prospective studies demonstrating
the comparative effectiveness of these therapies in terms of
important patient outcomes.
References
1. Thomas JM, Musani AI. Malignant pleural effusions: a review. Clin Chest Med
2013;34:459-71.
2. Leung L, Hsin M, Lam KC. Management of malignant pleural effusion:
options and recommended approaches. Thoracic Cancer 2013;4:9-13.
3. Penz E, Watt KN, Hergott CA, et al. Management of malignant pleural
effusion: challenges and solutions. Cancer Management and Research
2017;9:229-41.
4. Roberts ME, Neville E, Berrisford RG, et al. BTS Pleural Disease Guideline
Group. Management of a malignant pleural effusion: British Thoracic Society
Pleural Disease Guideline 2010. Thorax 2010;65 Suppl:ii32-40.
5. Nam HE. Malignant pleural effusion: medical approaches for diagnosis and
management. Tuberc Respir Dis 2014;76:211-17.
6. Sahn SA. Malignancy metastatic to the pleura. Clin Chest Med
1998;19:351-61.
7. Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural
catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients
with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA
2012;307:2383-89.
8. Putnam JB Jr, Light RW, Rodriguez RM, et al. A randomized comparison of
indwelling pleural catheter and doxycycline pleurodesis in the management
pleural effusions. Cancer 1999;86:1992-99.
9. Antunes G, Neville E, Duffy J, et al. BTS guidelines for the management of
malignant pleural effusions Thorax 2003;58 Suppl 2:ii29-38.
10. Clive AO, Jones HE, Bhatnagar R, et al. Interventions for the management
of malignant pleural effusions: a network meta-analysis. Cochrane Database
Syst Rev 2016:CD010529.
11. Dresler CM, Olak J, Herndon JE, et al. Phase III intergroup study of talc
poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest
2005;127:909-15.
12. Cardillo G, Facciolo F, Carbone L, et al. Long-term follow-up of video-
assisted talc pleurodesis in malignant recurrent pleural effusions. Eur J
Cardiothorac Surg 2002;21:302-6.
13. Myers R, Michaud G. Tunneled pleural catheters: an update for 2013. Clin
Chest Med 20123;34:73-80.
Complete this
course and earn
Q&A Self-Assessment
Questions:
1 CME Point
Answer these on page 13 or make an online submission at: www.hkmacme.org.
Please indicate whether the following statements are true or false.
1. MPE is most commonly caused by pleural metastases from colorectal
cancers.
2. Metastatic adenocarcinoma is the most frequent histological/cytological
finding in MPE.
3. Reexpansion pulmonary oedema can occur with rapid drainage of MPE.
4. Fever can occur after chemical pleurodesis for MPE.
5. Bleomycin is the most effective sclerosing agent used for chemical
pleurodesis.
6. General anaesthesia with single lung ventilation is needed in VATS
pleurodesis.
7. Decortication may be needed in trapped lung condition.
8. IPC system can allow ambulatory pleural drainage on an outpatient
basis.
9. Spontaneous pleurodesis would not occur in patients with long-term
IPC.
10. Pleuroperitoneal shunting is not commonly performed nowadays.
www.hkmacme.org
 Cardiology
The content of the January Cardiology Series is provided by:
Dr. TAN GuangMing
MBChB, MRCP, FHKCP, FHKAM (Med), Specialist in Cardiology
Dr. CHEUNG Shing Him, Gary
Complete Cardiology case MBBS, MRCP, FHKCP, FHKAM (Med), Specialist in Cardiology
0.5 CME POINT will be awarded for 一月臨床心臟科個案研究之內容承蒙譚廣明醫生及張誠謙醫生提供。
at least 2 correct answers in total

A patient with acute limb swelling

A 65-years-old male taxi driver with good past health presented with one-day onset of acute left lower limb
swelling and pain. Figure 1 showed his both lower legs upon presentation. Clinical examination showed palpable
2+ femoral, popliteal and pedal pulses on both lower limbs.

Q&A
Please answer ALL questions
Answer these on page 13 or make an online submission at: www.hkmacme.org

1. What is your diagnosis? 3. What will be your initial treatment

A. Acute limb ischemia option?
B. Critical limb ischemia A. Amputation
C. Phlegmasia Cerulea Dolens B. Unfractionated heparin
D. Phlegmasia Alba Dolens C. Leg elevation
E. None of the above D. Open fasciotomy
E. B & C
2. What imaging will you order?
A. Lower limb venous duplex 4. What will be your next step of
ultrasound management?
B. Lower limb arterial duplex A. Amputation
ultrasound B. Open fasciotomy
C. MR Angiography of lower limb C. Refer to Interventional Cardiology
D. XR lower limb for endovascular thrombolysis
E. A and/or C D. Systemic thrombolysis
E. Oral anticoagulation

Figure 1

December Answers
1) B 4) A, B
Patient was presented with malignant HT and
therefore must be admitted to ICU/CCU for close
monitor with intra-arterial line.

2) C
CORNELL Voltage Criteria for LVH
(Sensitivity = 22%, specificity = 95%)
• S in V3 + R in aVL > 24 mm (men)
• S in V3 + R in aVL > 20 mm (women)

3) A
Cardiothoracic ratio is more than 50%.
5) A, B
The content of the December Cardiology Series is Renal artery stenosis is the cause of renal
provided by: Dr. CHEUNG Ling Ling
MBBS(HK), MRCP(UK), FHKCP, FHKAM(Med), Specialist in Cardiology impairment and poor controlled HT and the
十二月臨床心臟科個案研究之內容承蒙張玲玲醫生提供。 definitive treatment is renal artery stenting.

