temporarily raise blood Hg levels through inhaling
more vapour”. We would like to add that since 2003
we have developed a new technique for the removal of
amalgam.5 This procedure makes it possible to control
the release of mercury vapour during amalgamreplacement therapy because the entire mercury
filling is removed en bloc,5 and mercury levels in saliva,
blood, and urine did not oscillate from baseline levels.
Gianpaolo Guzzi
Email: gianpaolo_guzzi@fastwebnet.it
Italian Association for Metals and Biocompatibility
Research – A.I.R.M.E.B., Milan, Italy
Paolo D Pigatto
Department of Technology for Health, Dermatological
Clinic, IRCCS Galeazzi Hospital, University of Milan,
Milan, Italy
References
1. Fan KL, Chan CK, Lau FL. Mercury exposure: the experience of the Hong Kong Poison Information Centre. Hong Kong Med J
2011;17:292-6.
2. Goyer RA, Clarkson TW. Toxic effects of metals. In: Klaassen CD. Casarett & Doull’s toxicology: the basic of poisons. 6th ed.
New York: McGraw Hill; 2001: 822-6.
3. Mutter J. Is dental amalgam safe for humans? The opinion of the scientific committee of the European Commission. J Occup
Med Toxicol 2011;6:2.
4. Gattineni J, Weiser S, Becker AM, Baum M. Mercury intoxication: lack of correlation between symptoms and levels. Clin
Pediatr (Phila) 2007;46:844-6.
5. Guzzi G, Minoia C, Pigatto P, et al. Safe dental amalgam removal in patients with immuno-toxic reactions to mercury. Toxicol
Lett 2003;144 Suppl 1:35S-36S.
Authors’ reply
To the Editor—We agree to Guzzi and Pigatto’s
comment that the blood and urine level of mercury
may not reflect the body tissue burden of mercury.
For mercury-poisoned patients, the best marker for
body tissue burden should be the concentration
in the effector organs, ie the brain and kidneys.
However, in most scenarios, these concentrations are
not measurable unless at autopsy. It is not practical
to rely on these measurements to diagnose mercury
poisoning. Therefore, in the report, we have stressed
the importance of obtaining a detailed exposure
history, evaluating the clinical signs and symptoms
and measuring the blood and urine mercury levels.
As for Guzzi’s technique of amalgam removal, we
have no further comments.
KL Fan, FHKAM (Emergency Medicine)
Email: kklfan@yahoo.com
Accident and Emergency Department, Queen Mary
Hospital, Hong Kong
CK Chan, FHKAM (Emergency Medicine)
FL Lau, FRCS (Edin), FHKAM (Emergency Medicine)
Hong Kong Poison Information Centre, United
Christian Hospital, Hong Kong
Malpractice claims: corrections
To the Editor—The authors in the Commentary
“Medical malpractice: prevention is often a better
strategy” in the October 2011 issue1 would like to
make two corrections.
First, the Bolam case was quoted under the
wrong name of Bolam v Chelsea and Kensington
Hospital Management Committee [1968] 1 QB 428.1
It should have been Bolam v Frien Barnet Hospital
Management Committee [1957] 2 All ER 118. In
Bolam, McNair J enunciated the legal requirement
for the standard of care in medical negligence,2
which is that in accordance with a practice accepted
516
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as proper by a responsible body of medical men
skilled in the particular art. In another case, Barnett
v Chelsea and Kensington Hospital Management
Committee [1968] 1 QB 428, a watchman arrived in
the Accident and Emergency nauseated after a cup
of tea. The casualty doctor simply advised that he
should see his general practitioner. The man died 5
hours later from arsenic poisoning. The court found
that the man would have died anyway because it
was too late to save him and it was not the casualty
doctor’s negligence that had caused his death. The
claimant thus failed to establish causation.2 This
case incidentally illustrates well the point raised
in the second paragraph of the article that a mere
adverse outcome is not a sufficient condition for a
successful negligence claim. This second case was
originally in the authors’ initial drafts but deletion
of words due to length restrictions resulted in the
erroneous hybrid name printed in the final script and
the authors apologise for that.
page 425 should have been “tortious” (pertaining to
“torts”, ie wrong doing).
David SY Wong, FHKAM (Surgery), LLM
Email: sywong@surgery.cuhk.edu.hk
Paul BS Lai, FHKAM (Surgery), LLM
Department of Surgery
The Chinese University of Hong Kong
Prince of Wales Hospital
Second, the word “tortuous” on the first line Shatin
of the third paragraph on the right hand column of Hong Kong
References
1. Wong DS, Lai PB. Malpractice claims: prevention is often a better strategy. Hong Kong Med J 2011;17:425-6.
2. Wong DS. Legal issues for the medical practitioner. Hong Kong. Hong Kong University Press; 2010: 22-4,183-7.
Note from Editorial Department: This article1 which appears on www.hkmj.org has been corrected.
Answers to CME Programme
Hong Kong Medical Journal October 2011 issue
Hong Kong Med J 2011;17:358–64
I. Colorectal cancer surgery of octogenarians in Hong Kong: who will survive?
A
1. True
2. True
3. True
4. True
5. True
B
1. True
2. True
3. True
4. True
5. True
Hong Kong Med J 2011;17:391–7
II. Menstrual disorders in a Paediatric and Adolescent Gynaecology Clinic: patient
presentations and longitudinal outcomes
A
1. False
2. False
3. True
4. False
5. True
B
1. True
2. True
3. True
4. False
5. False
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