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 9

 Dermatology

10 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
www.hkmacme.org
本診所將於 至 休息，

並於年初 開診。

This clinic will be closed from

to for Lunar New Year.

如有緊急查詢，請致電
In an emergency, please contact

HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

Dermatology

11
 Dermatology
Complete Dermatology case,
0.5 CME POINT will be awarded for
at least 3 correct answers in total
Dermatology Series for January 2018 is provided by:
Dr. LEUNG Wai Yiu, Dr. TANG Yuk Ming, William,
Dr. CHAN Hau Ngai, Kingsley, Dr. KWAN Chi Keung and Dr. CHANG Mee, Mimi
Specialists in Dermatology & Venereology
一月皮膚科個案研究之內容承蒙梁偉耀醫生、鄧旭明醫生、陳厚毅醫生、關志強醫生及張苗醫生提供。

A Six-year-old child with multiple itchy papule on his trunk

Q&A
Please answer ALL questions
Answer these on page 13 or make an online submission at: www.hkmacme.org

1. What is the clinical diagnosis?

a. Molluscum contagiosum b. Milia
c. Verrucae d. Skin tags

2. These lesions is not contagious. (T/F)

3. How are they transmitted?

a. Direct skin contact b. Autoinoculation
c. Sexual contact d. All of the above

4. All of the following findings are compatible with the

A six-year-old child presented with six
months history of progressive papules on
his trunk. Similar lesions were found in his
elder brother two months ago. It raised
his parent’s concern for growing itchiness
and pain. On examination, there were
multiple pearly papules of 1mm to 3mm
on his trunk, and dome shape umbilicus
appeared in some individual lesion. No
other skin manifestations were found.
above clinical diagnosis EXCEPT
a. Involvement of sole and palm
b. Involvement of genitalia
c. May regress spontaneously in months
d. Systemic involvement does not occur
5. What are the treatment options?
a. Topical treatment such as tretinoin cream and
trichloroacetic acid
b. Physical treatment including curettage, cryotherapy
and CO2 laser
c. Reassurance
d. All of the above

December Answers
1. B 4. B
The clinical diagnosis is thermal burn. This lady The electric blanket causes a secondary thermal
used an electric blanket while she was sleeping. burn for this patient complicated by secondary
She subsequently developed the painful patches infection. Topical and oral antibiotics are the best
afterwards. treatments to manage the wound.
2. T
Thermal burn can be diagnosed clinically by
medical history and physical examination. Only for
complicated case or suspicious case, skin biopsy
may be needed to exclude other medical diseases
– drug eruption, psoriasis.
3. C
Burns can be classified according to the depth of
the skin lesions into first, second, third and fourth
degree burns. Also ‘the Rules of nines’ can be used Dermatology Series for December 2017 is provided by:
Dr. CHAN Hau Ngai, Kingsley, Dr. TANG Yuk Ming, William,
to estimate the extent of total body surface area. Dr. KWAN Chi Keung, Dr. LEUNG Wai Yiu and Dr. CHANG Mee, Mimi
This approach divides the different the body into Specialists in Dermatology & Venereology
percentages of total body surface area. 十二月皮膚科個案研究之內容承蒙陳厚毅醫生、鄧旭明醫生、關志強醫生、
梁偉耀醫生及張苗醫生提供。

12 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
Name 姓名 Signature 簽名：

HKMA Membership No. or HKMA CME No. Answer Sheet

香港醫學會會員編號或持續進修號碼：
答題紙
Contact Tel No. 聯絡電話：

HKID No. 香港身份証號碼： - xxx(x)

January 2018
ANSWER SHEET
Please answer ALL questions and write the answers in the space provided. Please return the
completed answer sheet
to the HKMA Secretariat
SPOTlight - 1 (Fax: 2865 0943) on or
before 15 February 2018
Complete Spotlight, 1 CME point will be awarded for at least five correct answers
for documentation.
If you complete
1 2 3 4 5 6 7 8 9 10 the exercise online,
you are NOT required to
return the answer sheet by
fax.
請回答所有問題，
SPOTlight - 2 並於 2018 年 2 月 15 日前
將答題紙傳真或寄回
Complete Spotlight, 1 CME point will be awarded for at least five correct answers
香港醫學會
( 傳真號碼：2865 0943)。
1 2 3 4 5 6 7 8 9 10
如果選擇在網上完成練習，
便無需將答題紙傳真到
秘書處。

Cardiology Dermatology
Complete Cardiology, 0.5 CME point will be Complete Dermatology, 0.5 CME point will be
awarded for at least two correct answers awarded for at least three correct answers

1 2 3 4 1 2 3 4 5

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 13

 HKMA CME Lecture Online Scheme
To facilitate members in joining CME Lectures, the HKMA is going to launch the HKMA CME Lecture Online Scheme. As approved
by the Medical Council of Hong Kong, the Online Lectures provided through this scheme will be counted as attending the
lectures physically in earning CME points for non-specialists under the “CME Programme for Practising Doctors who are not
taking CME Programme for Specialist.”

Starting from 1 February 2018, the HKMA will arrange for CME Lecture Online through Facebook Live for CME Lectures that take
place in HKMA Wanchai and Central Premises. Please note that you can only either attend in person or watch one lecture online
at one time. For enquiry of the Scheme, please contact the HKMA Secretariat at 3104-9055 or email to cme@hkma.org.

Step 1:
Fill in Enrolment reply slip
on CME Bulletin for specific
lecture(s) available for CME
Lecture Online
(Must provide Email
Address used for Facebook
Registration)

Step 2 & 3 Step 4:

Receive Facebook private group invitation Watch live broadcast at designated time
sent by Secretariat to your Facebook (Real Time)
registered email.
Accept and join the Facebook group.

Step 5:
Complete Lecture Quiz
(10 Q&As in Google Form) and answer questions within two hours
after the lecture

Step 6:
Receive CME point(s) if doctors got ALL answers correct

14 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
 Policy for HKMA CME Lecture Online Scheme

1. As approved by the Medical Council of Hong Kong, the CME Accreditation for CME Lecture Online is for non-
specialists only.
2. Doctors must have a Facebook Account to join the CME Lecture Online.
3. Registration can be done by filling in the reply slip on HKMA CME Bulletin and return by email/fax.
4. Doctors can only either attend in person or watch one lecture online at one point in time.
5. Doctors must watch the lecture at real time and complete the online quiz within 2 hours after the lecture.
Late submission of the quiz will not be accepted. 1 CME point will be awarded for 100% correct answers in the
quiz.
6. One Facebook Group is intended for one specific CME Lecture only. Doctors must register with the HKMA
Secretariat in order to be invited to the Facebook group and to gain CME point after completion.
7. You are recommended to connect to Wi-Fi on your mobile device or computer while watching the lecture
through Facebook Live. Unstable internet connection will cause interruption to your viewing.
8. In case of technical issue and broadcast interruption, please be patient while our technicians will work on fixing the
problem; the video should resume in a few minutes.
9. Due to copyright issue, the Facebook group is exclusive for doctors who have registered; and the video recording,
powerpoint slides and quiz link MUST not be shared with non-registrants.

香港醫生網
The Hong Kong Doctors Homepage
www.hkdoctors.org

This web site is developed and maintained by the Hong Kong Medical Association
for all registered Hong Kong doctors to house their Internet practice homepage. The
format complies with the Internet Guidelines which was proposed by the Hong Kong
Medical Association and adopted by the Medical Council of Hong Kong.

We consider a practice homepage as a signboard or an entry in the telephone

directory. It contains essential information about the doctor including his specialty and
how to get to him. This facilitates members of the public to communicate with their
doctors.

This website is open to all registered doctors in Hong Kong. For practice page design
and upload, please contact the Hong Kong Medical Association Secretariat.

由香港醫學會成立並管理的《香港醫生網》，是一個收錄本港註冊西醫執業網頁的
網站。內容是根據由香港醫學會擬訂並獲香港醫務委員會批准使用的互聯網指引內
的規定格式刊載。

醫生的「執業網頁」性質與電話索引內刊載的資料相近。目的是提供與醫生執業有
關的基本資料，例如註冊專科及聯絡方法等，方便市民接觸個別醫生。

任何香港註冊西醫都可以參加《香港醫生網》。關於網頁版面安排及上載之詳情，
請與香港醫學會秘書處聯絡為荷。

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 15

 CMEnotifications

Antibiotic Stewardship Programme in Primary Care

Co-organizer : HKMA Kowloon East Community Network HKMA Shatin Doctors Network and
and the Centre for Health Protection of the the Centre for Health Protection of the
Department of Health Department of Health
Date : Thursday, 1 February 2018 Wednesday, 7 February 2018
Speaker : Dr. LAM Tin Keung, Edman
Senior Medical & Health Officer, Infection Control Branch,
Centre for Health Protection, Department of Health
Time : 1:00 – 2:00 p.m. Registration & Lunch
2:00 – 2:45 p.m. Lecture
2:45 – 3:00 p.m. Q&A Session
Venue : Lei Garden Restaurant ( 利苑酒家 ), Royal Park Chinese Restaurant,
Shop no. L5-8, apm, Kwun Tong, Level 1, Royal Park Hotel,
No. 418 Kwun Tong Road, Kowloon 8 Pak Hok Ting Street, Shatin
Moderator : Dr. LEUNG Wing Hong Dr. MAK Wing Kin
Hon. Treasurer, CME Convenor,
HKMA Kln East Community Network HKMA Shatin Doctors Network
Deadline : Friday, 19 January 2018 Friday, 26 January 2018
Fee/Capacity : Free-of-charge. Capacity is 48 Free-of-charge. Capacity is 60
Registration is strictly required on a first come, first served basis. Priority will be given to doctors
practising in Kowloon East districts (for lecture on 1 Feb)/ Shatin districts (for lecture on 7 Feb)
Enquiry : Mr. Ian YAU, Tel: 2527 8285 Ms. Candice TONG, Tel: 2527 8285

*Please call and confirm that your facsimile has been successfully transmitted to the HKMA Secretariat
if you do not receive confirmation 7 days before the event.
CME Accreditation : 1 CME point

REPLY SLIP
HKMA Kowloon East Community Network & Shatin Doctors Network Fax: 2865 0943
CME Lectures in February 2018

I would like to register for the following lecture(s): Please “✓” as appropriate
1 February 2018 (Kln East) 7 February 2018 (Shatin)

Name: HKMA No.:

Mobile No.*: Fax:
*Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone,
the Secretariat will still issue a confirmation letter to you.

Practising location: In Kowloon East districts (Please specify *: )

In Shatin districts (Please specify *: )
Others (Please specify: )
* Null entry will be treated as non-Kowloon East or Shatin member registration.
Signature: Date:

Data collected will be used and processed for the purposes related to these events only.

16 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
 CMEnotifications

CME Lectures in February 2018

Organizer/ : HKMA Kowloon City Community Network HKMA Kowloon West Community Network
Co-organizer and the Hong Kong College of Cardiology
Date : Friday, 2 February 2018 Tuesday, 27 February 2018
Topic : Improving Cardiovascular Outcomes in An Update on AF Management and
Patients with Type 2 Diabetes: Applying New Screening
Evidence in Practice
Speaker : Dr. WU, Enoch Dr. YUEN Ho Chuen
Specialist in Endocrinology, Diabetes & Consultant Cardiologist, St. Paul’s Hospital
Metabolism
Time : 1:00 – 2:00 p.m. Registration & Lunch
2:00 – 2:45 p.m. Lecture
2:45 – 3:00 p.m. Q&A Session
Venue : President’s Room, Spotlight Recreation Club ( 博藝會 ), Fulum Palace ( 富臨皇宮 ),
4/F., Screen World, Site 8, Shop C, G/F, 85 Broadway Street,
Whampoa Garden, Hunghom Mei Foo Sun Chuen, Mei Foo
Moderator : Dr. CHAN Man Chung, JP Dr. WONG Wai Hong
District Coordinator, Hon. Secretary,
Kln City Community Network Kln West Community Network
Deadline : Monday, 22 January 2018 Thursday, 15 February 2018
Fee/Capacity : Free-of-charge. Capacity is 36 Free-of-charge. Capacity is 60
Registration is strictly required on a first come, first served basis. Priority will be given to doctors
practising in Kowloon City districts (for lecture on 2 Feb)/ Kowloon West districts (for lecture on
27 Feb)

Enquiry : Ms. Candice TONG, Tel: 2527 8285 Mr. Ian YAU, Tel: 2527 8285
*Please call and confirm that your facsimile has been successfully transmitted to the HKMA Secretariat
if you do not receive confirmation 7 days before the event.
Sponsor :

CME Accreditation : 1 CME point

REPLY SLIP
HKMA Kowloon City and Kowloon West Community Networks Fax: 2865 0943
CME Lectures in February 2018

I would like to register for the following lecture(s): Please “✓” as appropriate
2 February 2018 (Kln City) 27 February 2018 (Kln West)

Name: HKMA No.:

Mobile No.*: Fax No.:
*Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone,
the Secretariat will still issue a confirmation letter to you.

Practising location: In Kowloon City districts (Please specify *: )

In Kowloon West districts (Please specify *: )
Others (Please specify: )
* Null entry will be treated as non-Kowloon City or Kowloon West member registration.
Signature: Date:

Data collected will be used and processed for the purposes related to these events only.

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 17

 CMEnotifications

CME Lectures in February 2018

Organizer : HKMA Central, Western & Southern HKMA Hong Kong East Community Network
Community Network
Date : Wednesday, 7 February 2018 Thursday, 8 February 2018
Topic : Asthma – What Should be Done to Help Palliative Treatment and Care in the Community
Patients Achieving Disease Control?
Speaker : Dr. WONG King Ying Dr. CHEN Wai Tsan, Tracy
Specialist in Respiratory Medicine Associate Consultant Physician,
Haven of Hope Sister Annie Skau Holistic Care Centre
Time : 1:00 – 2:00 p.m. Registration & Lunch
2:00 – 2:45 p.m. Lecture
2:45 – 3:00 p.m. Q&A Session
Venue : The HKMA Central Premises, The HKMA Wanchai Premises
Dr. Li Shu Pui Professional Education Centre, 5/F, Duke of Windsor Social Service Building,
2/F., Chinese Club Building, 21-22 Connaught 15 Hennessy Road, Wanchai
Road Central
Moderator : Dr. TSANG Kin Lun Dr. YIP Yuk Pang, Kenneth
Committee Member, Vice-chairman (In.),
HKMA CW&S Community Network HKMA HK East Community Network
Deadline : Friday, 26 January 2018
Fee/Capacity : Free-of-charge. Capacity is 80. Registration is strictly required on a first come, first served basis. Priority
will be given to doctors practising in CW&S district (for lecture on 7 Feb)/HK East district (for lecture
on 8 Feb)
Enquiry : Mr. Ian YAU, Tel: 2527 8285 Ms. Candice TONG, Tel: 2527 8285
*Please call and confirm that your facsimile has been successfully transmitted to the HKMA Secretariat
if you do not receive confirmation 7 days before the event.
Sponsor :

CME Accreditation : 1 CME Point (For CME Lecture Online, 1 CME Point is available for non-specialist only)

REPLY SLIP
HKMA CW&S and HK East Community Networks Fax: 2865 0943
CME Lectures in February 2018
Name: HKMA No.:
1
Mobile No. : Fax No:
I would like to register for the following lecture(s): Please “✓” as appropriate
Please choose ONE attending method for each lecture only
To attend the Lecture In Person To attend the Lecture through Facebook Live
1 CME point for non-specialists
7 February 2018 (CW&S) 8 February 2018 (HKE) 7 February 2018 (CW&S) 8 February 2018 (HKE)
Email address for login to Facebook2:

1
Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone,
the Secretariat will still issue a confirmation letter to you.
2
Please fill in the email address you used to login to Facebook if you want to attend the lecture through Facebook Live.

Practising location: In Central, Western & Southern districts (Please specify *: )

In Hong Kong East districts (Please specify *: )
Others (Please specify: )
* Null entry will be treated as non-Central, Western & Southern or Hong Kong East member registration.
Signature: Date:
Data collected will be used and processed for the purposes related to these events only.

18 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
 Meeting Highlights

Certificate Course in Psychiatry for Community Primary Care Doctors

The Certificate Course in
Psychiatry for Community
Primary Care Doctors co-
organized by the HKMA and the
Hong Kong Society of Biological
Psychiatry was successfully held
from September to December
2017. The 12-session Certificate
Course covered the topics
including mood disorders,
anxiety, psychosis, dementia,
sleep problems and common
psychiatric drugs etc.

Group photo of participants and speakers

HKMA-HKSH CME Programme 2017-2018 “Update in Medical Practice”

Dr. LAW Chun Key, Stephen, Specialist in Radiology, delivered a luncheon lecture on “Modern
Radiotherapy” on Thursday, 7 December 2017 at the HKMA Central Premises. Dr. LIU Shao
Haei kindly acted as the moderator for the event.

Dr. LIU Shao Haei (right) presenting a souvenir to the

speaker, Dr. LAW Chun Key, Stephen (left).

The HKMA Hong Kong East Community Network (HKECN)

~ Dr. CHAN Nim Tak, Douglas
Dr. Stephen YAU, Specialist in Clinical Oncology, presented on “Update in Management
of Lung Cancer” on Thursday, 7 December 2017.

Dr. CHEN Wai Tsan, Tracy, Associate Consultant Physician of Haven of Hope Sister
Annie Skau Holistic Care Centre, will deliver a talk on “Palliative Treatment and Care in
the Community” on Thursday, 8 February 2018. Interested members please refer to the Dr. Stephen YAU (left, speaker) receiving the
announcement on p.18 for details and enrolment. souvenir from Dr. Simon AU (moderator) during
the lecture on 7 December 2017

The HKMA Central, Western and Southern Community Network (CW&SCN) ~ Dr. YIK Ping Yin
Dr. CHEONG Yan Yue, Adrian, Specialist in Cardiology,
presented on “Local Experience in Managing Heart Failure with
ARNI” on Wednesday, 6 December 2017. Dr. LEUNG Hon
Bong, Specialist in Orthopaedics & Traumatology, presented
on “Update in Joint Pain Management” on Wednesday,
13 December 2017.

Dr. WONG King Ying, Specialist in Respiratory Medicine, will

deliver a lecture titled “Asthma – What Should be Done to Dr. Adrian CHEONG (centre, speaker)
receiving the souvenir from Dr. LAW
Help Patients Achieving Disease Control?” on Wednesday, Yim Kwai (right) and Dr. POON Man Kay
7 February 2018. Interested members please refer to the (left, moderator) during the lecture on 6
December 2017
announcement on p.18 for details and enrolment.
Dr. LEUNG Hon Bong (left, speaker)
receiving the souvenir from Dr. YIK Ping
Yin (moderator) during the lecture on 13
December 2017

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 19

 Meeting Highlights

The HKMA Kowloon City Community Network (KCCN) ~

Dr. CHIN Chu Wah and Dr. CHAN Man Chung, JP
Dr. LEUNG Kwong Chuen, Angus, Consultant in Clinical Oncology of Radiotherapy &
Oncology Centre of the Hong Kong Baptist Hospital, presented on “Local Experience
in Cancer Immunotherapy” on Friday, 8 December 2017.

Dr. WU, Enoch, Specialist in Endocrinology, Diabetes & Metabolism, will deliver a
lecture on “Improving Cardiovascular Outcomes in Patients with Type 2 Diabetes:
Applying New Evidence in Practice” on Friday, 2 February 2018. Interested members
please refer to the announcement on p.17 for details and enrolment.
Group photo taken during the lecture on 8 December 2017
From left: Dr. CHIN Chu Wah, Dr. Angus LEUNG (speaker)
and Dr. CHAN Man Chung, JP (moderator)

The HKMA Shatin Doctors Network (SDN) ~ Dr. FUNG Yee Leung, Wilson and Dr. MAK Wing Kin
Dr. WU, Enoch, Specialist in Endocrinology, Diabetes & Metabolism, presented on “Option of Oral Antidiabetic Agent for a
Better CV Outcome” on Friday, 1 December 2017. Dr. SHUM Chung Nin, Specialist in General Surgery, delivered a lecture
on “Management of Haemorrhoids” on Friday, 15 December 2017.

Dr. LAM Tin Keung, Edman, Senior Medical & Health

Officer of Infection Control Branch of the Centre for Health
Protection (CHP) of the Department of Health (DH), will
deliver a lecture on “Antibiotic Stewardship Programme in
Primary Care” on Wednesday, 7 February 2018, which is co-
organized by the Network and the CHP of DH. Interested
members please refer to the announcement on p.16 for
Group photo taken during the lecture on 1 December Dr. MAK Wing Kin (left,
details and enrolment. 2017 moderator) in photo with
Dr. SHUM Chung Nin (speaker)
during the lecture on 15
December 2017

The HKMA Yau Tsim Mong Community Network

(YTMCN) ~ Dr. CHENG Kai Chi, Thomas
Dr. CHAN Leung Kwok, Specialist in Obstetrics and Gynaecology, presented on “Osteoporosis for
Menopause Women 2017” on Tuesday, 5 December 2017.

The third session of the “Certificate Course on Allergy” titled “Co-morbidities of Allergic Rhinitis in
Children” will be delivered by Dr. LEUNG Ngan Ho, Theresa, Specialist in Paediatrics, on Tuesday,
6 February 2018. Doctors who attended 2 sessions or more will be given a Certificate of
Dr. Carmen HO (left, moderator)
Completion.
presenting the souvenir to
Dr. CHAN Leung Kwok
(speaker) during the lecture on
5 December 2017

The HKMA New Territories West Community Network (NTWCN) ~ Dr. CHEUNG Kwok Wai, Alvin
Prof. WONG Yeung Shan, Samuel, Professor and Head
of Division of Family Medicine and Primary Healthcare of
Faculty of Medicine of CUHK, presented on “Assessment
and Management of Older Adults’ Cognitive Impairment in
Primary Care Setting” on Thursday, 7 December 2017. Dr.
LAM Tin Keung, Edman, Senior Medical & Health Officer of
Infection Control Branch of the Centre for Health Protection
(CHP) of the Department of Health (DH), presented on
“Antibiotic Stewardship Programme in Primary Care”
on Thursday, 14 December 2017. This lecture was co- Dr. LEE Shin Cheung (left, moderator) Group photo taken during the lecture on 14
organized by the Network and the CHP of DH. presenting a Certificate of Appreciation December 2017
to Prof. Samuel WONG (speaker)
during the lecture on 7 December 2017

20 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org
 Meeting Highlights

The HKMA Kowloon West Community Network (KWCN) ~ Dr. TONG Kai Sing
Dr. LO Cheuk Kin, Specialist in Cardiothoracic Surgery and Associate Consultant of Department of Cardiothoracic Surgery of
Queen Elizabeth Hospital, presented on “Pectus Excavatum (Funnel Chest): What is it and How Do We Manage?” on Tuesday,
5 December 2017. Dr. LAM Tin Keung, Edman, Senior Medical & Health Officer of Infection Control Branch of the Centre for
Health Protection (CHP) of the Department of Health
(DH), presented on “Antibiotic Stewardship Programme
in Primary Care” on Tuesday, 19 December 2017. This
lecture was co-organized by the Network and the CHP of
DH.

Dr. YUEN Ho-Chuen, Consultant Cardiologist of St. Paul’s

Group photo taken during the lecture on 19
December 2017
Dr. LO Cheuk Kin (left, speaker) receiving
the souvenir from Dr. LEUNG Gin Pang
(moderator) during the lecture on 5
December 2017
Hospital, will present on “An Update on AF Management
and Screening” on Tuesday, 27 February, 2018. This
lecture is co-organized by the Network and the Hong Kong
College of Cardiology. Interested members please refer to
the announcement on p.17 for details and enrolment.

The HKMA Kowloon East Community Network (KECN) ~

Dr. AU Ka Kui, Gary
Dr. CHOW Pok Yu, Specialist in Paediatrics, presented on “MMRV: Importance of Vaccination”
on Thursday, 14 December 2017.

Dr. LAM Tin Keung, Edman, Senior Medical & Health Officer of Infection Control Branch of
the Centre for Health Protection (CHP) of the Department of Health (DH), will deliver a lecture
titled “Antibiotic Stewardship Programme in Primary Care” on Thursday, 1 February 2018. This Dr. Danny MA (left, moderator)
lecture is co-organized by the Network and the CHP of DH. Interested members please refer to presenting the souvenir to Dr. CHOW
the announcement on p.16 for details and enrolment. Pak Yu (speaker) during the lecture on
14 December 2017

HKMA CME Bulletin

Monthly Self-Study Series
Call for Articles
Since its publication, the HKMA CME Bulletin has become one of the most popular CME readings for doctors. This monthly publication
has been serving more than 10,000 readers each month through practical case studies and picture quizzes. To enrich its content, we
are inviting articles from experts of different specialties. Interested contributors may refer to the General Guidance below. Other formats
are also welcome.

For further information, please contact Miss Alison Hui at 2527 8452 or by email at alisonhui@hkma.org.

General Guidance for Authors

Intended Readers : General Practitioners

Length of Article : Approximately 8-10 A-4 pages in 12-pt fonts in single line spacing, or around 1,500-2,000 words (excluding
references).
Review Questions : Include 10 self-assessment questions in true-or-false format.
(It is recommended that analysis and answers to most questions be covered in the article.)
Language : English
Highlights : It is preferable that key messages in each paragraph/section be highlighted in bold types.
Key Lessons : Recommended to include, if possible, a key message in point-from at the end of the article.
Others : List of full name(s) of author(s), with qualifications and current appointment quoted, plus a digital photograph of
each author.
Deadline : All manuscripts for publication of the month should reach the Editor before the 1st of the previous month.

All articles submitted for publication are subject to review and editing by the Editorial Board.

www.hkmacme.org HKMA CME Bulletin 持續醫學進修專訊 Jan 2018 21

 CMECalendar

January 2018 30 Jan 2018 HKMA-KLN West Community Network

(Tue) New Treatment in Non-Small Cell Lung Cancer 1
16 Jan 2018 HA-PYNEH-Dept of Anaesthesia 1:00 – 3:00 pm Fulum Palace, Shop C, G/F, 85 Broadway Street, Mei Foo Sun Chuen, Mei Foo
(Tue) Continuing Medical Education Meeting (January) 1 Mr. Ian YAU – Tel: 2527 8285
7:30 – 8:30 am Conference Room, MB.02.41, PYNEH
Ms. Karman Wong – Tel: 2595 7143 31 Jan 2018 HK College of Family Physicians
16 Jan 2018 HKMA-Tai Po Community Network (Wed) Chronic Disease Management (CDM) Training Course 2018 2
(Tue) Fatty Liver 2:00 – 3:30 pm Diamond Room, 5/F, Cityview Hotel, 23 Waterloo Road, Yau Ma Tei, Kowloon
1 Ms. Teresa Liu – Tel: 2871 8899
1:45 – 3:00 pm Chiu Chow Garden Restaurant, Shop 001-003, 1/F, Uptown Plaza, No. 9 Nam
Wan Road, Tai Po 1 Feb 2018 HA-NT West Cluster-Dept. of Family Medicine
Ms. Hannah Lee – Tel: 6620 0185 (Thu) HA-Prince of Wales Hospital 1
16 Jan 2018 HKMA-KLN West Community Network 1:00 – 2:00 pm NTEC FM Teleconference-COPD: NAHC-resp programme & audit
(Tue) Update on Rheumatic Diseases-Common Important Presentation of Uncommon 1 Ma On Shan Family Medicine Centre (Host): live broadcast to other FM Clinics and
1:00 – 3:00 pm Diseases GOPCs of NTEC FM
Fulum Palace, Shop C, G/F, 85 Broadway Street, Mei Foo Sun Chuen, Mei Foo Tel: 2692 8730
Mr. Ian YAU – Tel: 2527 8285
1 Feb 2018 HKMA-KLN East Community Network
17 Jan 2018 HK College of Family Physicians (Thu) DH-Centre for Health Protection 1
(Wed) Chronic Disease Management (CDM) Training Course 2018 2 1:00 – 3:00 pm Antibiotic Stewardship Programme in Primary Care
2:00 – 3:30 pm Diamond Room, 5/F, Cityview Hotel, 23 Waterloo Road, Yau Ma Tei, Kowloon Lei Garden Restaurant, Shop No. L5-8, apm, Kwun Tong, No. 418 Kwun Tong
Ms. Teresa Liu – Tel: 2871 8899 Road, Kowloon
18 Jan 2018 Federation of Medical Societies of HK Mr. Ian YAU – Tel: 2527 8285
(Thu) Hong Kong Society for Healthcare Mediation 10# 1 Feb 2018 Federation of Medical Societies of HK
7:00 – 8:30 pm HK Mediation Council
Healthcare Mediation Skills Workshop (Thu) Hong Kong Society for Healthcare Mediation 10#
Lecture Hall, 4/F, Duke of Windsor Social Service Building, 15 Hennessy Road, 7:00 – 8:30 pm HK Mediation Council
Wanchai, HK Healthcare Mediation Skills Workshop
Ms. Vienna Lam – Tel: 2527 8898 Lecture Hall, 4/F, Duke of Windsor Social Service Building, 15 Hennessy Road,
Wanchai, HK
19 Jan 2018 HKMA-KLN City Community Network Ms. Vienna Lam – Tel: 2527 8898
(Fri) DH-Centre for Health Protection 1
1:00 – 3:00 pm Antibiotic Stewardship Programme in Primary Care 2 Feb 2018 HKMA-KLN City Community Network
President’s Room, Spotlight Recreation Club, 4/F, Screen World, Site 8, (Fri) Improving Cardiovascular Outcomes in Patients with Type 2 Diabetes: 1
Whampoa Garden, Hunghom, Kowloon 1:00 – 3:00 pm Applying New Evidence in Practice
Ms. Candice Tong – Tel: 2527 8285 President’s Room, Spotlight Recreation Club, 4/F, Screen World, Site 8,
19 Jan 2018 HKMA-Yau Tsim Mong Community Network Whampoa Garden, Hunghom, Kowloon
(Fri) Certificate Course on Allergy Ms. Candice Tong – Tel: 2527 8285
1
1:00 – 3:00 pm Session 2: Update Management on Atopic Dermatitis 3 Feb 2018 Hong Kong Medical Association
Crystal Ballroom, 2/F, The Cityview Hong Kong, 23 Waterloo Road, Kowloon (Sat) HK College of Family Physicians
Ms. Candice Tong – Tel: 2527 8285 2
2:15 – 4:15 pm HA-Our Lady of Maryknoll Hospital
23 Jan 2018 HA-PYNEH-Dept of Anaesthesia Refresher Course for Health Care Providers 2017/2018–
(Tue) Continuing Medical Education Meeting (January) 1 Primary care Infant and children dermatology
7:30 – 8:30 am Conference Room, MB.02.41, PYNEH Training Room II, 1/F, OPD Block, Our Lady of Maryknoll Hospital, 118 Shatin
Ms. Karman Wong – Tel: 2595 7143 Pass Road, Wong Tai Sin, Kowloon
23 Jan 2018 HKMA-Tai Po Community Network Ms. Clara Tsang – Tel: 2354 2440
(Tue) DH-Centre for Health Protection 1 3 Feb 2018 HK College of Family Physicians
1:45 – 3:00 pm Antibiotic Stewardship Programme in Primary Care (Sat) Certificate Course on Practice Management
Chiu Chow Garden Restaurant, Shop 001-003, 1/F, Uptown Plaza, No. 9 Nam 2
2:30 – 4:30 pm 8/F, Duke of Windsor Social Service Building, 15 Hennessy Road, Wan Chai, HK
Wan Road, Tai Po
Ms. Teresa Liu – Tel: 2871 8899
Ms. Candice Tong – Tel: 2527 8285
6 Feb 2018 HK College of Emergency Medicine
23 Jan 2018 HK College of Psychiatrists
(Tue) CAC Lecture Module (Jan-Jun 2018)-B) Major disorders in general adult (Tue) American Heart Assn 3
3 8:30 – 1:00 pm American Heart Association (AHA) Basic Life Support (BLS-P)
3:00 – 6:00 pm psychiatry: Psychopharmacology of schizophrenia and other psychotic disorders;
Phenomenology and neurobiology of schizophrenia HKEC Training Centre for Healthcare Management & Clinical Technology, PYNEH
Lecture Theatre, LG/F, Block J, KCH Ms. Fanny Lau – Tel: 2871 8877
Ms. Lucita Chan – Tel: 2871 8777 6 Feb 2018 HKMA-Yau Tsim Mong Community Network
24 Jan 2018 HKMA-Central, Western & Southern Community Network (Tue) Certificate Course on Allergy 1
(Wed) Advancement of Immunotherapy Against Cancers 1 1:00 – 3:00 pm Session 3: Co-morbidities of Allergic Rhinitis in Children
1:00 – 3:00 pm HKMA Central Premises, Dr. Li Shu Pui Professional Education Centre, 2/F, Crystal Ballroom, 2/F, The Cityview Hong Kong, 23 Waterloo Road, Kowloon
Chinese Club Building, 21-22 Connaught Road Central, Hong Kong Ms. Candice Tong – Tel: 2527 8285
Mr. Ian YAU – Tel: 2527 8285
7 Feb 2018 HKMA-Shatin Doctors Network
25 Jan 2018 HKMA-KLN East Community Network (Wed) DH-Centre for Health Protection 1
(Thu) SGLT2 is for Primary Care Doctors and Family Practitioners 1 1:00 – 3:00 pm Antibiotic Stewardship Programme in Primary Care
1:00 – 3:00 pm V Cuisine, 6/F, Holiday Inn Express Hong Kong Kowloon East, 3 Tong Tak Street, Royal Park Chinese Restaurant, Level 1, Royal Park Hotel, 8 Pak Hok Ting Street,
Tseung Kwan O Shatin
Mr. Ian YAU – Tel: 2527 8285 Ms. Candice Tong – Tel: 2527 8285
25 Jan 2018 HKMA-New Territories West Community Network 7 Feb 2018 HKMA-Central, Western & Southern Community Network
(Thu) HK College of Cardiology 1 (Wed) Asthma-What Should be Done to Help Patients Achieving Disease Control? 1
1:00 – 3:00 pm An Update on AF Management and Screening
Atrium Function Rooms, Lobby Floor, Hong Kong Gold Coast Hotel, 1 Castle 1:00 – 3:00 pm HKMA Central Premises, Dr. Li Shu Pui Professional Education Centre, 2/F,
Peak Road, Gold Coast, HK Chinese Club Building, 21-22 Connaught Road Central, Hong Kong
Mr. Ian YAU – Tel: 2527 8285 Mr. Ian Yau – Tel: 2527 8285
25 Jan 2018 HKMA-HK East Community Network 7 Feb 2018 HK College of Emergency Medicine
(Thu) Advancement of Immunotherapy for the Treatment of Lung Cancer (Wed) Joint Clinical Meeting & Didactic Lecture (JCM) 2
1
1:00 – 3:00 pm The HKMA Wanchai Premises, 5/F, Duke of Windsor Social Service Building, 15 5:00 – 7:30 pm QEH-Lecture Theatre, G/F, Block M; Multi-Function Room, G/F, Block D, Seminar
Hennessy Road, Wanchai Room, G/F, Block A, 12/F, Block R, Lecture Theatre, Queen Elizabeth Hospital/
Ms. Candice Tong – Tel: 2527 8285 PMH-Lecture Theatre, 7/F, Block H, Princess Margaret Hospital
25 Jan 2018 Federation of Medical Societies of HK Tel: 2871 8874
(Thu) Hong Kong Society for Healthcare Mediation 10# 8 Feb 2018 HKMA-Hong Kong East Community Network
7:00 – 8:30 pm HK Mediation Council (Thu) Palliative Treatment and Care in the Community 1
Healthcare Mediation Skills Workshop 1:00 – 2:00 pm The HKMA Wanchai Premises, 5/F, Duke of Windsor Social Service Building, 15
Lecture Hall, 4/F, Duke of Windsor Social Service Building, 15 Hennessy Road, Hennessy Road, Wanchai
Wanchai, HK Ms. Candice TONG – Tel: 2527 8285
Ms. Vienna Lam – Tel: 2527 8898
8 Feb 2018 HA-KWH-Clinical Research Centre
30 Jan 2018 HA-PYNEH-Dept of Anaesthesia (Thu) Research Club
(Tue) Continuing Medical Education Meeting (January) 1
1 1:00 – 2:00 pm Kwong Wah Hospital
7:30 – 8:30 am Conference Room, MB.02.41, PYNEH
Ms. Karman Wong – Tel: 2595 7143 Tel: 3517 7096

30 Jan 2018 HKMA-Tai Po Community Network 8 Feb 2018 Federation of Medical Societies of HK
(Tue) HKMA-Shatin Doctors Network (Thu) Hong Kong Society for Healthcare Mediation 10#
1 7:00 – 8:30 pm HK Mediation Council
1:45 – 3:00 pm HK College of Cardiology
An Update on AF Management and Screening Healthcare Mediation Skills Workshop
Chiu Chow Garden Restaurant, Shop 001-003, 1/F, Uptown Plaza, No. 9 Nam Lecture Hall, 4/F, Duke of Windsor Social Service Building, 15 Hennessy Road,
Wan Road, Tai Po Wanchai, HK
Ms. Candice Tong – Tel: 2527 8285 Ms. Vienna Lam – Tel: 2527 8898

#
For whole function

22 HKMA CME Bulletin 持續醫學進修專訊 Jan 2018

www.hkmacme.org